LOS ANGELES — The largest health care provider in South Los Angeles, which serves low-income African Americans and Latinos, is putting some of the city’s most vulnerable residents at risk of contracting the coronavirus by having patients come in for routine appointments, according to some medical professionals who work there.
As the coronavirus batters minority communities, some medical professionals said they are concerned that the facility, St. John’s Well Child and Family Center, is disregarding a key federal guideline intended to protect people from the contagion, which recommends that medical facilities reschedule nonessential appointments.
Seven medical professionals, including doctors and nurses, who spoke on condition of anonymity for fear of losing their jobs, said that they have taken their concerns to the chief administrator of St. John’s several times but that the practice has not stopped. Shortly after the professionals spoke with NBC News, two said they were fired.
St. John’s CEO Jim Mangia said he could not comment on personnel matters, but said the only reason a provider would be terminated would be for “a malpractice issue or severe behavioral issues.”
As of mid-April, the professionals said, 50 percent to 80 percent of patients they see in a day have no pressing medical concerns and should have had their appointments rescheduled or converted to telephone or video appointments to avoid potentially exposing them or others to the virus, which has killed more than 68,000 people in the U.S.
The 18 St. John’s community clinics serve some of the city’s most impoverished residents, including 35,000 undocumented immigrants a year, making it the largest health care provider to this population in the country, Mangia said. The nonprofit also champions social causes, including training staff members to form human chains around clinics to prevent Immigration and Customs Enforcement agents from entering.
The clinics serve an area where the proportion of people living below the poverty line is more than double the national average, according to census data. Many patients live in multifamily homes or homeless shelters and have chronic medical conditions, compounding their chances of contracting and spreading the coronavirus, the eight professionals said. African Americans and Latinos have been disproportionately affected by the coronavirus, according to a recent report from the Centers for Disease Control and Prevention.
“My fear is that once it hits this patient population, it will be the epicenter of L.A.,” one of the professionals said.
When the coronavirus broke out, some of the professionals called patients to reschedule routine visits and refill prescriptions over the phone, but they were quickly reprimanded by management and told not to call their own patients, they said.
“This is the first place I’ve worked that as a provider I’m not given the autonomy to care for them [my patients] medically,” one of them said after having encountered resistance to suggesting that patients with non-urgent needs be moved to telehealth visits.
“When you’re suppressing the expertise, the knowledge, the morals, the morale of providers who are here to take care of an underserved people, you’re almost just kind of re-oppressing them,” the professional said.
The CDC, the Los Angeles County Health Department and numerous national medical associations all recommend that telemedicine be used for routine visits to prevent the spread of the virus.
Congress approved expanded use of telehealth in March under the CARES Act, allowing federally qualified health clinics like St. John’s to bill Medicare for the online and phone visits.
Mangia, the CEO, said that the clinics are following CDC and L.A. County Health Department guidance “to the letter,” and that “of course” doctors can call their patients, adding that medical providers are allocated time to reach out to patients. When asked whether providers are allowed to determine which patients are considered medically urgent and to reschedule those with nonessential needs, Mangia pointed out that the clinic uses a centralized call center.
Mangia suggested that his staff’s reasoning for rescheduling patients was not one of concern but rather a desire to see fewer patients.
“We are dealing with a low-income population. This is not a Beverly Hills practice, and I know some of our doctors would prefer it was, but it’s not. … A lot of our patients are not comfortable talking to the doctor over the phone or even by WhatsApp or FaceTime,” Mangia said.
The medical professionals who spoke to NBC News say their suggestions that the clinics follow CDC guidance and cut down on nonessential appointments were met with accusations of being irresponsible providers.
“They try to insinuate that we do not want to see patients and we’re lazy. … It really degrades our morale … especially during this time,” a medical professional said.
Several providers said they were concerned that patients were being misled about telehealth options but could not speak up for themselves.
“A lot of them are undocumented, and they are not going to protest anything if someone tells them to come into the clinic,” a medical professional said.
Mangia denied the assertions and said that as of mid-April, 42 percent of St. John’s visits were conducted by telehealth. But he acknowledged that patients get the option only after they express concern about going into a clinic. Mangia said 40 percent of the people St. John’s cares for have chronic diseases that cannot be treated via telehealth.
“We’re calling every patient and offering them telehealth. Some patients, many patients are refusing it,” he said.
Mangia added that there is no financial incentive to withhold telehealth because St. John’s is reimbursed for such appointments at the same rate as regular appointments.
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The Centers for Medicare and Medicaid Services confirmed the rate and said it pays for virtual visits conducted by federally qualified health centers.
Lourdes Fajardo, 26, a St. John’s patient for more than a decade, said the option of a telehealth visit for her son’s recent routine physical never came up when she called to see whether it would be safe to go in. A few days later, when the clinic called to cancel because the doctor would be out, it offered her telehealth — but it made no mention of the coronavirus.
“I thought for a second they were calling to tell me it’s not necessary because of everything going on,” she said.
The professionals said Fajardo’s experience shows that patients may not be getting the appropriate information to determine whether an appointment is medically necessary.
“I don’t know if they [patients] understand that a physical can be held off, especially if they don’t need vaccines,” said a staff member who confirms appointments.
They said that call center workers who make the appointments have no medical training but that when patients hear it is safe to go into the clinic, they trust that the information is coming from their doctors.
“The call center, their advice is not our advice,” a professional said.
AltaMed, a neighboring federally qualified health care center also serving South Los Angeles, said that as of early April about 50 percent of its patients had been converted to telehealth, according to its medical director, Dr. Sherrill Brown. Providers first assess patients over the phone to determine whether they should come in or whether the need can be addressed by telemedicine, she said.
“We are trying to increase that amount as much as we can just to reduce risk for patients having to come into the clinic and be exposed to other people whether they are symptomatic or not,” Brown said.
The professionals at St. John’s said they are trying to balance what they believe is best for their patients and the clinics’ policies.
“From a public health response, that’s my fear,” a professional said, “that we won’t do our due diligence on our end for this community.”