No room for sick at county clinics
Closed facilities, layoffs due to fiscal crisis have swamped existing centers
By Rebecca Vesely, STAFF WRITER, Oakland Tribune
Monday, October 13, 2003

They sit elbow to elbow, chatting, reading, knitting but mostly just waiting.

They spill out into the hallways where children on all fours trace patterns on the worn carpet with a toy truck.

They listen for their names to be called by men and women in white coats, who rush in and then disappear behind doors with the lucky chosen.

Here at Eastmont Wellness Center off Foothill Boulevard in Oakland, patients are waiting longer and traveling farther for their health care.

Eastmont is one of three remaining outpatient clinics run by Alameda County. Two clinics closed at the end of June because of budget cuts -- one near downtown Oakland and one at Fairmont Hospital in San Leandro.

So it is up to Eastmont and the two other clinics still open -- Winton Wellness Center in Hayward and Newark Health Center -- to absorb at

least12,000 displaced patients amid fewer resources.

It's nearly 11 a.m. on a recent Thursday, and Daisy Urutia, a smiling, petite 49-year-old, has been waiting an hour to see a doctor. She's here for a checkup on her diabetes and to ask about dizziness and back pain she's experiencing.

For eight years, Urutia was a patient at Central Health Center -- the downtown Oakland clinic that closed. Now she comes here. The length of her bus ride has more than doubled, from 20 minutes to nearly an hour as well as the time it takes to get an appointment, from two weeks to a month.

"It's much more crowded here, and there are more patients coming from other clinics," Urutia said through an interpreter, still smiling as she squeezed onto a bench between two women who agreeably made room.

Edith Pinto, seated at Urutia's left, also has experienced longer waits since the clinics closed. A patient at Eastmont for six years, Pinto and her husband -- who are uninsured and pay out-of-pocket for their care -- could until recently get an appointment within two weeks. Now it takes up to three months, she said.

"I've never seen as many people here as in the last month," the 48-year-old janitor said through an interpreter.

Other women waiting nearby nodded in agreement.

Medical center closures hit hard

The county-run system for outpatient and hospital care, called the Alameda County Medical Center, is in dire financial straits. Last fiscal year, the system filled a $12 million budget shortfall partly by closing the two outpatient clinics and laying off employees.

Now, the medical center -- which includes Highland and Fairmont hospitals, John George Psychiatric Pavilion and the three clinics -- is under further duress. With a budget deficit hovering around $50 million, the medical center needs a financial shot in the arm to remain the primary source of health care for the county's poor and indigent.

Public hospitals across the country are experiencing more demand at outpatient clinics as people live better and longer with chronic illnesses such as diabetes, HIV and cancer. Over the past two decades, the number of patients in outpatient care has outpaced in-patient hospital admissions, according to the National Association of Public Hospitals, of which the Alameda County Medical Center is a member.

American public hospitals provide more than 28 million outpatient visits a year -- about half are preventative care, such as checkups. Forty percent of patients seen at public outpatient clinics are uninsured, according to the National Association of Public Hospitals.

At Eastmont, no more new appointments are available for the rest of the year, said nurse manager Eulalia Williams. Starting in September, patients were told to call back in October to make an appointment for January or February. Those needing ongoing care -- pregnant women and people with diabetes, for instance -- get top priority.

The waits are longest in adult primary care, though pediatrics and women's health are seeing more patients, too. By 9 a.m. on most mornings, 15 patients are waiting for a drop-in appointment, Williams said.

Winton Wellness Center in Hayward is setting a new record on patients seen. In August, the clinic treated about 700 adults in its primary care clinic -- the most ever -- and 240 more people than in April. The number of patients seeking drop-in appointments is steadily rising -- nearly 200 more people showed up in August than in June.

"We haven't seen numbers this high before -- even in the wintertime," said Winton nurse manager Pamela Burkhardt. "We're definitely running all day."

Even more patients than in winter

The clinic staff is expecting even more patients later this fall, once the flu season gets under way. Burkhardt added a second triage nurse to answer the nearly 1,000 phone requests for an appointment the clinic gets each month. Before, just one nurse responded to patient calls.

About 37 staff were transferred from the shuttered clinics. Thirty were laid off, and some left for other clinics that serve low-income patients, such as Lifelong Medical Care in Berkeley and Oakland.

"The staff complain about needing more staff," Williams said.

Many patients -- including those interviewed at Eastmont -- experience longer waits because they need an interpreter. More than half of patients at Eastmont speak Spanish as their primary language, and the clinic has too few translators -- just seven on staff.

Irene Cruz, a patient at Eastmont, waited an extra hour last month to see her doctor because no interpreter was immediately available, she said.

The evidence can be heard over the loudspeaker. Every few minutes, it squawked, "Interpreter to adult care!" Or "Interpreter to pediatrics!"

But a lack of interpreters is just one problem among many.

The Alameda County Board of Supervisors has pledged to keep the three remaining county clinics open -- at a cost of about $19.6 million a year. A coalition of elected officials and community activists are exploring floating a sales or parcel tax on the March 2004 ballot to raise money for county health care.

All this means little to the patients at Eastmont, who just want to see their doctor in a timely manner -- patients such as Sylvia Compean, who missed an appointment three months ago and then waited three months to get another.

Compean, who has sciatica, a term given to pain down the leg caused by irritation to the main nerve into the leg, was at Eastmont to get results of an MRI taken at Highland Hospital six months ago. She did not know why she had to wait so long to speak with a physician about the test.

When reached later by phone, Dr. Roger Peeks, medical director for the county, said if the MRI showed something amiss, the patient surely would have gotten an appointment sooner.

Contact Rebecca Vesely at rvesely@angnewspapers.com.