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Public Health and Private Doctors

by Daisy Lee Worthington Worcester

Co-Author, Volume 15 of the Federal Investigation of Women and Child Labor

April 1934


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Here was the realization of Dr. Pomeroy's dream, a strongly centralized administrative machinery, and a completely decentralized service, reaching out to the most remote rural dwellers, and taking to them modern medical and health service which many a city would envy. The Los Angeles County Health Department has been a pride of the American public-health movement as well as of socially minded Californians. Professional men from all over the country came to study its methods. Professional recognition of the executive himself came in Dr. Pomeroy's present position as president of the Western Branch of the American Public Health Association.

Yet, when I was in Los Angeles a few weeks ago, I found that curative and emergency work in all but one of the health centers had come to a dead stop. Many of the remaining services of the department, well-baby clinics, vaccination against smallpox and immunization against diphtheria, were under the fire of the organized doctors who had succeeded in closing the clinics and the emergency hospitals.

The only one of these centers where curative clinics still go on is in Alhambra, a city of about thirty thousand. This health center was completed in 1930. Its opening was celebrated by a fifty-page edition of the local daily paper. Its work was developed by Dr. S. J. Stewart, a man who brought to this small community seventeen years of experience as superintendent of state institutions in Nebraska, captain in the Medical Corps of the US Army during the World War in charge of neuro-psychiatric work, staff physician of St. Elizabeth's Hospital in Washington, D. C. Such, in general, has been the character of the men whom Dr. Pomeroy has obtained to aid him in his work. The Alhambra Health Center proudly displays the bronze plaque which was awarded to it in 1931 by the US Chamber of Commerce, for "Best Accomplishments in Health Conservation" of any city in the United States with a population between 20,000 and 50,000.

HIS center has not been closed because Dr. Stewart had the foresight to have inserted into the contract between the city and the county the provision that if ever the center ceased to be used for its original purposes, all the buildings and equipment would revert to the city of Alhambra. The community has demanded that the terms of the contract be kept. More than forty thousand signatures have gone into the supervisors (the health center serves an entire population of more than 200,000), demanding that the center be kept open. Dr. Harry Wilson, secretary of the Los Angeles County Medical Association, says that it is only a matter of weeks until it will be closed, as the doctors in the community will refuse to serve on its staff. The same opinion was expressed by Dr. Phoebus Berman of the Los Angeles County Hospital, medical director of the newly developed "San Fernando Plan," which the doctors have substituted for the healtn-center program. On the other hand, Dr. Stewart, in company with prominent citizens of Alhambra, says that the center will remain open, though the supervisors must hire a staff of physicians to be placed on the county payroll, even as Dr. Stewart himself is.

The community's pride in its enterprise is justified. The building itself is beautiful: white brick, with red-tiled roof, set back in the midst of green lawns and waving palms, its architecture a combination of early California and Monterey types. The equipment includes x-ray for the diagnosis of tuberculosis, hydrotherapy for the treatment of infantile paralysis, appliances for orthopedics, the most modern apparatus for dentistry, everything needful for the diagnosis and treatment of venereal disease.

On the day of my first visit, despite the rush of work going busily forward, the atmosphere within was that of quiet efficiency. Dr. Stewart was going about among the patients, greeting many of them by name, making friendly inquiries of those who were waiting for treatment, while the white-clad nurses moved about with all the orderly precision characteristic of the best modern hospital. In the emergency hospital, a young girl had just been brought in from the highschool with a broken leg which was being placed in a plaster cast. A group of mothers were watching their babies' weights and measurements at a wellbaby conference. A number of people were waiting to be interviewed by the friendly social-service worker. There was an entire absence of the condensed depression which so oftert marks public clinics, and a combination of dignity, graciousness and efficiency which I have not seen paralleled, even in the offices of private physicians.

This is the kind of health service which Los Angeles County has discarded because some of her doctors were hungry. There is no doubt about the cause. It came into the conversation of more than a score of people with whom I talked, representing widely different viewpoints. It was stressed by Dr. Harry Wilson, secretary of the Los Angeles County Medical Association; by Dr. Phoebus Berman, medical director of the County Hospital and of the new San Fernando Plan, by Arthur J. Will, deputy superintendent of Public Charities in charge of institutions; by Mary Stanton, secretary of the Health Division of the Los Angeles Council of Social Agencies, and by all members of the County Health Department with whom I talked. The entire story of the recent developments was the same in all essential details, no matter who related it.

A few years ago, many physicians were enthusiastic members of the volunteer staffs of the health centers. But as the lean vears continued, their private practices began to fall off, at first slightly, expectedly, then ominously. This was the situation in almost every section of the country, but in Los Angeles it had special significance because the health centers were there to deal with the other side of the dilemma which the doctors were facing. The dinics of these centers became crowded with patients. The doctors began to see some of their former private patiedts among them. Many of them had automobiles; some of them were still well dressed.

There were those who had once held good positions; those whose savings had been swept away by bank failures or were frozen in Building and Loan Associations. By 1932, when the doctors began to complain, many patients who had been living on savings that had not been lost, were reduced to complete dependency. They were swelling the mlmbers of the curative clinics. Most of them felt that they had a right to be there. They had built and supported these health centers in their days of plenty.

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