A Healthy Start : Downsizing: A nonprofit group will take over county-run clinics in Canoga Park and Valencia.

On any given day, the staff of a cramped and often chaotic private Pacoima health clinic immunizes 18 patients, gives about 200 free checkups and doles out dozens of prescriptions to poor people with few options and limited resources.

Now, after 23 years of cautious expansion in the San Fernando Valley, the clinic’s nonprofit operator, the Northeast Valley Health Corp., will take on a big new challenge by assuming control of Los Angeles County-run clinics in Valencia and Canoga Park.

Though health officials insist there will be no change in services for the poor who depend on the clinics, the Nov. 1 switch is significant: It represents the county’s first step toward a scaled-down health care system that emphasizes outpatient, rather than in-hospital care.

The county was forced to downsize its health program after President Clinton agreed to bail out part of its $655-million deficit on condition that the system reduce costs.

So far, the county has approved four other public/private clinic ventures and is continuing to look for partners for most of its 45 health centers and clinics as well.

By taking on the two county facilities, the Northeast Valley Health Corp., which now operates two similar clinics, will become the dominant provider of low-cost, clinic health care to the poor in the San Fernando and Santa Clarita valleys.

The Valencia clinic is the only low-cost public clinic in the Santa Clarita Valley. The group will also operate two of the three existing clinics in the northeast San Fernando Valley in Pacoima and San Fernando. And the Canoga Park facility is the only such clinic in the West Valley.

The San Fernando-based group runs clinics at a homeless shelter in North Hollywood and at San Fernando High School; provides health care to children at Vaughn Elementary School in Pacoima; and runs the regional Women, Infants and Children program, which uses state funds to provide baby food and nutritional advice to poor mothers and pregnant women.

After Nov. 1, the county health department will continue operating the Mid-Valley Comprehensive Health Center in Van Nuys and clinics in Burbank, Glendale and Pacoima. County officials said their goal is to privatize as many clinics as possible.

The Northeast Valley Health Corp.’s executive director, Robert Smith, said taking over the Valencia and Canoga Park clinics on three-year contracts makes sense for the group, whose clinics offer a range of services--from mammograms to X-rays to tuberculosis testing. He said the corporation will hire as many laid-off county employees as possible in the two clinics.

As is true at county clinics, the corporation’s patients come for prenatal care, family planning and testing for AIDS and other sexually transmitted diseases. Also like county clinics, the corporation’s facilities operate on a sliding fee scale, and do not turn away patients for lack of money or insurance.

“This is really a natural match for us because we serve the same kinds of patients--those who lack [health] insurance and are Spanish-speaking, for instance--as the county does,” Smith said.

According to county health officials, private health providers and neighborhood activists, the firm provides quality care.

“It’s going to be an easy transition,” said Lucia Carpenter, director of the county’s Canoga Park clinic who expects to be transferred to another county facility. “If we’re going to change hands in this particular health center, we are glad it’s going to be with them because they do the best work and they are used to our kind of patients.”

Added Rose Castaneda, an instructor at Pacoima Community Youth Culture Center, and who has long been active in politics in the northeast Valley: “They are a quality program and they’ve lasted through demographic changes, political changes, economic changes, everything.”

The Northeast Valley Health Corp. started in 1972 as a humble storefront operation on San Fernando Road. The idea was simple, said Smith: to offer health care to low-income patients in medically underserved areas.

About 1,000 federally funded groups sprouted up nationwide, including the northeast San Fernando Valley, Watts, East Los Angeles and Downtown.

Since then, Smith said the company has expanded to attempt to meet the health care needs in a section of the city where the poverty rate tops 40% in some neighborhoods, and where more than one in three residents lacks medical insurance.

Today, the group handles about 100,000 patient visits, an $18 million budget, and 350 employees, including 20 physicians.

Earlier this year, it opened a corporate headquarters in a former Department of Social Services building in San Fernando after its original Pacoima building was damaged during the 1994 Northridge earthquake.

Forty-seven percent of the corporation’s 19,000 clients are on Medi-Cal, the state’s medical insurance program for the poor, while 38% lack any insurance.

Because patients are represented on the board, they have some say in how the corporation is run. To qualify for the federal funds that make up a third of the corporation’s budget, a majority of the company’s board must use the clinic’s services and live in the community. The group is also funded by the county and state as well as private agencies.

The patient-dominated board is only one measure of the corporation’s emphasis on the relationship between staff and patients, said Gene Stevenson, administrator of the group’s Pacoima clinic.

“In some ways, we might appear to be more informal than county clinics because we try to encourage our staff to develop relationships with patients,” he said.

Positive patient reviews of the results abound.

On a recent day in the company’s Pacoima clinic, Maria Ivanes, 35, brought along three of her children when her 7-year-old needed to get immunizations for school.

Ivanes is a clinic veteran, coming there for eight years for a variety of services, beginning with prenatal care for her first-born, and continuing through checkups, physicals and immunizations for all of her five children.

“Since I’ve been coming,” she said, “I’ve gotten good quality health care, and I haven’t seen the reason to go anywhere else.”

Arcelia Casillas, who brought in her 7-year-old son who complained of stomach pains, agreed. “I like the way the doctors here treat you,” she said. “I already have a relationship with doctors, nurses and the receptionists, too.”

Still, the company has had growing pains.

In 1990, the federal government criticized the board of the company for not representing adequately the Latino population it served, and for excessive travel expenses.

Because the criticisms put much of the funding in jeopardy, Smith was hired as the new executive director, several long-term board members were replaced and the travel budget was significantly cut.

During its last financial review of the company, the federal government gave the corporation a rating of “good,” which means it has few outstanding debts.

Stevenson expects his company can operate the county clinics more efficiently because of lower labor costs and the fact that Northeast Valley Health Corp. must live within its means. “Our overhead tends to be much lower than at public agencies,” said Stevenson.