SR-106-023-02 (7)
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CH:VR:rrurnn
Clty council Meetlng: 6/11/85
Santa Monlca, Californ~a
10-8
JUM 11 'VI:
STAFF REPORT
TO:
Mayor and C~ty Council
FROM:
Commission on Older Amer~cans
SUBJECT:
Request to Endorse Rev~sed position Paper of the Santa
Monica Area Health Action Coalltion
At its meeting of May 15, 1985 the Commission on Older Americans
concurred with the act~on taken by Council on Aprl1 9 in regards
to the Santa Monlca Area Health Actlon Coalition's (SMAHAC)
posltion paper on County Health Servlces.
In particular the
Commission agreed wlth the recommendation of Councl1 to urge the
County to improve tralnlng for its personnel with respect to the
II ablli ty to pay" plan and to make changes 1.0 the current cllnlC
appolntment hours.
The Commisslon on Older fu-nerlcans has been made aware that the
SHAHAC has met wlth County staff Slnce the Aprll 9 CounCll
meetlng and has modlfled 1.ts paper.
(please see attached copy)
The Co~nlsslon would llke to endorse the paper as lt now stands
and requests Councll's permlssion to do so.
10-B
JUM 11 \985
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The paper has been revised from the or~g~nal in the follow~ng
three areas:
1. The revised paper notes the health cl~nics which prov~de
low or no-cost health care ~n the ~mmediate area.
These
clinics are able to flll the health needs of some
Wests1de resldents.
2. Progress wh~ch has been made at the Burke Center is
acknowledged.
In part1cular, the revlsed paper notes
that bllingual staff have been hired and that efforts are
belng made to ~nform patients about the Ab~l~ ty-to-pay
Program.
3. Wh~le the org~nal posltlon paper called for an expans~on
of serVlces offered at the Burke Center, the revlsed
paper calls for a comprehens1ve health care center of the
Westside.
Three such County facLl~ t.l.es currently exist
1n other parts of Los Angeles County.
In response to Mayor Reed's request
for the Commlsslon's
comments, the Commiss~on on Older Amerlcans would llke Council to
be aware that it endorses the intent of the paper, more so than
each specific issue that ~s raised, 1n the hopes that County will
be mot~vated to examlne chronic issues Wh1Ch need to be addressed
in its present system of health care del1very to the elderly,
homeless and poor.
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The Conunissl.on on Older AIDerleans 15 referrlng a copy of the
rev1sed posltlon paper to the Soclal Services Commiss1on.
RECOMMENDATION
The Commlsslon recormnends that Clty Council approve the
Comm1SSlon I S request for the COmm1SS10n to endorse the modified
pos1t1on paper wrltten by the Santa Monica Area Health Coalitlon.
VR:mmm
Attachment
(health)
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Santa ]\/lor!tal1-1T'm
Health Action Coalition
757 Pier Ave-jSarrralv\ontcaJG\.904-05 (20)395-067+
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HEALTH SERVICES FOR LOW-INCOME PEOPLE
IN THE SANTA MONICA-VENICE-WEST LOS
ANGELES AREA
A Position Paper on County Health Services by the
Santa Monica Area Health pet ion Coal~tion
May 19B5
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Summary
Key Findings
1. Community, private and County health services available
to low-1ncome people 1n the 5~nta Mon~ca-Ven1ce-west Los An~ele5
area do not adequately .eet the~r needs ~or ambulatory care.
inpatient care, or mental health services.
2. According to
Department 0% Health
neeting the needs o~
to enable 1t to do so.
State laws, the Los Angeles County
Services is primarily responsible %or
the poor and receives money ~rom the State
3. The Yvonne Braithwaite Burke Health Center, the main
County clinic in the area. prov~ciea limited ambulatory care that
does not meet the broad health needs of indigent persons ~n the
area.
4. Ind~gent patients can rece~ve inpat~ent and
ambulatory care only at Harbor-UCLA Medical Center. a
bus ride from 5anta Mon~ca.
comolex
two-hour
5. Mental health serv~ces for low-~ncome chronically
mentally 111 on the westa~de are seriously ~nadequate so that
p6tiente often exper~ence long waits to get ap?oi~tments a~
County facil1ties.
6. Members of the oubl~c are not adequately in=crmed 0= the
the2r r~ght to apply ~or the Coun~y's ab2l2ty-to-?ay plan.
K~Y RECOMMENDATIONS
1. The Burke Health Center should be expanded ~nto a ~ull
comprehensive health center. similar to County comprehensive
health centers in other parts 0= Los Angeles and providing the
zull range 0% services available at federally-%unded community
health centers.
2. The County should take immediate ~c~ion to publicize more
zully the ability-to-pay plan.
3. The Coun€y should prov1de transportation for ~estside
res1denta to Harbor-UCLA Med1cal Center for both emergency and
non-emergency care.
4. The County should establish contracts w2th some local
commun2ty c11n2cs to enable them to better serve 2nc2gent
patients whom the Burke Health Center is not able to adequately
serve.
