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Patients braved searing heat for free medical services at the Flying Doctors clinic. Photo: Suzanne Potter/California Health Report

By Suzanne Potter
California Health Report

On a recent Saturday hundreds of families waited patiently in punishing 108 degree heat – for the chance to get an eye exam and a pair of glasses – at Desert Mirage High School in Thermal, California. The line for medical exams snaked out the door, and the entire gym was packed with people waiting to see a dentist, nurse, podiatrist or Ob-Gyn. In other rooms physicians provided physical therapy, chiropractic exams, mental health evaluations, HIV tests, hearing tests, physicals and more.

In all, more than fifteen hundred people jammed into the free clinic offered by Los Medicos Voladores, also known as the Flying Doctors. Normally the group runs clinics in third world villages in Central and South America. But 17 years ago a local Nurse Practitioner named Rosa Lucas invited them to visit the rural communities in the eastern Coachella Valley (about 30 miles outside of Palm Springs) where entire families toil in the fields with little pay and no health insurance.

Lucas is now on the board of a group called Coachella Valley Volunteers in Medicine (CVVIM), which runs the only free clinic in the Coachella Valley.* “The Flying Doctors saw the conditions in our trailer parks,” Lucas says “and saw that they were just like the pueblos in Mexico that they were already serving. So they agreed to come here, too.”

Salvador Ceja Cervantes is an undocumented farmworker with bad vision and shoulder pain. He came to see an optometrist and a chiropractor. “I can’t bring my arm up over my head because of shoulder problems,” he said, in Spanish. His wife Elsa needs dental work. Their four kids were born here so they qualify for insurance through a low-cost insurance plan subsidized by Riverside County.

Ana Bautista, an undocumented retired farmworker, depends on the Flying Doctors for health care. “I have a rash on my face. It’s been there a week. I need the doctor to check it and I need glasses. It’s wonderful that they do this for the community. Without it I’d have to wait to get treated until I can save up the money to see a doctor or maybe go to Mexicali to see someone there where it’s cheaper.”

Sixty-one-year-old Francisca Rojas came with her husband and sister to get glasses. “I am a housekeeper. I work on my own so I don’t have insurance. An event like this is very necessary. Thanks to God it is here. Without it I don’t know where we’d be. That’s the truth. ”

Many of the patients at the fair are American citizens who say they’re struggling in this tough economy. Nita Carranza is a 29-year-old substitute teacher with a degree from UC Berkeley who came to see the doctor for an ear infection and a rash. “It’s really hard to get a full-time job that has benefits. I’m just trying to survive like everyone else. With all the budget cuts at the schools in California a lot of my hours have gone down. I’m thinking about going back to school to do something different.”

She’s worried about her hometown of Coachella. “A lot of people here do not have any type of insurance coverage. And they need it. It doesn’t matter, citizens or not, there are a lot of children and senior citizens in need of health care. It’s not just farmworkers, Mexican immigrants trying to get free health care. There are a lot of American citizens, definitely.”

Mayra Gonzalez is a homemaker and mother of three girls under the age of six. Her husband works full-time as a skilled carpenter but gets no benefits. “The kids have insurance but we don’t, so that’s why we are here. I feel glad to get this opportunity, because if we are sick we can’t pay for a doctor visit. Now we have this so at least once a year we can get our teeth and eyes checked. I have a hole in my tooth. I don’t want it to get infected.”

Valerie Bailey is 27 and has six kids – ranging in age from 11 to just 7 months old. She’s a full-time college student – studying criminal justice. Her husband just found work but the family’s health benefits haven’t kicked in yet. She’s got terrible vision, so on this day we find her in line for a vision check and a free pair of glasses at the health fair.

“I think it’s a great thing that they’re doing. I really appreciate it. I have been in college for more than a year now and it’s been a struggle the whole time. Cause I don’t have any insurance and it’s been too expensive to get glasses. It’s been very hard. I have to sit way in the front by the teacher.”

