Health & Medicine

UC Davis clinic serves the uninsured in Sacramento for free

Daniel Heidelburg normally heads to the emergency room when his breath gets short and his heart starts racing. But on one of his recent visits to the ER at UC Davis Medical Center, his doctor told him about a different option for follow-up care: the school’s free TEACH clinic.

Earlier this month, Heidelburg, 51, a former Paratransit driver from Oak Park, paid his first visit to the UC Davis clinic, which is housed inside Sacramento County’s Primary Care Clinic at 4600 Broadway. Heidelburg was examined by third-year medical student Kevin Dias and Dr. George Gallardo, a third-year resident. Dias and Gallardo are part of a core group of 25 medical students and nine residents who work at the Transforming Education and Community Health clinic, which treats about 2,000 patients a year.

Like many of the patients, Heidelburg’s condition is complicated. He suffers from respiratory disease and recently dropped one of his oxygen canisters on his left foot. Five years ago, he was diagnosed with atrial fibrillation – an irregular heartbeat.

Gallardo told Heidelburg his test results were good. “The guys in emergency didn’t see a fracture in your foot. ...  Your heart rate looks fantastic, and we’re going to send you to the lung guys.”

Heidelburg, who said he exhausted his savings and his COBRA supplemental insurance six months ago, pronounced himself satisfied. “For the treatment I’ve been getting here, I’ve seen a lot worse,” he said.

Started in 2005 with a $3 million grant from the U.S. Department of Health and Human Services, the TEACH clinic has likely saved taxpayers millions of dollars in emergency room visits, said Mark Henderson, UC Davis Medical School dean of admissions. “Emergency room care is vastly more expensive, and our medical students don’t cost the county anything,” Henderson said.

At the same time, Henderson said, the clinic has helped UC Davis attract a more ethnically diverse crop of medical students, many of whom intend to remain in primary care.

“Our mission is to serve the citizens of California and produce more physicians capable of, and willing to, take care of the neediest patients, not win the Nobel Prize,” Henderson said.

Two-thirds of the MDs who graduate from the TEACH program go on to practice primary care or general internal medicine, Henderson said, compared with only 20 percent of medical school graduates nationally. Experts predict a shortage of nearly 50,000 primary care physicians by 2020.

The TEACH program has helped make UC Davis Medical School one of the most diverse in California by attracting physicians of color, Henderson said. More than 40 percent of TEACH graduates in the last five years have been Latino, while only 4 percent of California doctors are Latino, Henderson noted. The doctors and medical students in the TEACH program include Latinos, Hmong, Indo Americans, African Americans and American Indians.

In June, the Sacramento Board of Supervisors was on the verge of eliminating the program as a cost-cutting measure. Dozens of students, community activists, doctors and professors testified to save the clinic, and the county reversed course.

“We got a temporary stay of execution from the Board of Supervisors until next year,” Henderson said of the program, which receives about $300,000 a year from the county in the form of facilities, nurses and support staff. Medical care is essentially free since UC Davis supplies the students, residents and consultations with specialists.

Henderson said the clinic fills a valuable niche for uninsured people and those on Medi-Cal.

“The Affordable Care Act is not a panacea for patients who have limited access to health care,” Henderson said. “You may dream everybody’s going to get Covered California insurance, but the reality on the ground is there are poor people and many people in insurance limbo who find it very difficult to get care. There aren’t enough primary care physicians, and many physicians refuse to see Medi-Cal patients because of low reimbursement rates.”

Even before it started providing care at the TEACH clinic, UC Davis operated free clinics for a few hours on weekends serving specific ethnic populations. For example, the Paul Hom Asian Clinic at 6341 Folsom Blvd. treats mostly Chinese and Vietnamese patients on Saturdays from 8 a.m. to 1 p.m. Clinica Tepati serves Latino patients from 9 a.m. to 1 p.m. Saturdays at 1820 J St. The Imani Clinic at 3415 Martin Luther King Blvd. in Oak Park treats patients on Saturdays from 9 a.m. to 1 p.m. The Shifa Clinic next to the V Street Mosque at 419 V St. treats patients who speak Urdu, Hindi, Punjabi, Arabic, Bengali, Fijian, Farsi, and Russian from 8:30 a.m. to 2 p.m. on Sundays. The Bayanihan Clinic, open Saturdays from 9 a.m. to noon at 1281 North Ave., treats many Filipinos, including uninsured Flipino veterans of World War II.

The TEACH clinic is open from 1 to 5 p.m. Tuesday to Friday, so it can provide more consistent care to patients than the clinics with limited hours, often by the same doctors and medical students they see if they’re hospitalized at UC Davis Medical Center.

Dr. Sara Teasdale, 29, a third-year resident who sees up to half a dozen patients a day, said a lot of them suffer from seizures, diabetes and/or mental health issues. “Their only option is the emergency room unless they come here, where you can get the best specialists from UC Davis to give you their time,” she said.

One of her recent patients, contractor Patrick Hackett, fell off a roof in February. He suffers from severe back pain, depression and a recent stomach hernia. Hackett said he has had no insurance since 2009, when his business folded during the recession. He visited the emergency room three times in one month – once racking up a $73,475 bill – before becoming a TEACH patient earlier this year, Teasdale said.

“He has had no ER visits since,” she said.

Many patients have an array of physical and psychological problems. Donald Dubose, accompanied by his wife Frances and two young children, recently arrived with back, knee and shoulder pain, arthritis, depression and confusion. Dubose said he’s suffers from seizures, short temper, paranoia and hallucinations when he’s off his psychiatric medication.

“I get frustrated and take off and I’ll be gone for days at a time,” he said.

Teasdale assessed his pain and depression levels, conducted a full interview and restarted Duboses’ psychiatric medication, which had run out months earlier. She scheduled a follow-up for him in two weeks.

“I love this place because it’s one-stop shopping,” Frances Dubose said.

Some of the UC Davis doctors working in the TEACH clinic said they were motivated by their own experiences growing up. Stephany Sanchez, who has stayed on as a primary care physician after completing her residency, said she grew up in El Paso, Texas, around many uninsured families who were undocumented or couldn’t afford care.

“I was very aware of the inequality and lack of access to medical care that many people endured, and the pain and sickness that could have been prevented early on,” she said.

Cheng Nguyen, a Hmong refugee from Laos who grew up in Oak Park, said she had to translate when her parents went to the doctor.

“I saw the disrespect and disparate treatment they encountered at clinics and hospitals, and it became the impetus for my dream of becoming a physician,” said Nguyen, who testified in support of the clinic before the Board of Supervisors.

Uninsured patients or those with Medi-Cal can access TEACH by calling (916) 874-9777 to request an appointment.