Noisy health-care debate overlooks free clinics' struggles

McClatchy NewspapersSeptember 6, 2009 

FREDERICK, Md. — One recent Monday, the line in the Church of the Brethren parking lot began to form at around 2:30 a.m. when a husband and wife arrived. They came almost 8 hours early in the hope of seeing a dentist — for free.

They soon watched the headlights of other cars as they pulled into the lot. Some would-be patients laid out blankets and sat on the pavement to wait for hours so they'd make the top of the walk-in list to see a doctor or dentist at the Mission of Mercy traveling clinic.

By the time the clinic, a converted recreational vehicle, opened its doors and the church's multi-purpose room became a waiting room, a nursing station and a dental office with blue dividers and folding chairs, more than 100 people had assembled.

At the check-in table, new patients were asked one question: "Are you insured?"

The Mission of Mercy, a group of traveling clinics that circulate through towns in Maryland, Pennsylvania, Texas and Arizona, is one of more than 1,200 free clinics across the nation that are feeling the effects of the economic downturn.

Their patient lists are growing as Americans lose their jobs and their health insurance, but as demand grows with rising unemployment, their donations are dwindling. This year, Mission of Mercy has $350,000 less than it did last year; it takes no government funds for its services.

"People are so afraid to give now, because they're thinking they could lose their job next," said Linda Ryan, the executive director of Mission of Mercy. "We're squished because we have more people in need; we need to grow now more than ever — who knows what will happen with health care?"

Over the past year, free clinics across the country have seen a 20 percent decrease in donations and a 40 percent to 50 percent increase in patients, said Nicole D. Lamoureux, the executive director of the National Association of Free Clinics. Last year, the clinics the association represents — which largely have been excluded from the health care debate — treated 4 million people. This year, Lamoureux expects, they'll serve some 8 million, 83 percent of whom come from homes in which at least one person works full time.

"Quite frankly, the need is so great at some point in time we'll hit a place where we have to say we need to start cutting," Lamoureux said. "We'd like to be a part of those discussions (on health care.) We really need to make sure that this legislation gives the people we serve access to quality health care."

On the outskirts of the nation's capital in Silver Spring, Md., on a recent Sunday, the waiting room of the Muslim Community Center Medical Clinic was packed with uninsured patients. It, too, has grown almost 50 percent in the last year, and about 15 percent of the new patients are uninsured after losing their jobs.

Although the U.S. spends more on health care each year than any other nation does, about 46 million people in America have no health insurance, according to the Census Bureau. While the number of uninsured Americans dropped from 2006 to 2007, indications are that the number has increased drastically in recent years and will continue to rise as unemployment swells.

Of uninsured families, about 27 percent make less than $25,000 a year, according to the census survey. About 19 percent of families make $50,000 or more a year. The federal poverty line is $22,050 a year for a family of four.

Even those with insurance, however, aren't safe from financial disaster when dealing with medical problems. More than 60 percent of bankruptcies are partly attributable to medical problems, according to a recent article in the American Journal of Medicine. Three quarters of those bankruptcies were among the insured.

Many who come to Mission of Mercy and the Muslim Community Center clinic work 40 hours a week or more, but still can't afford health care.

In the waiting areas of these clinics, most of the patients had no strong opinions on proposed health care changes; they don't have the time or desire to rage at protests. They want to see a doctor without bill collectors showing up at their doors demanding thousands of dollars or having loan officers denying them car and home loans because of their bad credit, they said.

"It's the richest country in the world," said Mohammed Munir as he waited in the Church of the Brethren to see a Mission of Mercy doctor recently. Munir, a truck driver, lost his job earlier this year after relocating from California. "We should get health care."

Dr. Mike Sullivan, a co-founder of Mission of Mercy, doesn't think the government will ever solve this problem because it lacks the love and faith that he and the volunteers have, he said.

"There are so many people that need now," he said in the back of the RV where he sees patients. "We were already pretty full before the economy fell apart."