Alan Kuehn, a dentist with the Borrego Community Health Foundation, has volunteered at this event for four years. “There are obviously some severe needs in the community. A lot of them have multiple needs, surgery, restorative work, really bad periodontal problems, cleanings. The amazing thing is that you have this many people donate their time. The effort is enormous and it’s going well. I feel I have to give something back to this community. That’s the way America should be.”

Lucy Moreno, with Clinicas de Salud Del Pueblo, did most of the work organizing this massive event, coordinating with more than 130 doctors from the Flying Doctors, plus 150 local doctors, registered nurses, nurse practitioners, medical students and administrative volunteers. CVVIM also helped with pre-planning and contributed half a dozen doctors and ten dental assistants to the event.*

Moreno says she makes the effort because the need is so great in the Coachella Valley. “It’s just the ratio of doctors to patients. We’re lacking in resources and access to affordable health services. Our clinic does provide those services but it’s just not enough.”

Quite a few families who have medical insurance showed up at the health fair anyway. “Many are underinsured. The most important things at this fair are dental and vision, because those are the ones that almost no insurance covers,” Moreno explained.

Many families qualify for free or low-cost insurance but don’t realize it. Medi-Cal covers the disabled and very low-income families. Riverside County Health Care (which debuted in January) helps patients who make slightly too much to qualify for Medi-Cal. And the county-run MISP (Medically Indigent Services Program) gives emergency care and preventative medicine to low-income adults, regardless of their immigration status. MISP is designed to save money by reducing costly visits to the emergency room by desperate patients. Clinicas De Salud del Pueblo set up a table at the health fair to help families start the paperwork to qualify for those programs.

Moreno says she’s saddened by the number uninsured people in Riverside County. “The system really needs to be fixed. Something needs to be done. In the meantime if we can have people come volunteer for things like this I’m all for it.”

Quite a few local non-profits set up booths to offer their services, including the FIND food bank, The Braille Institute, and Molina Health Care. Eduardo Guevara, community organizer for a group called Promotores Communitarios del Desierto, brought a contingent of volunteers to help with logistics, setting up tables, helping with supplies, and directing people to the correct waiting areas. “We’re trying to fill the gap in the medical services here in the area. We’re seeing each year more and more people coming.”

In fact, the next Flying Doctors clinic in the area will take place April 4-7, and will be held at an even bigger venue: the Riverside County Fairgrounds in Indio.

Guevara says he’s seen patients of all ages, infants to seniors and every age in between.
He says that for many people, this health fair is the only health care they get all year.
“Actually I know people who have to wait from one event like this until the next because they don’t have any money for medication. They wait six months, eight months, mostly related to diabetes and heart disease.”

To remedy that problem, CVVIM offered patients appointments for follow-up care at its free clinic in Indio, the first time that has been done at a local Flying Doctors’ event.

CVVIM Board Member Rosa Lucas says, “Since Coachella Valley Volunteers in Medicine provides no-cost high-quality health care to those who qualify for no other coverage, a hole in the delivery of health care has been filled. Our volunteers deliver care not only for patients identified at Flying Doctors but also for the thousands of individuals who are referred to us by clinics, pharmacies, and individuals.”

Lucas has studied the reasons why patients flock to the Flying Doctors’ events and the CVVIM clinic. “A lot of them are working class people who lost their jobs, lost their homes, etc. And a lot of them have had to take their Social Security benefits at age 62 because they lost their job. But they aren’t 65 so they don’t have Medicare yet.”

Martha Rossmann coordinated the trip for the local chapter of the Flying Doctors. She credits a public assistance health organization called Tzu Chi for providing critical infrastructure support.

“They brought in all of the dental supplies and dental chairs. They did all the set-up, including cubicles for the doctors. They even brought with them an acupuncturist to help with matters such as pain and stress relief, joint problems, carpal tunnel… all kinds of problems that people might have.” The Coachella Valley School District opened up Desert Mirage High School to provide the clinic with an air-conditioned space with free electricity and water.

The Flying Doctors started in 1975 as a group of doctors who are also pilots. The Coachella Valley is their only stop in the United States, although they’d like to expand.

