Authorities and the media focused heavily on the problem of illegal clinics in Latino neighborhoods after an 18-month-old girl died from medication that she allegedly received at an unlicensed pharmacy in early March. Investigations were ordered. Reporters filed stories from south of the border, where such backroom clinics thrive. And county health officials offered reactions that essentially ranged from "Gee, how'd those get here?" to "What can we do? It's part of the Latino culture."
But why these clinics have made their way stateside isn't a mystery. It's the medical economy, stupid.
While it's true that pharmacists in Mexico have wide latitude in dispensing medication and injections, it's also true that access to real clinics is problematic in Latino neighborhoods. Just 15 community clinics try to serve the health-care needs of the medically indigent-those lacking health insurance-for the entire county. As Chauncey Alexander, one of the Orange County Health Care Council's founders, observed in late 1997: "We don't have a safety net. It's a jungle for the consumer to find service."
The appearance of these clinics in Latino, often-poor sections of the county is understandable. This isn't a county-or a state, or a nation-that prides itself on easy, affordable access to quality social services or health care. In fact, measures taken in the past three years have done a great deal to harm a poor person's access to care.
Any discussion of social services in the U.S. has to begin with the 1996 Welfare Reform Act. Passed by a Republican Congress and signed by President Bill Clinton, the act set stringent targets for getting aid recipients off welfare and into work and dropped an astonishing 2.2 million people off the rolls in its first year. For Clinton and the Republicans, the number represented a victory. For welfare advocates, another number-private food bank Second Harvest's announcement that it served food to 10 percent of the country in 1997-exemplified a dark defeat.
For California, compliance with the 1996 act is proving all but impossible. Outgoing Governor Pete Wilson told Governor Gray Davis the state faces $7 million in fines for failure to get 75 percent of the state's two-parent welfare families into the workplace.
State officials say they'll appeal the fines on the grounds that most of these families-unlike nearly every other state-are immigrants who speak a language other than English. By 1997, when the fines kicked in, just 24 percent of these families were working. In addition, state officials say it's unlikely California will get 90 percent of the two-parent families into work, potentially subjecting the state to $28 million in fines.
But even those who get work after getting tossed off the welfare rolls may not find adequate health care. In October 1998, the nonprofit group Economic Roundtable released a study showing that the vast majority of employment for former welfare recipients was dead-end service jobs requiring low skills and providing low pay. For these families in Orange County, health care means waiting in line at one of the county's 15 overcrowded free clinics.
For California's growing noncitizen population, these statistics don't even matter. In early March, the Urban Institute reported that one-third of all noncitizen welfare recipients in the state simply dropped out of the welfare system. According to the study's authors, the 1996 act had a "chilling effect" on noncitizens-sending them away from even Medicaid and food stamps, services they could still legally use.
There could also be a fear of utilizing regulated medical-care facilities amid the rhetoric spewed by Orange County congressmen Dana Rohrabacher (R-Huntington Beach) and Ron Packard (R-Oceanside), who advocate restricting public care for undocumented residents. "We can't escape the costs of illegal immigration," Packard said in July 1998. "Whether an illegal alien is accessing federal benefits like welfare and health care or sitting in county jails after committing crimes, the local taxpayer always picks up the tab."
Dan Gleason, a health-promotions program manager for the county's public-health department, didn't know how many, if any, local noncitizens are going to unlicensed pharmacies, for the obvious reason that it's "hard to find people in the community who trust you." But recent events show noncitizens have much to fear. In February, the U.S. Supreme Court upheld the most controversial portion of the 1996 Immigration Reform Act, which speeds up deportations by banning judges from "intervening"-even where issues of political persecution are concerned. Of the nine justices, only Justice David Souter dissented.
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Even without the new law, deportations have skyrocketed. In 1992, the U.S. Immigration and Naturalization Service (INS) tossed 43,525 undocumented immigrants out of the country. In 1998, the INS deported four times that number-81 percent of whom were jettisoned to Mexico.
In the wake of one infant's phramacy-related death, county officials immediately set up a task force consisting of Third District Supervisor Todd Spitzer, Sheriff Mike Carona and District Attorney Anthony Rackauckus to investigate the problem of illegal clinics in Latino neighborhoods. Warned by First District Supervisor Charles Smith not to sweep Santa Ana and similar cities with massive police raids, the task force has wisely recommended a largely education-based plan for getting residents to established, regulated clinics.
But their task will be challenging. By their nature, unlicensed drug stores don't announce themselves as such-indeed, most operate in the back rooms of small gift shops and toy stores. "We just don't know how many of these are in the county," Gleason said. "We have not been successful in doing a thorough assessment of the problem."
The Santa Ana-based nonprofit Orange County Safe Health Coalition (for which Gleason is a volunteer) is distributing fliers to residents identifying local clinics where they can receive proper health care. If the reasons cited above is any guide, they have a long, difficult job ahead of them.