Dr. Linda Halderman and Medi-Cal

In her official biography, Assemblywoman Linda Halderman says she closed the doors of her Selma medical practice that she opened in 2003 primarily because of the low reimbursement rate by Med-Cal, the state’s health care system for the poor.

Sixteen miles south east of Fresno, Selma, population 22,846, is 78 percent Latino with a median income of $43,683 – nearly $16,000 lower than the statewide median. 

“Over 90 percent of the patients in my practice were women being evaluated and treated for breast cancer who were either uninsured or under-insured by Medi-Cal or the state’s breast cancer program,” the Fresno Republican said in an interview.

Many of her patients were referred by primary care doctors who had been searching – sometimes for months, Halderman says – for a breast cancer specialist.

Sustaining a specialized medical practice in California’s rural or low-income areas, already underserved by primary care physicians, is nearly impossible.

And what little chance there is, was destroyed by Medi-Cal, Halderman says. 

“For breast cancer consultation – conducting an exam, obtaining a medical history, going over a potential diagnosis and planning a course of treatment, maybe even getting ready for surgery – Medi-Cal paid $24 for that visit. It’s not a visit that takes seven minutes, as you can imagine.

“After I was out of the practice that rate was cut to $21.60 and then cut an additional 10 percent.”

For a partial mastectomy with 90 days of follow-up treatment, the reimbursement rate was $243. It has since fallen by 10 percent and is slated be reduced another 10 percent.  

“Patients came to me from a 70-mile radius,” she wrote a in a November 2006 article titled Vanity Care. “To close my doors to these women, or else close the doors of my practice entirely, would be a blow to the ideals that had led me to choose rural medicine in the first place.  For frightened women with a potentially lethal disease and few options for care, the cost would be far greater.”

Halderman kept her overhead down – one employee at the front desk.

“I was losing money on every single patient I took care of because my overhead, low as it was, was consistently over $24 per hour. If you want to accept Medi-Cal patients, you need to be prepared to lose money with every patient you see.”

She tried to boost revenue by adding cosmetic surgical procedures to her practice, writing in 2006:

“So, my general surgery practice is now a little schizophrenic. Beautiful women wanting to be more beautiful enter my office alongside women whose main desire is to survive the tumor that threatens their lives.  Their vanity involves the loss of part or all of a breast from surgery — or their hair from chemotherapy afterwards.”

But even that didn’t make ends meet, Halderman says.

“Could I live with my patients having to go through a wallet biopsy before I agreed to see them? No. I couldn’t live with that. So instead, finally, I just shut my doors.”

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