Uninsured face long waits at Madison's few free health clinics

Shawn Doherty  —  6/04/2008 8:52 am

It was a gorgeous Saturday morning and one of his two days off a month from work, but Lakhwinder Singh had to spend it inside a clinic on South Park Street, waiting.

He needed to get a prescription refilled for his gout. He can't afford insurance, and he has no doctor. Without the pills, he said, he would be in too much pain to work his job managing a gas station 45 minutes away in Fall River, where he is on his feet 16 hours a day pumping gas, working the cash register, stocking the shelves and mopping the restrooms.

Singh's bright orange turban was a welcome splash of color in the clinic, where about a dozen people with illnesses from diabetes to stomach pain waited ... and waited. For Singh, it took 4 hours before he got his pills. But patients at South Side MEDiC Clinic rarely complain. Although only open on Saturday mornings, the clinic is free, the medical care is expert and caring, and few patients there can afford to go anywhere else.

"I'm lucky to have a spot," he said. "This is one of the few places in Madison where I can get help."

The clinic, staffed and managed by volunteer UW medical students and supervised by a rotating group of doctors, is an example of the free, discounted and charity care that local providers, private corporations, government officials and neighborhood activists have stitched together to address the diverse and growing needs of Madison residents too poor, too confused, and too scared to seek regular medical care and coverage.

It also reflects the increasing strain this patchwork system is under.

The first MEDiC clinic was founded in 1990 by seven UW medical students and their professor, Dr. Ted Goodfriend, to accomplish two lofty goals: give medical students hands-on learning while providing hands-on medical care to the needy.

"It's a two-way street," said Andrea Schnell, a second-year medical student at UW. "We can learn about medicine and help people at the same time." The program's dual mission is made clear in orientation materials volunteers are required to read. Advice ranges from the practical -- "If it's WET and HUMAN, wear GLOVES!"-- to the philosophical -- students are reminded to remain sensitive to what the manual calls "vast gaps" in their patients' health care.

Today, the program has expanded to include 450 volunteer students from the Medical School as well as from UW's pharmacology, nursing, physical therapy and physician's assistant programs. Dozens of volunteer physicians supervise. In the course of the year, this team sees more than 1,300 patients at six clinics around the city, each of which serves a distinct population with its own needs and challenges--from the homeless with constant food infections to the mentally ill with constant delusions. Thanks to donations and volunteers, all this is done on a shoestring budget of less than $20,000.

"We don't have an excess of anything except goodwill," said Dr. Goodfriend, UW professor emeritus and now Associate Chief of Staff for Research at the Veterans Hospital.

At South Side, many patients are immigrants, mirroring the changing neighborhood around them. Just down the street is a popular Mexican restaurant, El Pastor, and the Mercado Marimar, a friendly neighborhood store stocked with Mexican soap operas, frijoles, tortillas and telephone calling cards.

One recent Saturday, the clinic's waiting room was humming with Spanish, Portuguese, Punjabi and English as moms and grandmothers chatted or talked on cell phones. Children played, for the most part quietly. They seemed to be used to waiting, too. "All week I had a really bad pain in my stomach, like I had to throw up," said Christian, 9, when asked why he was there.

Christian's mother is from Mexico. Census figures show the local Latino population has experienced explosive growth -- from 5,744 people in 1990 to 19,210 in 2004 -- making Latinos 4.6 percent of Dane County's overall population. Community advocates figure that adding undocumented workers makes the total number of Latinos in the county more like 50,000 or 60,000. This is the population served by South Side, and it presents new challenges.

If patients have no documents, they are ineligible for government-funded medical aid, and after visiting the free clinic for acute care, they are adrift again.

Even with documents, however, many immigrants find the medical system a maze. Costs are prohibitive. Many immigrants work temporary and seasonal jobs, which rarely offer insurance coverage. Singh, who moved to the U.S. 25 years ago from India and became a legal resident in 1983, recently moved to Madison from Michigan to give his four children a good education. He said he works from 5:30 in the morning until 9:30 at night, six and sometimes seven days a week. His pay: $2,000 a month, no benefits. "I can't afford $500 a month for insurance," he said.

Without insurance, medicine isn't affordable, either. In fact, focus groups conducted in 2005 by United Way of Dane County learned that Latino immigrants find it cheaper to ask relatives back home to send them medicine than to buy it in the states. "In our country we get public clinics, but health costs in the United States are loca -- crazy expensive," said Mayella, who is from Venezuela and whose husband was at South Side with severe stomach pain.

Language is another barrier. And fear of being deported. "You can see it in their eyes. They're afraid we'll ask if they're legal," said Kathy Williams, clinic coordinator at the Benevolent Specialist Project (BSP) in Middleton, the only free clinic for specialist care in all of Wisconsin. Williams, who has watched BSP's patient load nearly triple in the past five years, added: "We don't care if they fell out of the moon."

