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2004-01-08 -- LETTERS: More than ever. Health Care Crisis hit SF

I would like to know what the thoughts are of other DPH/CHN/Mental
Health caregivers and patients about the crisis we are facing in San
Francisco.  Many public primary care clinics are now so overloaded
they are either not taking new patients, or making appointments months
from now.  Folks who have been around a really long time say that they
have never seen it this bad.  I hear it is worse in L.A., but I live
and work here and it seems pretty bad to me.

If you are uninsured, and you do not have a regular doctor already in
the public system in SF, and you need a refill of your medications for
blood pressure or diabetes, or you have a nagging cough, you may have
to go to the emergency room or Urgent Care at San Francisco General.
Some, and sometimes quite a few, of those who show up and do not have
a real emergency have to be turned away because the sickest patients
have to be accommodated first.  The rest are seen when possible.  Docs
and NPs are under a lot of time pressure, and tell the patient to come
back if needed, but it is an exhausting process for the patient.

If you cannot get a "primary care" appointment before your refill runs
out, or you have new symptoms, you have to go through the same thing
again.  If you have an adverse reaction to a new medication (which you
might have to switch to, because only certain brands are covered in
the public system) you have two choices: stop the medication and hope
the underlying condition you take it for doesn't hurt you, or go in
and wait again.  Meanwhile, "routine" care is not available, and even
people who are urgent but not emergent may have to wait hours or days
to be seen if the ER is busy and the overflow to urgent care is too
much.  I have seen cases of folks who waited all night and all day to
be seen for problems that were urgent but not emergent.  At this
point, it is hard to separate their original symptoms from stress and
sleep deprivation!

So we are approaching a situation where you have to be really scared
or really motivated, or terribly ill to stay the course and get
medical attention.  In short, third world conditions.

And what can the docs do?  How many months of medication refills do
you give someone who needs powerful meds but is out there with no doc
that knows them?  How much longer do you make all the other patients
wait while you try to teach the patient to self monitor or you get on
the phone and try to "work the system" to get an appointment for the
ones who concern you the most?

And now we are being told that things will get worse...

Teresa Palmer M.D.

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Dear emergency coalition members,

Thank you Terry for getting to the heart or heartlessness of the
matter. Already columnists like Debra Saunders and Ken Garcia are
hailing the new terminator's courageous budget decision to cut
healthcare to the frail elderly, children and their parents as the
best thing since our invasion of Iraq.

I'm a primary care provider at the Cole Street Youth Clinic and am
waiting for the dance of the budget process to begin in earnest once
the other shoe drops tomorrow with a real look at the Terminator's
cuts. Public health will be hit hard so hard some of us, like our
patients, won't be able to get up again.  I'm still not sure I
understand why a car tax was so much more important than funding
healthcare for kids.  But there you go, I think to much like a nurse
who sees the long term damage that our salesman in chief aka the
terminator, will do if we go ahead with the cuts. I intend to join
thousands for the call in week, I'm choosing children's day, to offer
my professional opinion of the cuts along with others through the
Health Access network.

I will stay in touch about the specifics that will be proposed once
the process begins.

In solidarity,
Nancy Lewis, FNP
Cole Street Youth Clinic