“There are a lot of places that need this help and they’re not all third world,” Rossmann says. “We’re looking at possibilities of working in other areas in California. But it is a difficult environment. Because the regulatory issues: the insurance issue, questions about where doctors and dentists are licensed to practice by boards, those all have to be considered.”

*The story has been changed and updated to include the role of Coachella Valley Volunteers in Medicine in organizing the Flying Doctors event.

Photo: 4rank/Flickr

By Helen Afrasiabi
California Health Report

A discount drug card offered by the city of Santa Ana to help shoulder the exorbitant costs of prescription drugs has left some users asking “where is the discount?”

Cary, North Carolina-based Paramount Rx was chosen by the city among a few dozen proposals reviewed to contract with local pharmacies and facilitate this discount.

As a consumer prescription benefits manager, Paramount has a roster of commercial pharmacies it contracts with, including several operating in Santa Ana such as CVS and Walgreens. The discount card gives customers an incentive to have their prescriptions filled at those pharmacies. The pharmacies, in turn, share with Paramount the revenue generated by the increased customer volume brought in by way of the discount card.

Paramount extends some of that shared revenue to the city, according to spokesperson Scott Yates, who manages public relations for Paramount. This money received from Paramount will go entirely towards exercise facilities and programs that the city plans to provide, said City of Santa Ana Recreation Supervisor Jeannie Jurado.

“We thought a good way to use these programs we want to provide is to have people be healthy from the start,” Jurado said. “And we asked well how do we do that? So we brainstormed and this is the idea that came out of it.”

According to the Census Bureau’s 2009 survey, an estimated 33 percent of Santa Ana’s 320,837 residents are uninsured, with a median household income of $55,000. Obstacles to obtaining medications for these families include co-payments that are too large or a lack of insurance altogether. There is also the existing problem of Medicare patients who fall within the “donut” hole or gap between the time their prescription coverage dollar limit has been reached and resumes, making them responsible for up to $3,600 out of pocket.

Thus it began that Jurado, along with Executive Director Gerardo Mouet and councilwoman Michelle Martinez pursued efforts to help Santa Ana residents who may not be up for even a free fitness class because financial struggles force them to skip out on their medications.

But residents say the card has not been easy to use. After picking up the free membership cards at local pharmacies, libraries and senior and recreation centers, residents say they have presented them at pharmacies only to be denied discounts at the registers. The program is promoted as covering all FDA-approved drugs with a 15 percent discount on brand name drugs and a 40 percent discount on generic drug prices.

Lidia Soderman, a senior who works at the Santa Ana Senior Center, says the card is “not worth the paper it’s written on.” Though all of her medications are covered between her Medicare and supplementary insurance, her 47-year-old son’s situation is very different from her own. She thought this card was the answer to getting him medication at a price he could better afford.

Earlier this year a massive stroke forced the single father to quit his job, go on disability as well as Medi-Cal and move in with his mother. As a result of the stroke, he is now very dependent upon the pricey blood pressure medication Diovan. And it happens to be the one medication he needs for which there is no generic. Paying out of pocket to date, it has been costing him over $200 per month to stay on it. Using the Paramount Rx card, he came back from the pharmacy empty-handed, as he says he was told it wasn’t one of the drugs Paramount covered.

“These are the ones that matter,” Soderman says, “not the generics that already cost peanuts anyways.” Soderman, who is on a fixed income of $2,500 per month herself, says stretching her already tight budget to help her son, she says, borders on stretching her resources too thin.

Paramount representatives say Soderman was either given bad information or misunderstood the pharmacist. Diovan, they say, is one of the drugs covered by the program, and he should have received a discount.

Customer experiences at one Santa Ana CVS location and that of seniors at the Santa Ana Senior Center, however, suggest that Soderman is not the only person having trouble using her card.

At the South Main Street CVS store, Francisco Gomez carefully shuffles through a stack of discount cards he pulls out of his wallet when picking up his rheumatoid arthritis prescription at the counter. A senior with multiple ailments, Gomez explains in broken English that the card he is using is essential for him to afford that particular prescription. That card, however, is not Paramount’s. It is that of prescription discount provider California Rx. With regard to the Paramount Rx card, he dismisses it as “no good,” expressing that with Paramount Rx, drug costs still amount to “too much money.”

