Stretched to the limit
By ARTHUR JONES
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. Weve been here
before, said Fr. Michael Place, president and CEO of the Catholic Health
Association. It is no longer enough to promise partial solutions.
Americas 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, Its not that the Bush
administration has done nothing -- for example, theres $3.2 billion in
unspent CHIP (child health improvement program) monies being returned to the
states. Its that theyre not addressing the core dynamics of the
problem.
Which means theres 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 theyre stretched to
the limit.
Thats 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 cant 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 citys 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 Clevelands 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 Associations agenda.
Mercy Health System of Maines 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
its 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
Hospitals Family Life Center clinic in Fort Lauderdale are fortunate.
They benefit from two fulltime physicians on staff, said Franciscan Sr. Mary
OBrien, vice president of mission and sponsorship.
Thats possible, she said, because the Sisters of Mercy tithe
10 percent of the hospitals bottom line, about $600,000, toward the
clinic.
With or without insurance, no one is turned away if
theres need, said OBrien. 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 OBrien, 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 hospitals 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
clinics 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, couldnt afford to
keep paying COBRA and she had a sense of anger: How could I be here when
Ive done everything I can possibly do?
Forer said the Venice clinics 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.
Forers favorite example -- pulling enough strings to get a young woman a
kidney transplant operation at nearby Childrens 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 doesnt stop there. As with most free clinics,
theres plenty of advocacy work, too. In Florida, Holy Cross Maria
Soldani has testified in Tallahassee, the state capital, on health insurance
issues, particularly for childrens needs.
Our Lady of Lourdes Medical Center in Camden, N.J., in one of the
nations 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. Anthonys, 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
Centers 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.
Clevelands Hiller -- his clinic sees some 24,000 patients
annually -- summarizes what the clinics really want to do. Were
trying to put ourselves out of business, he said. If we had a
national health care system that was working, we wouldnt need to
exist.
But theres no national health care system on the political
horizon this year.
Related Web
sites |
Catholic Health Association www.chausa.org
Free Clinic of Greater
Cleveland my.en.com/~freclin
MEND www.wgn.net/~mend
Venice Family
Clinic www.venicefamilyclinic.org |
National Catholic Reporter, February 22,
2002
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