In Marin County, most Medi-Cal patients receive their primary care through an organization known as Marin Community Clinic. While the Marin clinic is not the only primary care provider in the county, it is by far the largest. As in most managed health care systems, a patient has a primary care provider and then receives specialty care as approved by the primary care physician. Marin Pregnancy Clinic is a limited services pregnancy center and does not provide primary health care. As described above, however, it is a presumptive Medi-Cal provider, and provides specialty care related to pregnancy.
Staff at Marin Community have complained from time to time about patients who receive their primary care from them but go to Marin Pregnancy Clinic for prenatal care. Some patients, as a result of pressure from the community clinic, have decided to stop receiving their prenatal care at Marin Pregnancy Clinic. But the hostility from the community clinic reached a new height this Spring when a patient ended up in the emergency room.
On May 17, 2013, an expectant mother and patient at Marin Pregnancy Clinic called for advice because she was suffering from flu-like symptoms. Her symptoms were such that the staff encouraged her to get an appointment with her primary care provider. Since Marin Community was listed on the patient’s Medi-Cal card as her primary care provider, she contacted them to set up an appointment. Staff at the community clinic responded that since she was not going there for her prenatal care, she would not receive an appointment for any other type of care. Marin Community’s nurse stated that it was unfair for Marin Pregnancy Clinic to “dump” patients on them and utterly refused to listen to the patient’s perspective.
Unable to see her primary care physician, the patient ended up in the emergency room. She describes her experience: “I had to go to Novato Community Hospital Emergency Room…where I was diagnosed with bronchitis, a bladder infection, and severe dehydration…I was very frustrated that I couldn’t be seen at Marin Community and I felt too sick and too weak to defend myself….”
Subsequently, a nurse in the community clinic’s maternity department called Marin Pregnancy Clinic on a diatribe about “dumping patients” on Marin Community. She spoke with Marin Pregnancy Clinic’s director of operations, Alison Oblites, and angrily expressed that she felt it was inappropriate for one of Marin Pregnancy Clinic’s patients to call Marin Community regarding anything, even if the patient was a patient of their primary care department. As Mrs. Oblites explains, “She made it clear to me that Marin Pregnancy Clinic’s patients would be turned away every time unless they transferred their care to Marin Community Clinic.” She refused to consider the community clinic’s duty to treat patients for whom it is the contracted primary care provider. Mrs. Oblites was stunned by the position they was espousing as well as by the unprofessional, vehement tone of the confrontation. She reported the conversation to Mrs. Strom.
Following this experience, Mrs. Strom felt that enough was enough. It was time to hold Marin Community accountable for its duty to its patients and its position as the largest primary care provider in the County. She asked Life Legal Defense Foundation to work with her in drafting an appropriate letter that would both complain about the offending conduct and demand that Marin Community accept and abide by its duty.
In researching the rules and policies that apply to a primary care provider in Marin County, Life Legal attorneys found that—not surprisingly— the community clinic‘s actions were exactly opposite of what they should have been. LLDF Staff Counsel Rebekah Millard comments, “Not only was Marin Community Clinic’s conduct unbecoming to a clinic providing care to low-income patients, it was also a failure to follow the policies applicable to a primary care provider.”
….Less than a week later, Mrs. Strom received a call from Marin Community’s CEO, Dr. Tavaszi, with her apologies and assurance that the incident would not be repeated….