South LA patient falls through health system cracks

Dr. Ellen Rothman, director of quality assurance for St. John’s Well Child and Family Center's Women's Health program.
Dr. Ellen Rothman, director of quality assurance for St. John’s Well Child and Family Center's Women's Health program.

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As part of KPCC’s focus on health care reform, Patt Morrison visited St. John’s Well Child and Family Center in South Los Angeles. While at St. John’s, Patt spoke with Dr. Ellen Rothman, director of quality assurance for the center’s Women’s Health program. Dr. Rothman shared this story about a patient who, despite St. John’s comprehensive care model, did not receive the care she needed.

Before coming to St. John’s, Dr. Rothman worked on a Navajo reservation. She says the irony of moving to a major metropolis is that she feels more isolated and faces greater challenges finding the services and care for her patients in South Los Angeles than she did while on the remote reservation.

“I had a patient who came in for weight loss and she was a pretty heavy lady, so the first time she came in, and she’s like, 'Oh, I’ve had weight loss,'" said Rothman. "I was kind of like, 'all right,' but every time she would come in, it would be one pound down, three pounds down, four pounds down. She’d had a pap smear within a year, that had some mild abnormalities, but wasn’t anything much, and abdominal pain, and that was really her only complaint.

“She was actually African-American, she just didn’t happen to have a dependent child living with her, so she didn’t have access to even emergency Medi-Cal, and for adults, once you already have a Social Security number and you’re already at that door of eligibility, it’s like a Catch-22, because in order to get services, you need to have not only diagnosis but disability, but to prove that diagnosis, you need some insurance."

"So for this patient I had set her up with a CAT scan. Through the county system, I did a referral. I did every blood test I could think of, and I remember she gave me a huge hug the day that I told her she didn’t have HIV. And I told her, I remember telling her, 'I sort of wish you did, because if you did, it’s medication, I can start it, I know how to get that.'"

"The CAT scan, we looked, we followed up on it. It turned out that the first referral I did, they felt like the scanned form — referral form — was illegible, so they just... tossed it out, and I don’t, I don’t know exactly..."

She didn’t get a CAT scan because the paperwork wasn’t good.

"This patient was also a two-way street, so she was also absent from care, so she lost – she left care somewhere after, I think, after, I think, after I did the second CAT scan referral.”

She didn’t come in for her follow-ups.

"I think her partner had been in a big accident — there was something going on in her family," said Rothman. "And so she didn’t come back to [the] clinic until about eight or nine months later, and when I saw her eight or nine months later, she was 70 pounds down, she was very, very thin. And I did another CAT scan referral.

"We sent her to the emergency room for very profound anemia. When she got to the emergency room, they transfused her and didn’t bother to ask why a 40-year-old woman should be so anemic and just discharged her with 'follow up to her primary,' which was me. And, you know, by the time she finally presented with her uterine cancer, it was extremely advanced.”

“And she, she ultimately she died of it and, the thing that made me the saddest is that she’d had all these encounters with health care professionals — myself on a number of occasions, a couple of times she had presented to the emergency room. And, and I felt like, you know — I work pretty hard for my patients and I work pretty hard to try and get them the services that they need. And the thing that made me absolutely the saddest is that she’d had all these interactions with the health care service, and not one of us could pull together the care that she needed.”

For more stories and ideas for health care reform, listen to KPCC's Patt Morrison this Wednesday, Feb. 10 at 1 p.m.