By Peter Maguire
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If, on the other hand, you are still standing and relatively coherent, HCA's patient referral "hot line" will provide you with a list of what they're calling either hospital or community-based public health clinics. And you will be given the distinct impression these are county clinics that will in fact screen you for WNV.
Don't count on it.
I contacted every one of the so-called "public health West Nile clinics" on HCA's list and was told by receptionists, nurse practitioners and supervisors that I was misinformed: they provide no WNV services of any kind. The only advice they had for me: "Go find an ER."
The last HCA-referred clinic on the list I called was a family medicine clinic in Westminster. I decided to play the sympathy card and told them I thought my brain was "swelling up fast" and I needed to come in immediately. Their response? "Call 911," where I would end up—you guessed it—at an ER.
Most of these local clinics, it turns out,are part of the privately run Coalition of Orange County Clinics, which managing director Joan Henry describes as a kind of "ad hoc health-care safety net" for the primary-care needs of mostly children and poor families.
"We don't even screen acute or life-threatening diseases like West Nile Virus," Henry explained.
"The Coalition of Clinics serves more than 186,000 walk-in patients per year. We are a funnel for all kinds of primary-care needs, but we were never meant to be urgent-care facilities for acute or even mild West Nile Virus cases. We have no mandate from the county, no memorandum of understanding to screen these cases. It's inappropriate for the county to send these cases to us when all we can do is refer them on to an emergency room for screening."
Which is not to say that Henry and the 31 clinics and 17-group coalition she represents across the county couldn't ramp up to take on the urgent need for WNV screening even if the county asked.
"It wouldn't be the first time we've stepped in to help the county out in a time of public need," she said. "But nobody's asked us."
Between private clinics that don't screen for WNV and ERs that won't test unless you're in the acute stages of illness because the diagnostic criteria is so high, is it any wonder confirmed cases of WNV in Orange County are so low? It's a game of medical musical chairs played out every day, not only for West Nile victims, but also for thousands of the uninsured and the underinsured in the county who, in the end, usually end up in the same place, lying on a gurney for hours in an ER, the health-care provider of last resort.
Henry says Orange County doesn't have what she calls the kind of "collaborative system of care you find in Los Angeles. There is the perception at the higher levels of [Orange County] government that this is such a wealthy county we don't need a publicly run system of full-care clinics, a managed-care approach to low-cost or no-cost [medical] services . . . or even a county hospital, for that matter," Henry said. "So the process of growing one in this county has been very slow."
UC Irvine Medical Center (UCIMC), a University of California-run teaching hospital, is as close as this county gets to a truly public "county" hospital. But taking on that task has proved too fiscally burdensome over the years, and UCIMC's handlers have recently backed away from that dubious title, in the services it provides, and in the fees it collects. The idea of truly public county clinics has also proved politically, if not financially, unworkable over the years. This is still Reagan Country.
If anything, the trend, even for the Orange County HCA itself, has been to cut services. The most recent example of that is the agency's decision to drop tuberculosis-screening programs from its list of public services.
But don't lay all of the county's health-delivery problems at the doorstep of its HCA, HCA administrators or medical personnel. Failure to follow through with an aggressive WNV health-care response begins with a county Board of Supervisors that has consistently failed to adequately fund a shrinking health-care system in this county at a time when increasing public-health demands are being placed on it. There are more than 500,000 uninsured living and working in Orange County according to a 2003 UCLA/California health-insurance-industry study. And that does not take into account the underinsured. How many of these people will have the wherewithal and the tenacity to seek and find WNV testing should they need it in a health-care environment that appears to be more obstructive than inclusive? With almost one-fifth of the county population under the radar of a health-care policy that does not account for them, how can the agency entrusted to monitor emerging health threats across the county develop a picture of this epidemic that is anything but fuzzy and incomplete?
Henry states the obvious—and frightening—when she says, "There's definitely a hole in public health care here in Orange County."