American Indian clinic struggles with cutbacks
Health center loses 20% of budget with governor's cuts
By Onell R. Soto
2 a.m., Oct. 2, 2009
Dr. Chelsea Richardson and dental assistant Franco Gonzalez gave Orlando McCollum a temporary crown yesterday at the San Diego American Indian Health Center. (Nelvin C. Cepeda / Union-Tribune)
“;How are we going to be able to provide the quality care to those in need?”; asked Dr. Edwin Cabrera, the downtown clinic's medical director.
DOWNTOWN SAN DIEGO — A downtown San Diego clinic is struggling after Gov. Arnold Schwarzenegger wiped out a $6.4 million program for community clinics serving American Indians in urban areas.
The San Diego American Indian Health Center has laid off 10 people, a third of its staff, and has been forced to close Wednesdays after it lost more than 20 percent of its budget.
“You just can't replace $543,000 overnight,” Chief Executive Joe Bulfer said.
A spokesman for the state Department of Finance said the cuts to clinics were part of $489 million in line-item vetoes required when the Assembly refused to go along with a budget deal the Senate approved in August.
“The veto was not the result of the governor having any issue or concerns about the programs,” spokesman H.D. Palmer said. “The governor was compelled to reduce general fund spending as much as he possibly could.”
The cuts are being challenged in a Sacramento appeals court, with a decision expected later this year.
When cutting overall state health care funding, Schwarzenegger said many of the 788 clinics affected would continue to get money from other sources and were in line for federal stimulus grants.
Federal stimulus grants have helped community clinics or clinics on reservations, but not the eight clinics that focus on American Indians who live in cities, said Paula Brim, who heads the San Diego clinic's board.
“We fell through the cracks,” she said.
In the meantime, patients who go to the cramped clinic on First Avenue just north of Maple Avenue on Wednesdays won't get service and may have to wait longer on the days the clinic is open.
“How are we going to be able to provide the quality care to those in need?” asked Medical Director Edwin Cabrera. “It's making it much more difficult.”
Such medical providers “do a lot with very little money,” said Jyl Hardenbergh, head of a statewide clinics consortium.
The state committed to funding health care for American Indians in 1954, when it took over many federal responsibilities, including education and policing reservations, said James Crouch, executive director of the California Rural Indian Health Board.
It created the Indian Health Program 40 years ago in response to a report on unhealthy conditions on reservations. The program grew slowly, eventually funding clinics in cities.
Tribes fund clinics, Crouch said, but their resources are finite. A fraction of California's 109 tribes have successful casinos. Plus, many of the people served in urban clinics like San Diego's come from elsewhere in the country.
The San Diego clinic helps the government fulfill its commitment to health care by making sure it matches the special needs of its clientele, 59 percent of whom are American Indians, many living near the poverty level.
“We have an understanding of the cultural and spiritual needs of Indian people,” Bulfer said.
Mental health services take native traditions into account and clinicians make sure patients understand what's going on because Indian patients might not ask many questions during exams, said Douglas Flaker, a fundraiser.