Healing, Learning

Sonia Cahill stands at the center of a vortex without flinching.

One moment she is palpating a liver, the next she is sternly telling a 53-year-old unemployed man that his intermittent chest pains are “muy grave.”

Walking down a short hall in the small storefront clinic, Cahill confers with two students in her family nurse practitioner course and in less than 45 seconds debriefs them on the patients they have just treated.

Welcome to CASA de Salud, the House of Health, the bustling free clinic in central Santa Ana that Orange County is running in conjunction with Cal State Long Beach.

Opened in July when a former free clinic serving Santa Ana and Costa Mesa shut, the facility is about to be turned over to the university, which will use it as a training ground for 35 to 40 students in its two-year nurse practitioner degree program.

The hope is to train future practitioners while continuing to offer community-based primary care to about 6,000 patients, most of them poor and Latino, who lost a place to go for medical treatment when the Santa Ana Free Health Plan clinic closed June 29.

“Having this clinic is a real big deal,” said Dr. Herbert Rosenzweig, director of medical services for the county Health Care Agency. “The old one closed so suddenly, it really was such an upsetting thing for the community.”

The agency has spent about $120,000 funding the clinic--including exams and prescription costs for patients--since July. That will end shortly when the operation at Edinger Avenue and South Broadway is turned over to Cal State Long Beach.

To help the university with the transition, the county will provide $100,000 in “bridge” funds, along with $50,000 each from Kaiser Permanente and CalOptima, the county’s managed health care program for the poor.

It is the first time in many years that the county has run a primary care clinic. Unlike Los Angeles County, which provides primary health care for its indigent population, Orange County relies on a series of nonprofit and privately run community clinics to provide those services, in some cases reimbursing them for some of the costs.

County Government Plants the Seed

“We want the county to be more involved in primary care,” said Jackie Cherewick, past president of the Coalition of Community Clinics. “But we want to give them some strokes for being involved in this one more than ever before. We really appreciate them . . . providing the seed money and stepping in at a critical time.”

County health care advocates described the scene in July as chaotic for the poor and sick in south Santa Ana and north Costa Mesa, who had relied on the two offices of the Free Health Plan clinic. To deal with the situation, the county staffed the clinic with its own employees. Then Cahill was hired to run a free clinic out of the Delhi Community Center on Central Avenue.

“The idea was to resettle these patients,” she said.

But it became apparent that the patient load could not be absorbed by surrounding community clinics in Santa Ana, Orange and Costa Mesa.

Health care advocates credit the county supervisors, especially Board Chairman Chuck Smith, with supporting an emergency fix while the health care community fashioned a longer-term solution.

“This has reawakened the county, particularly the Board of Supervisors, to the need at the very bottom level, at the street level for Orange County residents,” Orange County Medical Assn. spokesman Sam Roth said. “There is a tremendous unmet need.”

The exact transition date to full university control is not yet set and depends on the school receiving its clinic license and insurance, officials said.

Once the switch takes place, the office will be open five days a week. Patients will pay $10 for a visit, and they will be charged the cost of prescriptions and lab tests, though the school is seeking funding from drug companies to help subsidize prescription costs.

On Thursday, the county plans to acknowledge the clinic’s success and its imminent changeover with a ribbon-cutting ceremony with Smith presiding at the clinic offices at 1515 S. Broadway at Edinger Avenue.

“I was proud that community agencies joined with the county during this emergency to raise money, offer space and services,” Smith said Tuesday. “Student nurses [now] have an opportunity to gain experience in a clinic setting, and our community will be cared for by a first-rate medical staff. It is a win-win situation, and I am proud to have been part of this.”

The real celebrators, though, were at the clinic Tuesday morning: a dozen people quietly waiting their turn to see Cahill and her students in the clinic’s four small examination rooms.

Their circumstances were typified by a 42-year-old cook from Garden Grove, who was making his second visit for a persistent sore throat. A father of seven, he said that in January when he begins working full time and earning $9 an hour, he will start paying $160 a month for insurance through his job and will no longer need Medi-Cal.

In another room, Cahill--who wears soft shoes to ease the hours on her feet--had just referred Francisco Rivera to a cardiac doctor at the UC Irvine family clinic in Santa Ana after he was evaluated by student Barbara Donoghue.

Rivera, 53, who is unemployed, wanted a refill of a hypertension prescription--he had gone without pills for a month--but is told in Spanish that he must see a specialist for his chest pains.

“He needs a treadmill test,” Cahill said, acknowledging that despite her advice, Rivera might ignore the referral. So clinic medical assistant Lucy Sanchez will follow up.

“Sometimes patients delay going until it is a severe chest pain they can’t bear, because then they don’t care what it costs,” Cahill said. “I told him how dangerous it is in the long run for him to go without medication and without having it evaluated.”

Donoghue, a longtime nurse who wants the independence that comes with being a nurse practitioner, listens to her teacher, nods, then smiles. The clinical part of the program--each student must complete nearly 600 hours of training--is bringing her closer to that goal.

“It meets the community’s needs and we get hands-on with patients under Sonia’s mentoring,” she said.

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House of Health

A clinic in Santa Ana has been operating as a training ground for nurse practitioners as well as serving area residents four days a week since July, after the closure of a free clinic. CASA de Salud expects to expand its hours next month, when the county gives control of the part-time clinic to Cal State Long Beach’s family nurse practitioner program.

CASA de Salud

1515 S. Broadway

Santa Ana

Hours: 8 a.m. - 2 p.m., Monday-Wednesday and Friday

By appointment: (714) 285-9883.