A pharmacy technician who wished to remain unnamed said that in her experience, Paramount Rx has hardly proven to be competitive compared to that of California Rx, which provides up to 75 percent off all brand name prescriptions compared with Paramount’s 15 percent discount.

“This one [Paramount] just sits in here,” she says, pointing to a drawer under the cash register. “California Rx is the one we see pretty much all the time.”

Santa Ana Senior Center aide Yolanda Carillo also tried to promote Paramount Rx, in hopes that it would help the many seniors she personally knows who struggle with high cost of living, not the least of which is the cost of prescriptions.

“I’ve had two people come back and throw it in front of me,” Carillo said. She said one was an elderly man who claimed to be turned away for something as basic as insulin with the Paramount Rx card.

Others, Carillo said, have returned the card saying the discount was so low that it wasn’t worth the time.

Carillo believes for those who have not gotten anything out of it, some of the problems associated with using the card may be language-related. She says many of the people coming through the Senior Center both have multiple chronic illnesses and speak little to no English. They don’t have the wherewithal to persist when it comes to a solution or clarifying any miscommunication with their pharmacies, Carillo said.

Jurado believes it’s too soon to write Paramount off. She said the city will be measuring residents’ progress quarterly, and conduct an analysis of how they could get the most out of the card. That analysis will also uncover any impediments resulting from a language barrier which includes familiarity with how the card works.

“We will also be looking at that point on how to educate the public on the card’s usage,” Jurado said, acknowledging that there may be a learning curve in understanding the nature of prescription costs and the degree of savings people can expect.

Overall, she says, since it just launched in August, the 60 documented users aren’t enough for the city to assess how well the card is working.

Yates says that all FDA approved medications are covered and that the company’s numbers tell a different story. Those numbers show that Santa Ana residents have saved an average of 31 percent off of pharmacy retail prices for the month of August, he says.

“I can’t offer perspective about how the consumer got the wrong impression,” he said, suggesting that consumers refer to the Paramount web site for pricing and availability questions.

One source of misunderstanding might be that people on Medi-Cal already get discounts that might exceed what they would get by using the Paramount card. Also, many pharmacies give discounts to the uninsured on their own, and these, too, might mean that the Paramount card would not qualify a customer for a better deal, Yates added.

For now, Soderman says none of this is a consolation given what she faces at home with her son.

“My son is not one of the people that will be using the health centers right away even if his Diovan was covered,” Soderman said. “But they need to have compassion when they offer us something, offer something we can use.”

By Clare Noonan
California Health Report

It wasn’t easy for David Arceo to let his firstborn, Lizandra, leave home to attend UC Santa Cruz. His wife, Blanca, graduated from Fresno State and teaches first grade, but David attended school only through eighth grade because of illness. “I worry about it,” he said as his 17-year-old prepared to move away from home in Merced to attend the fall quarter. Still, he added, “I think if other kids did it, she can do it.”

A major reason he’s fine with the idea of college is the Parent Empowerment Program (PEP) run by the UC Merced Center for Educational Partnerships.

The 10-year-old center targets valley students, many of whom might not otherwise see college as a goal, and prepares them and their parents for higher education. “Our clear commitment is to fundamentally change the opportunity to learn,” said Jorge Aguilar, the UC Merced associate vice chancellor for educational and community partnerships.

Arceo and his wife attended PEP workshops that demystified all aspects of getting into and attending college: what courses and exams high-school students have to take in order to be admitted, how to fill out financial forms, what college courses to sign up for.

“It educates parents about college life for their children,” said Patrick Durr. “It takes away the fear of what college life will be like.” The social science teacher at Modesto High School coordinated the empowerment program that began there last year and will be held again in the spring. Presentations were given in English and Spanish, with the Spanish-speaking parents the most consistent participants, he said. An average of 40-45 parents attended each session and 36 earned a certificate of completion. Because the two-hour workshops were held in the evening, parents sacrificed to attend, Durr said. “It testifies to how important it is to them.”

