Pasadena Programs Hailed as Models for Aiding Children

Dr. Paula Verrette remembers.

She remembers sitting in school as a child in Louisiana, pus running down her leg from a third-degree burn. She remembers how the pus crusted in her socks, sticking them to her feet.

She remembers too that her work-weary mother--a maid and salesclerk raising seven children on her own--had no means to pay for a doctor.

From such memories, Verrette has forged a mission.

Whirling through Pasadena trailing loud laughter, she works to ensure that all children--even those without insurance or the money to pay for it--have access to regular medical care. And not just the rushed impersonal treatment of a hectic emergency room.

Verrette’s goal is to place every child in a “medical home,” a facility that provides inexpensive primary care--from routine checkups to treatment of common childhood ailments such as ear infections, diabetes and stomach bugs.

Otherwise, she says, uninsured children will face “survival of the fittest. . . . [They will be] sorted out by whether they die or get disabled from a problem that could be treated.”

Fueled by that fear, Verrette has worked with Huntington Memorial Hospital, the Pasadena Unified School District and Los Angeles County to develop a network of programs that have been hailed by health care workers as models for helping uninsured young people.

All revolve around the same basic principle: It’s cheaper, more efficient and a whole lot wiser to treat children before they get so sick that they need emergency room care.

That’s the rationale behind the hospital’s 4-year-old Urgent Care Clinic, where Verrette is in charge of pediatrics.

The clinic, in the red brick hospital on California Boulevard, is designed to treat the kind of minor crises--high fevers, asthma attacks, lacerations and the like--that often send uninsured patients to the emergency room. (A separate facility, known as the Dispensary, provides primary care for a maximum of $30 a visit. Both serve adults and children.)

The hospital bills patients $45 for each visit to the clinic, plus extra fees for some tests. In reality, though, patients end up paying whatever they can afford. “We don’t do a wallet biopsy,” Verrette said. “We don’t advertise we’re for free, but kids are not turned away.”

A similar philosophy will set the tone at a clinic to open in January in northwest Pasadena, one of the city’s poorest neighborhoods.

Known as CHAP, or the Community Health Alliance of Pasadena, the facility is a partnership between Huntington Memorial and Los Angeles County. Both children and adults will get primary care.

“This way we don’t have to give them episodic [emergency room] care and then say, ‘Goodbye and good luck,’ ” said Neena Bixby, administrative director of ambulatory services for Huntington. “We’re putting a safety net under these kids.”

Yet another thread in that net is the clinic crammed into a noisy, toy-strewn room in Pasadena Unified’s headquarters.

About one-third of the district’s 22,000 children are uninsured. The clinic serves them for free.

Bustling in for her weekly two-hour stint at the clinic one Tuesday afternoon, Verrette runs through the handful of cases that have stumped the nurse practitioners who handle most patients.

She tells one boy that the rash on his finger comes from his ring; from now on, she adds with a grin, he can only wear pure silver or gold. Next, a teenage girl comes in complaining of ovarian pain. Suspecting she’s pregnant, Verrette arranges for a free blood test.

When Altadena resident Lori Robinson arrives with two of her sons a few minutes later, Verrette hails them all by name.

Robinson, who runs a cleaning business with her husband, has no insurance. Before she found out about the clinic, her children’s health care was haphazard at best. She once sat home for three days with a son who was running a fever of 106. “I was worried about the cost [of a doctor],” she said. Now, however, she knows she can get good care for free. “Here,” she said appreciatively, “they give you whatever you need.”

If a medical problem proves too serious to be handled in the clinic, Verrette can refer patients across the street to Young and Healthy, a program that matches uninsured children with 280 doctors, dentists and therapists willing to treat them for free.

With volunteers, the school district and the hospital all pitching in, Pasadena “is looking to make a patchwork” to aid the uninsured, said Patricia Lachelt, director of health programs for the district.

Of course, the patchwork does have a few holes.

None of the clinics is open 24 hours a day, so parents have only the emergency room to turn to at night. And even when children start using one of the clinics as a medical home, they still don’t get a personal pediatrician. Instead, they receive care from whoever is on duty, usually a nurse practitioner.

Dr. Don Thomas, who works in the Huntington emergency room, said he has seen fewer children come in since programs such as Young and Healthy and the Urgent Care Clinic took off. His conclusion is both simple and heartening: “We’re getting [care] to them earlier.”