COUNTY OPENS N. HOLLYWOOD CLINIC.

Byline: Keith Stone Daily News Staff Writer

The doctor is in.

Los Angeles County's health center in North Hollywood began offering medical care Tuesday for high-risk pregnancies - a major step in the county's plan to shift its doctors out of hospitals and into neighborhoods.

By April, the North Hollywood center expects to begin offering nonemergency health care for adults five days a week, and eventually so will all five public health centers in the San Fernando Valley.

"We are working on a new identity. We are serving the same patients, but we are trying to treat them with a new approach," said Gretchen McGinley, who oversees the Valley's health centers.

In recent years, county health centers provided limited medical treatment, mostly for children, pregnant women and adults with TB or sexually transmitted diseases. The result is that many people with routine problems have ended up clogging the county's emergency rooms.

That is about to change:

Following near bankruptcylast year, the nation's second-largest health care system came under pressure from the federal government to basically reinvent itself. Now the county is trying to adopt some of the same practices that are the cornerstone of care for privately run HMOs.

Just like a health maintenance organization, Olive View-UCLA Medical Center and its network of health centers has adopted a catchy name - "ValleyCare" - to replace the more dry San Fernando Valley Cluster.

And just like an HMO, the county plans to eventually assign each patient a doctor, to ensure consistency of treatment and to take care of problems before they require hospitalization or expensive treatment, McGinley said.

"We will try to take care of the problem in the health centers so they don't end up in the emergency room," she said.

"And then you don't clutter up a hospital - which is an expensive place to deliver care - with patients who just need a few tests," she said.

Los Angeles County is embarking on these ambitious changes with the encouragement of President Clinton. He and his health administration have agreed in principle to relax Medicaid rules so that the county could spend its government grants in neighborhood clinics, not just in hospitals.

"We don't get paid for it well now in the free-standing clinics. We get paid better in the hospitals," said Jonathan Freedman, a spokesman for the county health department.

The county expects to formally submit its proposal for the waiver this week.

At the same time, Los Angeles is negotiating with a consortia of private doctors, clinics and hospitals to take over health care centers and run them under contract with the county. That already is occurring in Canoga Park and Valencia.

On the leading edge of this transformation in the Valley is the North Hollywood center at 5300 Tujunga Blvd. For Evelyn Martinez, the addition of high-risk pregnancy care means she no longer has to drive 45 minutes to Olive View in Sylmar.

And the 26-year-old restaurant worker said she no longer has to wait with the hundreds of people who converge on Olive View.

"It is easier for me," said Martinez, whose pregnancy was deemed high risk because she has had two miscarriages.