Framework

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Roy Lawrence, 49, of Los Angeles was diagnosed with cataracts at the To Help Everyone (T.H.E.) Clinic in January 2012, but he has waited nearly a year for eye surgery.

PHOTOGRAPH BY: Gina Ferazzi / Los Angeles Times

Lawrence struggles to read a text message on his phone after being diagnosed with cataracts at T.H.E. Clinic. "I want to see again," he said. "I've been waiting a long time."

PHOTOGRAPH BY: Gina Ferazzi / Los Angeles Times

Lawrence, second from left, leans forward while playing dominoes with his friends in the courtyard of his home in South Los Angeles.

PHOTOGRAPH BY: Gina Ferazzi / Los Angeles Times

Lawrence waits for an update on his referral to an ophthalmologist, 10 months after being diagnosed with cataracts at T.H.E. Clinic in Los Angeles. The Jamaican immigrant arrived in the U.S. nearly 20 years ago to pick apples. His immigration status prevents him from getting health insurance or unemployment benefits.

PHOTOGRAPH BY: Gina Ferazzi / Los Angeles Times

Nurse practitioner Sandeep Lehil examines Lawrence at T.H.E. Clinic in August 2012. Lawrence and patients like him are posing a critical challenge for the planned overhaul of the nation's healthcare system.

PHOTOGRAPH BY: Gina Ferazzi / Los Angeles Times

Dr. David Hwang performs a routine eye exam on Lawrence during a follow-up appointment at T.H.E. Clinic in October 2012.

PHOTOGRAPH BY: Gina Ferazzi / Los Angeles Times

Dr. Simon Bababeygy, an ophthalmologist at Los Angeles County/USC Medical Center, examines Lawrence, whose vision has deteriorated so much that he is considered legally blind.

PHOTOGRAPH BY: Gina Ferazzi / Los Angeles Times

Lawrence waits in the ophthalmology department at County/USC. Because he has diabetes and cataracts, his vision has been worsening. Now, after an abnormal heart test, he has to see a cardiologist.

PHOTOGRAPH BY: Gina Ferazzi / Los Angeles Times

Lawrence can't work or drive, and he relies on others to cook meals to avoid burning himself.

PHOTOGRAPH BY: Gina Ferazzi / Los Angeles Times

Lawrence waits to get a date for cataract surgery. He had waited for nearly a year for word, then went to the emergency room and was referred to the ophthalmology department at County/USC.

PHOTOGRAPH BY: Gina Ferazzi / Los Angeles Times

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By Anna Gorman

The blurry vision began early last year. Roy Lawrence ignored it as long as he could. But after falling off a ladder at his construction job, he knew he had to see a doctor.

He went to a community health clinic in South Los Angeles, where doctors determined he had diabetes and cataracts. The clinic could manage his illness but referred him early this year to the county health system for eye surgery.

Nearly a year later, Lawrence, a Jamaican immigrant without insurance, still is waiting for the operation. His vision has deteriorated so much he is considered legally blind.

“I want to see again,” he said. “I’ve been waiting a long time.”

Lawrence, 49, and patients like him are posing a critical challenge for the planned overhaul of the nation’s healthcare system. Federal officials are investing billions in community health centers like the To Help Everyone (T.H.E) Clinic, where Lawrence’s problem was diagnosed, with the hope they can keep more patients out of high-cost emergency rooms.

But a dearth of specialists available to low-income patients presents one of the bigger hurdles facing the country as it tries to bring spiraling healthcare costs under control. Doctors say meeting new government mandates to keep patients healthy and out of hospitals — a linchpin in the plan to reduce medical spending — will be virtually impossible without the ability to make timely patient appointments with specialists.

By the end of the decade, the nation will be short more than 46,000 surgeons and specialists, about 10 times more than in 2010, according to the American Assn. of Medical Colleges. Healthcare reform is expected to increase the shortage as more patients — many with complex and deferred health needs — become insured and seek specialized treatment.

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