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Practice What You Teach 

UCSF students wish the medical school would tend to their health

Wednesday, Oct 8 1997
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When she developed a vexing rash over most of her body, Liz Haswell figured at least she was in the right place. A graduate biochemistry student at the University of California, San Francisco, Haswell reasoned that surely -- with the resources of one of the nation's most highly regarded medical schools literally at her doorstep -- she'd be able to get some medical attention.

No such luck.
"I was completely covered with hives. Everywhere," Haswell says. But the student health clinic couldn't fit her in, and the only dermatologist available to see students was booked well into the next month. Haswell didn't feel like scratching for weeks while waiting to see a doctor. "I ended up not seeing anybody and just tried to self-medicate," she says.

The rash passed. Haswell's disdain for the health care UCSF offers its students has not. The 26-year-old Ph.D. student is not alone in her opinion.

It is appalling, several students say, that a prestigious medical facility like UCSF -- its campus chock-full of doctors, researchers, and cutting-edge medical technology -- offers only bare-bones medical care for its own students.

The much-trumpeted merger of UCSF's and Stanford's hospitals into a medical monolith, the students say, holds little promise that their own health needs will be met any better.

"It is a complete, total irony that at this premier medical facility, students don't get an opportunity to receive some of that care," says Renee Williard, a former UCSF student. During four of the six years she spent at UCSF before earning a Ph.D. in pharmaceutical chemistry in 1995, Williard served on a committee set up to consider the health needs of UCSF students. While health care improved somewhat during that time, she says, it still lags behind what might be expected. "By and large it's hit or miss," she says. "Some of it is excellent, but there are gaps in the coverage."

Big gaps, students say. The health care plan available to UCSF's students offers no vision or dental coverage. Students who want to see specialists -- like gynecologists or orthopedic surgeons -- must run through a bureaucratic maze hoping to get appointments, they say.

Even getting an X-ray, a seemingly simple undertaking at a medical school that owns countless X-ray machines, is not easy. Students who aren't in desperate straits have to catch shuttle buses to have X-rays taken at Mount Zion hospital some two miles away.

"If you're in dire emergency they'll give you one on-site. If you're just in a lot of pain they send you to Mount Zion," one student says.

The student health plan covers only $500 of prescriptions each year, which doesn't go far for students with chronic conditions who need regular medication. And some other basic health problems -- allergies, for instance -- are not covered at all.

Those gripes might sound familiar to anyone who has ever complained about his or her own HMO or health insurance plan. But the UCSF students contend their problems are particularly inexplicable, because most of them are studying medicine or some health-related science smack in the middle of a veritable brain trust of medical know-how.

Most of the shortfalls could easily be fixed, they say, if the school's administrators would simply take notice.

"It could all change if the administration felt this was a priority issue, and to date I don't think the administration has thought it was a priority," Williard says.

Cliff Atkinson, the UCSF associate vice chancellor responsible for student health, did not respond to SF Weekly's request for an interview.

But Dr. Henry Kahn, who took over as interim director of student health services six months ago, says the school is progressively doing better by its students. "From what I've seen, I believe the students get excellent care here," Kahn says.

Problems do crop up, Kahn says, and, not surprisingly, money is usually at the root.

Each year, students are required to pay $355 in fees to support the school's student health services, and another $369 to buy private insurance to supplement their coverage. That money is dear to the school's future doctors and graduate students, many of whom live on annual stipends of $15,000 to $17,000 a year.

But with only about 2,500 students pitching in, there's not enough money to finance a full-blown health care plan for students similar to what typical health insurers or HMOs provide, Kahn says.

In some instances, student health services can't afford the prices charged by UCSF's own clinics and doctors, Kahn says, so students are sent to facilities off campus for treatment. Sending students to Mount Zion for X-rays, for instance, is far cheaper than having them done at UCSF, Kahn says.

"I know there are complaints. I know there's a certain dissatisfaction with how the insurance works, but putting it in perspective, they do get a lot for [the money]," Kahn says. "My life would be a lot easier if the students did have full coverage. We're spending many hours trying to figure out how to get around the prescription limits and get our patients treated."

Students say they have few quarrels with Kahn or the actual student health clinic on campus. The clinic, staffed with two doctors, two nurse practitioners, two nurses, and some support personnel, adequately handles the daily parade of cuts, scrapes, and minor complaints that comes through its doors.

The problems start, students say, when they need protracted treatment or regular care from a specialist.

Tracy Ware, a 27-year-old biochemistry graduate student, has a thyroid disorder and a chronic, congenital back problem. Ware estimates that she spends $200 a month on treatment or prescriptions not covered by the student health plan.

"None of us are making very much money, if at all," Ware says. "Some people are going into debt by 20 grand a year, and just staying healthy while you're on campus shouldn't be such a big problem."

Ware finds it perplexing that an institution in the business of training doctors and health care professionals seems to take such little interest in the students' well-being. Why, she wonders, can't UCSF doctors and clinics at least treat students at discounted prices?

T.J. Cradick, a 31-year-old immunology student, agrees with Ware's assessment. Cradick has diabetes, which requires regular glucose monitoring, and he must wear an insulin pump. Cradick -- who receives a $15,000 annual stipend while pursuing his Ph.D. -- figures he spends $6,000 a year for medical care not covered by the UCSF student plan. He also gets some help from a family health insurance plan.

His medical condition is not particularly rare, and Cradick says it would seem well within the scope of UCSF's medical expertise to provide him some sort of help. "The level of hypocrisy of UCSF is what shocks most students," Cradick says.

A 24-year-old neurosciences graduate student, who asked not to be named, suffers from asthma and allergies requiring daily medication and shots every three weeks. She is fast approaching the limits on UCSF's coverage, and figures she'll soon be shelling out about $150 a month for treatment.

"Students with chronic illnesses do pay out-of-pocket costs," says Barbara Burgel, a nursing school faculty member and former chair of the school's Student Health Services Advisory Committee. But, Burgel says, the school must strike a tricky balance between offering the expanded coverage some students need and keeping insurance rates down for others who don't ask much from student health services.

Burgel says she'd like to see UCSF come up with some way to take over responsibility for providing student health care through its own hospitals and clinics, giving students direct access to the school's vaunted medical resources. That possibility is under consideration, Kahn says.

In the meantime, Liz Haswell is now having another beef with student health. In early September, Haswell was in Monterey, attending a retreat held annually by the biochemistry department. The first night of the three-day conference, Haswell came down with food poisoning, and had to be taken to a Monterey emergency room.

"I was fainting and had the worst day of my life," she says. "I was losing feeling in my arms and legs."

When she returned to San Francisco, Haswell was in for another shock. Because she contracted the food poisoning out of town and went to an emergency room in Monterey, she says, UCSF expects her to pay about $300 for her treatment. Had she been able to make it to the clinic on the UCSF campus, the treatment might have been slow, she says, but at least it would have been free.

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David Pasztor

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