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Summary
Key Findings
1. Commun~ty; ~r~vate and Coun~y health se:v~ces availab:e
to low-~ncome people ~n the Sante Mon~ca-Ven~cs-west Los An~eles
area do not adequately meet the~r needs for ambulatory care.
inpatient care, or mental health services.
2. According to
Department 0% Health
meeting the needs of
to enable ~t to do so.
State laws, the Los Angeles County
Services is primarily res?onsible for
the poor and receives money from t~e State
3. The
CCllnty clinic
does not meet
area.
Yvonne Braithwa~te Burke Heal~h Cen~er. the main
in the area, provides limited ambulatory care that
the broad health need a 0: indigent gersons ~n the
4. Ind~gent patients can rece~ve ~npat~ent and
ambulatory care only at Harbor-UCLA Med~cal Center. a
bus ride from Santa Mon~ca.
complex
two-hour
5. Mental health serv~ces fer low-~nccme chron~cally
mentally ~ll on the WestsLde are ser~ouslv ~~ace~uate so that
p~t~ents often exper~ence long waits to get ap?oi~tmentg a~
County =ecil~t1es.
6. Members 0: the oubl~c are not adecuetelv ~nfc=med 0: t~e
the~r rLght to apply for the County's ab~l~ty-to-pay plan.
K~Y RECOMMENDATIONS
1. The Burke Health Center should be expanded ~nto a iull
comprehensive health center. s~milar ~o County comprehens~ve
health centers in other parts 0= Los Angeles and ?rov~ding t~e
:ull range 0% services ~va~lable at federally-funded commun:ty
health centers.
2. The County should take immediate ac~lon to publlci=e more
fully the ab11ity-to-pay plan.
3. The
res~dents to
non-emergency
County shou:d prov~de
Harbor-UCLA Med~cal
care.
trans?or~at~on
Center for both
:cr ~estslde
emergency anc
4. The County should establish contracts with some local
commun~ty clLn~cs to enable them to better serve ~nd~?ent
patients whom the Burke Health Center is not able to adequately
serve.
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5. The County should establ~sh contracts w~th local
hcsp~tals for in-pat~ent care and =or complex out-~at~ent care
not ava~lable at the expanded Burke Health Center.
6. Santa Mon~ca ~est should become a full comrnun~ty mental
health center.
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The Santa Monica Area Health Act~on Coa11tion is an
organization o~ health care consumers and community-based
organizations which serves aa an advocate at local~ state. and
national levels ~or the health needs 0% Santa Monica area low-
income~ working-class~ and middle-clasg people. A primary
concern o~ the Coalition 1S access to health services in the
Venice-Santa Monica-West Los Angeles area. Public and private
health care providers have responsib111t1es to ensure the
access1b1l1ty ox qua11ty health serV1ces w1thout f1nanC1al
barriers to low-income persons.
1~ HEALTH NEEDS OF LOW-INCOME PEOPLE IN THE AREA
The Health Care Needs Assessment prepared for the City of
Santa Monica by the National Health Law Program as well as
test1mony presented both at a community forum 1n Santa Mon1ca 1n
March 1984 and a leg1slat1ve hearing in Los Angeles in October
1984 indicate that health services are not sufficiently ava11able
to 10w-1ncome persons in the Venice-Santa Mon1ca-~est Los Angeles
area. Only a t1ny proport1on of private phys1c1ans pract1c1ng in
Santa Monica w~ll accept Medi-Cal. The substant1al uninsured
popula~~on 1n this area has very few sources of care. The large
homeless populat~on is a particular source of concern. A recent
study conducted by researchers at the UCLA School of Publ~c
Health found t~at about 5.000 homeless people are l~v~ng on the
~ests1de. Although they are at h1gh r1sk of ~llness and
accidents, few have health insurance or coverage 0: any kind.
The "Heal th Ca~e %or tho"": Homeless ProJect. t. recent 1 y funtied by
the Robert ~ood Johnson Foundation, may partly allev~ate th~s
problem.
2. AMBULATORY CARE
Several cOllimunity, pr~vate nonprof1t and coun~y cl~n~cs
serve low-1ncome people ~n th1s ~re~. The Les Kelley Cl~n~c. ~
service of Santa Monica Hospital. provides a broad range of
ambulatory care. In 1983-84~ this clinic had 22.864 pdtient
V~S1tS. In order to be- el~g~ble to rece~ve care at the Les
KeJ 'ey Clinic, patients must either have Med~-Cal or Medicare or
me. _ income criteria; applicants w1th incomes below 5600 a month
o! over 52.000 are not adm~tted. Moreover. serv~ces at the
c~lnic are not free. The first visit typically costs at least
5150: bas~c fees for subsequent visits are 520. Thus, although
the Les Kelley Cl~nic serves the work~ng poor 1n the Santa ~on1ca
area~ the very poor are unable to obta~n care there.
