A state law also had to be
shoved out of the way. Its provisions are definite: no member
of a county hospital staff can be paid for his services. The
law was designed to protect the public, to prevent politicians
from using the county hospital as a means of paying off their
debts to politically minded doctors. All of these doctors who
came under the San Fernando Plan were placed on the staff of
the County Hospital. Admission to that staff had been a high
professional honor for which some of these doctors had few qualifications.
But how to get around the law
to pay them? The problem was solved by the passage of an ordinance
by the board of supervisors, which provided that the doctors
in these former health-center districts should be paid, not
for medical serviceãthat was illegalãbut for the use of their
offices and equipment. The provision that they should be paid
$1.50 for home visits and four cents a mile for the use of their
cars has also been construed to mean "use of office and equipment."
People once cared for in emergency hospitals of the health centers
are now taken into the County Hospital in Los Angeles City,
or placed in the private hospitals throughout the county, the
cost being borne by the County Hospital.
Under the San Fernando Plan
a social-service worker who is neither physician nor nurse really
plays the role of diagnostician. A person who wishes medical
care must first go to her, relate his symptoms and his economic
condition, and then either be rejected or assigned to a specialist
or a general practitioner, as the worker deems best. Each applicant
may then make five visits to the doctor, then returns to be
"socialed"ãa lovely word. Two reasons were given for this provision:
a check on the patient and a check on the doctor.
According to the doctors and
some of the public officials, the plan is working well. "It
has saved money for the taxpayers." Actually the San Fernando
Plan has proved more costly to the taxpayers. A few weeks ago
the County Bureau of Efficiency reported a study of comparative
costs made at the request of the city council of San Fernando.
Under the health department the average cost had been $1.06
per patient visit; under the new plan, for tte same period in
the following year, it was $1.03 per patient-visit plus costs
for home visits and contract care in local private hospitals
formerly carried in large part by health-department doctors
and nurses and the health-center emergency hospitals without
additional cost to the county.
Mr. Will explained that savings
are being made by eliminating chronic cases. "If some old fellow
comes along with diabetes, which he had long before the depression,
we just tell him that he can get along with his diabetes as
well now as he did then. It is the same with teeth," he added.
"Just because a man is out of a job is no reason for his getting
his teeth fixed up free of charge. I've got teeth of my own
that need fixing, but I manage to get along with them." Dr.
Berman spoke of the reduced cost that came from eliminating
nurses in the health centers; the doctors naturally provide
their own nurses. But in the course of conversation it developed
that none of the nurses who had been serving in the clinics
during the preceding year had been dropped. In order to prevent
opposition to the San Fernando Plan, all of them were brought
into the County Hospital.
DOCTORS and some officials
say that patients greatly prefer this plan; that they no longer
have to endure the ignominy of going to a public clinic; that
they walk into a doctor's office like any pay-patient; that
the long waits which characterize clinics are now avoided. The
patients, apparently, do not agree with the doctors and officials.
Out in the San Fernando District, they succeeded in securing
a grand jury investigation of their complaints, which were numerous
and varied. They do not escape the ignominy of relying upon
public charity; they have to go to the social-service worker
still stationed in the health center building; they do not walk
into the doctor's office like any pay-patient but are shunted
off into a back room. (One of the doctors with whom I talked
confirmed this complaint. "I couldn't have a lot of Mexicans,
you know, sitting out there with my private patients.") They
have to wait, they say, even longer than they did in the clinics,
because the doctors see pay-patients first.
Another complaint was of the
service. In speaking of this complaint, Dr. Berman said that
they were able to convince the grand jury that it was unreasonable.
"These people who had gone to the health centers were accustomed
to a lot of things that were unnecessary," he said. "One woman
complained that a smear hadn't been taken when her boy's eye
was infected. The health doctors were always taking smears,
you know. Well, this doctor knew that the eye was syphilitic,
so he didn't need a smear." Undoubtedly some patients do prefer
the present plan, but the grand jury investigation revealed
that others do not.
What does the general public
think of the situation? Mostly nothing at all. The average citizen
is not aware of it. Not even the social workers outside the
groups who are directly involved had any conception of what
was taking place. An upheaval affecting the lives of thousands
of people has been engineered by a handful of professional men
and executed by a board of supervisors, without consultation
of the general public, though it sets aside an investment that
that public has made at the cost of millions of dollars.