Dr. Larry Romane, the assistant medical director, sees patients in the middle of the RV as other doctors set up office in the front and back. The kitchen galley was converted into a mobile pharmacy with 250 free medications. There's no space for running water or a bathroom, only the makeshift offices, medications and bottles of hand sanitizer.

The manila folders start to arrive on the counter just after 9 a.m., and the patients file in to the RV.

"I thought I'd seen it all, from violent alcoholics, bank presidents, to the poorest of the poor who couldn't buy Tylenol for their child, but I was wrong," said Romane, a 35-year veteran of emergency medicine. "It was never possible for me to have any way of knowing whether that person leaving with a prescription I gave them could get it filled . . . . I never looked at a wound and said, 'I wonder if this person can afford this treatment?' I just treated the wound."

Now Romane tries to find the cheapest options for patients by running the smallest number of tests and providing the best care he can for free.

"To my mind, a lot could be learned if some of the people trying to reform health care spent a night in the ER or a day at the Mission of Mercy," he said.

In Silver Spring, Dr. Asif Qadri starts his day at the MCC Clinic. The clinic provides free health care to the uninsured and the poor.

At his private practice, Qadri often saw elderly immigrants with no insurance. So in 2003 he opened this clinic, and it's grown from one day a week to six. After failing to find a doctor willing to leave his private practice, Qadri retired and now works full time at the clinic.

"It's mind boggling how people manage," he said after seeing a father of four who supports his family on the roughly $7 an hour he makes as a gas station attendant.

"There needs to be an option for these people. The people who get crazy in these protests on health care, they're getting wrong information. It's scare tactics about killing granny and death panels. Maybe reform won't cover everyone, but it won't be 46 million uninsured."

Durenaz Abro walked into Qadri's office next.

"You were here in May, and I had you on Cortisone?" Qadri asked Abro as he looked at her charts.

Her asthma has gotten worse, and Qadri thinks she needs a heart catheterization to test the pumping of the heart and the flow of oxygen.

He prescribed her Singulair for her asthma. She must take it daily, and each pill costs $3.

"Can you afford it?" he asked. "If you can afford it you should take it."

"God only knows," she answered. She has no job and no insurance. Sometimes she helps out at her sister's store. There's no cheaper option for this medication.

Abro took her prescriptions and left.

"The catheterization is $5,000," Qadri said. "I'll try to arrange it with the (National Institutes of Health) so she doesn't get charged."

Then Asha Rosario walked in. The woman, dressed in a colorful pant and tunic set and flip-flops, makes $7.30 an hour at a boat-building company. Her husband can't find full-time work and makes $9 an hour at a part-time job.

"How are you?" Qadri asked.

"No new problems. I'm feeling itchy in my ear. I think this medicine I'm taking gives me a hard time," she said, pulling out the medicine prescribed to her and provided to her by the clinic.

Qadri had her lie down and he did a check-up.

"Stop this medication over the next few months and see if it changes," he said.

In March, Rosario was dizzy and couldn't walk. She negotiated the bill for her emergency room visit down to $2,000, and each month she tries to pay $120. Sometimes, though, she can't pay.

When she left, Qadri looked at her charts.

"I wish we had more resources," he said. "I really have to think hard about whether or not to order these blood tests. She has all these bills, and this will be another $30."

In Frederick, Jennifer Gerver, 29, waited seven hours at the Mission of Mercy for a checkup. In January, the single mother of three slipped on ice and hurt her back. At the emergency room at City Hospital in Martinsburg, W. Va., doctors treated her, and she's stuck with a bill of more than $5,000. She can't afford medication for the pain. She's also been diagnosed with bipolar disorder and depression.

Gerver makes just about $800 a month at McDonald's, and she hadn't had her medication in six months.

"I used to have good insurance, but they shut my company down," she said, referring to her job in customer service at AB&C Group, a call center that closed its doors last year. "I've got bill collectors at my door."

Sullivan gave her medication for her bipolar disorder and depression and pain medication for her back. She paid nothing.

"Without them, I'd be without my medication," Gerver said.

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