Health Care for the Needy: Orange County’s Time Bomb (1987)

The problem of providing adequate health care for thousands of Orange County is becoming more critical each month. There are thousands in Orange County who aren't covered by private health insurance and don't qualify for Medi-Cal or Medicare. For them, the hopes for medical care is out of reach or it must come under the impacted indigent medical services program or community clinics. Today we'll talk with people of the new United Way Health Task Force examining a problem. But first, let's look at some places where medical crunch is experienced every day. This is Orange County Health Care Agency's clinical services building in Santa Ana. Most of the people who come here have no private medical insurance, no Medi-Cal, no Medicare, and don't qualify for IMS (indigent medical services). For most of the 150,000 patients served here last year, this is their only medical care.

The patient load here jumped from 20,000 over the previous year. This young girl is receiving free immunization shots and polio vaccine, part of 200,000 immunizations given to 100,000 clients last year. The load is getting bigger every day and yet federal, state, and county funds are shrinking and new cuts are now being proposed. Another free facility is the Women, Infant, and Children, or WIC Clinic. It began in 1975 serving 10,000 poverty level infants, children, and women each year. Today it numbers 60,000 patients and the program continues to climb. For these mothers, infants, and children, there would be no other source of care. Many have hourly jobs and don't have resources or insurance to get services they need at local hospitals or from private physicians. 35% are Hispanic, 51% are Indochinese, all are poor. This is the family planning clinic, which provides free pregnancy testing, maternal health

services, and prenatal care. The story is the same, a critical need for limited services. Many women still have no prenatal care before they deliver their babies, despite the fact that 25% of such mothers will give birth to premature babies. First year, 1,000 pregnant mothers were turned away from prenatal services here because the clinic couldn't handle them. Dr. Gerald Wagner, pediatrician, is in charge of child health services, and he's been a public health physician in Orange County for the past 23 years. How serious is this problem of growing need for good health care in Orange County? Well, I think we continually see children in our clinics who have undetected abnormalities with a serious problem in access to medical care, where they're not able to get in to someone who can make diagnoses at an early stage treat abnormalities when they're easy to treat so that they don't form long-term disability. If you are poor, you also may go to the Community Clinic of Orange County in South Santa Ana.

This clinic is operated by the University of California College of Medicine. It provides all general family medical care with a staff of 34 family practice residents from the UCI hospital, plus five full-time doctors. This is the Women, Infants, and Children's Clinic. In 1986, there were 30,000 patient visits for the entire clinic compared to 14,000 the previous year. Five languages are spoken here. 50% of the patients are Hispanic, 28% are Southeast Asian. Many are among the county's 20,000 seniors whose income is at the poverty level. Here Dr. Jose Sandoval, a family practice physician, examines a patient. Patients pay if they are able, even if it's only $1 to $3 a visit. Otherwise they pay nothing. Dr. Mary Roth, family physician, is a professor at UC Irvine Medical School and is medical director of the Community Clinic of Orange County. How real is this medical crunch based on your experience here for the past seven years?

Over the seven years we've seen a decline in the number of places and the number of physicians who are able to see the indigent. The indigent is well defined in that it is all those persons who do not have the adequate cash or defined insurance to seek medical care when they need it. This includes undocumented aliens. This includes the working poor, those individuals who do not have health insurance. This includes the refugees who have limited coverage in their first months in this country. They have found that the average physician is not able to incorporate them in their practice, and therefore they seek a multitude of alternative sites for medical care. Community Clinic of Orange County, which has been here for 15 years, serving the underserved of Orange County, has found that slowly but surely the numbers of those who need to come to us is in large, including larger numbers from all over Orange County and not just from the Barrio. This is not just a Barrio practice, but includes individuals from Placentia, Anaheim and South County because there is a shortage. What happens if more facilities are not brought to address this problem? What do you see

in the future if nothing more is done? The first thing that will be lost is preventive medical care. Those things that could have been prevented, those illnesses that seem casually not to be important. Massive trauma will always be taken care of. But what my concern is is the preventive care such as prenatal care, well child care, care of hypertension, diabetes, and those chronic diseases that are not so obvious will not be cared for, and we'll have sicker people who have more morbidity, who will die in our hospitals.