On Monday, Toni Cisneros began her journey to get treatment for the swelling and pain in her face.
By Wednesday afternoon, she still was waiting, quietly reading "Love in the Time of Cholera" in the lobby at the Capital Health Center, a place of last resort for those without health insurance.
People are used to waiting for care at the Sacramento County facility, one of five such clinics for indigent people in the county.
But the situation is about to get a whole lot worse.
As early as March 1, the county plans to shutter the clinic on C Street, as well as its Northeast Health Center in Citrus Heights, to trim about $360,000 from its annual budget. The clinics serve a total of about 10,200 visitors a year, said county spokeswoman Laura McCasland.
"Please don't cut so far that you endanger the health of our community," county health officer Glennah Trochet warned supervisors as they contemplated the closures, asking them to spare deep cuts in programs for the neediest people. But the supervisors said they had little choice, given the county's $55 million shortfall.
After the targeted clinics close, the only options for county care will be the Primary Care Center at 4600 Broadway, the South City Health Center at 7171 Bowling Drive, and the Del Paso Health Center at 3950 Research Drive. The county closed another one of its clinics, in Oak Park, earlier this fiscal year.
Trochet and others said the new closures could portend disaster, forcing sick people to wait longer for appointments at the remaining clinics, to wait in longer lines for care and to head to emergency rooms if they are unable to get treatment in a reasonable amount of time.
"What are people supposed to do? Where do they expect us to go?" asked Lisa Licon, 49, a diabetic who has been out of work for two years because of health issues. "Certainly, the county has to do something. But this is not the answer."
At the clinic on C Street on Monday, a steady stream of patients showed up for TB tests, treatment of chest colds and care for more serious ailments. Some buried their faces in magazines or chatted on their cell phones. Others carried all of their possessions in bulging plastic garbage bags.
Bob Klinger, 57, had blood drawn and got an electrocardiogram in advance of surgery for a painful hernia condition.
"They told me to come back in a week," he said, adding that it might be months before he is able to get the operation. Klinger, an unemployed tree trimmer, was not complaining.
"I'm glad this place is here," he said. "It's a bad move to close it. A lot of people need a place like this these days. There are a lot more people on the streets."
Mike Francis, 45, waited for his turn to get the TB test required for admittance to homeless shelters. A college graduate with a degree in accounting, he, too, is unemployed.
"I guess the counties are doing the best they can under the circumstances," said Francis, who said he had just enjoyed "a wonderful lunch" at the nearby Loaves & Fishes complex for homeless people. "But I see a lot of these people ending up in emergency rooms for care," which will end up costing the system more money, he noted.
Cisneros agreed, arguing that the emergency room at UC Davis probably will bear the brunt of the closures.
"I don't want to be here," she said. But the 800-milligram Motrin pills she had been taking for days were no longer working on the pain in her face and neck.
Cisneros, 30, a hairstylist without health insurance, started trying to get care through the county on Monday, she said. But, with limited staffing, the public clinics are overwhelmed. So she kept coming back and waiting. Shortly after 2 p.m. Wednesday, someone called her name, and Cisneros stood up, smiling as though she had won the lottery.
Licon, the woman with diabetes who hasn't worked for a couple of years, walked into Capital Health with a John Grisham book in hand, prepared to wait awhile.
Licon said she held good jobs for most of her life before she was sidelined by health problems. Coming to the county clinic, she said, was depressing and humiliating.
"It's quite horrendous," said Licon, who has no income and is living with her former husband.
"Once, I had a house," she said. "I've had many cars during my lifetime. Now, I'm absolutely destitute. It's sad that you give to society all of your life, you work since the age of 13, and this is how you end up."
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Copyright (C) 2009, The Sacramento Bee, Calif.