Monday, May 10, 1999
Two Hamilton clinics closing
Hospitals brace for uninsured
BY JANICE MORSE
The Cincinnati Enquirer
HAMILTON — When two Hamilton health clinics close today, the future becomes more uncertain for Mandy Ramirez, her children and about 5,000 other patients.
“We don't know what we're going to do,” Mrs. Ramirez, 23, said last week when she brought her children, Joshua, 4, and Nick, 1, to the Henry A. Long Family Practice Center for their final visit.
She works in a factory; her husband works in construction. The family relied on the Long Center's convenient, low-cost health care.
“This is the only doctor's office I've ever brought my kids to,” she said.
The Long Center at 732 Central Ave. and its companion, the Joseph Center at 229 Dayton St., are closing because their private, nonprofit parent company, Lincoln Heights HealthCare Connection Inc., is in financial trouble — at least partly because of complex changes in U.S. health care.
Hundreds of other clinics are imperiled, officials say, including some of the two dozen or so clinics — privately run and government operated — that serve low-income people in the Tristate.
“Most of our centers are financially at risk, because we have no working capital, no reserves and more uninsured patients coming to us all the time,” said Randall Garland, executive director of Cincinnati Health Network, an association of clinics serving Hamilton County's poor.
Every time one of these clinics closes, consequences ripple beyond patients they served.
“The uninsured have an effect on all of us,” says Jeffrey A. Diver, executive director of
Supports to Encourage Low-Income Families, a nonprofit community action agency in Butler County.
When people are uninsured and cannot find affordable health care, they often delay getting treatment until they are seriously ill.
By then, their illnesses may have infected others, and they face long-term lost wages and potential job loss.
What's more, the cost of treating their serious illness — usually in a hospital emergency room — is many times greater than it would have cost to prevent the illness, Mr. Diver said. That, he adds, has implications for other patients.
“When these people can't pay for that emergency room visit, you know that cost is getting passed on to someone: everyone else,” he said.
Hospitals bracing
Hamilton-area hospital emergency rooms are bracing for what they fear could be an influx of uninsured patients formerly served by the Long and Joseph centers, said David Ferrell, president of Mercy hospitals in Hamilton and Fairfield. “Our emergency staff is concerned about availability of staff and long wait times.”
As a stopgap, Hamilton City Council agreed to expand services at its small East Avenue Clinic, but that site has no primary care for adults or dental services.
Butler County's only remaining clinic providing regular primary care to uninsured adults is the city-run Middletown Social Services and Health Center at 930 Ninth Ave., but it offers no dental care.
“After these clinics close, if you're an uninsured adult in Butler County and need primary care, what are your options? The patients are asking me, and I don't have much to tell them,” said Dr. Douglas Rahner, a board-certified family practice physician who worked at the centers and who will continue at the Mount Healthy Family Practice Center. “If there are services available, they often don't know about them, and even if they do, they don't have the transportation to get to the services. These people just kind of wallow in their need, and you don't find out about them until they show up in an emergency room deathly ill.”
Among more than 950 community health clinics across the nation, about 45 percent are financially at risk, according to the National Association of Community Health Centers (NACHC).
“Two converging forces in the health system are pressing health centers across the nation hard. First is the growing number of uninsured Americans,” NACHC spokesman Dale Galassie told a congressional committee last month. “Second, health centers are seeing increasing numbers of uninsured patients previously seen by other providers.”
43 million uninsured
About 43 million Americans lack any kind of health coverage — and more than half are the working poor, Mr. Galassie said. Increasing numbers of those patients are relying on health centers because managed care is forcing cutbacks in free and low-cost care from private physicians and teaching hospitals.
What is causing the increase in uninsured patients in the first place? Welfare reform.
Welfare-to-work programs are pushing people into low-paying jobs without health insurance.
“The great thing is that they have a job, but the bad thing is that they have no medical card, ” said Mr. Ferrell, the hospital president, who also heads the local Healthcare Leadership Group. “... So they're being forced to decide: Do I buy the bread and the milk or do I buy the prescription?”
That is reality for people such as Diana Davis, 37. ""I'm from Oxford; I don't have insurance and they don't have anything there, so that's why I'm here,” the mother of three said Wednesday at the Long Center. “I don't know what I'm going to do. I'm self-employed, and I don't make enough money to buy insurance, but I make too much to get a medical card. And I've got lots of health problems.”
(The card entitles a low-income person to subsidized care under Medicaid.)
A health care activist for more than three decades, Dolores Lindsay hears those stories every day. Mrs. Lindsay, executive director of the Lincoln Heights HealthCare Connection Inc., said the decision to close the Hamilton clinics was difficult.
“It's painful because in many ways, I feel like we abandoned a group of people who depended on us,” she said Thursday at the Lincoln Heights Health Center.
Dabbing at her eyes, she said: “It hurts. It really hurts. It's like losing two family members.”
Hard decision made
Mrs. Lindsay said she was forced to make the hard business decision to close the two Hamilton clinics because they had the highest percentage of uninsured. She estimated 63 percent of the Hamilton centers' patients were uninsured, about 10 percent higher than the overall percentage of uninsured at all four Lincoln Heights clinics.
That left her with two clinics — the Lincoln Heights center and the Mount Healthy center.
She told Hamilton officials a year ago that the clinics were in trouble. “In hindsight, maybe I should have been a little more forceful in telling them that, but that's not my personality,” she said. “Also, we had every reason to believe our federal grant was going to be approved.”
On April 1, Mrs. Lindsay learned that, despite 35 letters of recommendation, Lincoln Heights was approved to receive only $520,000 of a $1.2 million federal grant the company had sought. She said she received no specific explanation of the shortfall.
Within a few days, staff members were told the clinics would be closing. “It was definitely demoralizing,” Dr. Rahner said. “But do you know what was the first thing the staff said? They asked, "What about the patients?'”
Patients were sent letters giving them 30 days' notice that the clinics would close today. Some of them are choosing to find transportation to Lincoln Heights' other locations. Others do not know what they'll do.
Mrs. Lindsay says she tried hard not to leave Hamilton, “but the resources aren't there, and it became apparent there is nothing I can do to make them be there.”
That makes Gail Payne, the Long Center's dentist, angry.
“I think the leaders in Hamilton have the resources to have made this a viable project, but they chose not to — and I don't think they'll divulge the specifics as to why,” Dr. Payne said, pointing out that the dental service she provided at the Long Center was the county's only such service offered on an income-based sliding scale.
“A continuing relationship with Lincoln Heights would have provided a continuum of care without disruption of service to the patients, if financial support had been given.”
Management concerns
City Councilman Richard Holzberger worked on several health-care issues in the city. He said funds may not have been forthcoming because some officials had concerns about Lincoln Heights' management. He refused to elaborate.
Mercy Sister Monica Knipfer, chairwoman of the clinic board, told the Local Healthcare Leadership Group on April, “The integrity of management is not being questioned but the process of management is.” She would not elaborate.
Mrs. Lindsay said maybe her organization did not do everything correctly. “But no matter how it looks now, no matter what people are thinking or saying, we made a difference there. We did something for that community that no one else can do there for a long time,” she said. “We provided stabilization of primary care, a level of professionalism and delivery of service.”
Patients in the waiting room of the Long Center on Wednesday had nothing but praise for Lincoln Heights.
“They're great. It's not the way people think. It's not like you come in here and don't get good care because it's a clinic. In fact, you're treated better than they treat you in the private sector,” Oxford resident Ms. Davis said. “They don't just want your money. They care about you. They want to fix you. I don't think I'm going to ever be able to find any place else like this.”
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