In a sign of the times, free clinics have sprung up in the past few years in smaller towns like Boscobel, Richland Center, Stoughton and Dodgeville. But the six MEDiC clinics are the only free clinics in the city of Madison. South Side officials say they do not advertise. If they did, they would be overwhelmed.

Each MEDiC clinic is only open one shift a week, at most. South Side is open Saturdays between 9 and 12.

The waiting starts way before then. Even in brutal winter, the sick line up at the doors by 7:30 to get one of the 12 coveted spots on the roster.

"For a while, they were coming as early as 6:30," said Claudia Bulla, a front desk coordinator and Spanish translator, "but we told them to stop. It was so cold, and they had their babies. We worried they would get sick just waiting."

On a busy Saturday, especially during the flu season, coordinators say they have turned away as many as six patients for the twelve slots. "It was shocking for me," said Jose Delgado, who started as a front desk coordinator just recently. "I'm from East Los Angeles, and you see poor people who need help there, too. But the clinics there handle way more than a dozen people. Some had things that were pretty bad, and they don't have funds to go anywhere else. I knew they would end up waiting another whole week."

That's what happened last winter, when Singh brought in his teenage daughter with a severe sore throat. They were too late and the clinic was full, so he went home and tried "Indian medicine" -- steam, herbal tea, and good old Vicks rubs -- to get her better, he said. It worked.

But waiting too long for formal care can sometimes be risky. Dr. Nancy Pandhi, the medical director of South Side and an instructor with the UW Department of Family Medicine, also worries about what happens to her patients once they leave her clinic. She can give patients like Christian and Singh only episodic care. Where will they find a regular doctor and ongoing care?

"We're limited in what we can do," she said. "We do not provide continuing care to most patients. When it comes to chronic conditions, our hands are tied. We're really just a band-aid approach for these people."

Some private clinics in town provide free care but only for a limited number of referrals. Doctors and patient care experts say it can take weeks and even months to get into the two centers run by the only nonprofit clinic in town, Access Community Health Centers, that offers primary care to the uninsured on a sliding scale.

"The need is greater than our capacity," said Tammy Quall, development director for Access. There were no statistics available for how many requests for medical appointments are turned away every day, but Quall said that at last count the clinic received 60 more calls a day for dental appointments than it could handle. (Since then, Quall said, the clinic has improved the backlog.) A reporter calling to make an appointment for a medical checkup recently was told to call back in two weeks. When she asked what would happen then, she was informed she would probably just have to call back again in another two weeks.

The result? "People give up," said BSP's Williams. "And that's the reality."

Without regular medical care or doctors, the same conditions that drove many patients to South Side last month -- diabetes, pain and high blood pressure -- could push them into the hospital with strokes, heart attacks and serious insulin reactions. Indeed, officials at local hospitals report a spike in emergency room visits as desperate and poor patients turn to emergency care because they have no other option.

Meriter Hospital, the most visited emergency room in the city, hit a record last year for a total 42,627 emergency room visits. St Mary's next door has also seen a spike in emergency room visits, which increased 12.5 percent last year from the year before. St. Mary's is doubling the size of its emergency facility, and officials there are braced to see the problem get worse.

"Definitely, a fair percentage of our patients use the safety net of the emergency room for their primary care," said Dr. Kyle Martin, medical director for St. Mary's Emergency Services. "The tragedy is that a number of people come in and need to be hospitalized with diseases like diabetes and high blood pressure that could be controlled if they had better access. This is a problem that speaks to the health care crisis in our society."

At the same time, local hospitals are seeing a dramatic jump in requests for charity care. In 2005, Meriter spent $4.6 million on charity care, a number that nearly doubled to $8 million by 2007. St. Mary's reports spending $7.3 million on charity care in 2007, up from $4.3 million just a year before.

In an effort to curb expensive emergency room visits, local hospitals, clinics and activists are working on a pilot project coordinated by United Way that would hook poor patients up to free care from primary physicians. Advocates like Dr. Patricia Tellez-Giron, president of the Latino Health Council and a primary care physician at Wingra Family Medical Center on the south side, fight for an even broader solution. "We are working for universal health care for everybody," she said. "Everybody needs to have a medical home."

In the meantime, patients like Singh must cope the best they can. Reached on his cell phone as he was working at the gas station a few days after his visit to the clinic, Singh said he was feeling fine. But he was worried about his wife, who suffers from episodes of arthritis and depression. They are still in debt from the last time he had to take her to the emergency room, he said, and he doesn't know what they can do next time she has a painful bout. "She shouldn't have to suffer for a week before she can get help," he said. "Nobody should have to suffer in this super country."

As for him, he said he'd be OK until his medicine ran out in another six months. Then it will be time to head back to the clinic and wait some more.

Shawn Doherty  —  6/04/2008 8:52 am