Free for All

Frances Helfman was ensconced in a comfortable life as the suburban Los Angeles mother of teenagers in the summer of 1967. But her tidy, respectable world seemed incongruent with what was happening elsewhere in her city.

“The social unrest, the unpopular war, the draft, the sexual revolution, the assassinations, the drug experimentation. I had heard about this clinic that was seeing all these young people who needed help,” she says. So Helfman--moved by the desire to help those young people--drove to a dilapidated storefront building at 115 Fairfax Ave. She walked in, stepping around the long-haired, foul-smelling teenagers who lounged on the floor of the packed waiting room, and volunteered her services.

“Here I was: a hausfrau. I went to the beauty parlor every week to get my hair teased,” she recalls. “They put me to work immediately in the job co-op.”

In those days, the Los Angeles Free Clinic couldn’t sign up volunteers fast enough as it struggled mightily to care for a tide of teenagers with syphilis, strep throat or drug problems. Kids with no money.

“We struggled so very hard to keep it afloat,” Helfman says. “No one in the community thought we were doing the right thing. They thought we were encouraging drugs and sex--that was the big criticism. And another big criticism is that we did draft counseling.”

This summer, as it reaches its 30-year anniversary, L.A. Free is bigger, richer and more respected than its founders would have thought possible. Yet the clinic, housed now in a gleaming contemporary three-story building on Beverly Boulevard, is still providing health care for people who cannot pay--a concept that is as radical today as it was in 1967, maybe more so.

“Our philosophy was always one of being nonjudgmental, of treating people with a humanistic approach, of believing that people are entitled to health care. It was free. I felt that we were making a statement,” says Helfman, the clinic’s longest-active volunteer.

By surviving, growing--thriving, even--L.A. Free has made a statement, say those who have followed its evolution. The growing demands on the clinic, which now provides for 60,000 patient visits a year on a budget of $3.9 million, says something alarming about the number of people in Los Angeles County in need of free health care. But it speaks volumes about what can be done if a community cares enough, says County Supervisor Zev Yaroslavsky.

“It has become one of the premier providers of primary health care to poor people, the elderly, the uninsured,” he says. “They don’t do it for the money. They do it because they have a mission: that health care is a right, not a privilege. They have always practiced what they preach.”

L.A. Free is often referred to as a model for the way health care can be delivered--even though the clinic is clearly unique in the financial support it receives, largely from the entertainment industry, says Mandy Johnson, executive director of the Community Clinic Assn. of Los Angeles, which represents 25 free and community clinics. The clinic has established high standards for quality of care and has mobilized countless other clinics both locally and nationwide.

“They’ve really played an important role as a leader on access-to-care issues in California,” says Johnson, adding that clinic leadership was instrumental in helping form a network of statewide primary care providers who lobby for the needs of underserved populations. “They have spoken out on behalf of populations who sometimes don’t vote and who often don’t have a regular doctor who can advocate for them.”

And now, as it moves into its fourth decade, the clinic is preparing to extend its advocacy efforts by embarking on a risky new partnership with government. For the first time, it is joining the county to provide care for the poor, as part of efforts to reduce hospitalizations in the overloaded county system by shuttling more patients to private clinics. The tactic will boost L.A. Free’s client base by about 15,900 visits--and link it more firmly to the bureaucracy it has so passionately avoided.

“Throughout our history, the board went through so many long, philosophical battles about whether they should ever take a government dollar. And, if they did, would they be selling out,” says Mary Rainwater, executive director for the last seven years. “I have to say, there’s a part of me that’s apprehensive about a partnership with the county because it’s more bureaucratic. But indigent care is what we’re all about.”

Yaroslavsky credits L.A. Free Clinic and the Venice Community Clinic especially with providing crucial leadership as the county restructures its massive, crumbling system.

“They had every reason not to get involved with the county,” he says. “It’s a pain. It’s bureaucracy. There are 1,001 reasons not to be involved in a partnership with the county. But they know there is a potential health care crisis in this county, and they wanted to be part of the solution. A lot of other [providers] haven’t come forward.”

*

In the early days, the clinic leadership preferred to twist the arms of the wealthy instead of asking clients to pay fees or accepting government subsidies to care for the poor, says Mimi West, a former board member and founder of the clinic’s fund-raising arm, the Friends of the Los Angeles Free Clinic.

“We were tempted many times to charge for this or that. But I’m glad we didn’t do that,” she says. “We didn’t have to do that because, instead, we built up a lot of community support.”

West, like Helfman, was an affluent middle-aged woman who had about as much in common with hippies as she did with Martians. West, who has a master’s degree in social work, was new to Los Angeles in 1971. Her husband, Bernie West, had been hired as a writer for the CBS hit “All in the Family.” The CBS studios were across the street from 115 Fairfax.

