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No insurance? Good health care is still in reach

ENCINITAS — Among the reasons Encinitas is recognized as a top-tier health care system is the quality and range of services provided to uninsured and underinsured residents through North County Health Services, or NCHS.
The nonprofit provides primary medical care for individuals and families at the Encinitas Health Center at 629 Second St. and specialty care at the Encinitas Women’s and Children’s Health Center at 1130 Second St.
Services include exams, family planning, OB/GYN, pediatrics, adolescent medicine, adult medicine, vision care, dental care, and mental health and counseling. Referrals are made to specialists if needed. The center also enjoys a positive relationship with Scripps Hospital, Encinitas.
In addition, the health centers offer specialty clinics in areas such as attention deficit and hyperactivity disorder, childhood obesity awareness and prevention, podiatry, asthma treatment and management, and immunizations.
Put simply, the health centers serve as a safety net for the community. No one is turned away.
One Encinitas resident, a professor at a local college, wanted to share her story for the purpose of this article. However, she asked to remain anonymous because she has a teenager who is distressed and embarrassed by the financial situation the family suddenly finds themselves in. Recently the professor’s pay and hours were cut. The family’s problems were compounded when her husband was laid off from a local company just before the holidays.
She began by describing a visit to her opthamologist’s office a few weeks ago where she was lectured by a receptionist who told her she was irresponsible not to have health insurance. Afterward, the experience caused her to delay seeing a doctor when she sensed her blood pressure was becoming dangerously high.
“I was worried and I thought I was going to have a stroke,” she said. “I finally realized I couldn’t put it off anymore. It was such a relief when I called the Encinitas Health Center and made an appointment.”
The professor explained that the current episode is the first time in her adult life when she has been without health insurance. She added that she was raised in a family where her mother instilled an ethic of taking care of others.
In fact, it was through volunteer work with the Interfaith Shelter Network that she learned about NCHS.
“The first time I visited the health center I was crying because I’m not used to being on the receiving end of giving,” she said. “I went in and the place was immaculate and nicely decorated, and everyone had a smile on their face. They never made me feel bad that I didn’t have insurance. It was a remarkable experience.”
The professor had a similar experience on a subsequent visit.
“People don’t want to go to a place that’s perceived as a welfare place, but it’s not like that,” she said. “I just needed to be taken care of and they stepped up to the plate. Even when I get a job that has health insurance I’m coming back.”
The Encinitas Health Center is staffed with 19 clinical and clerical employees.
Dr. Carolene Madden serves as lead physician. She is board certified in family practice. Prior to coming to the center, she worked in urgent care and private practice.
Her staff serves between 60 and 70 patients a day, working in pods of one provider and two medical assistants.
“There is no difference between this office and private practice,” she said. “We have everything a patient needs. They appreciate what the doctor is trying to do.”
She added, “I want to retire here.”
Madden says the most common conditions for visiting to the clinic are no different than private practice: diabetes, hypertension, infections such as staph, minor surgery, skin biopsy, toenail removal and thyroid problems.
Nurse practitioner Colleen Veneri has been at the clinic since 1992.
“My goal was to work in a community clinic for two or three years,” she said. “I’m still here. I had a patient today who said, ‘I’ve been to a lot of private doctors but I get the best care here.’”
Patients go through a financial screening process on their first visit. They are charged based on a sliding scale. If the patient can’t afford to pay, financial arrangements are made.
Many patients who carry insurance report paying a fraction of what they are charged in their private physicians’ offices for both the visit and lab tests.
Dental services are also provided through a weekly mobile dental clinic. Patients who want to be seen right away can call (760) 736-6767 and ask to be directed to the Oceanside or San Marcos Dental Centers operated by NCHS. Dental services are affordable, and calculated on a sliding scale.
In addition, the clinic offers the Family Pact Program, which is similar to Planned Parenthood in Oceanside.
Routine pap and breast exams are performed at the health center. Once a month a mobile mammogram visits, bringing refreshments.
In addition to English, Spanish and Japanese are spoken at the center.
A couple of blocks away the Encinitas Women’s and Children’s Health Center provides comprehensive prenatal, perinatal, postnatal and postpartum education and care.
California’s Access for Infants and Mothers Program ensures that all pregnant mothers and their babies have quality health care. Even if patients have health insurance, their co-payment or deductible for maternity services is no more than $500.
Patients can be certified for Medi-Cal on site. The WIC program also has offices in the facility where low-income mothers can pick up coupons for formula.
A staff of 15 includes midwives and physicians, many of whom are double-board certified.
San Diego Perinatonatogy, specializing in high-risk babies, subleases space from the center and works closely with Children’s Hospital.
A genetics counselor visits the clinic once a month to consult with patients.
Postpartum classes give mothers who don’t have family in the area the opportunity to make connections.
Approximately 30,000 children are served throughout the county by NCHS.
NCHS also offers a medical assisting training program at the two health centers in Encinitas, which provides career advancement opportunities for existing employees who want to increase their skills and income.
Irma Cota, MPH, has been at the helm of NCHS since 1998. In addition to a masters degree in Public Health from San Diego State, Cota holds certificates in health administration from Johns Hopkins University, the University of California at San Diego and UCLA Johnson & Johnson. Recently she was named a 2009 Finalist for the San Diego Business Journal’s Most Admired CEO Award and a 2010 Honoree by KPBS during Women’s History Month in March.
NCHS’s 2010 annual campaign, “Connecting Children to a Healthy Future”, focuses on raising funds to help fund pediatric medical and dental services. A group of 25 community and business leader volunteers are helping to reach the goal of $350,000. For information about donations or volunteer opportunities, contact Dana L. Withall, fund development director at NCHS, at (760) 736-6710 or e-mail [email protected].
Encinitas Health Center is located at 629 Second Ave. in Encinitas. It is open Monday through Thursday from 8 a.m. to 6:30 p.m., Friday from 8 a.m. to 5:30 p.m. and Saturday 8 a.m. to 4:30 p.m.
For more information about NCHS services, visit