TAP-IN Weblog

Dallas Area Exemplifies Free Clinic Expansion

An article in the Dallas Morning News describes the proliferation of "charity clinics" in north Texas and quotes the executive director of the National Association of Free Clinics as she describes the critical role that such clinics play in covering the needs of America's uninsured. As Nicole Lamoureux told the reporter,

"Free clinics are the best-kept secret in America. Instead of waiting for the problem to be solved, free clinics are offering a solution right now."

The article focuses on the clinic-based activities of Julia Grenier, a 72-year-old nurse who treats a largely immigrant population of patients at the Plano Day Labor Center, one of 40 free clinics in the Dallas area.

"The hospitals totally ignore that we are saving their bottom line," Mrs. Grenier said as she bags supplies at her clinic. "Every visit here is a potential emergency room visit there. We stop problems from growing here."

Health Services Adjusting to Changing Economy

Health services for the uninsured must be light on their feet because the conditions they address are in constant flux. Changes in population, in local business climate and the economy as a whole lead are tending to increase the number of uninsured citizens requiring free or low cost health care. One illustration of this is taking place in Loudon County, Virginia, part of the expanding Washington, D.C. suburbs. In response to the evolving situation, the board of supervisors there is recommending that two of the local community health care services begin cooperating more closely or even consider merging.

The Loudoun Community Health Center and the Loudoun Free Clinic provide medical services to hundreds of uninsured and under-insured county residents each year. The two organizations, along with the Loudoun County Department of Health, are slated this summer to discuss the possibility of combining some operations.

Though the two services claim that such a merger could have unintended negative consequences, the supervisors point to the financial reality that a merger could reduce operating expenses enough that a mental health component and dental services could be expanded.

Health advocates say the need for free and low-cost health care is growing across Loudoun as the population increases. In recent years, the county's construction boom has brought a flood of low-paid workers, and the loss of many technology jobs has sent some middle-class people into poverty. More recently, advocates say, the need has become more acute with the worsening economy and the foreclosure crisis.

The article goes on to describe how the two entities being discussed have "vast ly different ways of operating," but the fact that a merger between these two unrelated services is getting so much attention tells you just how critical the situation has become.

States Can Ease Burden on Volunteer Retired Doctors

Jennifer Bunn, RN, writes articles about health care ethics in the impressively syndicated Web log Brain Blogger. Her latest essay is titled "Charity Begins at Home - U.S. Physicians Volunteer." It describes the challenge of providing care to our 47 million uninsured citizens, but its main points are that retired doctors are a key element in responding to that challenge, and we need to lower the barriers that discourage them from volunteering.

One way to help those patients who cannot afford healthcare would be to take advantage of retired doctors who want to serve the poor. States could pay licensing fees for these volunteer doctors, and could also provide insurance coverage in return for a minimum number of hours of service.

Some states have taken the initiative in offering licenses free of charge to volunteer physicians who serve only indigent patients or who serve in areas that are underserved. Some states offer licenses at a reduced fee. Some states have adopted legislation to limit liability of volunteers. The Volunteer Protection Act, passed in 1997, sets a minimum national standard for immunity laws for volunteers. Although it sets limits on awards, it still does not provide full protection and physician volunteers, or the organizations they work for, are still responsible for medical liability insurance.

With a large number of retired physicians who are civic-minded, states could go a long way towards easing the burden of the uninsured by making it easier for retired physicians to do what they do best.

AMA Presents Grants to 16 Community Clinics

Citing them as "outstanding free clinics," the American Medical Association has announced the awarding of grants ranging from $12,000 to $25,000 to clinics located across the nation, from Pennsylvania to California, from Michigan to Texas.

"We are pleased to honor the exceptional achievements of these free clinics and their dedication to providing quality, affordable health care," said Jean Howard, AMA Foundation President. "As the AMA advocates to expand medical coverage for the uninsured, the AMA Foundation supports their efforts by recognizing free clinics that demonstrate excellence in physician and community volunteerism, resourcefulness, sustainability, and leveraging partnerships."

The clinics receiving the 2008 Healthy Communities/Healthy America grants are:

• Community Health-In-Partnership Services, St. Louis, Mo.
• Community Volunteers in Medicine, West Chester, Pa.
• DuPage Community Clinic, Wheaton, Ill.
• Ebenezer Medical Outreach, Inc., Huntington, W.Va.
• Free Medical Clinic of Greater Cleveland, Cleveland, Ohio
• Health Care Access, Inc., Lawrence, Kan.
• Hope Medical Clinic, Inc., Ypsilanti, Mich.
• Hope Within Community Health Center, Elizabethtown, Pa.
• Kansas City Free Health Clinic, Kansas City, Mo.
• Martin Luther King Health Center, Shreveport, La.
• Milan Puskar Health Right, Morgantown, W.Va.
• Mountain View RotaCare Free Clinic, Mountain View, Calif.
• Open Door Health Center, Homestead, Fla.
• San Jose Clinic, Houston, Texas
• Social Welfare Board, St. Joseph, Mo.
• The Clinic, Phoenixville, Pa.