The Venice Family Clinic. the maJor commun~ty prov1der of
free and reduced-fee care, furnishes a broad range of primary
care serV1ces and some spec1alty care. In 1983-84. the cl~nic
had 11.216 patient visits. Nevertheless~ it cannot meet the
total demand. Many o~ the cl1nics at the Venice Family Clinic
are full~ and some patients must wait several weeks fo~
appointments. Moreover. the current level of funding does not
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The Santa Monica Area Healt~ Ac~~on Coal~tion is an
organization of health care consumers and community-based
organizations which serves as an advocate at local, state, and
national levels %or the health ~eeda 0: Santa Monica area low-
income, working-class, and middle-class peo?le. A pr~mary
concern of the Coalition ~s access to health services ~n the
Venice-Santa Monica-West Los Angeles area. ?ublic and pr~vate
health care providers have responsibll~ties to ensure t~e
access~b~l~ty of qual~ty health serv~ces w~thout f~nanc~al
barriers to low-ineoRe persons.
1. HEALTH NEEDS OF LOW-INCOME PEOPLE IN THE RRER
The Health Care Needs Assessment prepared for ~he C~ty of
Santa Monica by the National Healeh Law Program as well as
testlmony presented both at a community forum ~n Santa Monlca ~n
March 1984 and a 1eg~slat~ve hearing in Los Angeles ~n October
1984 indicate that health services are not sufficiently ava~lable
to low-lncome persons in the Venice-Santa Mon~ca-West ~os Angeles
area. Only a t~ny proport~on o~ private ?hys~c~ans ?ract~c~~g ~n
Santa Monica w.ll accept Medi-Cal. The substantlal uninsured
populac~on in th~s area has very few sources 0: care. 7he large
homeless population is e particular source o~ concern. A recen~
study conducted by researchers at the uCLA School 0: ~ubl~c
Health found ~hat about 5.000 homeless oeop:e are l~y~ng on the
~ests~de. Although they are a~ h~gh r~s~ of ~llness and
accidents, few have health insurance or coverage of any Klnc.
The "Health Ca~e xor the Homeless ProJect," recently funrled by
the Robert Woed Johnson Founca~ion, may partly allev~ate th~s
problem.
2. ~MBULATORY CARE
Several COmmunity, private nonpro%~t and county cl~n~cs
serve low-~ncome people ~n th~s aree. The ~es Kelley Cl~n~c. a
service of Santa Monica Hos?ital. provides a broad range of
ambulatory care. In 1983-84, this cl~n1c had 22,554 ?a~ien~
V~s~ts. In order to be~ el~g~ble to rece~ve care at the Lee
Ke]ley Clinic, patients must e~~her have Med~-Cal or Med~care or
m~__ income criteria; applicants with incomes below S5CO a month
or over S2.000 are not adm~tted. Moreover, serv2ces at the
c~~nic are not free. The first v~sit typica:ly costs at least
5150; bas~c fees for subsequent visi~s are S20. Thus. alt~ough
the Les Kelley Clinic serve~ che work~ng poor ~n the Santa ~on~ca
area, the very poor are unable to obta~n care ~here.
The Venice Family Clinic. the maJor commUnltY prov~der 0:
free and reduced-fee care, furnishes a broad range 0% primary
care serV1ces and some spec~alty care. In 1983-84. the cl~n~c
had 11,216 patient visits. Nevertheless, it cannot meet the
total demand. Many 0% the cl~n~cs at the Venice Family Clinic
are full, and some patients must wait several weeks for
appointments. Moreove~. the current level of funding does not
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perm~t the cl~nlC to provlde
a~bulatory serv~ces.
a full
range cf comprehenS1Vg
In addltion, other commun~ty cl~n~cs prov~de a more l~m~ted
scope of serv~ces to low-lncome people. ~or exemple. the
~estslde Women's Cllnlc provldee gynecolog~cel care, the Los
Angeles Chlldblrth Center provides maternlty and gynecologlcal
care, and Planned ?arent~ood provldes fam~ly planning eerVlces.
Dental care is provided by the UCLA Ven1ce Dental Cllnic and the
dental clinics 0: St. John's Hospital and Santa Monica Hospital.
Some 0: these services, such as those 0: the Ch1ldblrth Center
and the UCLA Dental Cllnic, have minimum charges which exclude
indlgent persons. Even with that limitation, some of these
services have long waitlng lists: for example. the UCLA Ven1ce
Dental Cl~n~c has a one-year waitlng per~od ~or appolntments.
The Los Angeles County Department of Health Serv~ces (DHS)
operates three cllnlcs In the area. two of whlCh provlde only
llmited PUb:1C health services. The Yvonne Bra~thwalte Burke
Health Center. the only County medical cllnic in ~h~s area.
served 35,965 pat~ent VlSlts In 1983-84. The Culver Clty
Subcenter and the Venice Subcenter, both of WhlCh are County
publlc health cl~nlcs, together ~ad about :4,000 patlen~ VlSlts
In tha~ same f2acal year.
