Don't Get Sick: The crisis in Stanislaus County

A health care crisis is sweeping the Central Valley, devastating middle-class and poor families and threatening to overwhelm the region’s fragile safety net.

The deep recession has pushed the ranks of the uninsured here to unprecedented levels. At the same time, a dire state budget deficit has forced lawmakers to drastically scale back or eliminate key health care programs for the state’s poorest residents.

At the nexus of these two trends lies a troubling new reality: Across class lines, people are struggling to access care — or simply are going without.

Doctors and nurses at county and nonprofit clinics say they're seeing mounting numbers of out-of-work professionals and laid-off blue-collar workers joining the chronically poor and undocumented in waiting rooms throughout the region.

Dr. Negin Taher examines Donna Dudley, 47. (Darryl Bush/The Modesto Bee)

In the past few years, growing numbers of unemployed workers have added 700,000 to the ranks of the state's uninsured, bringing the total to 7.1 million.

In Stanislaus County, more than 90,000 people are uninsured, including a quarter of all adults ages 18 to 64, according to the most recent census data. An additional 105,000 low-income residents are enrolled in the state's Medi-Cal program.

"When people become uninsured, not only do they live sicker, they die younger, they're one emergency away from financial ruin and there are very few options available," said Anthony Wright, executive director of Health Access California, which advocates for affordable health care for all Californians. "It's a tattered safety net that has gotten worse because of the budget crisis."

Federal health care reform has begun gradually rolling out — expanding coverage through small businesses and community health centers, and providing new insurance options for young adults and people with pre-existing conditions. But many of the bill's major provisions — which, as passed, would ensure some form of coverage for virtually all legal residents — will not take effect until 2014.

Until then, with cuts to health care on the horizon in Sacramento, and with California burdened with one of the nation's worst unemployment rates, some patients are finding there's no safety net left to catch them.

While the whole state is suffering, counties in the Central Valley — including Stanislaus — have been hit particularly hard.

• In the past five years, applications to the county's Indigent Adult Health Services program for the uninsured rose more than 40 percent.

• Some 55,000 Stanislaus County adults on Medi-Cal saw their dental, podiatry, psychology and other "optional" benefits eliminated in July 2009.

• The county Health Services Agency, a system of six primary care clinics that was ailing before the recession, has lost 126 positions since 2005, a quarter of its staff. As a result, the clinics see 14,000 fewer patients than they did five years ago.

• County Behavioral Health and Recovery Services, which oversees mental health and drug and alcohol services, closed three mental health clinics five years ago and in the past three years lost almost 200 employees — nearly 40 percent of its staff.

Asked where the uninsured mentally ill can go to access care, Denise Hunt, the department's director, said simply: "I don't know."

"It's been very difficult," she said. "Let's just put it that way."

Unprecedented need

While numbers help outline the contours of the crisis, they don't capture the frustration and embarrassment that Dr. Del Morris, the county medical director, sees in many new patients seeking care from the county clinics.

"They've never experienced in their life having to do this kind of thing," he said. "Some of them have given up a lot of pride."

He rattles off a list: