Public Counsel eNews

Innovative Pilot Program Advances Healthcare at “Hope Central”

“The rates of tuberculosis, AIDS, hepatitis and sexually transmitted diseases in this neighborhood are strikingly higher than in the rest of Los Angeles County,” says Dr. Lisa Levsen Abdishoo, Medical and Executive Director of the Los Angeles Mission Community Clinic (LAMCC) on skid row in downtown Los Angeles.

“Only 6% of the patients we see have MediCal or Medicare insurance, and none have private healthcare insurance,” continues Dr. Levsen Abdishoo, “and more than thirty percent of the homeless adults we serve have one or more chronic diseases such as diabetes, arthritis, hypertension or cancer, but, she says with a smile, we prefer to call this clinic “Hope Central.”

The narrow halls of the mission clinic offices are crowded with both her dedicated medical staff and the residents of the community. In the waiting area, lining the walls, are religiously themed posters bearing mottos of faith and hope. One reads: "For I know the plans I have for you," declares the LORD, "plans to prosper you and not to harm you, plans to give you hope and a future." (Jeremiah 29:11). The LAMCC patients, men, women and children, all look tired, worn, and yet relieved to be in the safe surroundings of the clinic, with the doctor and her staff close at hand.

Dr. Levsen Abdishoo is glad to have Public Counsel close at hand, “The free legal assistance we receive from Public Counsel and its volunteers really makes a difference,”

The work of LAMCC is overseen by a dedicated volunteer board of directors, one of six participating boards in the Public Counsel Community Development Project’s Healthcare Clinic Governance Initiative, a pilot project funded with a generous grant from The California Endowment. The purpose of the pilot is to enhance the organizational strength of safety net healthcare providers like LAMCC through an on-site program of free legal, regulatory compliance and board development assistance. By providing legal assistance and training for the board and senior management, the pilot seeks to enhance the ability of clinics that serve the most vulnerable populations of Los Angeles County to survive in difficult financial times, and to devote more of their limited resources to patient care.

LAMCC was itself conceived in difficult times. In 1995, budget problems in Los Angeles County led to severe cutbacks in service at county medical facilities, and the first of many recent healthcare access crises for its more than 2 million uninsured residents. One ray of hope emerged in a most unlikely place. A Skid Row “crack house” hotel was purchased and remodeled to contain five examination rooms, intake and phlebotomy rooms, a classroom, a dispensary and several offices. Shortly thereafter, the Los Angeles Mission Community Clinic (LAMCC) opened its doors to the uninsured of Los Angeles, and began providing primary healthcare for men, women and children living in an area with the highest concentration of homeless individuals in the United States.

LAMCC and all the other pilot participant clinics have been granted either Federally Qualified Health Center (FQHC) or “look-alike” status because of their demonstrated ability to provide high quality, cost-effective and comprehensive health care to medically underserved people regardless of their ability to pay. “At the heart of the FQHC designation,” says Sarah Stegemoeller, staff attorney with Public Counsel’s Community Development Project, “is that what makes these clinics truly unique among healthcare providers: consumer governance. With rare exception, the majority of every FQHC and look-alike board must be comprised of the medically underserved low-income patients who rely on clinic services as their primary source of medical care.”

Given the populations typically served by FQHCs, their consumer members often have not previously served on boards of any sort and need extensive training both with respect to the role of a nonprofit board generally and legal issues that are unique to healthcare institutions. More experienced board members also need training, particularly continuing education with respect to the important oversight responsibilities that are triggered by fraud and abuse laws, False Claims Act issues, and the innumerable federal and state regulations related to patient care.

“This is where the Public Counsel’s pilot project comes into play and, frankly, it’s a very exciting and cutting-edge area of law,” says Dan Grunfeld, Public Counsel’s President and CEO. “It’s coordinated through our Community Development Project by Sarah and the volunteer attorneys from firms throughout Los Angeles to bring to each clinic's boardroom critically needed expertise in healthcare, regulatory compliance, employment and corporate law that none of the clinics could afford to hire on their own.

Sarah emphasizes the critical importance of tailoring training modules to the specific needs of each clinic: “FQHC boards are required to meet every month, and the directors of our pilot clinics are incredibly committed, but often over-extended. While nonprofit board training may be available from a variety of sources, it typically is not free and does not address the unique issues that face community clinics located in the diverse neighborhoods of Los Angeles County. Besides, generic training seminars require board members to take additional time that they cannot afford away from employment and family obligations. By working with each participant board to prioritize its learning needs, and then offering training at each clinic site in manageable bites during the time of the regular meeting, the pilot maximizes participation and minimizes cost.”

“The proactive nature of this work is what’s so innovative,” says Liz Bluestein, directing attorney of the Community Development Project. “We’re not waiting for these boards to buckle under the inevitable pressure of the governing consumers’ inexperience. Healthcare law is difficult enough for attorneys, much less the uninitiated.”

“Of course,” says Sarah, “as compliance education is shared, it is inevitable that compliance concerns will arise. The premise of the pilot is that no legal obstacle should create a barrier to the provision of health services through a community clinic, and the potential cost of legal help should not compromise the desperately needed health care from clinics, which are already strapped for financial resources.”

Ultimately, it is the goal of the pilot to help each of these clinics become what every viable nonprofit must be: less dependent on the vagaries of government funding and more attractive to new board members and new funders. As the community-based boards of the pilot clinics are strengthened and empowered, the voices for healthcare advocacy in Los Angeles neighborhoods will multiply, allowing the clinics to more effectively serve their patients, and become more powerful change agents in their communities.