Hellth-Care on Potrero Hill

by Laure McElroy

Regina Sharon is a homegirl, a third generation San Francisco native and mother with deep roots in her Potrero Hill community. She is also at present (like me) a member of California's state-funded medical insurance program, Medi-Cal. For as long as Regina can recall, her family has gotten healthcare from their neighborhood clinic, the Potrero Hill Health Center (PHHC).

Two months ago, an eight months-pregnant Regina visited PHHC, seeking to be seen as a drop-in. "I was near the end of my last trimester but I hadn't had any prenatal care. I had been planning to make an appointment anyway, but I decided to go in that day rather than wait because I had been feeling sick all week."

"Feeling sick" in this instance meant far more than morning sickness; Regina was having hot flashes, headaches, and her hands and feet were enormously swollen. "I have a history of health problems around pregnancy," she says. "I miscarried my first child, and with my second I had preeclampsia so bad, I had to stay in the hospital for almost a month. I was really concerned for me and for my baby, and I was relieved when they told me I could go in that day, because I didn't know what was going on with my body."

Hearing Regina's story made me reflect on my own health care history. My mother raised me in Oakland, CA; she was a working-class woman, a single parent by virtue of divorce. Her ex-husband, my father, had a corporate job with middle-class benefits, including a health plan on which the court ordered him to list me as a beneficiary. This meant that although we were by no means wealthy, as a child I enjoyed regular shots, check-ups and care, preventive and otherwise, administered to me in spacious, fully equipped offices by sleek, respectful, well-fed staff. My mother was just like any other mother; she wanted me clean, well-fed, and above all, healthy.

Mother-to-be Regina kept her appointment at PHHC, happy that she only had to wait a week to be seen. She took her preschool-aged son with her, since it was a weekday morning and she did not have childcare.

"I arrived, checked in, and was taken to an exam room," she said. "The exam rooms aren't really rooms, they're just spaces partitioned off with curtains. So I was in the exam room waiting and my son kept slipping out into the hallway, you know, running around like kids do. I was trying to keep an eye on him but I wasn't feeling well at all, and they don't have any toys or play area for patients' children there.

Well, about 15 minutes later, this doctor, not my doctor, comes into the room without announcing himself or asking, dragging my boy by the arm. He glares at me and snaps in a very nasty tone, 'You need to control your children when you're in this clinic!'"

The doctor left and an outraged Regina called a friend on her cell phone to describe the event. In the conversation she expressed her opinion about how the man had treated her, using some choice words. "I said to her, 'you know what this m-therf----er just
did?' I was very angry, but I wasn't shouting or even speaking in a normal tone; I lowered my voice because I did not want to be overheard. It was a private conversation. I wasn't talking to him at all when I said what I did, he wasn't even in the room! I didn't
like the way he had talked to me or the way he had mishandled my son, but I was sick, and I wanted to be seen, not cause a scene."

Despite her precautions and despite what one could call a reasonable assumption that her right to a private telephone conversation would be honored as she waited alone in the exam area, the rude doctor overheard her. "He stormed back in, carrying on about how I needed to apologize for calling him out of his name. He was yelling. He didn't care my son was there. I thought he was going to hit me."

Regina pointed out to him that since he hadn't been the room at the time and she had had no idea that he was listening to her phone call, she couldn't have been addressing him, but her goal was to visit her own doctor, not to insult another. "I told him that I was sorry if I had upset or offended him in any way, even though I had not actually been talking to him." The angry doctor finally left, and she thought the matter was finished. But 10 minutes after he exited, the head nurse came in and told her that she would have to leave the clinic or be "escorted" out by the police.

…

Safely ensconced in the rosy glow of pre-HMO corporate healthcare benefits, as a child I knew nothing of the kind of HELLthcare mistreatment that those of us who cannot afford increasingly expensive private care, those of us who depend on so-called "safety net" services, sometimes endure. My innocence ended one Sunday night in 1994 when I visited the hospital near my house, seeking care for a painful case of food poisoning.

This hospital happened to be private, and as a twenty-something who was (like many of us) much worse off financially than my parents were at the same age, I was medically indigent at that point in my life, no health insurance at all. When I got to the emergency room, clutching my stomach in agony, the front desk staffer looked me up and down then immediately started trying to persuade me to leave and go to the public hospital, which was a half-hour bus ride away. I insisted on being seen where I was because I was afraid that the diarrhea and the vomiting would start up again while I was trapped on the bus.