However, there are serious ~nadequacles In County serVlces
that e~e not compensated by communlty-based or prlva~e ca~e tha~
lS zlna~cia:ly ecces81b~e to ~he Door. Because coun~les are held
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respons~ble by S~ate law for care to lndigent persons ana because
the County receives State funds to help pay for. lndigent health
care, th2S posltlon paper focuses on problems wlth Coun~y heal~h
serv~ces that limit access to ambulatorv health serVlces of low-
income enc indigen~ persons in the Venice-Sante Xon~ca-West LOB
Angeles area. These problems involve the ab~llty-to-pay plan.
the conprehe~siveneg8 of services, and transportation.
2. i.
Ab~l~ty-to-Pay Plan.
A state law (Chapter :594, Statutes o~ 19B2) requ~reg
count~es to prov2de c.~e on a slld2ng fee scale. offerlng :ree
care to the poorest p&~~';nts. and to notlfy all patlents of thelr
rlght to apply for thlS abll~ty-to-?ay (ATP) plan. Many groups
have charged that Los Angeles County lS ~n v~olat~on o~ the law.
At a leglslat~ve hearing conducted In October 1984. a phys~clan
at Roybal Comprehenslve Health Center 1n East Los Angeles
test~f~ed: "There ~s an unwrltten pol~cy not to tell people about
the ab~llty-to-pay program. and ~t affects thousands o~ people...
Most physlc~ans don't even know what the ablllty-to-pay plen 15."
In August 1984, the ~estern Center on Law and ?over~y conducted a
phone survey o~ 21 County clln~cs and hospltalG: hal: of the
employees answer~ng the phones denled the ex~stence of an
abl12~y-ta-pay plan.
The Burke Health Center
notlfY1ng pat1ents about the
has 'TIade
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plan.
conslcerable progress In
Untll very recently.
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however~ the record of the Burke Center WQS no better than th~t
0% other County clinics. Many poor pat~ents who were unaole to
pay the $20 clin~c visit fee were referred to the Venice Family
CI~nic without being informed of the ATP plan. This problem has
recently been allev~ated by the installation of new signs in the
cl~n~c wa1t1ng room and by instructions to recept1on~sts and
nurses about the ATP: these changes have apparently resulted 1n
more patients being adequately informed about the AT~ and
cpp11cat1on procedures. Although the Coa11t~on applauds these
improvements, we have found that Spanish-speaking pat~ents who
ind~cate that they are unable to pay the 520 cl1nic fee are often
not being informed about the ATP and are instead s1mply referred
to the Venice Family Clinic.
Even when patients are informed about the ATP plan's
eX1stence~ the f~nanc1al screen1ng process 1tself d1scourcges use
0% serv~ces. It is both cumbersome and t1me consum1ng. Pat1ent
Admitting Workers are available for screening at the Burke Center
only three days a week. Some pat1ents must make at least two
viS1ts because they are not told about the documentation they
need unt~l the~r in~t~al interv1ews. Th~s lengthy process delays
the prov1s~on of needed health care and further d~scourages
~estside res~dents from applY1nq for the ATP plan.
Because pat1ents applY1ng for the ATP plan must furn~sh
proof of res1dence, homeless people often flnd It d~if1cult to
qual1fy. Although they may use a reletlve's or Erlend's home as
thelr mail~ng address, th~s ~s not an option for many homeless
people, 1nclud1ng many of those most 1n need of medlcal care.
The fee requlred for service ~t County clln1cs constltutes a
serious barr~er to many indigent people. School nurses in Santa
Mon1ca recently have testified that some slck ch1ldren reierred
to the Center are unable to obtain services there.
Pharmaceut1cal services have not been cons~stently lncluded
~n the ATP plan. The pr1ce of many prescrlptlon medlC1nes 1S
proh~b~tive to many of the Burke Health Center's pat1ents. A
physician at the UCLA School of Medicine reported that one former
patient, a Medically Ind~gent Adult with hypertenslon, could not
afford the price of his medicine after responsibility for his
care was transferred from UCLA Medical Center to the County
system, and he suffered a fatal stroke.
Recommendations:
2.1.1. The Burke Health Center should contlnue its efxorts
to inform pat1ents about the ATP plan. It is essent~al that all
patients who phone or go to the Center be ~nformed of the
existence of the plan and how to apply for it. (The Coal~tion
w~11 continue to monitor the Center's compliance w~th this County
policy and State law and w~ll ~eport to the Center director and
others any problems ~t identif~es.)
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t."e~ .-,.,en r;.,:".a":...
r ~tl& ...0 be w - ....... 'e ~ 0
_he Sur~e cen~e - ~hO ~ere unao' :
h ~eoord of _' ooor oa~,en~s . ~enioe ,aa'.Y
hO~e~er. t. e . c'in'os, ~anY - 'e~~ed ~o _he ~r:ob1e~ haS
Co~n~Y _ f ~e~e re- .' -h's - .
