Pediatric clinic's private practice model comforts kids and families

March 15, 2012

Doctors follow low-income patients from birth through teen years, building trust, care quality

When his kindergarten class held a party for "special guests" last year, 7-year-old Jacob Critser had no trouble figuring out whom to invite.

"Dr. Alla Aminova holds a very special place in Jacob's heart," says his mother, Wanda Critser.

Jacob was born with a congenital heart problem — tricuspid atresia with pulmonary stenosis — a condition that has prompted three surgeries so far in his young life. Though he has a team of doctors that he sees twice weekly at Stanford University's Lucile Packard Children's Hospital in Palo Alto, Calif., Jacob's medical home is at O'Connor Hospital's Pediatric Center for Life in San Jose, Calif., where staff members, including Aminova, oversee everything from routine immunizations to school support services for him.

"The level of care and compassion at PCFL is outstanding," says Wanda Critser. "Despite the huge number of patients they see every day, the staff always goes beyond the call of duty to make sure everyone is okay."

Cynthia Hutchinson, mother of Cyrus Fitch, 16, and Cassondra Hutchinson, 11, shares much the same sentiments. Though neither of her children have serious health concerns, she says the consistent care they have received at PCFL over the years has led to a "level of comfort" impossible to duplicate at any other area clinic open to children covered by government-sponsored health insurance. The clinic also treats children covered by private insurance and uninsured children.

Early intervention
Dr. N. Thad Padua, the center's medical director, has been Cyrus' pediatrician since the boy was 5. The continuity of that patient-doctor relationship helped Padua diagnose and then medically manage Cyrus' attention deficit/hyperactivity disorder long before serious school problems occurred, Hutchinson says. As a teen, Cyrus still feels comfortable enough to discuss sensitive topics with Padua.

"At our last appointment, Cyrus was concerned about the possibility of premature hair loss. Dr. Padua handled the issue with such understanding; he referred Cyrus to a dermatologist to examine his scalp," says Hutchinson. "Our family feels incredibly lucky to be a part of PCFL."

Opened in 1991 as an extension of O'Connor's Center for Life obstetrics program, the pediatric clinic originally was conceived as a full-service medical clinic to provide quality health care for the many newborns at the hospital whose low-income families could not access pediatric care.

"We are a collaborative effort — a nonprofit, hospital-owned clinic operated with private pediatricians," says Padua. "We mirror the dedication of the Daughters of Charity Health System to serve the sick and poor by offering everything from well exams to urgent care treatments, case management and referrals to economically disadvantaged children, up to 18 years of age, in the greater San Jose area."

Multicultural patient base
The pediatric center's goal is complicated by the diversity of the Santa Clara County population it serves — one that is among the most multiethnic in the country. According to center manager Quina Wilson, the center's patient population is 82 percent Hispanic/Latino, 10 percent Caucasian, 5 percent Asian American and 3 percent Black American and African immigrants.

"A majority of our patients and families speak a primary language other than English," she says. "We place an emphasis on providing culturally sensitive care; members of our staff are proficient in Spanish, Russian and Tagalog as well as English."

In the 20 years since its inception, the center has grown exponentially, both in patient population and the panoply of services it provides.

"At the beginning, our staff consisted of a sole pediatrician, one nurse and one receptionist handling 20 to 30 appointments per day," recalls Padua, who has been at the pediatric clinic since it opened its doors. "Today we have three full-time and two part-time physicians, a part-time nurse practitioner, three nurses, one social worker, one full- and one part-time medical assistant, a manager, three front-office people and an administrative support person. On a busy day, we can easily see 95 to 100 patients."

Ongoing care
What distinguishes PCFL from other area clinics established to serve the poor and the uninsured is its private practice model, in which each patient is assigned a primary care physician and sees that physician from infancy through adolescence. That consistency, says Padua, nurtures ongoing trust between doctors, patients and their families, and allows for consistent monitoring of health and related factors. The clinic sees asthmatic patients every three months to make sure they have proper medications. It offers preventative health education programs to address diabetes and obesity, and it promotes literacy through a "Reach Out and Read" program.

That same private practice model has grown to include wraparound services to address the mental and emotional well-being of patients as well. Center social worker Heather Vogel estimates that she sees 2,000 out of the 4,000 children at some point during their years as clinic patients.

"Much of my job is helping families access community resources, be it for postpartum depression, neglect, abuse, anxiety, behavior problems, learning disabilities or even suicide attempts," she says. "Sometimes I just make referrals for counseling or therapy, other times I directly advocate for kids who need support services at school."

In addition, Vogel spearheads the "Back-To-School Drive" and the "Christmas Clothing and Toy Giving Campaign for Children" each year to benefit 150 of the clinic's most impoverished patients, an effort supported by office staff as well as hospital associates.

Demand to increase
As state and local funding for safety-net clinics and health care resources continue to dwindle, PCFL finds itself filling the void left by financial cutbacks. And as the Patient Protection and Affordable Care Act makes greater numbers of families and children eligible for government-sponsored health insurance, demand is certain to increase as well. Last year, the center provided more than 14,500 primary health care visits. This year, it expects to administer more than 16,000 visits.

"Our clinic serves a great purpose — one that keeps growing and growing. By providing timely, quality care to children, regardless of their financial status, we can avert so many more serious health problems later," says Padua, who recognizes that his passion for the clinic's mission is rooted in gratitude for the opportunities he's had.

"I grew up in San Francisco, and my parents, who were immigrants, also struggled financially. My father worked three different jobs; my siblings and I never saw him," he says. The clinic, he adds, is his way of giving back to the community — and hopefully ensuring it a brighter future.


Copyright © 2012 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2012 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.