Bodega clinics serve the uninsurable, but some question their practices

PANORAMA CITY - On a busy boulevard in the San Fernando Valley, where a tire store, a seafood restaurant and a dental office all share the same block, Maria Canas stood on the sidewalk to make a pitch she believed few could turn down.

She was promoting a weekend health fair at Clinica Medica San Miguel where blood and urine tests for cholesterol, diabetes and thyroid problems went for $90.

“Are you already a patient here?” she asked moms who pushed strollers or the elderly who walked by the clinic on Van Nuys Boulevard. “Come to our health fair!”

Clinica Medica San Miguel is one of several medical clinics along Van Nuys Boulevard that serve a predominately Latino population. They are often the places that advertise free pregnancy tests or deals on cardiograms and medical exams on banners across their storefront windows.

The medical practices are what Dr. Mark Ghaly, with the Los Angeles County Department of Health Services, has nicknamed bodega clinics. That’s because like small markets in strip malls, “they are right between Chinese food restaurants and 7-Elevens,” he said.

But they remain a mystery to the formal health care network in Los Angeles County. Some physicians like Ghaly worry about the quality of care they offer. “A lot of us in the formal health care community are distrustful,” Ghaly said. “We just don’t know enough. We’re ignorant.”

Ignorant, he said, because there’s no way to check if these clinics are operating ethically. A quick glance through the California Medical Board’s online search shows that licenses at three clinics that operate along Van Nuys Boulevard are all up to date, and there is no pending litigation.

Ghaly, who is deputy director for community health for the county department, said the clinics appear to serve a clear purpose, which is to provide health care to the undocumented immigrant community that have no other options.

Under the Affordable Care Act, undocumented immigrants are ineligible for Medicaid, subsidized health insurance or access to state and federal exchanges to buy a plan. In Los Angeles County, an estimated 1 million people will likely remain uninsurable, according to some estimates. Their options for health care often include going to a hospital emergency rooms, where they wait long hours, or to busy nonprofit community health centers, or these bodega clinics, also known as a clinica familiar.

Unlike federally or state-funded health care centers, many clinicas only take cash or a combination of Medi-Cal and cash.

Ghaly said he can understand why the undocumented immigrant population turns to these clinics.

“When you look at their model, it’s an all-cash practice,” he said. “They offer low rates and they are open at hours for people doing day labor work. I think it’s an interesting model, if they really do deliver as much care as they say they do.”

Ghaly said the Department of Health Services has considered inviting the clinics into a formal system, but he said the department hasn’t had the resources to investigate the possibilities.

There may not be enough time anyway. Some of these clinics are already suffering under the Affordable Care Act, he said.

“No doubt, Obamacare, or expanded coverage for low-income people eats into their business a little bit, but that also could be true for any business,” Ghaly said.

SOME QUESTION CLINICA’S PRACTICES

If that’s true, then good riddance to some of these clinicas, said Dr. Glenn Lopez, a family practitioner specializing in community medicine. Lopez operated a mobile health clinic that visited several San Fernando Valley neighborhoods in partnership with Providence Health & Services. He now provides the same mobile care in South Los Angeles working with Saint John’s Health Center.

While he worked in the Valley, he heard about some questionable practices at various clinicas.

“It’s an emotional issue for me because patients I saw in my mobile clinic told me stories,” he said.

One common story was the excessive and unnecessary use of sueros, a liquid solution given through an IV. Patients pay $150 to cure cholesterol or another potentially deadly condition with an IV solution.

Lopez said there is a cultural belief among Latinos that if a procedure doesn’t hurt, it’s not good medicine.

“Unless you are severely dehydrated, you don’t need an IV,” Lopez said.

Another practice is selling a 30-day supply of medication and requiring the patient return to the clinica for more drugs instead of giving them a prescription so they can buy the drugs elsewhere for a cheaper price, Lopez said. He said patients should ask for a prescription and be wary when told to visit a doctor monthly for an indefinite period in order to manage their diabetes or hypertension. If a clinic is ethical, it will give a patient a prescription, Lopez said.

It’s an incompetent doctor, he said, who can’t help a patient control their diabetes in three months. Lopez also said patients should demand a copy of their medical records because it is the law, he said.

Clinicas may also find themselves in a battle to serve the medical needs of Los Angeles County’s uninsured. A new program called My Health LA launched this month, and it offers free health care to thousands of undocumented youth and adults. The $61 million program will assign people to one of 164 community clinics countywide that will become their medical home. There, the patients will receive primary care, chronic disease management, prescription medications and referrals to specialty care at county facilities.

“This is a game changer,” Lopez said. “Now they are going to have certain services covered, and a lot of this abuse will go by the wayside. The only way we’re going to see their demise is by competition.”

But for some patients such as Victoria Chirinos, 26, clinicas like San Miguel feel familiar, like home. It is the place where she brings her three young children for checkups and vaccines, and where she receives women wellness examinations.

“It’s free here, and I think everyone is nice,” she said. “If I go to the emergency room, I’ll wait for hours.”

She was, however, concerned about a $120 fee for an upcoming ultrasound.

“I’m worried about it,” she said.

Dr. Mahfouz Michael, who founded Clinica Medica San Miguel in 1981, admitted his clinics were struggling, but he said anyone who runs a community clinic practice outside of the nonprofit world is feeling the pinch of Obamacare. Michael has opened several such medical offices across Los Angeles, including a walk-in clinic in South Gate, another in North Hollywood and a new urgent care in Montclair.

“I’m not too sure how we’re going to survive,” Michael said. “We don’t know exactly how this is going to work.”

Michael said his clinics take Medi-Cal patients and walk-ins who pay cash. His clinics are open 24 hours and patients don’t have to wait long, he said.

“We do ask for money up-front,” he said. “We try to work with people. We can’t just be, well, if you don’t have money, we’re not going to treat you.”

Michael also said he understands the questions about the clinicas that are untethered to the nonprofit community health centers. Because his clinics take Medi-Cal and other insurance plans, he said, they are audited. He said the state Medical Board has inspected his clinics based on complaints made by who he believes are his competitors. There are no violations, he said. His clinics were among the first to offer electronic medical records, he added.

“We have really very high standards of care,” he said. “We can’t afford to be noncompliant.”