Why are Fresno-area Native American clinics sending staff home during coronavirus pandemic?
Health care clinics serving Native Americans in the Fresno-area are grappling with the same testing and supply shortages faced by other hospitals, but they’re also sending many of their staff, including medical personnel, home.
That includes staffers 65 and older as well as those with underlying conditions that make them particularly vulnerable to severe complications from the coronavirus.
Many referrals for specialty care, such as dental care, are on hold. Clinics are doing the best they can, according to Charles D. Fowler, chief executive officer at Central Valley Indian Health, Inc.
CVIH was formed by five local tribes – the North Fork Rancheria, Picayune Rancheria, Cold Springs Rancheria, Big Sandy Rancheria and Santa Rosa Rancheria.
CVIH has asked 20% of its 130 staff across all clinics to stay home to slow the spread of COVID-19, Fowler said.
The CVIH clinic in Clovis has brought in two temporary physicians. All the CVIH clinics only operate 8 a.m. to 5 p.m., so for after-hours, patients may be referred to a local hospital.
These clinics only provide primary medical and dental care.
Native Americans in need of specialty care get referred to community providers by CVIH, and if their tribe is in California, CVIH will pick up their bill. But Fowler said many specialty care referrals are on hold by community providers.
“Anything that’s elective, any elective surgery – that’s just on hold,” he said. “That’s only common sense.”
The Centers for Medicare & Medicaid Services have released a list of recommendations for adult elective surgery, which includes dental work. Fowler said someone who needs braces won’t get them now.
CVIH, which operates five clinics in three counties, including Fresno, is only getting 15 COVID-19 tests per clinic, Fowler said. But they are not clear on whether those 15 tests per clinic are for a week or even longer, he said.
“We know it’s not for a day,” he said on Tuesday. “Testing is still limited to those with fever, cough, difficulty breathing.”
All clinics under the CVIH annually serve more than 55,000 Native American patients in Fresno, Madera and Kings counties. So far, the CVIH clinics have tested eight patients and all were negative, Fowler said.
Fresno County this week reported its highest daily increase of confirmed coronavirus cases, and on Wednesday, the county’s total went up to 82 cases. Madera County has had a total of 25 cases, including one person who recovered and another patient who died. Kings County had five confirmed cases as of Wednesday.
In the Valley, there were nearly 200 total confirmed coronavirus cases early Thursday, with two deaths in Tulare County.
As of early Thursday, a total of 359 Indian Health Service patients in California had been tested, and 16 test results had come back positive, with 226 turning up negative, according to the agency’s website. The remaining are pending.
Nationwide, a total of 4,667 Indian Health Service patients have been tested with 268 confirmed cases.
“We must be vigilant in our efforts to slow the spread of infections among our patients and within the communities we serve,” the agency says. “The federal government is working closely with state, local, tribal, and territorial partners, as well as public health partners, to respond to this public health threat.”
But testing challenges are improving, Fowler said, now that Quest and LabCorp are evaluating tests.
“Prior to (March 23), all testing had to be approved by county health departments, and that was a problem,” he said. “We cover three counties.”
The clinics also are facing a shortage of protective personnel gear, such as masks, gowns and gloves, but Fowler said, that’s a “nationwide” predicament.
Fowler, who has a long career as a health administrator, said he’s never seen anything like the current situation before. Despite the clinics handling the situation and making their operations work with a reduced staff, there’s “a lot of fear out there.”
This story was originally published April 2, 2020 at 12:48 PM.
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