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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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AS one woman said, "I was always proud of our health center; I used to take visitors to see it, never dreaming that I would one day have to go there. But when my baby was sick and I couldn't afford a doctor, I suddenly realized that there was one investment which we had made that was not lost. Now," she added bitterly, "that has gone along with our other bad investments."

The doctors felt poor, undoubtedly often with reason. But their actual trouble was handled without reason. They blamed the health centers for the loss of their patients. Pomeroy built the health centers, so he was to blame. Pomeroy was being paid. The nurses were being paid. His staff was being paid. Everybody was being paid but the doctors. The social workers were not on the job! They were admitting everybody to the clinics! A physician in a distant California city who had never been inside of one of the h;ealth centers talked to me heatedly about Dr. Pomeroy and the whole public-health movement in Los Angeles County, because of the "outrageous laxity of the social-service department, which admitted even millionaires to the free clinics."

There is not a shred of evidence that the medical social service work of the health centers was in any way responsible for the increased attendance during hard times or that its professional standards were lowered by the great increase in service that depression brought. All work was under the direction of a highly trained chief medical social worker. Each center had a medical social worker and a secretary.

A study conducted by members of the Los Angeles Branch of the American Association of Social Workers indicates that the training required by this department is higher than that for most public agencies.

Zdenka Buben, chief medical social worker, analyzes the work of her department as follows:

No patient was ever admitted who was able to pay more than fifty cents per visit to the health center. All applicants were admitted through social service, and interviewed by a medical social worker. Each case was treated on its own merits, the basis for decision being the medical need of patients and family, and the financial and social situation. A budget guide was given the medical social workers, covering minimum needs for shelter, food, clothing, service charges (water, heat, light) transportation of the wage earner, and incidentals. The worker was expected to compute the amount of money a patient and his given family needed for the bare necessities of life, and compare this amount with total income and obligations. If the patient or family had a margin above the amount collected by our clinic, it was assumed that they could meet their medical or dental bill. The medical social worker's job was to adjust the payments for medical care according to the family's ability to pay. Fees collected (from ten to fifty cents per visit) were turned over to the volunteer doctors.

Eligible patients were given an admission card on which there was an expiration date. The patient presented this card each time he came to the clinic. When the card expired, he was returned to medical social service for a social recheck. With the knowledge of the patient, wages were verified with the employer. If the patient had had the services of a physician in the county during the past year, a letter was sent to that doctor, explaining that the patient had applied for treatment at the health center, giving a brief statement of his complaints and social situation, and asking the doctor if he wished to release the patient for clinic care. Ineligible cases were referred elsewhere according to their needs. It was a policy in the medical social service division that a patient never leave the health center without knowing "what next."

Applicants for clinic care were received by medical social workers. Any who could pay more than 50 cents a visit were asked to consult a private physician

In December 1932 the Committee on Medical Social Service of the Los Angeles Council of Social Agencies, issued a report on the Economic Condition of 250 Clinic Patients. The report says:

All of the clinics represented, reported various rules used in determining the eligibility of patients, but only one, a public-health department (Eastside Center, Los Angeles County Health Dcpartment), made use of a budget for the study of the financial condition of each patient and his family, with a view to determining the ability of the patient to pay for medical care.

The other clinics studied were all those of private agencies. This same study revealed the fact that the average monthlv incomes of families admitted to the health center clinic were lower than those of all others, with the exception of the All Nations Clinic. The average monthly income of the health center group was $37.76, that of All Nations, $28.74. The other ranged between $57.86 and $62.78.


Kay Davis, University of Virginia, © 2001-2003