Thursday, Sep. 10, 2009

Recession frays local ‘safety net’

Volunteers at free clinic strive to serve more patients with fewer donations

Carolyn Stover arrived at The Free Medical Clinic at 7:30 a.m. Wednesday to see if she could get treatment for chronic back pain.

She got lucky. The medical clinic had enough volunteer doctors to treat 43 patients. Some days, the clinic can see half that many people.

Stover, 59, signed up for a 1 p.m. appointment and had a seat in the lobby to wait. With no job, no health insurance and no coverage by Medicare or Medicaid, Stover has few choices.

“I thank God for this place,” she said. “I’m willing to sit here for a long time.”

The Free Medical Clinic on Harden Street in Columbia provides primary care for adults without health insurance who live in poverty. More than 12,000 patients visit each year.

However, the recession has hit the clinic, which relies on donations to pay staff and buy supplies, with a one-two punch, said Dr. Todd Crump, the clinic’s volunteer medical director.

First, donations are down as people tighten their household budgets. As a result, the clinic could be forced to cut its hours to three days a week from four days.

Second, more people are coming through the door as they lose their jobs and the medical benefits those jobs provided, Crump said.

Statewide, the number of uninsured is growing. This summer, the S.C. Public Health Institute reported that one in five of the state’s 4 million residents does not have health insurance, according to the S.C. Public Health Institute.

LINING UP FOR CARE

This year, the number of people the free clinic has had to turn away each day has more than tripled, said Dennis Coker, the clinic’s executive director.

Patients line up outside the clinic’s doors before dawn, Crump said. On winter mornings, family members take turns standing in line while the others sit inside heated cars, he said.

Appointments are granted on a first-come, first-served basis. Everyone must bring proof of his or her household’s income.

Once the slots are full, people are told to come back the next day, Crump said.

“It’s not perfect,” he said. “But it is free. We try to make it as ideal as possible.”

Sonya Brown, 50, of Columbia, who is unemployed, said she might be dead if the free clinic did not exist.

When she started having throat problems last year, volunteer physicians diagnosed cancer. The clinic found a local surgeon to treat her for free.

And, the clinic provides medicine for the cancer’s side effects, such as Nexium for acid reflux and antibiotics for chronic ear infections, she said.

“I wouldn’t have any kind of medical treatment whatsoever,” she said. “I depend on The Free Medical Clinic.”

If the clinic is forced to operate fewer days, the number of people sent away will increase significantly, Coker said.

Many, including Brown, could end up in hospital emergency rooms, where treatment is more expensive.

Crump sees this at his regular job as a physician in Lexington Medical Center’s emergency department.

Often, problems caused by high blood pressure and diabetes send the uninsured to emergency rooms, which are obligated to treat everyone, he said. He’s even had patients apologize after telling him they had no other option for getting their blood pressure prescriptions refilled.

Crump said the free clinic provides continuing care for those diseases so people stay healthier. High blood pressure and diabetes affect more than half the patients.

MONEY CHALLENGES

The clinic does not want to send patients elsewhere. But if it doesn’t make up a projected $85,000 shortfall in this year’s budget, that could happen, Coker said. The clinic receives financial support from the United Way, churches, local hospitals, businesses and individuals.

Donations are down across the board, he said.

Crump said he has seen some patients who once were donors.

“These aren’t homeless drunks,” he said. “These are your neighbors who have 2.3 children, an SUV, a dog and a cat.”

In July, the United Way cut its funding to the clinic by $32,000. And the clinic’s May fundraiser, a golf and tennis tournament, was canceled because too few people registered to play. That tournament had been expected to raise another $30,000, Coker said.

The donations pay for 10 staff members, including a family practitioner.

Besides cash donations, the clinic relies on volunteer doctors, nurses, pharmacists and medical records administrators.

It also takes donations from pharmaceutical companies. Last year, it dispensed $3.7 million worth of medication. Coker expects the pharmacy to fill $4.2 million in prescriptions in 2009.

All of this is done so the clinic’s patients don’t have to pay.

A SAFETY NET

Meanwhile, the United States continues its debate on how to best care for the uninsured.

Patients and staff at The Free Medical Clinic are on the front line of the issue, but they are uncertain about how to solve it.

The patients agreed health reform is needed but found the various proposals confusing. The staff predicted that no matter what changes are made, there will always be people in need.

“We consider ourselves to be the safety net for the safety net,” Coker said.

For patients like Stover, that safety net is a godsend. On Wednesday, she pulled a $1 bill from her purse and dropped it into a donation jar. It’s what she could afford.

The clinic provides inhalers for her asthma. She has chronic back pain after falling off a ladder when she worked at Wal-Mart years ago.

Stover left her job as a high school cafeteria cook three years ago to care for her mother. When her mother entered a nursing home recently, Stover applied for her old job.

But the job wasn’t available because of budget cuts. Now, she’s receiving unemployment, getting extra job training through the S.C. Employment Security Commission, and applying for jobs all over town.

“I need a job with benefits,” she said. “If I had the benefits, I could see a therapist and my back would get better.”

She quit going to her regular doctor because she no longer could afford to pay $68 for an office visit. She heard about the free clinic while talking with other people in the waiting room of an Employment Security Commission work force center.

“There’s a lot of people who need help,” she said.

Reach Phillips at (803) 771-8307.

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