Monday, December 01, 2008

County, Golden Valley step in when people can't afford care

By KEN CARLSON
kcarlson@modbee.com

last updated: November 19, 2007 08:27:27 AM

Griselda Ruiz is like thousands of seasonal cannery workers in Stanislaus County.

She has employer-provided health insurance when she is sorting vegetables from late August to October, then hopes she doesn't get sick the rest of the year.

The Modesto woman was stricken with diabetes when pregnant with one of her two children, and as often happens with gestational diabetes, the disease came back.

As her diabetes escalated this past year, Ruiz bought medicine during two trips to Mexico. She sought help at the Golden Valley Health Center on Sixth Street in Modesto last summer after the pills ran out.

At the clinic, a test showed her blood sugar was five times above normal and put her at risk of a stroke or going into a diabetic coma.

Ruiz, 52, told Marlene Perez, the clinic's health educator, that she hadn't come in sooner because she was unaware of the nonprofit clinic's sliding fee scale.

She was put on insulin, and Perez taught her to inject the medication and check her blood sugar at home. Ruiz also was monitored weekly until her blood sugar was under control.

She scrapes up $30 to see a doctor at the clinic, but visits with the educator and lab tests are free, and a 30-day supply of medicine from the Golden Valley pharmacy costs her $16.

The Golden Valley clinic is part of the health "safety net," a loosely connected network of health care districts, county clinics, public hospitals and federally funded health centers.

Golden Valley's more than 20 primary care clinics in Merced and Stanislaus counties are part of the federal health center program, a remnant of President Johnson's War on Poverty, launched in the 1960s.

The safety net providers care for patients who are shut out of a commercial medical system that caters to people with insurance. And their patient load is growing.

The number of Golden Valley patients in Stanislaus County swelled from 27,400 in 2004 to 38,600 in 2006. The number served in Stanislaus and Merced counties rose nearly 30 percent, which is consistent with patient growth nationwide in the federal health center program.

In the valley and nationally, community health centers are dealing with rising costs of providing care and a dramatic increase in patients with chronic diseases -- fully a quarter of patient visits are for treatment of chronic illness, according to the National Association of Community Health Centers.

The Stanislaus County Health Services Agency has served 70,000 to 80,000 patients a year, up to 16 percent of the county population. But annual deficits ranging from $8 million to more than $16 million have cast doubt on the future of the county health system.

The county's efforts to downsize its separate network of clinics have diverted patients to the other community clinics.

"It's a fragile system," said Marc Smith, administrator for five Golden Valley centers in Stanislaus County. "If Golden Valley wasn't able to expand, you would have people with major unmet medical needs."

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Golden Valley began as a migrant health program in 1972 and was expanded to serve not only rural towns but the urban poor in cities such as Modesto and Merced. In addition to primary care, its services include pediatrics, women's health, dental care and mental health counseling.

The patients are not only seasonal agriculture workers, but the unemployed, the working poor, single mothers, the homeless, undocumented immigrants and people with mental disorders.

As federally qualified health centers, the clinics receive enhanced reimbursements for Medi-Cal patients and accept patients regardless of their im- migration status.

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