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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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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 department—public servants—be paid to private physicians.

Well-Baby Conference
The medical society opposes well-baby conferences if advice is given

Last 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 can—or is likely—to 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 did—and probably few could—afford 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, who—if anyone—is 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 laundries.

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.

In 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 afflicted them.

The 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.

No 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 the many.

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