Monday, Sept. 26, 2011 | For at least a decade, studies have consistently shown that Santa Ana’s population faces the worst urban hardships of any major city in the United States.
Yet the city has had no free clinic to treat the many people who fall through the health care safety net. As a result, fewer people can work, communicable diseases spread faster and patients are more likely to end up in emergency rooms when their untreated illnesses become worse.
Attempts to establish free clinics in Santa Ana have met limited success in recent years for a variety of reasons. But public health advocates are now seeing some cause for optimism.
In July the federal government provided a $1.5-million grant to open Santa Ana’s first free clinic, which will be staffed by nurse practitioners from UC Irvine.
Last November, the Share Our Selves (SOS) organization started a free wellness service providing health screening tests 20 hours a week to the one hundred or so families of El Sol Science and Arts Academy, a small public elementary charter school in Santa Ana.
The federal grant will allow expansion of that program, offering care to anyone regardless of the ability to pay. Construction is underway. The SOS-El Sol Wellness Center, 1010 N. Broadway, is scheduled to open in January.
The clinic will help many Santa Ana residents who now often go without care because they don’t have the resources to travel to free clinics elsewhere in the county. But, say advocates, it must be a first step in a larger effort to meet Santa Ana’s overall need, which is daunting.
“The challenges today are significant,” said Karen McGlinn, directer of Costa Mesa-based SOS, which operates a free clinic there. “You have to be innovative,” combining nonprofit programs to be economically feasible, she added.
Four years ago, UCI medical students, nurses and other health professionals attempted unsuccessfully to open a free clinic on South Main Street in Santa Ana. The medical students were unable to find an acceptable site and are having a hard time adding voluntary supervisory physicians.
Eventually, the students opened the UC Irvine Outreach Clinic at the Orange County Rescue Mission’s Village of Hope in Tustin. On Saturdays, a cadre of volunteers sees patients at the village’s Hurtt Clinic, which offers health services to anyone during the week.
But because of a lack of resources, the UC Irvine Outreach Clinic hasn’t blossomed as have those at other UC medical schools.
Historically Poor Care
Orange County is one of the wealthier counties in California and has plenty of hospitals and medical offices for the well-insured. But health care for the poor historically hasn’t been a high priority.
Nowhere is this more evident than in Santa Ana, where poverty has lead to disproportionate suffering from such disabling diseases as diabetes, high blood pressure and high cholesterol.
In 2000, the Nelson A. Rockefeller Institute of Government in Albany, N.Y., published an analysis of census data showing that Santa Ana had the worst urban hardship of any city of more than 100,000. A study update was done in 2007, reaffirming the city’s rank.
The analysis’s definition of hardship is based on poverty, overcrowded housing, lack of education and dependency of the young and old, among other factors. These all contribute to health care shortages for Santa Ana’s 340,000 residents, of whom about 75 percent are Latino. About 120,000 of these residents have no health insurance, according to reports issued by county agencies.
There are government-financed health care programs for categories of indigents, like the state Medi-Cal program and the county Medical Services Initiative. There are nearly100,000 Medi-Cal recipients in Santa Ana. At any given time, more than 6,000 patients in Santa Ana use the Medical Services Initiative, the highest total of any Orange County city.
Santa Ana now is designated a “medically underserved area” by the federal government, which means its residents have limited access to care. Making things more difficult are economic and residency restrictions on these programs that often disqualify working poor and undocumented immigrants.
This is the reason that free clinics are needed. At the SOS-El Sol facility, Fitzparick said, all government programs are to be honored, and they will treat anyone who doesn’t qualify.
“It is sad,” says Camille Fitzpatrick, a UCI nurse practitioner who is coordinator of care and teaching at the SOS-El Sol facility. “But we are very excited about the new clinic.”
The history of the UCI medical student drive to create the Outreach Clinic shows the difficulties of providing free services in the city. Even now the medical students face barriers to expand.
In 1996, medical students launched Clinica Carino, offering health screening once a month at a church.
But then in 2001, UCI administrators told the team trying to boost free services that a full-service free clinic in Santa Ana wasn’t needed and wouldn’t work.
The university couldn’t afford a free clinic, there was adequate health care access in Santa Ana, and undocumented immigrant patients wouldn’t come, the administrators claimed at the time. Only a clinic for referrals and medical education would work, they said.
In 2007, a team of students and faculty completed a needs assessment, noting the Rockefeller Institute analysis.
Dr. Emily Dow, medical director of the UC Irvine Family Health Center in downtown Santa Ana, was instrumental in developing the needs study and the Outreach Clinic.
“We don’t have enough health resources to address poverty; it is all about poverty,” Dow said. “The Outreach Clinic is a great service for people who have nowhere else to go. And medical students learn the value of volunteerism.”
The needs report concluded that “current evidence strongly suggests [the 2001 administrative] objections are either no longer valid or are surmountable.”
After the needs report, students acquired a site in Santa Ana on Main Street near Washington Avenue and spent about $800 on facilities. But the landlord unexpectedly shut them out. In 2008, they started the Outreach Clinic in Tustin.
Since Glenn Gookin first started volunteering at the Outreach Clinic in 2003 as an undergraduate, he has seen the need.
“Helping the patients could be very uplifting,” said Gookin, who just completed his UCI doctorate in toxicology and is starting medical school in Florida.
Gookin recalls a diabetic laborer who came in with infected feet and eye problems that periodically prevented him from working.
“He would come in unable to walk, but we’d get him back on his feet,” said Gookin.
But there also were frustrations, particularly in treating borderline psychotic mental patients. Despite such need, volunteers say, they have been unable to win approval from UCI administrators to add the several psychiatrists who wish to volunteer.
For physicians to work at the clinic, they must first be approved as a member of the UCI unsalaried faculty. They then are covered by the university’s medical malpractice insurance.
UCI administrators declined to discuss voluntary faculty recruitment, but a spokesman said the university is seeking a $10,000 grant to pay a physician resident in psychiatric training to work at the Outreach Clinic.
UCI medical students hold out hope they someday will have a clinic like those at other campuses. They know the needy in Santa Ana do too.
Rex Dalton is a San Diego-based journalist who has worked for the San Diego Union-Tribune and the journal Nature. You can reach him directly at email@example.com.