Health and Private Doctors
by Daisy Lee Worthington Worcester
Co-Author, Volume 15 of the Federal Investigation of Women and
What now remains to the Los Angeles County
Health Department is routine work in sanitation, vital statistics
control of communicable diseases, well-baby conferences and
other educational services. Even these long-accepted branches
of orgalnized publichealth work are under attack. As in some
other parts of the country (see Survey Graphic, January
1934, Health, Inventory by Mary Ross) an effort is being made
by members of the medical profession to see that money previously
paid to the salaried staffof a publichealth departmentpublic
servantsbe paid to private physicians.
The medical society opposes well-baby
conferences if advice is given
summer the Los Angeles County Medical Association drew up a
long document giving their idea of the whole duty of a health
department. This embodied the principle of the San Fernando
Plan, declaring that all treatment whatsoever should be given
under the Welfare Department, not the Health Department, and
given only to indigents "all social-serviced by the Welfare
Departrnent." "Treatment" was defined in a most inclusive manner.
To examine a well child would be "treatment" if advice of any
kind were given, presumably even as to tooth-brushing or keeping
one's windows open at night. Such a rule would cut out the wellbaby
conferences or the school physician's advice as to food, or
as to rest and exercise for cardiac children in the regular
classes, for example. Advice as to diet was considered "the
practice of medicine" and ruled out of the province of the Health
Department though even advertisers may fill the air and the
billboards with what they will.
Under the proscribed "treatment"
comes a further provision that health-department nurses should
visit and supervise tuberculosis patients under the care of
a private physician only at the physician's request or with
his consent or under the regulations of the Welfare Department.
Though the Health Department is charged with the control of
communicable disease by law, under the police power, it is suggested
that private physicians instead of health-department staff be
used for vaccinating people against smallpox, immunizing them
against diphtheria, or other communicable disease under some
such arrangement as the Detroit Plan (see Survey Graphic,
January 1934, p. 39). This means that the family would pay the
physicians for these services when they could, and when they
could not pay he would receive a stipulated payment from public
funds. There is no claim that such a measure would be an "economy."
The Detroit health offficer,
Dr. Henry Vaughan, himself estimates that that plan costs the
city three times as much as health-department services would
cost for the same work. The Los Angeles County Health Department
can give immunization against diphtheria for 33 cents, can care
for patients with venereal disease at a cost of 42 cents a patient
visit or tuberculosis for 39 cents. No private physician canor
is likelyto provide treatment at such rates as these.
Immunization against smallpox
and diphtheria has been provided by the Health Department for
everyone who asked, rich and poor, on the ground that communicable
disease is no respecter of persons; the aim is protection of
the whole community. There is ample evidence in past experience
in Los Angeles County and elsewhere to show that people are
slow if not wholly unwilling to pay their own money for preventive
measures, especially in times when most families must count
every penny. Even in the best of times few families didand
probably few couldafford to pay for supervision of well
children such as is given by the Health Department's conferences.
Is there the slightest chance that if these are given up, the
children will get that care from anyone?
If such recommendations as
the Association has made should be carried through and the Welfare
Department becomes the custodian of the sick poor, whoif
anyoneis going to look out for the floating population
which is so large an element in the life of I,os Angeles County?
The Welfare Department has authority to care only for persons
who have been residents of the state for three years and of
the county for one year. Non-residents constituted nearly a
third of the patients treated in the tuberculosis clinics of
the Health Department, many of them in occupations which make
them a danger to the general public, such as foodhandling or
Nor does it seem likely that
the physicians could hope for pay from the Welfare Department
for caring for these people; if they received it, it would enormously
increase expenses, since this service has been given by the
health-department staff at no addiIf the Medical Association
and the Public Health League have their way, the Los Angeles
Health Department will soon be relegated to the position in
which Dr. Pomeroy found it in l915, when the job of the health
officer was to tack a quarantine placard upon a door, and clean
up nuisances. Not only Los Angeles is threatened, but every
community in California. A few weeks ago word was received that
Merced County was about to add a new wing to its county hospital.
An emissary from the Public Health League was sent up at once.
He returned to boast that he had succeeded in blocking the movement.
reality, the Health Department and its clinics have been the
strongest allies of the practitioners of scientific medicine.
They have done much to offset the steady stream of propaganda
that is being poured into Los Angeles by cu]tists and charlatans.
Almost every person who has gone to a health center, whether
for advice, diagnosis or treatment, is, if not a potential patient
for some private physician, at least a potential voter. The
medical profession in California has suffered greatly already
from those outside their ranks who have wielded great political
power. As an instance one may cite a policy of the new County
Hospital in Los Angeles where there is an osteopathic wing,
to which every tenth patient is sent automatically, whether
he believes in osteopathy or not. By closing the doors of the
health centers, the doctors have opened the way for a flood
of anti-scientific propaganda, in which they with the general
public may suffer more serious losses than any which have yet
state of mind that lies behind the doctors' strike in Los Angeles
County has not, unfortunately, been absent from other parts
of the country. But as the development of public-health organization
has been more complete and effective in Los Angeles than in
any other large unit, so is the breakdown the more serious and
significant. There is an ironic twist in the fact that the doctors,
striking with one hand at what they call state medicine, should
eagerly reach with the other for public money. The person who
seems to have gone without voice in the controversy, and almost
wholly without knowledge of its reach and implications, is that
very taxpayer whose money is being transferred from public service
to private pockets.
one doubts that the doctors along with other professional groups
have been hard-pressed by these last years, nor that we need
now, more than ever, a social realignment of medical service
that will give doctors greater security of income and patients
greater assurance of adequate care in time of need. What has
happened and is happening in Los Angeles County however, is
a mockery to the constructive American spirit which is struggling
to push our country through and out of hard times. The advantage
of the few has been made paramount to the service and need of