LOCAL HEALTH CLINIC CLOSURES LEAVE PATIENTS WITH ILL FEELINGS.

Byline: Susan Abram and Troy Anderson Staff Writers

NORTH HOLLYWOOD - The sign taped to the door of the county's North Hollywood health center warned of the clinic's imminent closure. It struck 16-year-old Irlanda Santos as unfeeling and unreal.

Since childhood, Santos has walked to the center, just a few steps from her house off Tujunga Avenue, for sore throat exams, back-to-school shots, or just to talk with the doctors, nurses and aides she grew up with.

Santos now has a child of her own, and the fact that the clinic will not be there for her after the end of the month is just beginning to sink in.

``I just wanted to make sure it was true,'' Santos said as she sat with 1-year-old daughter Jackie in the waiting room last week. ``I like the doctors here. I already know all of the people. Now I have to find somewhere else to go. I'm going to have to learn how to drive or take two buses to Olive View.''

Since 1953, the 7,500-square-foot building in North Hollywood has been one of the few area clinics where the poor and uninsured could receive medical care.

Last year, the center logged more than 30,000 visits - more than any other county clinic in the San Fernando Valley - offering everything from prenatal care to immunizations, to family medicine and other services.

Now the North Hollywood Health Center, 5300 Tujunga Ave., as well as Valley clinics in Burbank and Tujunga, are among 11 clinics countywide that stopped taking walk-in patients this month in preparation for closing.

Others that have already closed include ones in Alhambra, Azusa, Bell Gardens, Florence-Firestone, Imperial Heights, Lawndale, Norwalk, Pico Rivera and Huntington Park.

In addition, school-based clinics at Kennedy High School in Granada Hills, Pacoima Elementary School, Vaughn Street Charter School in San Fernando and Gardena High School have also closed.

The move follows a Board of Supervisors' vote earlier this year to trim health spending by $100 million. The cuts will force more than 26,000 patients to find health care elsewhere as the health department attempts to reduce its budget by $800 million as federal bailout funds run out by 2005.

County officials have been making plans to refer some of the 3,000 patients who visit the North Hollywood and Tujunga clinics to Olive View-UCLA Medical Center in Sylmar and to the Mid-Valley Comprehensive Health Center in Van Nuys.

Despite warning letters and the new limits on walk-in patients, some patients are meeting closure plans with denial.

They say they cannot foresee a trip to the remaining clinics. Others dread the thought of visiting county hospitals, where emergency room waits average about four hours.

``I don't know,'' said a reserved Rosa Lopez of North Hollywood when asked her plans for future medical care. ``I don't drive.''

Lopez's response could be heard across the Valley - in Tujunga, for example, where about 10,000 patients a year are seen, and in Burbank, where an additional 16,000 visits were logged last year.

``Instead of taking one bus, it's going to be two now,'' said Carla Nino, assistant administrator for the Valley Care Health Center Operations.

The situation is difficult as well for the clinic staffers, said Jose Felix, who oversees 50 employees at the North Hollywood center.

``We have people on staff here who live in Valencia and the Antelope Valley who have been transferred to Long Beach and Torrance,'' he said.

Dr. Myrna Kahn, the center's lead pediatrician, said she and other physicians are filing grievances with labor unions because of the transfers.

Despite her own worries, she remains concerned for the clinic's thousands of patients.

In the last seven years, health care professionals have worked to encourage preventative medicine among the poor, a population that often does not access health care until there is an emergency.

The county's decision to close neighborhood and school-based clinics will disrupt those preventative habits, which will be difficult to relearn, even if a windfall of funding should come, and the clinics are reopened, administrators said.

More than 80 percent of the patients who come to the North Hollywood clinic do not speak English, Kahn said. Many are illiterate in their own language and need help translating their medications.

Kahn points to a character in an episode of the television program ``ER'' as an example of what could happen.

``She read the prescription as take 11 pills a day, not as take one pill once a day,'' she said. ``It's just a television show, but we see that all the time.''

Health problems like diabetes, tuberculosis and sexually transmitted diseases are at the top of the list among patients who visit the clinic.

``The middle and upper classes don't see this as a problem,'' Kahn said. ``But many of these people are part of their families. They are their housekeepers, their children's friends.

``I foresee tremendous public health problems,'' Kahn continued. ``I foresee tragedy all the way around.''

Board of Supervisors Chairman Zev Yaroslavsky said the patients from the North Hollywood and Tujunga clinics and other patients in the San Fernando Valley still have eight public and private clinics the county contracts with to go to. These include the Mid-Valley Comprehensive Health Center in Van Nuys, San Fernando Health Center, Mission City Community Network in North Hills, Valley Community Clinic in North Hollywood, Northeast Valley Health Corporation in Pacoima, San Fernando and Canoga Park and El Proyecto del Barrio in Canoga Park.

``Anytime you make it more inconvenient for anybody to get medical care it's not a good thing,'' he said. ``That's why this is such a mess for us. But this is just the tip of the iceberg.''

On Oct. 29, the Board of Supervisors are scheduled to vote on the next round of health cuts, which include closing the emergency rooms at Olive View and Harbor-UCLA Medical Center in Torrance and converting the hospitals to outpatient facilities.

CAPTION(S):

3 photos

Photo:

(1 -- color) Irlanda Santos, with her daughter, Jackie, 1, has always relied upon the North Hollywood health center. The clinic, along with 11 others countywide, is closing in an effort to trim health spending by $100 million.

(2 -- 3) Van Nuys resident Jackeline Garzona, 23, who is eight months pregnant, waits at the North Hollywood health clinic, left. The facility is one of 11 countywide slated for closure. Above, Josefina Garibay, 39, with children, from left, Bryan 14, Lupita, 1, and Frankie, 6, speaks with a nurse at the North Hollywood health clinic.

Tina Burch/Staff Photographer