OS other 5Z0 clin'c ~,s,t ee 0; the ,~p p"an. - ~e~ e,ons ,n ~h.
peY the t bein9 ,nfor~ed - inetalle~,on 0> ceot'O~,e~s and
Cl,niC ~,thO~ e0e~,ated bY ~e ~,one to re. e~.-ed ,n
recentlY b~en a r~o~ and bY ,netr~ - heoe apparentlY re ~; and
cl~t\~c ~a~_~n_t.~e ~~n.. t.heSe cnange~ d abOUt. t.he ~,-'
. "n" . _ infor~e _~.a~dS ~he.a
nur~e& aPOU~ . ~g adeq~ate.Y 1 t.on a.'- .
atient. be'" oh the Coa ' . oat,entS ~no
m.ore i? rooedures, ,1thO~' 5 ",sh_epeal<.ng - o..""n
appl,Cat,on p ~e~e fo~nd thst pa. ZO cl,n'c fee are, -- d
ent.. we .. - to paY the $. · d $~~p~Y re~err:e
,~pro~e~ theY are ~nab.e dare ,ne_ea
ind,cate th~~soreed ebO~~ the ,~p an
not bein9 ' ,ae,lY Cl,n'o'
to t.he \Jen!.ce
e
e
~..,..o olar,'~
pout.. 't.pe ." - e
inforeed a .$ sco~rege. u.
_ a ti"n V are cess ,':.se.' d' ? a-' en':.
So"n ~n"n P 1 so-een,n, pro cona~e,no'"
h $,nanc,a' e and t,ae . 0 ~~e cen':."r
e~,stence. t e ~t ie both o~aber~o: ecreenin, at ~he ~- leaS':. tWO
OS ser~,cee. are a~ailable .0 ~e e~st aa~e a- _heo
d ittin9 ~or~ers ~ soee pat,en -h .oc~een~a':.,on-'
h a .eY' a ~ee' ld abo~t _.e ceas .elaYs
onlY three e -heY are oot to w' ~h's leng~hY pro d'SCo~raqe'
~is,tS becaus ~-io,t,al ,nterO,e . re end further .
need ~ot,l the'- $ needed health oa -he ,~p plan.
. ",-,on 0- ' . na f.or: -'
the pro~'-' fro~ app'Y' _ . <~rn>'
t~e_.eide rea,denta 0 nlan ~~s- . .
~ __ $ r t.he p.1'. l'" . ,~,cu'':.
ly,n9 .0 ' nd .~ "".. '
aecauee patienteho~~e.e oeople of~en.:~r f~,end'S hO~e
"' of rea ,dence . a~ us" a re 1 a~' ~e _, f or ~anY "o"e C'
proo. "' ,1 "-hO~9h t",eY a. ,e no~ an op __0'; d,Cal care.
q~al'-Y' . 0 addres" th,a ~oat ,n need o' ae
t.-e,r ~a,Hn- ~.. oS thO.e '
p c' ~d,ng ~a..' s., .~..
people. ,n . coun"-Y cl,n~cs con .~~ S
d for .eroice ~t, 5C"00' nuree.
~he fee req~,re n~ ,ndigent peOp.e. s'o~ ch,ldren re~'
r,er to aa , $.ed _hat so"e .
aeriO~e ber tlY ha~e teati.' ,- ae~.icee ~here.
~on,ca recen able ,,-0 obta,n .
to the center are ~n ns,s"-en"-lO ,n'
, _ haoe not been CO __on aed'c"
, ~e_~.ce- ~'e~cr~O~-
t,Ca- _ _ ' aanY'" _' pat.~e!\
Phareace~ ~he pr,ce o' t" cen~er's
"the ~~? plano of the a~r~e ~eal' oo~ted t"a~ one
,.. '0 "anY f ~ed,C,ne reo - CO
proh.b.ti~e' UC~h school 0 · · ~it'" hype<tens'~~,
nh'{S~c~Bn a~ t.h~ ll~ lnd,qent ,d~l- <ter respona'bi"'~
t" ... ee. .cs ~ d'C~ tie e - ~ 0 t....e
tient. a" < hi' ee · · · cen~er -
pa ~ t.-e prioe o. ~Ch ~ed,ca.
afforu" · ed $rO" - .
trena.err . $ ta' stro<e.
care wae $$6,ed a.a .
nO. he ~u-_...-
syst.etl\o a
~ooe~endati~ne' 'd eont,n~e i'
C ~e~ shOu~ '
r~e ~ealth en- - .- ,a essent,a
Z.~.~. ~",e a~ abo~t the ,~Q plaeno :~ be ~n!O~~e
pat,entS t",e ente" - ,~hC
to ,nfor~ hone or gO to po'Y for ,-" ..-
pa~ienta whO l"e plan and hO~ t~~': -;o"pl,ance ~,,,-h -
e~'6tenoe OS aonitOr the cen - to t"e Cen,,-er d
"l.l. continUe t.o 1 and ~.~l.l ~e?or~
~~ S~ t.e a~ )
poliey and _a ,t ,den~,f>ee.
othere anY proble"e
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2.1.2. The scr8en~n9 process should be stre~ml~ned.
eliminatlng procedures end requ~rement5 that discourage pec?le
irom applying.
