Los Angeles Times

Clinics fill need for healthcare

During the pandemic, emergency OB-GYN centers allow patients to avoid long waits.

- By Rachel Scheier This story was produced by Kaiser Health News (KHN), a national newsroom that provides in-depth coverage of health issues and that is one of the three major operating programs at the Kaiser Family Foundation. KHN is the publisher of Cali

Appointmen­t backlog drives many women to urgent care.

SAN JOSE — Last spring, only weeks into the pandemic, Christina Garcia was spending her days struggling to help her two young sons adjust to online schooling when she got such a heavy, painful period she could barely stand. After a few days, her vision began to blur and she found herself too weak to open a jar.

Garcia’s regular OBGYN — like most medical offices at the time — was closed, and she was terrified by the prospect of spending hours waiting in an emergency room shoulder to shoulder with people who might have COVID-19.

By the time she stumbled into the newly opened Bascom OB-GYN urgent care clinic at the Santa Clara Valley Medical Center, clutching a pillow to her belly, Garcia was pale and dehydrated from blood loss and certain she was dying.

“If I didn’t get to the clinic when I did, I think, things could have ended up very different,” said Garcia, 34, who underwent an emergency hysterecto­my for uterine fibroids.

Her story illustrate­s a long-standing gap in women’s healthcare. For years, many women with common but urgent conditions like painful urinary tract infections or excessive bleeding in the aftermath of a miscarriag­e have faced a grim choice between waiting weeks for an appointmen­t

with their regular OB-GYN or braving hours in an ER waiting room.

Urgent care OB-GYN clinics have begun popping up around the country in recent years, and the pandemic has increased demand. While no data are available on the number of urgent care clinics for women, they are part of a surge of interest in urgent care clinics in general and other alternativ­e models like retail clinics and so-called digitalfir­st healthcare startups. One of these, the New Yorkbased Tia (“aunt” in Spanish), won $24 million in venture capital funding last spring and is opening clinics nationwide.

“It’s clear that access and convenienc­e are increasing­ly more important to consumers than seeing a specific provider,” said Dr. Rob Rohatsch, chief medical officer at Solv, an app that books urgent care appointmen­ts.

The Urgent Care Associatio­n

has reported steadily increasing visits by people who use its members’ walkin clinics as an alternativ­e to hospital emergency department­s. Traffic to these clinics has surged during the past year, according to Solv.

The Bascom clinic had been a nearly decadelong dream of Drs. Cheryl Pan and Anita Sit, two obstetrici­an-gynecologi­sts at the Santa Clara Valley Medical Center, a sprawling public hospital that serves as the regional trauma center, treating critical cases like car accident and gunshot victims and relegating people suffering less life-threatenin­g problems to long waits.

“Women — perhaps pregnant or bleeding — could be sitting there 12 to 14 hours, depending on the time of day,” Pan said.

After the onset of the pandemic, doctors worried that women with serious or even deadly issues like Garcia’s might avoid seeking

treatment for fear of contractin­g COVID-19. ER visits plummeted an unpreceden­ted 42% in the early months of the pandemic, according to the Centers for Disease Control and Prevention.

“You can imagine that a woman with three kids at home might be even more scared,” Sit said. “We just couldn’t keep sending women having miscarriag­es to wait hours in the COVID tent.”

Instead, women can now be triaged over the phone and seen within a day or two at the Bascom OB-GYN urgent care clinic. Bascom is equipped to treat conditions from severe morning sickness to ectopic pregnancie­s that require emergency surgery. In its first year, the clinic has treated some 1,300 women and served as a backup to local clinics that provide basic reproducti­ve health services in counties hundreds of miles away. It’s still in its pilot phase, however, operating weekdays from 8:30 a.m. to 5 p.m., which “leaves a big chunk of offhours that we cannot serve women,” Sit acknowledg­es.

A handful of other clinics have taken the concept of urgent care for women a step further. Dr. Miriam Mackovic runs Complete Women Care, a chain of four clinics in the Los Angeles area that also has an emergency care center in Long Beach, which is staffed 24/7 with a nurse practition­er and equipped with a lab and a pharmacy. Women who walk in are typically seen within 30 minutes, according to Mackovic.

One woman who turned up at a Complete Women Care clinic said that, after desperatel­y seeking treatment at an ER one night for a nasty yeast infection, she got a bill in the mail for $1,500.

“In the middle of the night, urgent care centers are closed. OB-GYN offices are definitely closed. So, what is her option except the ER?” asked Mackovic, an obstetrici­an-gynecologi­st .

Mackovic ticked off cautionary tales of patients who’ve arrived at her clinics from as far away as Arizona and Nevada after suffering for weeks while trying to schedule routine operations for uterine cysts or twisted ovaries.

“The medical advances are here. Most emergencie­s can be resolved on an outpatient basis — a woman can have a hysterecto­my with just a fine incision and be home the same day,” Mackovic said. “But a woman who has a miscarriag­e calls her OB, who says there’s no openings for weeks, so she goes to the ER, and the physician says: ‘Are you dying? No? Then follow up with your OB-GYN.’ ”

Fees for the uninsured — around 20% of Mackovic’s clientele — run from $100 to around $600, she said.

Women in the United States have for years lagged behind those in other rich countries in both their access to healthcare and their health status. America has the highest maternal mortality rate among developed nations. Some women see a doctor only in an emergency.

“We have diagnosed so many cancers in the last few years because women walked in for another reason,” said Dr. Adeeti Gupta, founder and chief executive of a chain of clinics in New York City called Walk In Gyn Care that provides care without appointmen­ts.

Gupta’s three clinics have grown steadily since she opened them seven years ago. But after the coronaviru­s hit the city hard, she has seen an uptick in patients — 40% in one location.

The country needs more accessible, comprehens­ive women’s healthcare to treat everything from the menstrual pains of adolescent­s to the hot flashes of postmenopa­usal grannies, Gupta said.

“The thing about women,” she said, “is their problems never stop.”

 ?? Rachel Scheier Kaiser Health News ?? THE BASCOM OB-GYN urgent care clinic was a longtime dream of Drs. Anita Sit, left, and Cheryl Pan. The clinic opened last year at a San Jose public hospital.
Rachel Scheier Kaiser Health News THE BASCOM OB-GYN urgent care clinic was a longtime dream of Drs. Anita Sit, left, and Cheryl Pan. The clinic opened last year at a San Jose public hospital.

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