School Clinics Offer Primary Medical Care

At 5 feet, 6 inches, a 14-year-old boy tips the scales at 280 pounds, causing his doctor to worry about the early onset of diabetes. Another boy suffers from post-traumatic stress disorder triggered by the death of his brother, who was hit by a gang member’s stray bullet.

They are, in the words of a clinic staffer, just two of the “little people with big problems” who seek treatment at Maclay Family Health Center at Maclay Middle School in Pacoima. Although many students need only a checkup or antibiotics, children with more serious ailments walk through the door every month. For many, the center is their only source of medical care.

In Southern California, school clinics are moving beyond providing basic services such as inoculations and vision tests to become primary health-care centers for students and sometimes their families. School-based clinics were established 15 years ago in the Los Angeles Unified School District, which has 27. Other districts with longtime health centers are Culver City, Pomona and Pasadena.

“If the clinic wasn’t there, they wouldn’t get care or would travel to a county hospital,” said Margaret Lee, director of special projects at the county Department of Health Services. “We have research that shows that school-based clinics relieve the burden on trauma centers and emergency rooms.”

Although critics contend school districts should not be in the health-care business, medical and social service workers say clinics fill a void in low-income communities, such as the northeast San Fernando Valley where Maclay is located.

A report released last month by the U.S. Department of Health and Human Services found that in 1999, 13% of the nation’s schoolchildren did not visit a health clinic or a doctor’s office in a one-year period. It also found that 12% of children under 18 had no health insurance coverage.

The Maclay clinic, which opened in April, also serves children from three local elementary schools: Fenton Avenue, Pacoima and Broadus. It is the district’s largest clinic on a middle school campus and the only health center in LAUSD funded solely by the federal government.

Health care is especially pressing in the northeast Valley, where county and nonprofit clinics and hospitals are overburdened, officials said. In a 1999-2000 county health survey, 21% of children in the northeast Valley did not have medical insurance coverage and 32% lived below the federal poverty level--$16,895 annually for a family of two adults and two children.

Another campus in the area, Pacoima Middle School, will open a clinic in February that will be run by the school district and the county. It will be open two nights a week for parents of students of the middle school and four local elementary schools, said Sharon Swonger, who oversees school clinics in the northeast Valley. Only two other clinics in the district, Foshay Learning Center in Los Angeles and Elizabeth Learning Center in Cudahy, offer medical services to families, said John DiCecco, the district’s director of health partnerships.

The Maclay clinic, which operates on a $300,000 federal grant and offers only limited mental health and nutrition counseling to families, handles about 150 visits a month from students, many of whom are referred by school nurses, said supervising physician Charlene Huang. Parents must consent to all services their children receive, including birth control, she said.

Young patients often need ongoing medical care or mental health counseling for conditions brought on by domestic violence or childhood obesity, Huang said.

Maclay nursing coordinator Adriana Linares said parents have told her about waiting a month or longer for a routine checkup for their children at county-run clinics and hospitals. Colds and rashes can mean a full day in a waiting room with dozens of other patients. Because many parents have multiple jobs and limited transportation, they often decide to skip health care altogether, Linares said.

Thirteen-year-old Armando Juarez of Pacoima said he rarely visited doctors in his native Mexico, where he lived most of his life. Armando underwent his first comprehensive physical examination last week at Maclay, blushing his way through questions about his home environment, whether he ever feels depressed, and his sexual and drug history.

His answers help doctors determine what Huang calls his “holistic health.” Although the shy teenager squirmed through the personal questions, his mother, Maria Carmen Beltran, 39, said the environment was much more comfortable than at a county clinic.

But Lance Izumi, director of the education unit at the Pacific Research Institute, a conservative think tank in San Francisco, said that schools should not be providing health care and that money would be better spent on books, improving buildings and paying teachers. “The reason we have schools is to educate kids,” Izumi said. “Health care and other issues are secondary to the school.”