2.1.3. Pharmaceut~cals should be cons~5ten~:y and ex?l~citly
included in the ATP plan.
2.2. Lack of Comprehensive Care
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The Burke Health Center fails to provide comprehensive
ambulatory care needed by ~ww-income res~dents of the Venice-
Santa Mon~ca-West Los Angeles area. It does provide some limited
pediatric and adult ambulatory care, family planning, l~mited
gynecological care, ~mmun~zatLons, commun~cable dlsease testing
and treatment, and prenatal care. However, its prevent~ve.
d~agnostic and treatment services are ~nadequate. For example.
~t does not provlde more than slmple medical care of any k~nd,
and specifically does not o=zer physlcal medicine or orthopedic
care, adequate chronic disease treatment. nutrltion educat~on.
health educatlon. EKG. or any dental serv~ces. There are
frequent and long delays In obta~n~ng laboratory re5u~tg. X-ray
services are not available every day.
A ~er more extensive range o~ services is provided by the
three comprehenslve health centers located in other par~s oi the
County. These centers offer the~r communlt~ea a full range of
med2cal care, including ped~atr~c and adult med~cine. prenatal
and gynecolog~cal care. physical medlc~ne. o~her medical
spec2alt2es. health and nutr~t~on ~ciucatlon. complete dental
care, full laboratory and x-ray services, and complete outpat~ent
pharmacy. These broad services a~e also included in standards
for community health centers established by the U.S. Public
Health Service Act (Sect~on 330).
Numerou= studles have found that community health centers
help to ra~5e the health status of ~es~dent5 of the~r serv~ce
areas. They also are cost effective. Researchers from the UCLA
Departments of Soclology and Psychology recently reported that
community health centers reduce the use of both hosp~tal
0utpatient clinics and emergency rooms. In add~tion, people
Jrose normal source o~ care lS a community health center have
half the rate of hosp~tal adm~8sions as users oz hospital
outpatient clinics, and the~~ length o~ atay is signi~icantly
shorter.
The hours of service llmi~ use of the Center. C12n~cs are
not open even~ngs or on Saturdays. Working adults often cannot
take time off ~or medical visits. As a result. some parents have
been unable to get lmmun~zatlons the~r chlldren need to attend
school.
The staf:ing ratio at the Burke Health Center is lower than
at the three comprehensive health centers. As a result. all
staff members are overworked. The lack of a social worker makes
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~t d~ff~cult for the center to h~ndle such w~despre~d problems as
child abuse.
Because 70-80 percent 0% the patients at the Burke Health
Center are Spanish speaking and a growing proportion 0% patients
speak other languages, it 1a essential that most staff members be
bil~nguel. The Center recently has emphasized hiring bilingual
sta%~, and the proportion of b~l~ngual sta%f members. hes
~ncreased substantially. The Center should ensure that every
non-Engl~sh speaking pat~ent be able to communicate with
-physicians.
Harbor-UCLA Hospital Medical Center provides back up
services for the Burke Health Center. However. there are long
waits for care at many 0% the hospital's cl~nics. Moreover,
--there is no transportation readily available to patients. Nor is
there even eff~cient tranaportation of laboratory and other
.-
ancillary services between the Burke Health Center and the
hospital.
The commun~ty clin~cs in the area cannot meet all the needs
not now met by the County's Burke Center. Despite the~r best
efforts, these clinics have severe l~mits on their ~unds and
resources. Furthermore, this is a responsibility of the County--
one for wh~ch it receives substantial funding from the State.
Recommendations:
2.2.1. The Burke Health Center should be upgraded to a full
comprehen8~ve health center, with the full range of preventive.
diagnostic, curative, and ancillary services that are provided at
the County's other comprehens~ve health centers. Da~ly x-ray
services, EKG serv~ce5, and a social workpr should be added
immediately.
2.2.2. Full out-pat~ent pharmacy serv~ces should be prov~ded
immediately end, as noted earlier, automatically covered by any
basic clinic ~ee or ATP eli9~bility.
2.2.3. The hours of oper< ion should be expanded. Cl~n~cs
should be open even~ngs and = ~urdays to serve working people;
adequate 24-hour access to et .!rgency consultatl.on and care l.S
essentJ..8.l.
2.2.4. The sta~fing levels should be improved.
2.2.5. The
bilingual sta:ff".
Center should continue to hire additional
2.2.6. In addition to developing the Burke Health Center
into a %ull comprehensive health center, the County should
establish contracts with community clinics that have demonstrated
their commitment to serving the poor to provide care for County
eligible indigent patients who cannot be adequately accommodated
at the expanded County health center.
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~t d~ff~cult for the center to h~~dle such w~cespre~d pro~lem6 ~~
child abuse.
