Patients here desperate to see experts

By KEN CARLSON
kcarlson@modbee.com

last updated: November 19, 2007 05:13:47 AM

Melissa Feemster of Turlock knows the frustration of not having private health insurance.

She awoke one morning unable to move. A herniated disc in her lower back was pressing on a nerve, causing her severe pain and the loss of feeling in her right leg and buttocks.

The single mother became incontinent and was unable to continue working as a waitress at the Elegant Bull in Delhi and a Perko's in Turlock.

Feemster needed to work to feed her three children, and her Medi-Cal card wasn't much help in getting an appointment with back specialists in the area, she said.

A physician's assistant at Delhi Medical Clinic referred her to a specialty clinic at the Stanislaus County Health Services Agency in Modesto.

"The doctor's first words to me was that he donated his time to the county," said Feemster, who felt the consultation went downhill from there. "I feel for women who have jobs that don't give them insurance. He made me feel like I was a nobody because I had Medi-Cal."

According to Feemster, the specialist said even if he could help her, getting authorization from Medi-Cal to perform surgery would take six to eight weeks.

Feemster left the clinic not knowing if or when she would get the authorization and continued to take pills for the pain.

Back at the Delhi clinic, her family practitioner got her in to see a surgeon at the University of California at San Francisco Medical Center, a hospital designed to deal with more complex cases.

"I was in surgery within a week," said Feemster, who now has an office job. She since has married and has insurance from her husband's employer.

The lack of specialists willing to take Medi-Cal patients has been a pet peeve of her physician's assistant, William Dennis-Leigh. Before he retired this fall, the Delhi Medical Clinic administrator told numerous stories of low-income patients who endured pain for months while trying to find specialists to treat them.

Other nonprofit clinics have sent patients to Fresno or Sacramento just to have their tonsils removed.

A matter of money, paperwork

Even insured patients can have a difficult time in the Northern San Joaquin Valley, with its slim roster of specialty physicians.

Stanislaus County has 48 specialists per 100,000 residents, compared with 113 per 100,000 in Santa Clara County, 230 per 100,000 in Marin County and 252 per 100,000 in San Francisco, according to the Central Valley Health Policy Institute at California State University, Fresno.

San Joaquin County has 44 specialists per 100,000 and Merced County, at 21 per 100,000, has one of the lowest rates in the state.

Because of low reimbursements and paperwork hassles, an increasing number of specialists across the country are not accepting patients with Medi-caid, the nation's health coverage for the poor. (Medicaid is called Medi-Cal in California.) The Center for Studying Health System Change, a nonprofit research group, reported in 2006 that nearly half the nation's physicians were not taking Medi-caid patients or restricted how many they accepted.

In a California survey, 85 percent of medical directors at community health centers said their patients frequently had trouble getting access to specialists, according to the California Healthcare Foundation. The clinics had the most trouble referring patients to neurologists, immunologists and orthopedists.

A random survey of 10 specialty practices in Stanislaus County last month found that seven did not accept Medi-Cal, two accepted Medi-Cal but restricted the number of patients, and one said it accepted Medi-Cal referrals.

• Comments
• Add Comment
• Disclaimer