Shortly after a miscarriage a few months ago, Silenia Fernandez was surprised by a phone call from her doctor at the Burke Health Center in Santa Monica.
It was nothing more than a follow-up call to see how she was doing after the traumatic experience. But to Fernandez, the show of concern was appreciated and a sign that the clinic was under new management.
The Burke Health Center is one of eight Los Angeles County health clinics that were taken over by private, non-profit organizations as part of a plan to ease the county's 1995 health budget crisis.
"The doctors give us more attention now, and a phone call like that wouldn't have come a couple years ago," said Fernandez, a mother of four who has come to the clinic since 1992.
The county-owned Burke clinic is now managed and run by the non-profit Venice Family Clinic. Clinic officials are careful not to claim that their medical care is better than what the county offered just better organized.
"Our doctors and county doctors are both equally well qualified," said Jeff Catania, director of development for the clinic. "The difference now is that a patient can, in many more cases, receive all the health care they need in their own community and not have to travel to the county hospitals for specialty care."
Fernandez's comments echo those of other patients who have seen the Burke clinic switch from county staff management to private management under the county's Public-Private Partnership.
When the Venice Family Clinic took over on Nov. 1, 1995, the county doctors and other staff were transferred to other county centers. The Venice facility, which has served the area's indigent since its founding in 1971, brought in its own doctors and style of management.
It set out to expand the clinic's range of services, which had been limited to prenatal care and things like immunizations far short of what is usually considered "family medicine."
The Public-Private Partnership is part of the county's plan to broaden the number of clinic sites, expand services and redirect low-income patients away from county hospital emergency rooms for treatment of "ambulatory" problems.
Under the plan, the Venice Family Clinic also took over management of the Venice Health Center. Three other Los Angeles area non-profit clinic organizations each took over two county clinics and more may follow.
Clinic Executive Director Elizabeth Forer said county doctors and staff were relocated to other facilities mostly because they wanted to remain working within the county system, which offers civil service protections and other benefits.
The clinic posted all its positions with the county in case there was interest, she said.
"In any case, we were starting to offer different services so we had to staff differently," Forer said.
In a survey of 100 Burke clients who had visited the clinic before and after the switchover, 90 percent described the new management as equal or surpassing what they had known before.
"We asked about everything from pricing to technical quality, convenience, general satisfaction and amount of time with the doctors, and people overwhelmingly said it was as good or better than before," said Terry Hair, who participated in the study as an intern from UCLA's Masters of Public Health program.
"The study also found people reporting that they made fewer visits to county hospitals and other facilities after the switchover," Hair said.
Since the transition, the Burke clinic has made family medicine services available as the Venice Family Clinic formed a "patchwork" of alliances with local doctors, private hospitals and other medical facilities who donate varying amounts of equipment, lab time, specialist doctor visits and other services for clinic patients.
So while a patient may have to travel a few miles from the clinic for a treadmill test or orthopedic treatment that the Burke center can't provide, it's a vast improvement over going to the closest county facility, Harbor-UCLA Medical Center in Torrance.
In all, this patchwork consists of 500 physicians and 2,400 volunteers.
Still, the amount of available resources is described as less than bountiful. While the Venice Health Center staff has learned to stretch resources, resident physicians can have a difficult time adjusting.
"Sometimes we'll have a resident without an understanding of our mission, or that we have, for example, access to only five CAT scans a month with one of our partners," said Dr. Karen Lamp, a family medicine physician who spends Monday mornings at the Venice Health Center, which specializes in services for women and teens.
Cost comparisons between the county and the private operators are difficult because of the way the county counted patient visits and because the Venice Family Clinic gets a lump sum for patient care at all three of its clinics including one that was never under county management.
The Venice Family Clinic gets $6.7 million for the current fiscal year for running the three clinics the Venice Health Center and the Burke Health Center, which were formerly operated by the county, and the original Venice Family Clinic.
Burke has 13,000 annual visits, the Venice Health Center has 10,000 annual visits and the Family Clinic has 55,000 annual visits.
A year and a half into the Venice Family Clinic's involvement (the commitment goes by year-to-year contracts), the organization's director of medical services said the system is working but still needs some fine-tuning.
For example, if a doctor determines that a patient requires immediate hospitalization, the patient cannot be admitted directly to a county hospital. Instead, the patient must first be seen by doctors in the hospital emergency room.
"They should be able to bypass that extra set of doctors and get in for the treatment they need immediately," said Director Susan Fleischman.
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