“I was so taken with what was happening there, how poor they were. There was never any money for rent. The Smothers Brothers paid the rent for a number of months. And Lenny Somberg, the [clinic] director, only got $100 a week, if he got paid at all,” West says. “I began to nose around to find out why there was no money and no plan. And when I approached leaders in the community, I found out that most of them knew about the clinic and knew it did good work, but no one had asked them to help.”

By the time that West had cranked up fund-raising support, the hippies were gone and a much more diverse crowd of poor and down-and-outers lined up for the clinic’s services. Plans were drawn up to move to a larger building on Beverly Boulevard. But three days before the move, Somberg was shot and killed by a burglar in the clinic’s business office. “It was terrible,” Helfman recalls. “Lenny was the most wonderful human being. I give credit to the board for holding things together at that time.”

The 1980s marked the beginning of the breakdown of the health care system nationwide as costs soared and the number of uninsured Americans grew.

The clinic had already begun attracting the attention of health officials who viewed it as a model for the efficient, compassionate care of the poor, says former Assemblyman Burt Margolin, who served as the county’s health czar in 1995. “The clinic was important to us who are advocates of health-care reform,” he says. “They were the ones in the trenches, delivering the care. They were an inspiration for us and a model for what the future needed to be.”

But the clinic was grappling with the growing need for free health care while struggling to stay afloat. Despite money woes and the bleak lives of their clientele, the staff managed to remain upbeat, says Barbara Marshall, a longtime volunteer nurse. “We didn’t get depressed because we were making a difference.”

Marshall, a registered nurse, discovered the clinic in 1984 when her husband, producer Garry Marshall, was asked to help with a fund-raiser. She decided to check out the clinic and ended up volunteering there two days a week for the next 14 years. “It became one of the joys of my life,” she says. “To touch these kids--physically--to put your arm around these kids was the most fulfilling thing to me.”

Because the clinic has been free from contracts with insurance providers, its doctors have, over the last decade, enjoyed their position as one of the last bastions of traditional medical practice, where economic pressures are not as central to medical judgments, says medical director Susie Mandel, who was first exposed to the clinic during a residency.

“The doctors here only have to worry about the patient,” Mandel says. “We are a very efficient and very compassionate mode of health-care delivery. We’re a microcosm for where health care should go--to care for the whole person.”

For example, clients can receive basic lab tests and prescriptions, dental care, eye care, basic legal services, or just a shower and clean clothes. The clinic also depends on a large contingent of residents from Cedars-Sinai Medical Center who get a big taste of community medicine and primary care.

The clinic’s second facility, called the Hollywood Center, is devoted to the care of homeless and runaway youths and provides everything from basic health care to prenatal care, drug counseling and job training.

The comprehensive nature of its services--as well as the beauty of its striking glass-front building with its neat waiting areas (hung with ‘60s art and photographs) and sophisticated exam rooms--surprise many visitors, Mandel says.

“The biggest misconception people have of us is that they think we’re some kind of county facility,” she says. “Before, we were providing more of a Band-Aid approach to health care. But, now, we are doing more extensive medical care than ever before.”

The clinic’s growth has been dependent on volunteers, Rainwater says. Today, it has a roster of about 80 full- or part-time staff and 600 volunteers.

“We use volunteers in a very core, fundamental way; not to straighten out the papers or put stamps on envelopes,” she says. “We use them to check people in, to help deliver patient care. We ask for quite a commitment, and our ability to see patients is dependent on them.”

To be sure, however, it has been the generous support of the entertainment community that has allowed the clinic to flourish, observers note. When the board decided to build a new clinic in the late 1980s, West led a drive that raised $2.3 million in 18 months. A building design was donated by the L.A. Community Design Center, and the Senial Ostrow Building, named for the late founder of the mattress empire and philanthropist, opened in 1990.

“Some people in the entertainment industry came to the clinic over the years when they were out-of-work actors,” Marshall says. “These people can’t say enough about the clinic. We couldn’t do without the business people on our board. And we couldn’t do without the banking community. And we couldn’t do without the doctors. But when you can get a studio to back your fund-raising events, everything becomes easier.”

And, says Margolin: “The clinic [fund-raising staff] has argued that those who have the capacity to give have a moral obligation to do so. They have been very aggressive in making that case.”

*

On a sweltering midweek morning, Billy Coats, a homeless man, age 41, is first in a long, quiet line that curves around the street corner. He just wants to take a shower today, but he has sought care at the clinic in the past for hepatitis.

