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Stretched to the limit


The Catholic Health Association, in the wake of the Jan. 29 State of the Union address, has praised the promised drug benefits for seniors and insurance subsidies, but deplored the “grave injustices” in U.S. medical coverage.

“President George W. Bush has shown strong leadership by bringing critical focus to important health issues. We’ve been here before,” said Fr. Michael Place, president and CEO of the Catholic Health Association. “It is no longer enough to promise partial solutions. America’s nearly 39 million uninsured deserve a health care home.”

Place lamented this “grave injustice,” still unaddressed by the president and Congress. “Basic health care services for all is absolutely necessary in a just society.”

Place told NCR, “It’s not that the Bush administration has done nothing -- for example, there’s $3.2 billion in unspent CHIP (child health improvement program) monies being returned to the states. It’s that they’re not addressing the core dynamics of the problem.”

Which means there’s nothing in the current legislation to relieve the pressure on those agencies that nationwide are trying to provide care to the uninsured -- agencies like Catholic hospital health outreach services and other community-based free clinics. And they’re stretched to the limit.

That’s the view from cities like Portland, Maine, Venice, Calif., Fort Lauderdale, Fla., and Cleveland.

Quite simply, the community health agencies’ biggest common headache, said Marty Hiller, is “the struggle to meet increasing demands with diminishing resources.”

Hiller, president of the Free Clinic of Greater Cleveland, is also head of the newly formed National Association of Free Clinics (there are more than 700 nationwide) that exist primarily, said Hiller, “by enjoying good local support, and managing to stay in front of the survival curve.”

Meanwhile, among the needy, the hardest hit for medical coverage “are those at the upper end of the working poor,” said Neva Cram in Portland, Maine. “They can’t take advantage of our services.” This is despite the fact the clinic has just raised its ceiling to include people making twice the income levels that determine poverty according to federal guidelines (about $27,000). It is the families just above that who miss out, she said.

Cram, a city employee, directs the four-evenings-a-week Portland Community Free Clinic, which she describes as “a unique partnership of community volunteers, Mercy Hospital and the city’s public health division.”

The Portland clinic, said Cram, survives only because “the docs and everyone are volunteers. We have specialists who will see people in their offices. Mercy Hospital does labs, screening, gives grants,” she said, “but other costs are rising. Medications, even though many are donated, have increased 175 percent over last year.”

Hard to believe, said Cleveland’s Hiller, but the Federal Drug Administration has begun “instituting onerous reporting and documentation requirements” that make it more difficult for pharmaceutical corporations to donate prescription drug samples to free clinics. This is but one issue on the new Free Clinic Association’s agenda.

Mercy Health System of Maine’s Tim Prince, a former health care consultant, said that for the newly unemployed, “COBRA is price prohibitive. People suddenly without coverage are doing without care. Or it’s leading to the increased use of emergency rooms.” (COBRA is the system that allows ex-employees to maintain previous coverage at their own expense.)

Hospital clinics do what they can, and folks who use Holy Cross Hospital’s Family Life Center clinic in Fort Lauderdale are fortunate. They benefit from two fulltime physicians on staff, said Franciscan Sr. Mary O’Brien, vice president of mission and sponsorship.

That’s possible, she said, because the Sisters of Mercy tithe 10 percent of the hospital’s bottom line, about $600,000, toward the clinic.

“With or without insurance, no one is turned away if there’s need,” said O’Brien. The “cultural imperatives” of the patients, predominantly Haitian with some Hispanics, means that most want to make some sort of token payment, she said. Even so, said O’Brien, a clinic social worker checks with the patient to see if they are entitled to benefits they have not signed up for.

Marvé Saint-Fleur, Family Life caseworker, said that the majority of people coming to the clinic have low-paying jobs and are uninsured. Like most of the other clinics, the hospital’s Family Services utilizes its friends on its medical network to seek specialist care, for everything from orthopedics to plastic surgery.

Liz Benson Forer is executive director at the largest free clinic in the country, the Venice (Calif.) Family Clinic, which handles about 83,000 visits from some 17,000 patients a year. Volunteer medical personnel, labs and screening services provide $4 million-plus in in-kind services on top of the clinic’s state-county-city contracts and fund-raising-supported $12 million budget.

The Los Angeles area is reeling from cutbacks in the airline, tourist and dot-com industries, so the Venice clinic is trying to monitor who its new patients are.

“It usually takes a few months before newly laid-off people show up here,” Forer said. “At first the people are busy looking for work and trying to stay healthy. But then, after a few months, they fall ill.

“We had a woman last week, she was 50, working at a good job for 30 years,” said Forer. “She was laid off, couldn’t afford to keep paying COBRA and she had a sense of anger: ‘How could I be here when I’ve done everything I can possibly do?’ ”

Forer said the Venice clinic’s biggest continuing headache “is trying to patch everything together. Labs and blood samples go in five or six different directions [to labs that donate the service]. Coordinating that and the specialty care, we have to be extremely organized. But miracles happen here every day,” she said. “We do help people.” Forer’s favorite example -- pulling enough strings to get a young woman a kidney transplant operation at nearby Children’s Hospital.

Community clinics, she said, are both a vital factor in the social safety net, plus “we relieve a lot of stress on hospital emergency rooms.”

But the work doesn’t stop there. As with most free clinics, there’s plenty of advocacy work, too. In Florida, Holy Cross’ Maria Soldani has testified in Tallahassee, the state capital, on health insurance issues, particularly for children’s needs.

Our Lady of Lourdes Medical Center in Camden, N.J., in one of the nation’s poorest cities, has its own Community Health Practice clinic and gives support to other community-based programs including two parishes with clinics, Sacred Heart and St. Anthony’s, said Scott Share, vice president for marketing.

“We distribute fliers in the community,” said Share, “hoping to catch the people falling through the cracks -- the working poor and the homeless.”

Lourdes’ Betty Burke, who coordinates the Community Health Practice, said the numbers coming to the clinic are increasing, though growing community awareness and not just joblessness may be responsible for some of that.

Several clinics, like those in Camden and Portland, Maine, have separate programs for the homeless. In Springfield, Mass., Mercy Medical Center’s Community Health Program (which also has a Vietnamese health project) finds homelessness increasing and their needs mushrooming.

Executive Director Doreen Fadus said that Massachusetts’ homelessness situation is so severe that homeless families are being bused from eastern Massachusetts to the western part of the state because there is no more room in emergency shelters or motels.

“Homeless shelters here have been at capacity for 30 months straight,” said Fadus. But the medical problem with busing the families, she said, is it means the client population is “90 miles from their medical providers.” They are also, she said, “90 miles from their school systems, from jobs and job hunting, from their housing search workers and from their welfare offices.”

People like Fadus and Mark Casanova, executive director of Homeless Health Care Los Angeles, echo what other health outreach program staff around the country said. That the lack of affordable housing, along with rising unemployment, is also a health issue.

Cleveland’s Hiller -- his clinic sees some 24,000 patients annually -- summarizes what the clinics really want to do. “We’re trying to put ourselves out of business,” he said. “If we had a national health care system that was working, we wouldn’t need to exist.”

But there’s no national health care system on the political horizon this year.

Related Web sites

Catholic Health Association

Free Clinic of Greater Cleveland


Venice Family Clinic

National Catholic Reporter, February 22, 2002