Because 70-80 percent 0% the patients a~ the Burke Health
Center are Span4sh speaking and a growing ?roport~on of pat~enta
speak other languages. it is essential that most sta~= members be
bil~ngual. The Center recently has emphaB~%ed hiring bi:ingual
sta=:~ and the proport~on of bhlingual sta:= members. has
~ncreased substantially. The Center should ensure that every
non-English speaking patient be able to communice~e with
~physicians.
Harber-UCLA Hospital Medical Center provides beck up
services for the Burke Health Center. However. there are :ong
waits zor care at many 0% the hoap~tal's cl~nics. ~oreover,
-there is no transportation readily available to patients. Nor is
there even e~~~cient transportation 0: laborato~y anc other
ancillary services between the Burke Health Center and the
hosp~tal.
The commun~ty cl~n~cs in the area cannot meet all the needs
not now met by the County's Burke Center. Desp~te the2r bes~
efforts. these clinics have severe l~mits on the~r :unds and
resources. Furthermore. this is a responsibility o~ the Coun~y--
one for wh~ch i~ receives substant~al iund~ng from the State.
Recommenda~ions:
2.2.1. The Burke ~ealth Cen~er should be upgraded to a iu~l
comprehensive health cen~er. with tOe full range of prevent~ve.
diagnostic. curative, and ancillary services that are provided a~
the County's other comprehens~ve heel~h centers. Da~:y x-ray
services~ EKG aerv1ces~ and ~ soc~~l workpr should be added
immediately.
2.2.2. Full out-pa~lent pharmacy serv~ces should be prov~dec
immediately and~ as noted eerller~ au~cmaticsl:y covered by any
basic clinic ~ee or ATP eligibility.
2.2.3. The hours of operE ion should be expanded. Cl~n~cs
should be open even~ngs and S, turdays to serve work~ng people;
adequate 24-hour access to emergency consultat~on and care ~a
essent2s1.
2.2.4. The sta~%in9 levels should be improved.
2.2.5. The
bilingual staz:.
Center should cont~nue to hire additional
2.2.6. In add1tion to developing the Burke Health Center
into a full comprehensive health center~ the County should
establish contracts with community clinics that have demonstrated
their commitment to serving the poor to prOVide care for County
eligible indigent patients ~ho cannot be adequately sccommoda~ed
at the expanded County health center.
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2.3. Transportation
Because the Burke Center does not handle complex or chronic
cases. many Wests~de residents must go to Harbor-UCLA Meci~cal
Center ~or care. Pat1ents ~ho are taken by ambulance to Harbor
General are respons~ble ior ambulance costs.
The County Department 0% Health Services also does "not
provide transportation from the Santa Monica area to Harbor-UCLA
Medical Cente~ for non-emergency care. Travel by bUB takes over
two hours each way and involves trans%ers. The $35 cab ~are
(each way) 1s beyond the means o~ the overwhelming maJority o~
County pati~nts. A ~est Loa Angeles indigent cancer patient
receiVing weekly chemotherapy treatments at Harbor-UCLA Medical
Center thus must spend a m~n~mum of four hours a week travelling
to and ~rom appointments. Some pat~ents who are too 111 to
negot~ate the bus system s1mply forego treatment.
Recommendation:
2,3.1. Until the County provides adequate comprehensive care
in this area, it should provide transportation ~or Wests~de
residents to Harbor-UCLA Hosp~tal and Medical Center for both
emergency and non-emergency care. Subsequently, transportat~on
should be prov~ded ~or Wests~de residents who need Berv~ces not
yet ava~lable in the commun~ty.
3. IN-PATIENT CARE
(
The two maJor hospitals in San~a Monica--St. John1s and
Santa Mcnica--provide care for indigent patients only on .an
emergency basis. Uninsured patients brought to theBe hoap~tals
by ambulance are stabilized and then transferred to County
~acilities. Only Santa Monica Hospital has a Medi-eel contract,
but many physic~ane ~ho practice there do not accept Medi-eal.
Indigent patients and the la~ge group 0: Medl-Cal recipients
who are not accommodated by Santa Mon1ca Hoaoital rece~ve in-
patient care at Harbor-UCLA Hospital. several miles away. The
distance of th1S hospital from the Westaide cre~tes numerous
problems. Fam11ies often are unable to Vls1t the~r r~lat~ves and
provide the support that 15 cons1dereci essent1ed to heal~ng.
Continuity of care end effective discharge planning are more
difficult for 'patients who live far from the immediate
environment of the hospital.
Recommendation:
3.1. The County should establ~sh contracts with local
hoep~tals fer both ~n-pat~ent care and ~or complex out-patient
care not available at the expanded Burke Health Center.
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4. MENTAL HEALTH SERVICES
Mental health services available to low-income persons in
this area are inadequate and fragmented. Adequate mental health
services are particularly important in this area because of the
large homeless population~ a significant proportion of whom are
the deinstitutlonalized mentally ill. The local Veterans
Administration hospital hae exacerbated this problem by~ its
pract~ce of d~scharging patients before they are ready and
w1thout adequate d1scharge plann1ng and outpat1ent serV1ces.