A Doctor Comes Home to Volunteer

Taken from a local TV station's report on the Web:

Dr. Kenya Sekoni lives in Lansing, Michigan, but she grew up and has family in Jacksonville, Texas. On   visiting her relatives, she couldn't help but notice that none of the local clinical services for the uninsured were staffed with doctors.She tried searching for volunteer doctors in the East Texas region, but found none.

"It made me sad to see people walking around with diabetes, with heart disease that didn't have any care and I asked them, well doesn't the community have a free clinic, No, there's no free clinic here."

So Dr. Sekoni and one of her associates from Michigan decided to be the volunteer doctors for Cherokee County and the Jacksonveille area, providing a full range of services free of charge through a mobile clinic sponsored by a local church.

"Anyone who walks through these doors, it's as if they're walking into their primary care doctor."

Dr. Sekoni's hope is that her service will inspire more local doctors to answer the call for volunteers.

 

 

CBS News Reports on Michigan Clinic

Reporter Seth Doane remembered the clinic that had impressed him this past winter in Mississippi, especially the selfless volunteer nurse practiioner who was "working as hard as she could to serve a population that had very limited access to medical care." So when he heard stories of a much-praised doctor working at a clinic in Flint, Michigan, he knew it would be a story worth telling on the network's evening news. In a blog article describing how his reporting came about, he told the backstory:

I learned about the clinic after reading a couple of local stories about a volunteer there, Dr. Samuel Dismond, who recently won a community service award for his work. Dismond is a thoughtful, gentle man who told me that it's "rejuvenating" to volunteer at the clinic. Though he also said that "it can be a frustration to me, as a healer, [to see] so many people we're not able to help and not help adequately.

There are plenty of people in Flint that do, indeed, need help. Home to General Motors, there have been a number of layoffs as factories have been closed down and shifts have been cut. When we were at the clinic, Dale Willis who had just been permanently laid off from his job at an auto-parts supplier came in for the first time. Willis was clearly shaken by the loss of his job and worried that it would be hard to find another one at his stage in life. Willis told me that he'd even consider taking a job as a janitor if he needed to. "If you'd asked me at 21 what I'd be like at 51, I'd say, in a lot better situation than I am now!" Dale said.

The actual video that was shown on the CBS Evening News on June 11 can be seen here.

North Carolina Web Site Directs Uninsured to Care

If you're a North Carolinian without insurance or a regular source of health care, you can look up your nearest options using this new Web site provided by the North Carolina Institute of Medicine. Using simple dropdown menus and checkboxes on a Web page, someone looking for care enters their location, their insurance status and the kind of care they're needing. The system searches its resources and provides them with the name, address, hours and phone numbers of clinics or other facilities that meet their needs, plus a map showing the exact street location.

Given the undercapacity of so many medical care facilities, information and referral systems like these should be available everywhere. Finding facilities is half the battle.

A recent study found that only about half of the uninsured were aware of community services that could help them.

"We wanted to put together a resource so people would know what's available in the community," said Pam Silberman, president and chief executive officer of the Institute of Medicine. "It also helps communities know where there are gaps" to establish new programs.

HOW DOES IT WORK? It lists each county and sorts for various services such as pharmacies, free clinics, mental-health programs, and doctors and dentists who take Medicaid, the federal insurance coverage for the poor. About 250 organizations are listed.

WHO PAID FOR IT? The effort was funded by grants from the Duke Endowment and Blue Cross & Blue Shield of North Carolina Foundation.

WHAT PROMPTED THE IDEA? A task force formed by the institute studied the services available to people in the state who don't have insurance and recommended in 2005 that the Web page be developed.

WHY NOW? More and more people in North Carolina have no insurance and are struggling to find health-care services, Silberman said. In 1999-2000, the rate of the state's uninsured increased 25 percent, she said, while it rose nationally 12 percent. The primary reason was a loss of employer-based coverage, she said.

 

New Jersey Assembly Considers Volunteer Physician Immunity Bill

One of the greatest obstacles to expanding the ranks of volunteer doctors is the lack of protection from the costs of malpractice insurance. So, every time another state moves closer to providing that protection, a whole new wave of retired physicians takes a fresh look at the option of volunteering their skills and experience for the benefit of the uninsured.

The New Jersey bill, sponsored by a doctor, Assemblyman Herb Conaway, MD, "would protect physicians who provide volunteer patient care and the clinics or federally qualified health center (FQHC) where they serve from civil liability."

"Across New Jersey, there is a shortage of doctors to provide medical services to low-income residents," said Conaway.  "As a practicing physician who volunteers at a clinic I realize that the threat of liability is great and must be reduced.  It is vital that we do all that we can to attract quality doctors to donating their time to improve access to health care for the many underinsured New Jerseyans."

Conaway's bill (A-2861) would provide immunity to volunteer physicians and the nonprofit clinics or federally qualified health centers where they volunteer their services.  The measure was designed to encourage more retired doctors to volunteer their time to increase access to affordable quality health care.

"By providing immunity to physicians and the health care centers they serve at New Jersey will boost the overall health of many underserved residents," said Conaway, chairman of the health panel. 

The measure would require volunteer doctors to be licensed to practice and would make them immune from liability for care reasonably provided in good faith.

Conaway said the influx of doctors volunteering their services means citizens will have access to medical care much sooner which increases the likelihood that they will be diagnosed and treated earlier for health conditions. 

The bill was released 11 to 0.  It now heads to the Assembly Financial Institutions and Insurance Committee for further consideration.

The Cold Waiting Line for Clinic Care

It gets mighty cold during the winter in Madison, Wisconsin, where 450 medical students at the University of Wisconsin volunteer their services at 6 MEDIC clinics around the city. Given the funding limitations and the other obligations of the volunteers, the system is only able to treat 1,300 patients over the course of a year. Typically, a clinic will be open for 3 hours, one day per week, so uninsured citizens often arrive early and wait outside for one of the coveted 12 spots on the limited schedule.

"For a while, they were coming as early as 6:30," said Claudia Bulla, a front desk coordinator and Spanish translator, "but we told them to stop. It was so cold, and they had their babies. We worried they would get sick just waiting."

On a busy Saturday, especially during the flu season, coordinators say they have turned away as many as six patients for the twelve slots. "It was shocking for me," said Jose Delgado, who started as a front desk coordinator just recently. "I'm from East Los Angeles, and you see poor people who need help there, too. But the clinics there handle way more than a dozen people. Some had things that were pretty bad, and they don't have funds to go anywhere else. I knew they would end up waiting another whole week."

Another clinic organization, Access Community Health Centers, also provides services for the uninsured, but they, too, find themselve unable to come close to meeting the need.

"The need is greater than our capacity," said Tammy Quall, development director for Access. There were no statistics available for how many requests for medical appointments are turned away every day, but Quall said that at last count the clinic received 60 more calls a day for dental appointments than it could handle. (Since then, Quall said, the clinic has improved the backlog.) A reporter calling to make an appointment for a medical checkup recently was told to call back in two weeks. When she asked what would happen then, she was informed she would probably just have to call back again in another two weeks.

Dentists, Hygienists and Winnebagos

If you can't get to - or afford to go to - the dentist, in the Puget Sound area of Washington state, the dentist may very well come to you with Medical Teams International's mobile dental clinic. Uninsured adults can get free dental surgery through the clinics, where over 300 dentists and 600 dental hygienists count themselves as volunteers. As the Seattle Times reports,

They roam aboard one of 10 converted Winnebagos — three in the Puget Sound area and seven in Oregon — and, for no charge, they clean, drill, fill and pull teeth inside the mouths of grateful patients.

Dr. Stephen Knoff says, "The need out there is so huge, and the supply is so minimal," even giving "one day a month will make a huge difference."

Many Medical Teams dentists are retirees. One such person is Dr. Allen Brown, a Seattle dentist who closed his practice after 45 years and donated his equipment to the group.

On Wednesday, Brown worked on a first-time patient, Marty Askelson, in a well-equipped, if cramped, white Winnebago in the parking lot of Northshore Senior Center in Bothell. The Winnebago features two dental chairs and an X-ray machine; dentists can handle root canals and extractions and anything that doesn't require general anesthesia. Medical Teams charges a fee only for dentures, which are sold at steep discounts.

Askelson, 74, of Kenmore, marveled through a numbed mouth that he got a cavity fixed for $15 (charged by Northshore, not Medical Teams). He described Brown as "very thorough, very professional" and grinned that the price was unbeatable.

Askelson planned to return for treatment of two remaining cavities.