A constant uncertainty: Behind the scenes at a South LA clinic

June 26, 2012, 11:44 a.m.

South Central Family Health Center has served the South L.A. community for 31 years. (Mae Ryan/KPCC)

Most who walk through the doors of South Central Family Health Center are there for one of three things: diabetes, high blood pressure or lower back pain.

That's according to David Noya, a family physician at the clinic. Noya's been there about seven years now, although that wasn't really the plan. He went to medical school in Guadalajara, Mexico, and did his residency at USC/California Hospital. That's what brought him to South Central Family Health.

"We do some rotations here as a resident, and that's how I became familiar with the clinic," he said. "I saw what they were doing and I decided this is what I wanted to do. I wasn't sure how long I was going to stay, and now it's seven years later." He laughed.

"When you're talking about giving full comprehensive care, we really do take care of the full spectrum of patients," said Noya. True to his job title, he takes care of entire families – "the newborns all the way up to the great-grandparents."

No patient turned away

South Central Family Health has been part of the crucial safety net that essentially is health care in South Los Angeles for about 31 years. The majority of its patients are Latino (90 percent) and uninsured (60 percent); many who do have insurance are on Medi-Cal. (About one percent have private insurance.) Although there are patients who pay out of pocket based on a sliding scale – a fee which usually ends up being about $25 – there are patients whose visits get filed under "uncompensated care." That is, they don't pay anything.

"Because we're a federally-qualified health center, we don't reject anybody," said Genevieve Filmardirossian, the center's associate director and chief operations officer. "We don't refuse to provide services to anybody independently of their legal status, financial status, anything."

The clinic offers a full range of services, including screenings, diagnosis and treatment, as well as preventive, prenatal and well child care. As for how it does that, Development Director Jerra Ferguson says the government is one of the clinic's "primary donors."

"The majority of our money comes from the federal or county funding we can secure," she said. And that's on top of grants and fundraisers. But South Central, like most other clinics in dense, impoverished urban areas, is in a bit of a limbo.

"We're going through some tough times right now because of the uncertainty with the federal and state budget," said Ferguson. "But we've never been in dire straits."

But the way the Supreme Court rules on the Affordable Care Act (ACA) may test that. Chief Medical Officer Felix Aguilar says the best-case scenario for the clinic is if the entire law is upheld; second-best is if the court strikes down the individual mandate and keeps the Medicaid expansion provision intact. And though he says it won't be a fatal blow if the entire law is struck down, things will get tough.

"We provide preventive care," he said. "The problem occurs when patients need hospital or specialty care. Then it gets a lot more complicated because they have to go through the county. The county does a good job of providing care, but the waits are quite long because it's so overburdened."

He says the ACA would give patients access to more hospitals and that if only part of the law is struck down, California as a state can proceed to legislate to fill in the gaps. But if the entire law is struck down, he says the Medicaid money to the state will go away, causing a "trickle-down effect."

"If it doesn't pass, who knows," said Aguilar. "I don't think we'll be in dire straits, but we'll go back to what we're doing now, which is keeping the boat afloat."

And keeping the boat afloat may not be enough for the families whom South Central Family Health Center serves.

"If it passes, a lot of our patients who are currently uninsured will have access to coverage," he said. "The majority of our patients are the working poor – folks who work at gas stations, car washes. They're custodians in hospitals. They work in hotels downtown; they're the servers; they're the gardeners. We have a lot of that. The majority of our patients work, the kids go to school and they go to church on Sunday. Really stable families. So they will definitely benefit from access to health care."

The health landscape of South L.A.

Noya attributes the three most common ailments he highlighted – diabetes, high blood pressure and lower back pain – to both environment and genetics.

"If you look around this area, there aren't a whole lot of places where you can get fresh fruits and vegetables, but you look at every corner and there's a fast-food place or a liquor store," he said. "We definitely have to change that."

(Filmardirossian pointed out that just down the street, at Central and Vernon, there was a Jack in the Box and Louisiana Fried Chicken across the street from each other. And so it goes on the southside.)

Noya said the environment was only part of it. "It's genetic as well," he said. "Latinos have a high prevalence of diabetes. Then the other thing we see is a lot of depression and that's from various factors" – factors like chronic disease, socioeconomic status and the simple fact that it's not easy living in South L.A.

"Sometimes we're scared to screen for depression because we open up a can of worms," said Noya. "We don't have the resources to refer them – it's not just giving patients a medication and then saying it's going to go away." The clinic does have a mental health provider, so it's starting to get that support, but there's still a major lack of resources.

And there's no shortage of health problems in the area: asthma, oral health, high rates of sexually-transmitted diseases and high teen pregnancy rates are all issues the clinic deals with on a more-than-regular basis. A big part of it, says Noya, is education.

"That's why it's important for a patient to have a medical home," he said. "Because when, say, a mom brings her kid in because he's having asthma symptoms, he should be on a controlling medication so it doesn't get to that point. And if they're not educated on what those medicines are and what they do for him, they wind up here frequently or go to the emergency room frequently. Educating the patient is a big part of what we do here."

Without that education, and without preventive care, the end results can get expensive – and dangerous.

"The cost of taking patients that are in out-of-control diabetes or hypertension is high," he said. "And that leads to stroke, heart diseases, heart attacks. Those people wind up in the ICU. If we don't do preventive care, it's going to end up costing more. That's what happens when people don't have access to health care."

Challenges and rewards

Aguilar says he's seen patients wait up to a year-and-a-half to receive care from the county.

"I had a lady who needed a hip replacement," he said. "She was 63 and waited, waited, waited. And then she turned 65, got Medicare and three months later had her hip.

"Those are the realities our patients face," he continued. "The county provides good healthcare once you're in. But it is a long line to get in."

As for the fix, Aguilar says there's no panacea.

"There is no silver bullet," he said. "But what we see is that there are other poor, similar communities that have better health outcomes than we do." He pointed to Harlem in New York as an example.

"Basically what we are focusing on is education, education, education," said Filmardirossian, "so we can empower them to take care of themselves. We can only do so much."

Ferguson pointed to a different type of education, saying "there's a direct correlation between poor academics and poor health."

For his part, Aguilar says providing health is all at once a complicated and collaborative endeavor, with a considerable element of struggle.

"We as a clinic are part of the solution," he said. "If you have diabetes, you need three things: diet, exercise and medical care. We're only one leg of that stool, and the other two need to be there. Folks need to be active; they need to be able to get healthy foods; they need to be able to access care. In South L.A., I think we need a very engaged community – even though we're in the shadows of downtown, sometimes it feels like we're somewhere else because the community is so isolated."

Noya agrees, but doesn't hesitate when he says it's worth it. "Our patients, they're just so appreciative of the care that you give to them, and that's what keeps drawing me back to staying here," he said.

After seven years, he doesn't think it'd be easy to leave – especially with the lunches his patients have grown accustomed to bringing him, or the knick-knack souvenirs he's collected from patients who bring him back gifts when they go on trips to their native countries. "Those are things you don't find in a lot of other practices," he said.

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