Although a number of agencies offer counselling to the
mentally ill. most charge minimum fees that exclude indigent
persons. Santa Monica West Mental Health Clinic provides some
outpatient counsellin9~ medicat10n. and emergency evaluation and
referrals. but it cannot meet the total demand. Poor people who
often must wait unacceptably long periods for appointments
because sta:fing levels are low.
In-patient mental health facilities also are scanty. Only a
few Medi-Cal beds are available at St. John~s Hospital
Psychiatric Un1t. In-patient faci11ties at Harbor-UCLA Hospital
often are filled to capacity and transportat~on is unavailable.
The chronically mentally ill alao require a range 0:
res~dent~al treatment centers ~nd non-res~dent~al programs. The
few '"board and cere" fecl.l.1.tl.es ~n the Sant~ Mon~ca area iurn1.sh
room and board and d1.spense da~ly medicat~on. but they fail to
serve the psychosoc~al needs oi their clients. No "satell1.te"
hous.1.ng is available for ind~viduals who are ready to become more
independent. The recently-opened -ProJect Return Center in Santa
Mon.1.ca provides vocat1.onal, educat1.onal and soc1.al programs for
~he m~ntally d~5abled l1.ving 1.0 the commun1ty. but more programs
are needed.
Recommendation:
4.1. Santa Monica We~t should become a iull comrnun1ty mental
health center. Adequate mental health aerV1.cea w1th outreach
and :follow-up are especially important to the needs 0: the
homeless population.
5. CONCLUSION
Although this report :focuses on the most serious :failures of
the County health services. our ultimate goal ~s broader than
nerely correcting these faults. The County should prov1de not
a~mply adequate care. but h1gh quality care, geared toward the
needs of target populations. We are committed to working toward
o public health system which emphas1zes preventive as well as
curative services. delivers care through interdisciplinary teams
includ1ng staff recru1.ted from the commun~t1.es served. 9~ves
consumers a prominent role 1n governance. and recognlzes that the
scope o~ med1cal care properly includes economic. $oC1al. and
environmental factors.
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4_ MENTAL HEALTH SERVICES
Mental health services available to low-~ncome persons in
this ere a are inadequate and :rsgmeneed. Adequate mental health
services are p6rt~cularly important in this area because o~ the
large homeless population. a significant proportion o~ whom are
the deinstitutionalized mentally ill. The local Veterans
Adm~niatration hospital has exacerbated this problem by~ i~s
pract~ce 0% d~schar9in9 pat~ents before t~ey are reedy and
w~thout ~dequ~te d~scharge plann~ng and outp~t~ent serv~ces.
Although a number 0% agencies offer counselling to the
mentally ill. most charge min~mum fees that exclude indigent
persons. Santa Monica ~est Mental Healen Cl~nic provides some
outpatient counselling. medication. and emergency evaluation and
referrals. but it cannot meet the total demand. Poor people who
o:ten must wait unacceptably long per~ods =or appoin~ments
because staf:ing levels are low.
In-patient mental health =aeilit~es also ere scanty. Only a
zew Medl-Cal beds ere available at St. John's Hospital
PSYChiatric Unit. In-patient =ac11it~es at Harbor-UCLA Hosp~tel
of~en are filled to capacity and transpor~at~on is unavailable.
The chronically mentally ill a:ao require a range 0:
res~dent~~l treatment centers ~nd non-res~cent~al pro9r~ms. .ne
few uboard and care" ::ac::.l:.t.l.es ::..n the Ser;t::!. !'l.on::..ca area iurn1.sn
room and board and d~apenae da~~y med:l.cat~on# but they =a~l to
serve the psychosoc~al needs 0: t.heir cl~entSA No ".satell~teU
housing is available for ind~viduals who are reedy to became more
independent. The recently-opened ProJec~ Return Center in San~a
Mon::..ca provides vocat::..onal. educat::..onal and soc::..al programs for
~he m~ntally d~sabled l::..v::..ng l.n the commun~ty. but more programs
are needed.
Recommendation:
~.lA Santa Monl.ca ~e~t should become a full ccmmun~ty mental
health centerA ^dequate mental health 6erv~ces w~th outreach
and fallow-up are especially ~mportant to the needs of ~~e
homeless population.
5. CONCLUSION
Although this report focuses on the moat serious failures 0:
the County health services. our ultimate goel ~s broader than
merely correcting these faultsA The County should prov~de not
s~mply adequate care# but h~gh qual~ty cere, geared toward the
needs of target populations. We are committed to work~ng towa~d
a publ~c health system which emphas~zes preventive as well cs
curative services, delivers care through interdisciplinary teams
includ~ng staff recru~ted from the commun.t~ea served. g~vea
consumers a prom~nent role ~n governance. and recogn~zes that the
scope o~ med~cal care properly includes econom1C. soc~al. and
environmental factors.
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