“They saved my life,” he says. “I was in Las Vegas when I got sick, and no one would help me out. But when I got here, they saw me and then sent me to Cedars-Sinai. They are real sweetheart people. It’s nice to go somewhere and not feel like you’re being a bother.”

Not everyone here is destitute. Maria Campos came to the clinic a year ago when she was sick and out of work. Today, she is accompanying a friend for treatment. Campos is employed again and has insurance coverage provided by her new employer. “Last year, I didn’t have any insurance and I came here. It was good, safe and clean. I was surprised. I had expected something else,” she says.

Sisters Loreta Ziyalova, 42, and Esmira Adamian, 41, were also surprised by the classy treatment they received. They drive from Glendale to seek care and drop off a small donation when they leave. “We so appreciate them,” Ziyalova says. “It is such good service. The doctors and all the people who work here are very kind. It’s not that different from clinics where you pay.”

It seems incredible now to the clinic’s supporters that only five years ago, the board of directors launched a discussion on whether L.A. Free Clinic would soon not be needed. It was 1992, and with Bill Clinton’s election, universal health care seemed almost a sure bet.

“We really thought that we might go out of business because health care would be for everyone and we wouldn’t have people lining up outside around the block to see us,” says an exasperated Marshall. “It’s sad because we were so optimistic. Finally, we thought, the rest of the world is realizing that everyone needs health care. But the need now is more than it ever was. The clinic needs to double its work.”

Indeed, while national health care reform is a distant memory, access to care for the poor and uninsured is more difficult than ever, Johnson says. “We are in an environment where government desires very strongly to cut back on the money spent on health care. That is happening both at the federal and state levels. And it’s happening at the local level as Los Angeles County limits the number of individuals who get health care through the general relief program.”

Adds Margolin: “Los Angeles County has the largest concentration of uninsured--2.6 million--of any community in the United States. Without facilities like L.A. Free, that population would be even more poorly served and at-risk than they are currently. It’s easy to think there will be some outside solution that will come down the read. But the reality is that that hasn’t happened, and it isn’t going to happen in the near future.”

The L.A. Free Clinic has also retreated quickly from the idea of ever closing its doors. A 30th anniversary fund-raiser has allowed it to expand some services, including more preventive care, Rainwater says. Bernie and Mimi West, for example, recently gave a $500,000 endowment to broaden dental services, including a pediatric dental clinic.

“We see the opportunities to do new things and it’s hard to restrain ourselves,” says Rainwater, who is looking at a probable budget of $5 million for the next fiscal year. “The biggest challenge to the clinic right now is how to continue to balance the needs of the community, which is really overwhelming . . . with the resources that we can bring to the table. This is a clinic that doesn’t like to say no. But we have to.”

Funds today are divided equally between government money, including grants and contracts, and private money from foundations, corporate and individual gifts. Perhaps no free clinic has evolved into such a comprehensive health care facility while remaining largely unencumbered by insurance and government forces.

And that is why the challenges of the future--including the partnership with the county to provide indigent care--are a little unsettling to Rainwater and the other longtime clinic supporters. “We believe in a partnership of the government and the private sector working together,” she says. “But we have to have the ability to sustain things when government funds are shaky.”

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The Growth of a Clinic

* Summer 1967

A group of volunteers opens the Albert Schweitzer Free Clinic on Fairfax Avenue.

* November 1967

The clinic board ousts two volunteer psychologists who reportedly have no professional credentials.

* Jan. 1, 1968

The board hastily reorganizes as a nonprofit corporation called the Los Angeles Free Clinic.

* Early 1970s

The clinic staff struggles to pay the rent. Elvis Presley walks in with a donation of $10,000.

* 1973

The Friends of the Los Angeles Free Clinic is founded and becomes the fund-raising muscle behind the clinic’s financial battles.

* 1974

The client base has tripled since 1967 and efforts begin to move into a larger building.

* Nov. 3, 1975

Three days before the clinic moves, Executive Director Lenny Somberg is shot and killed during a burglary at the clinic’s business office. The killer was never found.

* 1982

The clinic joins forces with Childrens Hospital to launch the High Risk Youth Program providing services to homeless and runaway youths in Hollywood.

* Mid-1980s

In 18 months, $2.3 million is raised for new, larger clinic.

* April 1990

Sen. Ted Kennedy (D-Mass.) presides over the grand opening of the new headquarters on Beverly Boulevard.

* 1992

A $1 million endowment from the Mark Taper Foundation helps purchase a building in Hollywood to house the High Risk Youth Program.

* 1997

The clinic runs on a yearly budget of $3.9 million with 80 full- and part-time staff and 600 volunteers.