Health specialists targets 'underserved' population

CASTLE -- In the old Castle Air Force Base hospital, Dr. Angelica Ruiz is a busy doctor.

The young woman has been working at the old hospital, now known as Castle Family Health Centers, for the past year, helping the littlest ones, the weakest, the ones who desperately need health care.

Ruiz is a pediatrician, seeing up to 25 patients a day. She's in the Merced area because she wants to make a difference. "The population here is so underserved. Many of my patients don't go to the doctor on a regular basis and I want to change that," Ruiz said.

Ruiz is one of many specialists working out of Castle Family Health Centers, a rural health clinic that helps people who are on Medi-Cal or uninsured. The center has been located at Castle since 1999, and before that it was located at the old Bloss Hospital. "We've really grown in the last five years," said Edward Lujano, chief executive officer of the clinic.

A rural health clinic like Castle has to be located in an area that's medically underserved. The providers at a rural health clinic, and the clinic itself, are reimbursed by Medi-Cal, California's version of the federally funded Medicaid, at a higher rate. "The higher reimbursement is what keeps us going. We get about 99 percent of our money from our patients," said Lujano.

The clinic gets no grant monies, but offers a complete roster of medical specialties, including obstetrics, urology, urgent care, a pharmacy, dental surgery and more.

Because 85 percent of the people seen at Castle are on Medi-Cal, and the rest uninsured, it's often hard for patients to see specialists outside of the clinic. The reimbursement rate is low for most other physicians, and they refuse to see these patients. "We are lucky because our overhead is very minimal. We don't have to pay rent," said Lujano.

The clinic was given the deed to the property by the United States Air Force, and no money changed hands.

Although a few specialists are available for patients at Castle, the clinic has found it tough to recruit physicians to work there. Lujano said that there aren't many medical students choosing to become family practice physicians these days; instead, they are becoming specialists, where they can make a lot more money. "We are desperate for family practice physicians. We are having to use locums now, which are very expensive," said Lujano.

There are some incentives for doctors to come to clinics like Castle. Up to $25,000 repayment a year can be done on school loans if doctors work at Castle, Lujano said. "But we are trying to target young doctors who want a life, the ones who gravitate toward an urban population. They don't want to come here," said Lujano.

Not Ruiz. After growing up on the East Coast and going to medical school in Pittsburgh, she did her residency in Madera at Children's Hospital Central California. "My exposure in Madera showed me that there is a huge need in this community," Ruiz recalled.

There is such a dire need that the Castle clinics see about 7,000 patients a month, according to Lujano. And patients tend to stick with Castle for years. Debbie Kelley, director of business services at the clinics, has been an employee there since 1981. "I've seen third generation patients come in. It's not a 'treat and then they are gone' situation," Kelley said.

In the future, the clinic will also have a new children's behaviorial health center. The old emergency room at Bloss Hospital is being remodeled within the next 45 days. "We need this so bad. A lot of children have issues, and having a doctor who understands children can help the entire family," said Lujano.

Although a lot has changed since the building was an Air Force hospital, Lujano is still planning for the future. "We want to grow and modernize. And we want to bring more doctors here, for our patients," said Lujano.

Reporter Carol Reiter

can be reached at 209-385-2486