A Catholic church tucked in deep among San Bernardino neighborhoods just five miles from Loma Linda University was the original site of the LLU-affiliated Social Action Community Health System, known as SACHS. The mission of SACHS was to provide health care and other services to the underserved in the local San Bernardino County. Original meetings of SACHS supporters trace back to the 1960s, but it wasn't until 1995 that SACHS found its own independent facility, thanks to the search efforts of the previous dean of LLU School of Public Health Richard H. Hart, M.D., Dr.P.H., now president of Loma Linda University and its various entities.
Dr. Hart seized a generous offer from the government to acquire clinical space that had been part of Norton Air Force Base, and this site opened in October 1995, almost 15 years ago, as SACHS-Norton. Kenneth Hart, M.D., served as the first director of this 50,000-square-foot facility. At the time, he only had one coworker at SACHS-Norton in his front desk person, who would check patients in, run them back to do their vitals, see them to a patient room, run back to the front to take calls, and so forth.
Over the next few years, SACHS-Norton's clientele dramatically grew from around 1,600 patients in 1995 to around 37,000 patients in 2009. In 2010, services now include primary care, obstetrics/gynecology, pediatrics, dental, behavioral health (including marriage and family therapy, parenting apart classes, sub- stance abuse therapy, and psychiatric counseling), physical therapy, speech therapy, occupational therapy, a WIC program (women, infants, and children), La Escuelita (adult English as a second language classes and community meeting spaces), the CAPS program (volunteer tutoring by LLU medical students), and two food pantries including the separately run Helping Hands Pantry.
Of its 50,000-square-foot space, SACHS-Norton currently occupies 43,000 square feet, with additional space in its two satellite locations at the SACHS-Arrowhead and SACHS-Frazee clinics. LLU students from nearly every health care discipline may be found participating in rotations in SACHS-Norton's various departments on any given day. A walk through the SACHS-Norton facility reminds the visitor of the facility's sheer size, stretching on past doorway after doorway.
Following SACHS-Norton's abundant success, Nancy Young, CEO of SACHS, shared how the last 18 months have been the most difficult of her nearly 10-year tenure at SACHS. "We've always had our struggles and challenges," said Ms. Young, "but over this past year and a half, we almost daily have patients come to us who were insured last month, but have lost their jobs since."
In the past, the SACHS management team would take turns paying for individual patients' care in order to not turn people away, but recently the need has become so great that SACHS has developed a Blessings Fund to help these patients.
"We have a cost center number for the Blessings Fund, and 100 percent of what is donated goes into the fund and straight to providing primary care services to those in need," said Ms. Young.
Ms. Young noted that, when SACHS team members go out into the community, they find that people are looking for funds like the Blessings Fund, because they rightfully want to know that their money is going specifically to uninsured individuals. "There are no administrative costs withdrawn from Blessings Fund donations," said Ms. Young. "If you were to hand me a $10 bill today, that $10 bill goes directly towards a patient's care." Currently, SACHS representatives visit events throughout San Bernardino and beyond to share what SACHS offers, but Ms. Young remembers that when she first came here, she was surprised by how few people in the Loma Linda community were even aware of SACHS. "I really made it a point to get the word out about SACHS in the Loma Linda community, because the people who are in our Loma Linda family are some of the most incredible peo- ple," said Ms. Young.
Through the years, employees and students across the university and medical center have provided tremendous assistance to SACHS. "We have many friends in general counsel and medical staffing, as well as several other departments throughout Loma Linda," said Ms. Young. "Some make a point to stop by regularly with cars loaded full of groceries for our dried foods pantry."
Before coming to SACHS, Ms. Young had never worked in an Adventist setting. She was raised Irish Protestant and has had a lifelong passion for service, so she was thrilled to work for LLU and find herself in a mission-oriented community. "I was amazed when I came here 10 years ago," Ms. Young said. "Adventists tend to be extremely mission-hearted, and it's wonderful to see how this trait is ingrained through the Adventist family. I tried to encourage this type of energy in my own family, and both of my children chose LLU School of Medicine.
"And my grandchildren," said Ms. Young, "I always keep saying to them, 'Who did you help today? How did you make a difference today?' They're teeny-tiny, but that's really what has to happen to cultivate that commitment to service. This commitment is scriptural; it's every part of who we are."
Through SACHS' commitment to service, it has become the safety net for primary care in San Bernardino County. On a daily basis, SACHS receives referrals from emergency rooms at surrounding hospitals, and it ultimately aims to meet patients at the primary care level so that patients avoid the astronomical costs of an emergency room visit.
These costs are avoided through SACHS eligibility coordinators (ECs). SACHS-Norton staffs a crew of ECs where typical medical practices would have a receptionist. However, this group is responsible for more than checking in patients. ECs are the first people patients speak to when they contact SACHS, and they must be fluent in the various qualifications and guidelines for programs offering health care funds for the uninsured.
If a patient enters SACHS without insurance, an EC checks if this patient qualifies for Medi-Cal health care coverage through the state of California, which the patient would receive that day, the rest of the month, and the next month. Meanwhile, Medi-Cal would send the patient an application for Medi-Cal coverage. For patients with Medi-Cal, a sliding-fee scale is applied to costs based on the patient's income level; a $120 office visit could slide down to $60, which would slide down to $45 for follow-up appointments.