English is not the first language for more than 67 percent of parents in the program, according to statistics on the center’s web site. The existence of such language and cultural barriers can make higher education seem an intimidating and unreachable goal. “Sometimes a kid is qualified but the parent says, ‘No, I’ve heard crazy things,’ “ Durr said.

PEP targets just that mom and dad, “unwilling parents of willing students,” vice chancellor Aguilar said with a laugh.

That could describe David Arceo, who said, “If it was me, I want her to stay here.”

Going to college “was a decision she made,” he said of Lizandra, who is interested in studying law. He said he told his daughter “it’s good you be a lawyer. You fight all the time.”

This is followed by his pointing out that Lizandra went to preschool at the tender age of 2 years, 7 months. She’s still his baby.

Spending time on a college campus made him more comfortable with the idea of her going away to college. A perk for parents who attend a majority of the eight PEP sessions is a bus trip to a guided tour of a college campus. It might include stops at a police station and a dorm cafeteria. The idea is to address parents’ concerns about safety as well as provide a feel for their student’s everyday life.

Over the years, Arceo has toured the campuses of CSUs Fresno, Sacramento and Monterey Bay, and UC Davis. “I liked them all,” he said, despite his opinion of UC Davis as being “too big, too many bikes. I’ve never seen so many bikes at a university.”

Lizandra has been involved since middle school in the Center for Educational Partnership’s initial program — UC Scholar EAOP (Early Academic Opportunity Program). It aims to get youngsters thinking about college early and, as they move to high school, get them into courses that will qualify them for higher education.

The group workshops in middle school turn into several annual one-on-one sessions with an advisor as the young scholars go through high school. That’s a good thing, Lizandra said, because “some kids didn’t feel good talking about their grades” in front of other students. The advisors “never say they’re too busy, no,” she said. “They always listen.” Center staff help high-school seniors apply for college and learn to write personal statements, according to Aguilar.

Lizandra attended a weekslong workshop that taught how to write effective college applications. She said her UC Scholars advisors provided “extra hope and a source I can go to.” Without the program, Lizandra said she would “kind of be lost in the application process. I probably wouldn’t be ready.”

“If parents go to the program it makes it easier for parents and the kids,” she added, explaining that in her mother’s college days, applications went snail mail while everything now is computerized. Lizandra said she takes comfort in the PEP sessions illustrating to her parents that even though computers will make some of her college chores faster and easier, “I’m still working hard.”

UC Scholars was the center’s first program. “It taught us that it was extremely difficult to work only with students and not other stakeholders,” said Aguilar. A cornerstone of the center now is its liaisons with families and school districts in a far-flung area that ranges from Bakersfield to Modesto, Avenal to Strathmore. Other programs at the center include one that compiles data on student enrollment and success, and another that looks for talented low-income students to help them become among the first generation in their family to attend college.

The center has brought in $15 million in grants over its 10-year history, Aguilar said, and served 10,000-plus people with that money. An additional 14,000 “benefit from our presence,” he said.

“College attendance is abysmally low in the valley,” Aguilar pointed out. So, while the center is part of UC Merced and started with a program called UC Scholars, the center wants to serve area students’ “overall college needs no matter where they go,” he stressed. “Many of our students enroll at CSU.”

By Suzanne Potter
California Health Report

California appears to be getting a handle on pertussis, one year after a new vaccination law went into effect.

The highly contagious disease, better known as whooping cough, killed ten infants in the state in 2010 and infected 9,000 people: the most in 60 years.

But California hasn’t seen a single death from the disease in 2011 or in the first half of 2012, according to a recent report by the California Department of Public Health (CDPH). The last time California had an entire year without pertussis deaths was 1991. The CDPH says that the disease is at a historic low – with an incidence rate of less than one case per 100,000 as of April 2012.

That’s more than seven times lower than the national rate, according to the Centers for Disease Control (CDC).

Dr. Ron Chapman, the director of the CDPH, credits a huge effort by California’s public health officials, school districts and community clinics to get kids vaccinated. “Greater awareness of the disease, more rapid diagnosis and treatment, and increased vaccination rates contributed to saving the lives of infants.”

