To Some, the Best Remedy

The number of storefront medical offices catering to a Latino clientele is surging throughout California as immigrants look for accessible and affordable health care -- with a flavor of home.

More of these clinics -- common south of the border -- are opening as doctors and other businesspeople meet the growing demand in Latino neighborhoods. For immigrants, the clinicas offer a medical-care culture typical of their homeland -- characterized by an unrushed, Spanish-speaking physician willing to provide aggressive treatments for patients whom he might never see again.

The phenomenon is playing out dramatically in the growing immigrant community within Orange County, where clinics are offering low fees and gifts to attract patients.

Some medical offices employ Mexican doctors lacking California licenses who, in this country, serve as physician assistants. Their culturally distinctive bedside manner and practices -- including administering medicines with shots versus by mouth -- are popular among Latino immigrants.

Indeed, one such doctor’s office in Anaheim, Clinica Medica Mi Pueblo, advertises with the slogan, “You don’t need to go to Tijuana anymore.”

The increasingly competitive clinics promote themselves on the streets and in church bulletins. A few boast that they accept only cash and credit cards -- no insurance -- as they troll for patients who have few low-cost healthcare options.

“We know there is a major problem with access to care, and it disproportionately affects people who are low-income, people who are immigrants, people who are Latino,” said Dr. Michael Rodriguez, a UCLA family medicine professor and chairman of the Latino Coalition for a Healthy California. “It is in their neighborhoods where storefront doctors pop up.... They are filling a need not being met by our public health clinics.”

The care provided by these storefront offices, he noted, is available without appointment -- in contrast to long waits at nonprofit community clinics, and more affordable than services offered in emergency rooms and more mainstream, private doctors’ offices.

While Orange County has 31 nonprofit, government-subsidized community clinics, Santa Ana alone has at least 94 private, for-profit clinics such as Mi Pueblo that charge as little as $15 a visit, according to an estimate by the Orange County Coalition of Community Clinics. The number of such clinics statewide is not tracked by government or health organizations.

Many storefront offices refer to themselves as “clinicas” because in Mexico the word implies a better level of care than the “health centers” that serve indigents.

Clinic owners -- usually private-practice doctors -- hire flyeros, as they are known in Spanglish, to distribute fliers in the 4th Street shopping district in Santa Ana, a city where 74% of the population speaks Spanish. Some offer blenders and radios, and $10 discounts to new patients.

“When we have the choice between clinics, we try to go where we can get the most value, and where Spanish is spoken,” said Maria Delgado of Long Beach, who went to Mi Pueblo after hearing its radio advertisement. “When you are sick, you want to make sure you really understand what is happening.”

Mi Pueblo is run by Roberto Esquivel, a Mexican doctor who immigrated to the United States as a janitor. He upped the competitive ante in April by opening his Anaheim office 24 hours a day. The clinic sees about 110 patients each day -- when office visits cost $25 -- and as many as 30 patients overnight, when the cost is $45, he said.

The company runs a second clinic in Anaheim and one in Santa Ana that specializes in male disorders. None accepts insurance.

The Mi Pueblo medical team includes a mix of a dozen or so California and Mexican doctors. The Mexicans work in the United States with physician-assistant licenses under the supervision of California physicians.

Shunning insurance saves the clinic the back-office costs of seeking reimbursements, Esquivel said. The low office fees also reflect increasing competition among the clinics and the lower salaries paid to some personnel.

Other clinic owners are following the business model.

Dr. Roy Sweeney, an Argentine who holds a California medical license, opened Clinica Medica Guadalupana in Santa Ana 18 months ago because, “I saw a population in need. People get sticker shock in emergency rooms, and there aren’t many options outside them.”

The clinics are popular with Latinos, but their reputation has suffered among those who equate them with unlicensed practitioners.

Like private doctors’ offices, the storefront clinics are not regulated by the state. They are viewed by their clientele, Rodriguez said, as places to seek treatment for occasional maladies, not chronic illnesses.

The fact that they are frequently staffed by migrant healthcare providers may unfairly stigmatize them, Rodriguez added.

America Bracho, founder of Latino Health Access, a nonprofit health advocacy organization, said, “There are always questions about these clinics, but in many cases, they can be a good way for people without insurance to get care and get it quickly.”

The competition is creating some hard feelings among operators.

“My concern is the quality of the care,” said Christina Carballo, administrator of Clinica Medica Familiar in Santa Ana. “The clinics just think about how many patients they can jam in. I call a patient and ask why they want their records transferred to another clinic, and the answer is often that the other clinic offered them a gift.”

Rodriguez said nonprofit community clinics may be more highly regarded than storefront clinics, in part because they are regulated by state authorities. But even among skeptics, he said, clinics are popular because of their low fees and the ability to quickly accommodate patients without an appointment.

Esquivel’s business plan is to rival Tijuana by offering medical services in Orange County that reflect traditional Mexican care.

Both Tijuana and Orange County clinics offer streamlined services that can include laboratory tests and pharmacy services at one site, but the costs can be higher here.

“What I like is that this feels like home here,” said patient Cristina Munoz, 64, of Anaheim, who came to the clinic with persistent nausea. “I feel like I can ask questions without being laughed at. I can do it in Spanish.”

Isabel Becerra, acting chief executive officer for the Coalition of Community Clinics, said that while initial fees at private clinics may match those charged at community clinics, private clinics may charge patients more than the posted fees of $20 to $30, as they add the cost of lab tests and prescriptions.

“The good thing is that these clinics are there, because they meet a need. [But] there is a lot of false advertising. It’s hard to tell what the bill will be,” Becerra said. “Twenty-five dollars gets you in the door, but there can be other charges. Many clinics are legitimate, but there are a few that give them all a stigma.”

Under poster maps of Mexican states that send the most immigrants to the United States, Anaheim resident Antonio Pulido, 53, sat in the Mi Pueblo waiting room, where Esquivel offers Mexican cookies.

Pulido said he turned to the clinic because he recently lost his job -- and his health insurance.

“What’s funny is my co-pay was sometimes as much as the visit is here,” he said. “And here, I don’t make an appointment, I don’t wait for doctors. I just get what I came for.”