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Sunday, November 7, 2004
Free clinics struggle to fill widening void
Copyright © 2004 Blethen Maine Newspapers Inc. | ||||||||||
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Also on this page: FREE CLINICS IN MAINE | |||||||||
BIDDEFORD — Waiting patients page through magazines or gaze into space as doctors and nurses in white coats flit from room to room with clipboards. That something's different at this health center becomes apparent only after watching patients leave the center without paying a bill. Everything offered here - the blood work, the medical services, even brand-name prescriptions - comes at no charge. "If we're going to be a free clinic, then everything's got to be free," said Dr. Francis Kleeman, founder of the Biddeford Free Clinic. "That's just the way we've been doing it." Established in 1993 in city-donated space, the Biddeford operation is one of the oldest and largest of Maine's free clinics, each year serving nearly 700 York County residents who do not have health insurance. A handful of similar centers have sprung up throughout the state, from Ellsworth to Rockland to Portland, creating a tier of vital - if limited - health resources for thousands of Mainers who have nowhere else to turn for affordable care. Medication for high blood pressure and high cholesterol amounts to at least $300 a month for Debbie DeYoung of Old Orchard Beach - too much to handle on her $16,000-a-year salary as a manager of storage units. Since she first started coming to the Biddeford clinic several years ago, she has been on a regular drug regimen. She's also kicked her smoking habit with an 8-week supply of a nicotine patch. "I can't say enough for these people," DeYoung, 49, said. "They don't even know what they do." For decades, the hospital emergency room served as the place of last resort for uninsured residents. Hospitals are prohibited by federal law from turning anyone away, but they can charge more to uninsured patients than what insurance companies have negotiated to pay for their customers. Many uninsured patients let bills go unpaid or rely on charity care. Then they avoid the hospital until emergency strikes again. Doctors and nurses on the front lines knew the cycle could be stopped. It was so simple - if only people received timely care and learned to better manage their health, they could avert a health crisis while lessening the squeeze on the health care system. Following the model of free clinics set up in other parts of the country, many of these doctors and nurses learned to write grants, sniff out private donors and enlist in-kind services of nearby hospitals, which often loaned clinic space for free. They also recruited volunteers - not only to provide the medical services, but to file paperwork and secure sample drugs from doctors' offices and drug makers. Over the last decade, the clinics have helped thousands of patients stem problems such as heart disease, diabetes and hypertension. Some of the clinics are offering cutting-edge health care. The Oasis Health Center in Brunswick, for example, has tailored regular clinics for patients with diabetes, depression and "complex care" needs - someone who is combating both substance abuse addiction and hepatitis C, for example. These clinics allow patients to be seen by a team consisting of a nurse practitioner, a doctor and a nurse to do follow-up with a patient, rather than just one professional. "A caregiver, like anybody else, they get blinders on," said Dr. Peter McGuire, the clinic's medical director. "But when you use a team that meets to discuss these cases you can come up with some 'wow' ideas." Because of tight space and limited time, free clinics can see only so many patients. Some clinics are open on a first-come, first-served basis, like Biddeford, leading people to arrive hours ahead of time to secure one of 12 slots. Others, like the Free Medical Clinic of Down East Maine in Ellsworth, are by appointment only. The Root Cellar sees only patients from Portland's East End. Another problem at free clinics is that rarely do patients see the same health care provider from visit to visit. The clinics rely on a rotating group of doctors, medical students and nurses who typically are available only in the evening. This poses a problem particularly in the area of mental health services, where fragile patients need the stability of seeing the same provider. Depression makes up more than a third of the diagnoses at many of the clinics and, while the clinics can provide patients with medication, few can offer the services of a full-time counselor. The Leavitt's Mill Health Center in Buxton, Maine's newest clinic, is trying to provide continuity of care with a volunteer counselor and a student studying to be a licensed clinical social worker. Similarly, patients are assigned to providers from a particularly constant stable of volunteers. But the clinic's founder, Patsy Leavitt, a nurse, recognizes that there only so many people that volunteers can see. "We haven't hit our max yet, but we know that if we saw everybody in the area who should be seen, we probably would definitely not have the capacity that we have," Leavitt said. Providers at free clinics say they will keep doing what they can for as long as it takes to reach universal health care in Maine. But Kleeman, for one, is not holding out much hope for that anytime soon. When he opened the clinic, Kleeman had planned to "be out of business in five years." More than a year ago, he and the other clinic leaders decided to approve a set of renovations. With a fresh paint job, new computers for record-keeping and more shelf space in the pharmacy, his clinic appears ready for a long haul. Staff Writer Josie Huang can be contacted at 791-6364 or at:
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