After waiting 2 hours, an inordinate amount of time considering there were only two other people in triage, a nurse led me back into a freezing exam room. She brought me a gown and an extra sheet, and then told me to strip and lie down on the exam table, a frosty metal affair covered by a stingy strip of butcher paper. An hour and forty five minutes after that, the doctor on duty entered. I smiled at him, relieved, until I noticed his glare, which was even colder than the table. "Sorry," he clipped, lip curled, "but we don't give out opiates. You won't get any drugs here."

I stared at him, nonplussed; it had never occurred to me that the man would assume I was trying to scam the place for drugs. I had been concentrating only on the burning pain in my stomach and bowels, and not the political and social realities that plague me as a Black woman with very little money trying to access medical care in the US. I begged, nearly cried, and ultimately refused to leave until someone helped me, or told me what to do to help myself. The doctor scowled even deeper and stomped out of the exam room again. He came back with a thimble sized cup half full of Pepto Bismal, and pushed it toward me, lips tight. I actually thanked him, drank down the medicine, and left.

It took me until the next morning both to get over the poisoning and to fully feel how angry and humiliated I was behind the emergency room doctor's treatment of me. But I didn't go back to complain.

Doctors are considered superior in the American collective; even for those who are well - off enough to buy into the wealthy - are - healthy healthcare system, holding doctors and their institutions accountable for bad behavior is an uncomfortable, uphill battle. I was not coming from a place of material privilege AT ALL, and I was of course, painfully aware that I didn't even have that limited amount of power. I wanted to go in there and burn the place down with my scorn and my righteousness indignation, I wanted to scream at his superiors and grind an apology from them all, but I didn't pick up the phone because I knew my place, or so I thought, and I was afraid.

…

Regina continued her story."I was pregnant, I was sick and I had lost a baby in the past. I asked to see my doctor, I begged them to see me, but they wouldn't listen. They just kept telling me that I had to go until the police came and took me out by either arm. There was no referral to anywhere else, no checking my vitals, no nothing."

Switching to another primary care physician under the Medi-Cal "managed care" system would take time; Regina was angry and
humiliated, but her concern for her unborn child prompted her to call PHHC back that afternoon to ask her doctor when she could see her, stressing her symptoms. Her doctor advised her to wait a week. She kept calling.

Two weeks after the incident, she received a letter from her own doctor (who had not been involved in the incident) stating that the only way she would be allowed back on clinic property was if she signed a formal letter that the hostile, offensive himself had written, which had her admitting that she had threatened him and apologizing.

"I was still sick, had gotten worse, in fact, probably because of all the stress. I was so afraid." She stared at me levelly, hands clasped on top of her belly. "I knew that what they were asking for wasn't the way it had happened, but what else could I do? I signed the letter."

Signing such a letter may seem like an inconsequential thing, but threatening or otherwise abusive behavior toward another person while on clinic premises, especially a staff person, is grounds for denial of services according to the rules of public clinics in San Francisco. Regina Sharon, who has a history of pregnancy related illness, came into PHHC sick, afraid and seeking care for herself and her unborn. Regina felt that the doctor who had behaved abusively toward her used her vulnerability, her sickness and her need for medical care, to pressure her into admitting to something she had not actually done.

Why? Maybe that admission was necessary to excuse what otherwise would've been an unprofessional loss of temper, or maybe using it to deny her services later was an act of retaliation. Maybe, as one clinic insider suggested, Regina's individual episode of abuse is part of a systematic pattern of disrespect and even outright discrimination that targets people who come to the clinic unable to pay through to the higher realms of the sliding scale.

I do know that though what happened to Regina Sharon and what happened to me may sound dissimilar, but a sinister thread connects our histories; neither Regina nor I were given even the most cursory care because we were seen as people who had no money, no recourse, and thus no entitlement to proper treatment. If any of the medical staff we encountered had thought of us as being able to fight back, to field lawyers or powerful friends, there is no doubt in my mind that we would have been treated with more respect.

Laure McElory is a digital resister, welfare QUEEN, community journalist for POOR News Network and author of the recently published zine, System Bitch , which explores humans’ interactions and relationships with the systems that exist in today’s modern society from a myriad of voices. It is an intense collection of stories, poems and artwork that evaluate and question the existence of numerous systems and their effect on human life. For more information on System Bitch or to order a copy please call POOR Magazine 415.863.6306