San Francisco Chronicle - Thursday, September 17, 1992

Ordered by Mayor Frank Jordan to find $25 million in immediate budget savings, health department staff members last week put the 25-year-old medical clinic on the hit list. Closing it January 1 will save the city an estimated $785,000 before the fiscal year ends in June, $1.6 million a year thereafter.

The clinic on 24th Avenue is the only one of its kind in the west side of San Francisco. Seven others -- all surviving the cuts -- sit in the busier neighborhoods to the east, like Chinatown, Bayview and the Western Addition, where the city's poor are clustered and more visible. NO REPRIEVE EXPECTED

Receptionist Aria Glenn has weathered other shutdown scares -- the clinic escaped the budget ax earlier this year and was once targeted by the Agnos administration -- but this time she knows the city's money problems are deep. "There was no logic to this decision," she said, shaking her head. "They made it in a week, behind closed doors."

By the standards of teeming San Francisco General Hospital, Health Center No. 5 is not a bustling, overcrowded place. It stands unobtrusively in a neighborhood of two-story bungalows with two-car garages. Traffic is light. You can hear birds in the trees.

But the poor of San Francisco come here at a steady pace: Young Asian women and their children, Russian immigrants, an elderly black man. They come to have their blood pressure checked, their medications adjusted, their babies vaccinated. Eight out of 10 have no insurance at all. The average cost of a visit is $5.

Health Center No. 5 director Luz-Mary Harris is visibly pained at the prospect of losing her clinic. "I understand that cuts have to be made," she said. "But it is like asking you, 'Which of your fingers would you like me to cut off?' "

NOT A VOCAL POPULATION

Harris looks at a map of San Francisco and wonders why her center lost out. "It leaves the whole western part of the city uncovered," she said. The working poor who make up her clientele do not have a strong political voice, she said. "If this neighborhood was more organized, this neighborhood would not have been chosen."

Closing Health Center No. 5 will put an end to nearly 5,000 visits to clinic doctors and nurse practitioners annually; to nearly 18,000 checkups with clinic nurses; to 19,000 home visits and telephone checkups to homebound patients by public health nurses.

In the waiting room, patient Michael Yee puzzled over a bill for $10. He was there just to have his tuberculosis skin test read, and he felt the charge was too high. "This is too much for low-income people," he said. "At San Francisco General Hospital, it is free."

STRAIN ON EMERGENCY ROOMS

If the clinic closes as planned in January, most of the working poor who make up Health Center No. 5's clientele will have little choice but to take the hour-and-a-half bus ride to the city hospital.

Budget cuts are expected to double waiting times at the San Francisco general emergency room, to as much as 16 hours. Appointments at hospital clinics, which must be made weeks in advance, will be cut by at least one-third, saving an estimated $4.4 million by June.

Brian Young, 36, who says he gave up his private insurance when it refused to pay his doctors for treatment for his HIV infection, began seeing a doctor he could call his own after learning about the clinic in his neighborhood. He called the decision to close it "appalling."

Karen Lindsay, 31, said she qualifies for Medi-Cal, the state medical program for the poor, but could not find a private doctor who would treat her for chronic fatigue syndrome. The city's neighborhood clinic "is the difference between having a doctor and not having one," she said.

Clinic medical director Dr. Lisa Johnson sees the closure of the clinic as a reversal of an ambitious experiment in public health, through which San Francisco hoped to forestall costly hospital stays by emphasizing primary care close to the people who need it.

"In this field, you have a sense of people falling through space, and we catch them," she said. "It was obviously working."

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