Other states aren’t faring so well in the battle with pertussis. The CDC reports that Wisconsin, for example, is deluged with patients – it has a whopping 67.5 cases per 100,000 people. The U.S. as a whole saw more than 25,000 cases of pertussis and 13 deaths in 2012, as of last month.

School districts like Coachella Valley Unified (just south of Palm Springs) held multiple free immunization clinics over the summer- including one just days before school began. They’ve seen a major drop in the number of families using those clinics this year compared to 2011, when the law first went into effect. Last year, they targeted all students between 7th and 12th grades. This year, they focused on 6th graders and students new to the state.

“We saw over a thousand students last year for the vaccine and this year we’ve seen about 200,” said Mary Ramirez, Program Coordinator with Clinicas de Salud Del Pueblo – the clinic that partnered with the school district to offer the free immunizations.

The law now states that kids in the 7th through 12 grades have to get the Tdap booster shot (which covers tetanus, diphtheria and pertussis) in order to start school. Most kids get an initial series of shots before age 7, but studies show the protection wears off in about five years, just as kids are entering the 7th grade.

Pertussis causes a painful cough that can last for months, especially in babies who are too young to be vaccinated. Teresa Nicolle, a longtime school nurse at CVUSD, says, “It’s to prevent children from infecting their younger siblings and also the elderly who are at high risk of disease and death. So as long as our population is vaccinated properly it’s a preventative measure, not only for the community but for the students as well.”

Harried parents are grateful for the free immunizations. Liliana Alvina, from Indio, brought her two boys into the free clinic after her pediatrician turned them away. “I did take them to the doctor’s office and they didn’t have any vaccine at the moment. So this is great. I know they need it. If they can’t go to school then I can’t go to work!”

Maria Rios Gambon and her three kids just moved to town from Rialto – an hour away. She brought the kids to the free clinic on the first day of school because her new pediatrician was booked up for the next two months. “This is great. I went to the Mecca Clinic and they sent me here, ” Maria says.

Lupe Garcia Torres recently brought his four kids to the U.S. from Mexico after waiting two years to get their immigration papers.

“It’s great. It helps a lot. We tried to make appointments in other clinics. The kids would have been kept out of school for two weeks without the immunizations,” she says. “Luckily I went to the Clinicas de Salud del Pueblo in Coachella, and they told me about this free immunizations. Otherwise we wouldn’t have known.” According to the CDC, Tdap boosters are not generally recommended in Mexico.

The booster shots are not just for students. The CDC recommends that all adults who live or work with infants and the elderly get the Tdap shot to stop the spread of pertussis.

By Chris Richard
California Health Report

Ontario dairy farmer Patricia Van Dam worries that a proposed health screening tool will lead to onerous new environmental regulations that fail to distinguish between her farm and polluting industries nearby. Photo: Chris Richard/California Health Report

For decades, San Bernardino County has been a state leader in the statistics of despair: low educational attainment, high unemployment, low household income, low birth-weight babies, high pollution levels, inadequate health care.

The baleful statistics mounted up, but policy makers had no uniform way to bring them into a framework and chart their interactions. Now, a state agency is preparing a tool that will coalesce such indices in a color-coded map, one that highlights the communities that are most vulnerable to environmental health risks.

The proposed California Communities Environmental Health Screening Tool will help local government officials determine where to direct resources and programs, said George Alexeeff, director of the Office of Environmental Health Hazard Assessment, which is overseeing the project.

Maps produced by early versions of the tool show much of San Bernardino County tinted dark, a visual marker of compounded health risks.

Some fear the colored maps will stigmatize their communities, increasing the burden of regulation on businesses already there and scaring prospective employers away.

“I’m concerned that government is going to be the ones who identify the disadvantaged communities,” said Assemblyman Mike Morrell, R-Rancho Cucamonga. “In other words, they pick the winners and the losers.”

Morrell predicts businesses seeking to open in areas the map labels disadvantaged will face additional, burdensome restrictions on what they’re allowed to do and new regulation on how they do it.

