By Amy Silverman
By Olivia LaVecchia
By Monica Alonzo and Stephen Lemons
By Chris Parker
By Michael Lacey
By Weston Phippen
In Unity's parking lot, three Enterprise rental vehicles with Arizona license plates awaited their drivers and passengers -- who had made the trek on the previous evening. The passengers included the Latino, who by now was pacing inside the clinic.
Located on Beach Boulevard, a thoroughfare that runs east from the Pacific Ocean, Unity takes up the first floor of an unremarkable two-story structure. Buena Park zoning records show Unity moved there last summer, replacing another clinic.
Papers filed with the California Secretary of State last August 29 say Unity is owned by Gordon Merrick, of Santa Monica, and Michael Chan, of Cerritos, California. Merrick is a veteran of the outpatient surgery world, most prominently as a consultant to outpatient clinics seeking accreditation and licensing.
Neither he nor Chan responded to telephone and e-mail requests for comment.
The number of outpatient surgery centers nationwide has surged from 2,425 in 1996 to 3,570 at the end of last year. The clinics accounted for 75 percent of all surgeries performed nationally in 2002, compared to just 15 percent in 1980, according to the U.S. Inspector General.
Many physicians say they prefer the clinics to hospitals because they can make more money, and faster. For various reasons -- including less red tape and fewer interruptions -- doctors can perform three times as many surgeries in outpatient settings than at hospitals.
That translates roughly into three times more income.
But an Inspector General's report last year warned that such clinics -- called "ambulatory surgical centers" -- have been operating with inadequate oversight. The report speaks of the dangers inherent in the lack of governmental supervision, both for the health of patients and because of potential health-care fraud.
Felix Navarro was one of the lucky ones. He underwent two medical procedures in Southern California late last year -- a colonoscopy and a septoplasty -- without the nagging physical troubles that other rent-a-patients have been griping about (especially those who have undergone sweat-gland surgeries and circumcisions).
A shy, unassuming 59-year-old who works at Onyx, Navarro's own odyssey from Cuba to Phoenix in the mid-1990s was remarkable. He says he and five other men escaped from Fidel Castro's Cuba by rowing a boat to Islamorada, on the southern tip of Florida.
Navarro later migrated to Phoenix -- where a son already was living -- through the graces of Catholic Social Services, and began to learn how to be an American.
Through an interpreter, Navarro says he'd known for months about "the trips to California," as he calls them. "Everything was fine with me, with my body. Qui [Pham] asked me if I wanted to go, and I went because I needed the money."
Navarro says Pham drove him and a carload of others to California each time after work on Friday afternoons. After sleeping at a motel near the Knott's Berry Farm theme park, Navarro says he and the others were taken before dawn to the Unity clinic, a short distance away.
Navarro says that one of his procedures, the septoplasty, took about 15 minutes. "They sprayed my nose, did something up there for a little bit, that was it. No big deal."
Under the terms of his insurance policy, Navarro was supposed to pay $2,500 for each of his "out-of-network" procedures. But like the other rent-a-patients interviewed by New Times, Navarro says he's never paid anything out-of-pocket for his procedures.
"Me pay them?" he asks, incredulous. "I don't think so."
After each procedure, Navarro continues, he collected his cash from Qui Pham, then returned to Phoenix on Sunday.
"Didn't miss work," Navarro says. "Like nothing happened."
During Navarro's second trip to the coast, he says, Pham told him to complain that his stomach was bothering him. That apparently was enough for a doctor working at Unity last October to immediately perform a colonoscopy. (The medical records Navarro has in his possession are incomplete, and don't reveal the physician's name.)
While uncomfortable, the procedure usually is uneventful and relatively inexpensive. Simply put, doctors examine the inside of the colon using a flexible tube with a tiny video camera attached to the end of it.
Actually, preparation is said to be the worst part of colonoscopy. Doctors restrict their patients to a clear liquid diet before the procedure, and then complete the cleansing of the colon three or four hours before the procedure with an enema. The better the cleansing, the more accurate the test, medical experts say.
But few of the rent-a-patients interviewed by New Times say they had a pre-test cleansing. To the contrary, says another patient, Jhoan Alvarez, "I ate normal, a burger or something, after we got to California. Nothing much, but it was food."
The cost of a colonoscopy has dropped dramatically in recent years; typically it now ranges from $500 to $1,000. But Unity billed Blue Cross $41,278 for Navarro's procedure, a ridiculously padded sum.
One month later, on November 7, Navarro received a check for that exact amount in the mail. He, too, cashed the check, even though he knew he was supposed to turn it over to Qui Pham.
"Qui asked me every day for the check at work, and then [Unity] started calling me," Navarro says. "The lady from there said they'd give me a $5,000 bonus if I gave them the check, that I would have a good Christmas. I just put them off."