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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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Dr. Pomeroy was one of the first to recognize the plight of the doctors. In the annual report of 1932-33, there is a further statement of a policy that he had long advocated: "We would recommend most heartily that the private physicians who are donating their time in the clinics be paid some remuneration for their services." At such a proposal, however, a cry went up from the Medical Association, "State medicine!" It was considered evidence that the health officer was aiming only to build up a machine which would cut the ground from beneath private practice.

The stand of the organized medical profession was cloaked in an appeal to cut taxes and relieve the taxpayer of what was declared to be an unwarrantable burden. As a matter of fact, the budget for the year beginning 1932 had been cut nearly 40 percent from that obtaining two years earlier, though treatment-clinic services had doubled, and care in the venereal-disease clinic tripled. It is estimated that the small taxpayer in the county with a $3000 home now pays about fifty-eight cents a year on his tax bill for health-department service. As is later detailed, the change has not brought a saving to the taxpayer.

In 1932, the opposition of the Los Angeles County Medical Association was bulwarked by the added force of the Public Health League. Composed at first of members of the medical profession, the organization soon included dentists. and nurses, and then interested members of the lay public, the abused taxpayers. Its guiding spirit is Dr. Harry Wilson, secretary of the Los Angeles County Medical Association, who frankly labels the County Health Department a "colossal piece of state medicine." The organization has become state-wide. It publishes a magazine called the Guardian which blazons on its cover the several purposes of the organization. Among them:

To protect public health by preservation of modern scientific medicine, dentistry, and nursing, and to strive by legitimate publicity to oppose all objectionable forms of socialized medicine.

To protect the private physician, dentist, nurse and hospital from unfair competition by those that are tax-supported or charitysupported.

In many quarters the opinion is expressed that this uprising of the medical profession was a result not only of the depression, but of the reaction to the report of the Committee on the Costs of Medical Care, with its advocacy of health insurance and group clinics. A private group clinic in Los Angeles, the Ross-Loos Clinic, comes in for scarcely less vituperative abuse than the County Health Department.

Health Center
At Santa Monica as elsewhere the health centers of the County Health Department brought the poor the costly facilities needed for scientific diagnosis and care

IN July 1932 the doctors were successful in having the work of the curative clinics taken from the Health Department and placed under the outpatient department of the County Hospital, a part of the department of Public Charities. Dr. Pomeroy's clinic directors, men with long and wide experience, were replaced by internes from the County Hospital. The public-health social workers were also replaced by those from the County Hospital. As Arthur J. Will, deputy superintendent of charities, said, "Pomeroy's social workers were trained under public-health standards; we had to replace them with workers whose experience had been gained under the Pauper Act; and you know, yourself, that there is a big difference."

Then, in the summer of 1932, when savings had been exhausted, when the relief budgets of the County Welfare Department had been cut almost to the vanishing-point, and there was every reasonable expectation that the number of people in need of free medical care would be greatly increasedăthe order went out to cut down the admissions to the clinic. The numbers were reduced. Some of those who were eliminated came under the provisions of the Pauper Act which makes eligible for poor relief only those who have been residents of the state for three years and of the county for one. No one knows what became of them.

This step brought no relief for the doctors. No patients came back to them.

Then a year later, a group of doctors from the San Fernando District where the first health center had been established so proudly seven years before, went to the county supervisors with a threat and a "plan." The doctors had struck. They would not, could not, continue to work for nothing. They would rather play ball or golf. Their "plan" was to close up the clinic with all of its equipment, modern to the last degree, and treat the patients in their offices at a cost of fifty cents a visit with an additional charge for bandages, x-ray, laboratory work, and so on, these last to be provided at cost. Only those doctors were to participate who previously had been giving their services to the clinics.

Some provision had to be made for the care of the sick poor in the San Fernando Valley. The supervisors agreed to the plan. It was adopted August 1, 1933, for a ninety-day trial. At the end of the ninety-day period, the supervisors ordered it to be put into effect in all the other health centers of the county. Alhambra alone stood out against the decree. Every other curative clinic and emergency hospital under the County Department of Health was closed. Equipment worth hundreds of thousands of dollars was left to rust and dust in the closed-up rooms of the health centers.

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