“This will be a job killer,” he said.

Lee Brown, executive director of the California Construction Trucking Assn., said his industry already has complied with state and federal regulations to clean up air pollution, including a move to lower-emission diesel vehicles that he estimated cost heavy-equipment users billions of dollars statewide.

“How clean do you get? Do you get like a clean room environment? Is that going to be good enough?” he asked. “They set a standard, they keep lowering it. Set a standard, keep lowering it, lowering it. And there’s a cost every time you lower that standard. A huge cost.”

Alexeeff said the tool is designed to further California’s eight-year-old environmental justice program. That program, administered by the state Environmental Protection Agency, is charged with analyzing and preventing or reducing the cumulative impacts of pollution, especially among minorities and the poor, who disproportionately live in highly polluted areas.

The technology to be employed in compiling the maps already is commonly used by such agencies as forestry services, to determine where fire risks are high, and by police departments that identify crime hotspots, then develop community-based policing or patrol strategies to quell them.

But Patricia Van Dam, who owns a 400-cow dairy farm in Ontario, faults the proposed environmental tool for basing its analysis on zip codes.

“Behind me, I have 3,500 houses. I have 40 acres with nothing on it. But I’m going to be lumped in with all the houses in the same zip code,” she said.

Van Dam considers many of the current state and federal regulations on her industry arbitrary, laid down by bureaucrats who don’t understand farming. Gayle Covey, executive director of the San Bernardino County Farm Bureau, has told Alexeeff’s staff that she wants a prohibition on using the tool to regulate business, raise permitting fees or require the replacement of polluting equipment.

Penny Newman, executive director of the Center for Community Action and Environmental Justice, agreed with Van Dam’s criticism of mapping according to zip code. Focusing the tool on census tracts would provide more precise information, she said.

Newman, though, is less patient with business resistance to the concept of a comprehensive look at the health risks to residents of high-poverty, high-pollution neighborhoods.

“If anybody’s going to be paranoid, (neighborhood residents) have the right to be paranoid. They’ve been left out of everything. This methodology that’s being put together is really to identify those unique situations and to start doing something to correct it,” she said.

“If we’re going to utilize the few resources we have, we need to focus them on the places that need them the most.”

As an example, Newman cited the neighborhood just north of the BNSF freight transfer facility in the city of San Bernardino. The goal set in the federal Clean Air Act for an acceptable exposure to airborne toxins is that they might cause at most one case of cancer per million people. But according to a 2008 report for the state Air Resources Board, the estimated cancer risk for that San Bernardino neighborhood is about 3,300 chances in a million.

“These communities have been targeted over and over again for the worst facilities, for the most pollution,” Newman said. “It doesn’t happen by accident, and it’s damn well time that we start correcting it.”

In the San Bernardino Mayor’s office, Chief of Staff Jim Morris said he likes an approach that sees more than one source for public health ills. He said the environmental contamination poses one health hazard, but poverty makes that hazard worse by limiting health care options.

“We’re understand that the solution is complicated and requires a multi-faceted approach, But the goods movement industry can’t just say, ‘Don’t target us because if you adopt more strict standards about emissions, we won’t be able to survive,” he said.

“Let’s talk about, ‘What regulatory environment can you live with? How can you contribute to overcoming those other challenges that are also contributors to those same public health problems, such as educational attainment?’”

In the neighborhood just north of the BNSF yard, several businesses have closed, leaving rows of empty storefronts on Mt. Vernon Boulevard. The houses behind the once-thriving commercial thoroughfare are small.

They look battered.

Lifelong resident Sandra Ramirez, 48, said she worries about how exposure to diesel fumes from the freight facility might be undermining her teenage son’s health. But, Ramirez said, she’s out of work and too poor to move away.

She doubts things will improve, with or without a new health risk screening tool.

People who are worried about putting food on the table don’t have time or energy for activism, Ramirez said.

“Me, personally, it would bother me if they pollute the area,” she said. “But then at the second hand, you know, hey, if it brings jobs, people are going to want them.”