St. John’s Web Exclusive

Feb 7, 2010

As part of KPCC’s focus on health care reform, our own Patt Morrison visited St. John’s Well Child and Family Center in South Los Angeles, where she spoke with medical practitioners, public health officials, local politicians and patients. Here are stories of health care realities and hopes for health care reforms through the eyes of the neediest patients in Los Angeles.

While at St. John’s, Patt spoke with Dr. Ellen Rothman, director of quality assurance for the clinic’s Women’s Health program. Before coming to St. John’s, Dr. Rothman worked on a Navajo reservation. She says the irony of working in a major metropolis is that she feels more isolated and faces greater challenges finding care for her patients in south Los Angeles than she did while on the Navajo reservation. Dr. Rotham told the following story about a patient who, despite St. John’s comprehensive care model, did not receive the care she needed.

DR. ROTHAM: “I had a patient who came in for weight loss and she was a pretty heavy lady, so the first time she came in and she’s like, “Oh I’ve had weight loss,” I was kind of like, “alright.” But every time she would come in, it would be one pound down, three pounds down, four pounds down. She’d had a pap smear within a year that had some mild abnormalities but wasn’t anything much and abdominal pain and that was really her only complaint.”

“She was actually African American, she just didn’t happen to have a dependent child living with her, so she didn’t have access even to emergency medical, and for adults, once you already have a social security number and you’re already at that door of eligibility, it’s like a catch 22, because in order to get services, you need to have not only diagnosis but disability but to prove that diagnosis, you need some insurance.”

So for this patient I had set her up with a CAT scan—through the county system I did a referral. I did every blood test I could think of and I remember she gave me a huge hug the day that I told her she didn’t have HIV. And I told her, I remember telling her, “I sort of wish you did, because if you did, it’s medication I can start it, I know how to get that.”

The CAT scan, we looked, we followed up on it. It turned out the first referral I did, they felt like the scanned form—referral form—was illegible, so they just…tossed it out and I don’t, I don’t know exactly..”

PATT: “So she didn’t get a CAT scan because the paperwork wasn’t good?”

DR. ROTHAM: “Right, she didn’t get a CAT scan because the paperwork wasn’t good. This patient was also a two-way street, so she was also absent from care, so she lost…she left care somewhere after, I think after I did the second CAT scan referral.”

PATT: “So she didn’t come in for her follow-ups?”

DR. ROTHAM: “She didn’t come in. I think her partner had been in a big accident—there was something going on in her family. And so she didn’t come back to the clinic until about eight or nine months later and when I saw her eight or nine months later, she was 70 pounds down, she was very, very thin. And I did another CAT scan referral.

We sent her to the emergency room for very profound anemia. When she got to the emergency room, they transfused her and they didn’t bother to ask why a 40-year-old woman should be so anemic and just discharged her with “follow up to her primary,” which was me. And, you know, by the time she [was] finally presented with her uterine cancer, it was extremely advanced and she, she, ultimately she died of it and…um, the thing that made me the saddest is that she’d had all these encounters with health care professionals—myself on a number of occasions, a couple of times she had presented to the emergency room. And, and I felt like, you know—I work pretty hard for my patients and I work pretty hard to try and get them the services that they need.

And the thing that made me absolutely the saddest is that she’d had all these interactions with the health care service, and not one of us could pull together the care that she needed.”

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