Disease, Care Costs Afflict Poor

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.

Her dizziness and fatigue, doctors there told her, were due to kidney and liver ailments, and her daughter suffered from parasites.

Her husband makes $200-$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, a service that assists 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, out of fear of a huge bill 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.

‘Characteristic of a Third World Country’

The network of clinics in the San Fernando Valley that treat the indigent is still struggling back from the Northridge earthquake and county budget woes, and is inadequate to meet the needs of an explosion in lower-income population, experts said. A Times survey found:

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

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

The disease “suggests the existence of conditions more characteristic of a Third World country than a modern-day industrial region,” according to an academic report on the outbreak.

* Because the poor health of students has interfered with learning, three northeast Valley schools have created full health clinics on campus to treat those enrolled and, in some cases, their siblings. A fourth school-based clinic is scheduled to open early next year.

* The Valley as a whole receives about half of the funding for outpatient services as other underserved areas, such as downtown and 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.

In addition to Olive View-UCLA Medical Center in Sylmar, there are two small county clinics, three school-based 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 and offer a greater range of services.

The $120-million Olive View-UCLA Medical Center received 177,000 outpatient visits from Valley residents in the past year--86% of them indigent or Medi-Cal users. 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 simply attempt 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 poor patients in the Valley. Instead, 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 [him] just in this little area around Pacoima,” said Beth Osthimer, a senior attorney at San Fernando Valley Neighborhood Legal Services.

Some uninsured are eligible for government assistance but do not realize that they qualify. Others--many of them new to this country and lacking a command of 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.

But the school called his parents and sent him to a clinic and then County/USC in a two-day, $1,100 odyssey.

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 garages with two or three families sharing a bathroom or kitchen--ideal conditions for the spread of contagious diseases, public health officials said.

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

Tim Dagodag, a medical geographer from Cal State Northridge 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.”

Dental care also is a pressing need. A four-chair emergency dental clinic for indigent patients at Olive View closed after the Northridge earthquake. It finally reopened a year ago with three chairs housed in borrowed rooms. In a small step forward, eight private dentists in the Valley agreed this year to accept poor and uninsured emergency dental patients.

No breakdown is available of how much government money for health care goes to the northeast Valley.

But the San Fernando Valley Service Planning Area--one of eight in the county--has the second-highest estimated number of visits for Medi-Cal and uninsured patients.

The number of uninsured in the northeast Valley has doubled in the past five years to 137,000, according to the Los Angeles County Health Department.

‘Getting Worse in the Valley’

The need for medical services is so great that Dr. Patrick Dowling, head of the department of Family Medicine at UCLA Medical School, has proposed special financial incentives to attract doctors. The UCLA Dental School has a similar proposal to establish a community dental clinic in the Pacoima area.

The program would enable newly graduated physicians to pay back their student loans by working in urban clinics. The federal program is restricted to areas of extreme poverty and great need.

Dowling hopes to set up the program in Sun Valley, an area so devoid of services for indigent patients that Ron Hansen, Supervisor Zev Yaroslavsky’s health services deputy, called it a “black hole.”

Dowling predicted that the 2000 census will show immense demographic shifts in the Valley in the past decade.

“I think it’s getting worse in the Valley, and the trend may be getting more so,” Dowling said. “Whereas the others--like South-Central and East Los Angeles--may be bottomed out.”

“I think the northeast Valley is as underserved as any place in South and Central Los Angeles,” said Dowling, who has worked all over the city. “But it is harder to get funding here because [the problems are] not as well known.”