A panel of health specialists spoke proudly to an audience of 40 first-year med students. In the panelists’ eyes, the impossible had been realized at the Center for Community Health on Los Angeles' Skid Row.

Finally a place existed in downtown L.A. where doctors could address a range of medical needs for homeless patients on Skid Row. For the first time ever in a downtown clinic, primary care, mental health care, substance abuse treatment, and HIV care had all become available under one roof. Even a dentistry office and fully equipped eye care center awaits them. “One-stop shopping” became the panelists’ catchphrase.

Behind the speakers, a metal detector stood silently, turned off for the special event. The front desk featured three screens showing footage from outdoor security cameras. The clinic smelled like mild cleaning solution. The doctors smiled. This clinic, or as they prefer to call it, this “medical home” is their baby.

But beneath the surface of hope and optimism and increased patient retention rates, there are cracks revealed during a tour of the clinic.

The burden on these clinics is huge, especially considering the effects of the closure of Martin Luther King, Jr./Drew Medical Center in 2007, which caused a jump in the number of patients, said Dr. Paul Gregerson, chief medical officer of John Wesley Community Health, which operates the Skid Row clinic.

After county supervisors voted to shut down King because of its myriad problems, state legislators approved SB 474, the $100 million fund that was created to help preserve health care in South Los Angeles by distributing money to independent clinics. This cash flow will decrease once money begins to go toward the new hospital that is supposed to be opened to replace King in 2013.

Money aside, the homeless population is difficult to care for. Patients forget appointments and they have trouble maintaining regular medicine regiments. People with diabetes, for example, lack a refrigerated place to store insulin.

Many have mental illnesses. One paranoid-schizophrenic cancer patient, for instance, thought his cancer was caused by the doctors’ X-rays, said Dr. Anne Celona.

Celona works outreach for the clinic, visiting cafeterias like the Hippie Kitchen to reach patients directly and remind them of appointments. She’ll see six to eight patients on any given day. Some patients have regular providers at L.A. Mission or Hubert H. Humphrey Comprehensive Health Center and use the clinic as an in-between for refills of medicine, she said.

They sometimes come in for what Dr. Celona calls “drive-bys,” where they visit the clinic to see what medicine they can get at that moment.

The homeless patients’ view is that they need speedy care. They often have meetings scheduled with social workers and other community helpers, in addition to their medical appointments.

A patient might approach Celona to request a TB test, but Celona might also discover that the patient’s blood pressure has skyrocketed. There’s sometimes not time to address both issues before the patient needs to move on.

“My medical training tells me, ‘Oh, your head’s going to blow up. We need to address your blood pressure.' But she needs to get her TB test ‘cause she has to get to her shelter, ‘cause it’s going to rain.”

She has to coax them into treatment conversationally, she says. She talks to them as if she’s chatting with an old friend on the street.

“Have you had any high blood pressure before? Yeah? Well, it’s kinda high, but let’s do your TB test and we’ll listen to your heart and stuff like that.”

A new women’s center down the street from the clinic will open in December. The center will offer mammograms. Right now, patients have to go to a location to make a mammogram appointment, then leave, and then come back for the appointment. With this population, that’s too many steps.

“Unless you’re symptomatic, why are you going to take a bus ride there and then go and wait, then get an appointment, and then come back?” Celona said.

Hurting for Money

Gregerson led a group of med students towards some of the treatment areas. The Center for Community Health sees 150 patients a day, he explained.

“Well, we book 150 patients a day, but there’s a 50 percent show-up rate, so it’s actually 75 people with appointments and 75 walk-ins,” he said.

The clinic opens at 8 a.m., but people typically start to line up around 5:30 a.m., Gregerson said.

At the eye-care center, identified by a bright orange “Optometry” sign, Gregerson opened the door. The light was off, but the outlines of large pieces of equipment were visible.

“In here,” Gregerson said, “we have one of the biggest tragedies in health care.”

Initially the state provided funding to build and equip an eye-care center, but then funds were cut, and now there’s no money to staff the center. Gregerson didn’t bother turning on the light.

The dental clinic is not much better off. Like the eye center, the dental branch is spacious and well-equipped. The dental chairs looked pristine, almost unused, but the center can only afford to staff it on Fridays.

The earliest available appointment for a dental visit is in March.

They make exceptions for emergency situations because Medicare covers those, but in dental care, only tooth extractions are considered emergencies.

“Actually, the county has paid us money to take some of the overflow of patients that were previously getting their primary care there. So we actually keep our clinics open until 9, 10 o’clock over in that part of town so that people have access to care because during the day we’re booked to the max,” Gregerson said in reference to SB 474.

Assemblyman Isadore Hall - one of the authors of AB 2599, the bill that opened the gateway for funding for the new King medical center - said that the funds currently going to clinics would be reduced or reallocated, but that he doesn’t think that “all the funding will go away.”

The need for the new medical center – and the public outcry over King’s closure – was so great that the city could not afford to delay action, especially because of the demand for an adequate trauma center, Hall said.

“Our community was dying literally in transit because there was not a facility they could be immediately transported to,” Hall said. “They cannot afford to go five or six miles away in traffic.”

Gregerson understands the importance of a nearby trauma center, but wishes that hospitals and primary care centers could work together more.

"They’re getting good care there, but there’s nobody to follow them up. Once the main visit is over, they’re not hooked into a medical home," Gregorson said. "They end up going back and forth and not finding a permanent source of care.”