County health officials describe the clinics as a parallel health care system, serving a vast number of uninsured Latino residents. Yet they say they have little understanding of who owns and operates them, how they are regulated and what quality of medical care they provide. Few of these low-rent corner clinics accept private insurance or participate in Medicaid managed care plans.
“Someone has to figure out if there’s a basic level of competence,” said Dr. Patrick Dowling, the chairman of the family medicine department at the David Geffen School of Medicine at the University of California, Los Angeles.
Not that researchers have not tried. Dr. Dowling, for one, has canvassed the clinics for years to document physician shortages as part of his research for the state. What he and others found was that the owners were reluctant to answer questions. Indeed, multiple attempts in recent weeks to interview owners and employees at a half-dozen of the clinics in Southern California proved fruitless.
What is certain, however, is that despite their name, many of these clinics are actually private doctor’s offices, not licensed clinics, which are required to report regularly to federal and state oversight bodies.
It is a distinction that deeply concerns Kimberly Wyard, the chief executive of the Northeast Valley Health Corporation, a nonprofit group that runs 13 accredited health clinics for low-income Southern Californians. “They are off the radar screen,” said Ms. Wyard of the bodega clinicas, “and it’s unclear what they’re doing.”
But with deadlines set by the federal Affordable Care Act quickly approaching, health officials in Los Angeles are vexed over whether to embrace the clinics and bring them — selectively and gingerly — into the network of tightly regulated public and nonprofit health centers that are driven more by mission than by profit to serve the uninsured.
Health officials see in the clinics an opportunity to fill persistent and profound gaps in the county’s strained safety net, including a chronic shortage of primary care physicians. By January 2014, up to two million uninsured Angelenos will need to enroll in Medicaid or buy insurance and find primary care.
And the clinics, public health officials point out, are already well established in the county’s poorest neighborhoods, where they are meeting the needs of Spanish-speaking residents. The clinics also could continue to serve a market that the Affordable Care Act does not touch: illegal immigrants who are prohibited from getting health insurance under the law.
Dr. Mark Ghaly, the deputy director of community health for the Los Angeles County Department of Health Services, said bodega clinicas — a term he seems to have coined — that agree to some scrutiny could be a good way of addressing the physician shortage in those neighborhoods.
“Where are we going to find those providers?” he said. “One logical place to consider looking is these clinics.”
Los Angeles is not the only city with a sizable Latino population where the clinics have become a part of the streetscape. Health care providers in Phoenix and Miami say there are clinics in many Latino neighborhoods.
But their presence in parts of the Los Angeles area can be striking, with dozens in certain areas. Visits to more than two dozen clinics in South Los Angeles and the San Fernando Valley found Latino women in brightly colored scrubs handing out cards and coupons that promised a range of services like pregnancy tests and endoscopies. Others advertised evening and weekend hours, and some were open around the clock.
Such all-hours access and upfront pricing are critical, Latino health experts say, to a population that often works around the clock for low wages.
Also important, officials say, is that new immigrants from Mexico and Central America are more accustomed to corner clinics, which are common in their home countries, than to the sprawling medical complexes or large community health centers found in the United States. And they can get the kind of medical treatments — including injections of hypertension drugs, intravenous vitamins and liberally dispensed antibiotics — that are frowned upon in traditional American medicine.
The waiting rooms at the clinics reflected the everyday maladies of peoples’ lives: a glassy-eyed child resting listlessly on his mother’s lap, a fit-looking young woman waiting with a bag of ice on her wrist, a pensive middle-aged man in work boots staring straight ahead.
For many ordinary complaints, the medical care at these clinics may be suitable, county health officials and medical experts say. But they say problems arise when an illness exceeds the boundaries of a physician’s skills or the patient’s ability to pay cash.
Dr. Raul Joaquin Bendana, who has been practicing general medicine in South Los Angeles for more than 20 years, said the clinics would refer patients to him when, for example, they had uncontrolled diabetes. “They refer to me because they don’t know how to handle the situation,” he said.
The clinic physicians by and large appear to have current medical licenses, a sample showed, but experts say they are unlikely to be board certified or have admitting privileges at area hospitals. That can mean that some clinics try to treat patients who face serious illness.
Olivia Cardenas, 40, a restaurant worker who lives in Woodland Hills, Calif., got a free Pap smear at a clinic that advertises “especialistas,” including in gynecology. The test came back abnormal, and the doctor told Ms. Cardenas that she had cervical cancer. “Come back in a week with $5,000 in cash, and I’ll operate on you,” Ms. Cardenas said the doctor told her. “Otherwise you could die.”
She declined to pay the $5,000. Instead, a family friend helped her apply for Medicaid, and she went to a hospital. The diagnosis, it turned out, was correct.
Health care experts say the clinics’ medical practices would come under greater scrutiny if they were brought closer into the fold.
But being connected would mean the clinics’ cash-only business model would need to change. Dr. Dowling said the lure of newly insured patients in 2014 might draw them in. “To the extent there are payments available,” he said, “the legitimate ones might step up to the plate.”
This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.
