News Articles, 1995-1997
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Proposed Clinic Closure, New U.S. Rules Put Pressure on Providers

At the Clinica del Pueblo (the People's Clinic) in Northwest Washington, the telephone rings every few seconds, but the receptionist tells callers in Spanish that no appointments are available for six weeks. Patients have to climb three flights to get to the clinic, where nurses and volunteer medical students examine them in closet-sized cubicles among stacks of files and shelves of medicine.

"We are open six days a week, 12 hours a day, and we use up every available space," said Andrew Schamess, the private, nonprofit clinic's only full-time physician. "But we have to turn away far more people than we can see, often with serious problems. It breaks your heart every time."

Pressure on this clinic, and a half-dozen others in the District's Latino community, has worsened in recent weeks because of new welfare and immigration laws that tighten restrictions on who may receive federal health benefits. Also, there are concerns about a proposal by D.C. officials to shut down one of the clinics and shift its services to a health center 12 blocks away.

In the suburbs, Latinos generally have more health care options. Although there are fewer low-cost clinics in their neighborhoods, their incomes are higher, and a greater percentage are legal permanent residents who are eligible for public health assistance or have jobs that provide private health insurance.

In the District, the half-dozen low-cost, bilingual health centers serve the large concentration of Latinos in the District's Adams-Morgan, Mount Pleasant and Columbia Heights neighborhoods. Together, they see more than 30,000 people a year, most of whom are poor and uninsured immigrants, and they treat everything from toothaches and croup to cancer and AIDS.

Jose Blanco, 54, a security guard from El Salvador, calls the Clinica del Pueblo , in Columbia Heights, an "island of salvation" for his children's checkups and his own diabetes. "Our salaries are too low to pay for insurance, but here they give you medicine free, and if you have to go to the hospital, they send [an English-speaking person] with you to explain."

Although booked to capacity, the clinics collect little money from patients. More than 70 percent of Latinos in the city have no health insurance, and their average per-capita income is about $15,000. In addition, many clients are Central American refugees who are in the United States under temporary amnesty and cannot receive public medical assistance. Many of them work at low-level jobs that provide no health insurance. Most clinics charge modest fees based on income but treat some patients for free, relying on a combination of grants, donations and volunteers to make ends meet.

Latino patients say that in addition to offering inexpensive care, the clinics are especially sensitive to their cultural and legal concerns. They don't, for instance, ask prospective patients about their immigration status -- a policy much appreciated since, according to community leaders and federal officials, at least 20 percent of the District's estimated 85,000 Latino residents are in the United States illegally.

One development causing concern for community health care providers was a proposal last month by officials of the Public Benefits Corporation, which has replaced the District's public health department, to close the public Adams-Morgan Clinic, which treats 800 patients a month. They would merge it with Unity Health Care, a four-story private, nonprofit clinic in Columbia Heights that serves 3,500 patients a month. Community leaders and the Adams-Morgan clientele have vehemently protested, citing concerns about the 12-block walk and losing a medical staff they have come to trust.

"Please don't close my clinic," Elba Cabrera, 34, a housekeeper from El Salvador, pleaded with officials at a recent public forum. "My doctor told me they might close it, and I cried a lot. I love everyone there."

But officials of the Public Benefits Corporation said they need to find creative ways to improve neighborhood health care while making it more cost efficient, in part by combining services at several of the District's 11 public neighborhood health centers.

Moving the tiny Adams-Morgan clinic from its cramped quarters in the Marie Reed Elementary School to the spacious Unity Health Care building, officials said, would be a logical and innovative experiment in public-private health collaboration. But officials said that after hearing such strong opposition, they do not want to run roughshod over the Latino community and will take another look at the proposal.

"We are trying to establish a primary care system that will be available to all groups, and we are particularly committed to the uninsured and to people who have traditionally been denied access to health care. That certainly includes the Hispanic community," said Betsy Reveal, benefits corporation board chairman. "We don't care if they're employed or unemployed, legal or not legal. We want to make sure there is adequate primary care in the community."

The issue of trust is especially important for local Latinos these days, because new federal rules require local governments to report the immigration status of those who apply for public assistance. Officials at several clinics said they are no longer sure whether to encourage clients to apply for Medicaid -- federal medical assistance to the poor -- even for their legal children. And some immigrants, they said, have been afraid to come in for treatment lest they be deported.

Recently, local Medicaid processing centers sent out notices to applicants telling them that in some cases the centers now must report illegal residents to the Immigration and Naturalization Service. Officials will not ask the immigration status of those seeking Medicaid for their children, the notice said, but "when we become aware . . . that you or a member of your household" is illegal, "we must document that fact. This documentation is available to the INS."

"There are so many rumors, and people are scared," said Teresa Rosa, a social worker at Unity Health Care. "We are afraid if we send in the [Medicaid] forms, we may be doing people more harm than good." Officials at Unity and other clinics said some mothers who are illegal immigrants are sending their children in with neighbors because they do not want to risk being caught.

At Columbia Road Health Services, a nonprofit clinic in Adams-Morgan, staff member Gina Clifford said some longtime clients have "gone underground" and asked if they can be treated at home. One illegal immigrant named Marta, a part-time housekeeper from South America, said the clinic had helped her through several pregnancies and found her shelter when her husband beat her.

Now, though, she is afraid to apply for Medicaid for her children.

"My children are American citizens, but I have no papers," she said.

Even for those who are legal, health care providers in the community say they are concerned about the effect of new welfare and immigration laws on Latinos. Some Central American refugees once eligible for Medicaid have been barred from receiving it. Also, many poor immigrants sponsored by relatives may no longer qualify for Medicaid because their sponsors' income is now counted in deciding eligibility.

At Unity Health Care last week, a Guatemalan refugee, Vitalicio Mendez, 36, paced the floor as he waited for his pregnant wife to have an exam. The construction worker, who is in the United States on a temporary work permit, said that his family was turned down for Medicaid and that he cannot afford the $50 a month it costs for health insurance from his employer.

"I am healthy, so I don't need it, but I have a wife, four children and another one coming," he said. "What if I end up in [immigration] court? Who will help them then?"

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