Disease, Care Costs Beset Poor in Valley

When 8-year-old Evelyn Salcedo needed a tonsillectomy, her mother took her to Michoacan for the operation.

The reason: Ana Salcedo had been charged $400 earlier for tests at a hospital in the San Fernando Valley. Without insurance, government assistance or private means, Salcedo could only afford a doctor in Mexico.

It was the same for Rosaura Haro. When she and her daughter needed medical tests, she went south. There she learned that her dizziness and fatigue were linked to kidney and liver ailments, and her daughter suffered from parasites.

Her husband makes $200 to $400 a week when he is working, barely enough to feed and clothe the family, much less provide health care.

Here, “if you don’t have the money, you just don’t go,” Haro said.

Haro and Salcedo are not alone, said Melva Atayde with the Health Consumer Center, which helps low-income Los Angeles residents.

“It’s not that easy to go to Mexico every time you need something,” Atayde said. “But if that is the only means people have of paying for care, that’s what they will do.”

Others are reluctant to accept care under any circumstances, for fear of huge bills or the mistaken belief that accepting assistance could later jeopardize their chances at citizenship, said Beth Osthimer, a senior attorney for San Fernando Valley Neighborhood Legal Services.

A Times survey shows that thousands of poor families, largely immigrants, live in cramped, unsanitary conditions in the northeast Valley, squeezed into trailers without hot water or in garages with two or three families sharing a bathroom or kitchen. The conditions are ideal for the spread of contagious diseases, public health officials said.

The network of clinics in the San Fernando Valley that treats the indigent, still struggling back from the Northridge earthquake and county budget woes, are inadequate to meet the needs of an explosion in lower-income population, experts said.

* Nearly half the adults in the northeast Valley lack health insurance, among the highest concentrations in Los Angeles, and a rate comparable to the worst areas in the nation.

* Public health officials have found an alarming and persistent outbreak of shigella, an intestinal disease typically found in developing nations, concentrated in the northeast Valley.

* Because poor health of students has interfered with learning, three northeast Valley schools have created full health clinics on campus. A fourth school-based clinic is scheduled to open in early 2001.

* The Valley as a whole receives about half of the funding for outpatient services as other underserved areas, such as downtown, Hollywood and South Los Angeles. But the Valley is near the top in Los Angeles County in the estimated number of times uninsured or government insured patients need help.

Schools Open Clinics

In addition to Olive View Medical Center in Sylmar, there are two small county clinics, the three school clinics and four private clinics in the northeast Valley that offer some services to the indigent. A larger Mid-Valley clinic, which will accept patients from the northeast Valley, will reopen in Van Nuys this fall offering a greater range of services.

The Olive View Medical Center had 177,000 outpatient visits from Valley residents last year, 86% of them indigent, but hospital executive Wes Simmons said the hospital still has to turn people away.

“The demand is greater than the supply by a substantial amount. The services we have are not adequate to take care of the patients we have,” Simmons said.

“I always think of the need as almost a bottomless hole,” said Gretchen McGinley, the chief operations officer for ValleyCare, which helps provide services for the indigent.

As a result, many poor in the northeast Valley wait until their condition grows critical, then flood local emergency rooms, costing the taxpayers two to four times the amount ongoing primary care would have.

Others try to take care of their own health needs. One said she rubs her children with herbs when they become sick. Another simply prays for good health.

Most of the northeast Valley’s uninsured are working poor, according to advocates.

In addition, medical services such as orthopedics and neurosurgery are simply not available to indigent and poor patients in the Valley. Those patients must travel to County-USC Medical Center to get care, sometimes an insurmountable barrier for those without access to a car.

When 23-year-old Arleta resident Jaime Joel Medellin, who is working but does not have health insurance, tripped and chipped a bone in his leg in July, he was told by doctors at Olive View that he would have to go to County-USC for treatment.

“They told me that was the best they could do because there is no orthopedics in the Valley,” he said.

Unable to drive his stick-shift pickup truck because of his leg injury or to get a ride, he paid cash for care at a private facility. He vowed he wouldn’t get more medical care until he gets health insurance.

“There are tens of thousands like that just in this little area around Pacoima,” said Beth Osthimer, a senior attorney at San Fernando Valley Neighborhood Legal Services.

Some uninsured qualify for government assistance, but don’t know it. Others, many of them new to this country and not fluent in English, have trouble filling out lengthy applications for medical assistance. If they are rejected once, they often never apply again.

Some residents forgo all care--even for broken limbs--rather than risk a bill they cannot pay. Luis Vazquez, a maintenance worker in San Fernando, broke his hand seven months ago and never saw a doctor.

“We didn’t have enough money. We don’t have insurance. We don’t have a car. We don’t have Medi-Cal,” his wife, Guadalupe, said. The hand still swells when he uses it too much at work, Vazquez said.

Fifteen-year-old Lorenzo Reyes of Panorama City said he would not have gone to the doctor when he broke a bone in his hand if he hadn’t been at school.

Intestinal Disease

But the school called his parents and sent him to a clinic, and then County-USC hospital in a two-day odyssey. His father, Jose, panicked when he got doctors’ bills for $1,100.

Of particular concern to public health professionals has been the incidence of shigella, an intestinal disease strongly correlated with conditions of poverty.

Tim Dagodag, a Cal State Northridge medical geographer who studies the effect of overcrowding on health, found the disease across Los Angeles County, but particularly in the northeast Valley. The highest concentrations were in Pacoima, Arleta, San Fernando and North Hollywood.

“What you’ve got up there is problems from people who don’t have the economic wherewithal to take care of themselves in poor living conditions,” Dagodag said. “You have people living in trailers and garages. People who don’t have access to warm water and soap.”