"As you can imagine, with this much Medi-Cal work and work with the underserved, there is a huge loss margin in the SACHS budget," said Ms. Young. "So we are in the process of applying to change SACHS into a federally qualified health center, or an FQHC." This transition would result in the federal government providing subsequent compensation for any Medi-Cal or Medicare work done at SACHS. This federal support would allow a much-needed expansion of SACHS services in order to provide for the large uninsured population in San Bernardino County.
"We plan to submit our application this July or August. It will be a while before we hear back, and we are prayerful," said Ms. Young. "We feel very blessed to serve so many individuals in our community. This is our passion--and we're good at it."
SACHS-Arrowhead satellite
Off the freeway through narrow residential lanes, SACHS-Arrowhead is located on a small commercial strip in the heart of a San Bernardino neighborhood. Cars are a little more beat-up here and lawns overgrown--not as green.
Entering the SACHS-Arrowhead clinic, the lobby is divided in two. One side has sleek cushioned chairs and a lamp with its base still covered in cellophane; the other side has rows of aged beige plastic chairs with metal arm rests.
Yadira Corona, medical assistant (MA), stepped out from the front office. "How do you like the wood floor?" she asked. "As you can see, we're in the middle of remodeling. The patients like it. It makes you kind of feel like you're getting better treatment, you know."
SACHS-Arrowhead opened within a year of SACHS-Norton back in 1996. Currently, it sees about 30 patients per day with Anita Adorador, D.N.P., as the single provider along with two MAs. At SACHS-Arrowhead, primary care as well as obstetrics/gynecology services are provided for all age groups by an entirely bilingual staff.
After a busy morning, Dr. Adorador left the clinic to attend her sick son at home, so Ms. Corona said about her boss, "Our provider really goes out of her way to help patients. She's sometimes on the phone for an hour just trying to investigate and talk to specialists so that a patient can receive better care."
Mornings tend to be the busiest time at SACHS-Arrowhead. The clinic is open four days a week starting at 7:00 a.m. This time was chosen due to safety measures taken in this San Bernardino community. Patients simply don't show up near sunset. "Like around October when it's already dark by 4:00 p.m., we don't really have any patients come in the afternoon," said Ms. Corona.
Appointments at SACHS-Arrowhead are primarily walk-ins. When there were scheduled appointments, about 70 percent of these were "no-shows." Patients sometimes call in just before walking over to the clinic, which works especially well with sick children.
"It's kind of funny," Ms. Corona said. "When they get here, they often see someone they know. We'll be seeing the mom, the dad, the kid, the friend, the sister-in-law--everybody. They'll call out,'Hey! You're here?!'"
"As long as they know we're here, and they feel better with their family and friends coming here, it's great," Ms. Corona said.
SACHS-Frazee satellite
Yasmin Chene, MPA-C, in a patient room at the back of the SACHS-Frazee clinic, pointed out a window to a small church. On the side of the church, there was a sign reading Community Center and a man piling up weeds into a USPS bin.
"That church," Ms. Chene said, "is the Catholic church where the original SACHS was based. This was years ago when Dr. Richard Hart was a resident. They would hold clinics there during the week when there weren't church services. It's interesting how things have changed; back then, there was not as much privacy-- only curtains set up as patient rooms."
Later on, in 2004, the City of San Bernardino remembered SACHS and asked the organization to offer services in the current building of the SACHS-Frazee clinic. The building had been given to the city by the federal government, and in turn, the city gave the building to SACHS so long as health care services were provided.
The Catholic church behind Frazee had since been turned into a city community center where clothing and food are distributed."It's kind of nice having this center next door, especially since we know they like us and invited us back here," said Ms. Chene.
Similar to Dr. Ken Hart almost 15 years ago at SACHS-Norton, Ms. Chene served as the first director of Frazee with one assistant. While only having office hours two days each week, the two provided care to around 40 patients per month. Six years later, that same assistant, Rosa Lazaro, M.A., continues to work with Ms. Chene. The staff has grown and is still entirely bilingual, and SACHS-Frazee now sees approximately 200 patients per month during those same two days per week.
Ms. Chene also serves as an LLU faculty member, and other LLU faculty physician assistants (PAs) have joined her as providers at Frazee. Overall, the PA program at LLU has been very supportive of the clinic.
"The PA program sends providers and student volunteers to Frazee," said Ms. Chene. "Frazee has become a major part of the community service for the program."
Like SACHS-Arrowhead, SACHS-Frazee has its own small lab, and many immunizations are kept in stock for a children's vaccination program."We have a person who comes to Frazee just to work for that program," said Ms. Chene. "That's one of our strengths here, serving the children.
"We're the newest addition to SACHS, and we are just small, only two trailers joined," said Ms. Chene."But we have been certainly blessed by the patients we see and the support Loma Linda and other donors provide us. These are what keep us going."
To contribute to the SACHS Blessings Fund, please contact Nancy Young at (909) 382-7190 or nyoung@llu.edu.
This story was originally published in the Summer 2010 edition of SCOPE.