Health and Private Doctors
by Daisy Lee Worthington Worcester
Co-Author, Volume 15 of the Federal Investigation of Women and
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
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
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.