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For needy, free clinics offer alternative to ER
'Where would we go (for health care) if not for this place?'
Connie Sexton
The Arizona Republic
Jan. 30, 2007 12:00 AM
Francisco Aguilar's medical file sits in a cardboard box, stored in a Phoenix church.
His doctor arrives there to treat him in a Gulf Stream RV packed with medical supplies and personnel.
The 46-year-old construction worker waits in a metal folding chair, amid patients and nurses he knows.
Aguilar's medical home is the Mission of Mercy Mobile Clinic. There, he gets free treatment for diabetes and other ills.
Aguilar is among a growing number of Valley people turning to charitable health clinics. Before he found Mission of Mercy, he went to emergency rooms. But the increasing outreach of Mission of Mercy and other clinics brought Aguilar and thousands like him into their preventive-care orbit.
"This is where they come for primary care. They used to show up in the emergency rooms, but they are coming here now for more of their chronic care," said Catherine Amiot, Mission of Mercy's executive director in Phoenix.
There are several reasons:
• Some clinics, like Maryland-based non-profit Mission of Mercy, have stepped up their services and outreach. Mission of Mercy, which handled about 9,200 visits in 2006 compared with 8,500 in 2004, has worked with area hospitals and organizations to increase its visibility.
• The percentage of Arizonans without health insurance has risen, from 17 percent in 2004 to 20 percent in 2006, according to U.S. census data. That means more people are looking for basic care anywhere they can get a price break.
• Health officials say they are seeing a surge in asthma and diabetes, which disproportionately hit the poor.
• Clinics are generating buzz. Urgent-care clinics have mushroomed across the Valley and are advertising heavily. Clinics have popped up in grocery stores. They offer convenience and cost savings for people of all economic levels, particularly for treatments of flu, sinus problems and more. A basic visit at a grocery clinic can cost about $60. Community clinics that receive federal funds often have a sliding fee scale based on income. Mission of Mercy, which gets only private funds, doesn't charge.
For the uninsured, often the working poor, charity clinics can help. A family of four that makes too much money to qualify for the state health plan but too little to afford insurance has only a clinic or the ER.
Janice Ertle, director for a St. Vincent de Paul clinic in Phoenix, said the clinic has seen a 20 percent increase in patient visits over the past six years.
"People need a place to be their medical home and have their care managed," said Marisue Garganta, director of community health and integration at St. Joseph's Hospital and Medical Center. To cut down on ER visits for basic care, the hospital has tried harder to spread the word about clinics such as Mission of Mercy. "(Still) for every one of those patients who visit a clinic," Garganta said, "there is another who comes to the ER that didn't need to."
Can't afford office visit
Sherry Bonnell of Phoenix hopes that if someone in her family gets sick, it's on a Wednesday. That's the day the Mission of Mercy van comes to Shepherd of the Valley Lutheran Church at 15th and Maryland avenues.
On a recent cold Wednesday morning, Bonnell huddled with her 12-year-old son as they waited at the church.
Nicholas Bonnell coughed. His chest hurt, and it was hard to breathe. "He just feels lousy," Bonnell said, stroking his back.
She would prefer a doctor's office. But it's not an option now. Although her job provides health insurance, she said she can't afford the $600-a-month family premium. The state health care plan isn't an option because she and her husband make too much money to qualify.
"Where would we go if not for this place?" she said, adding, "They don't make you feel bad for not having money."
After a few hours at the clinic, including a check of Nicholas' heartbeat by a retired cardiologist, Bonnell was told he was OK, just dealing with a lingering cold.
Mission of Mercy doesn't ask any questions about finances. Donations are welcome but not necessary. Many families leave what they can, slipping a dollar or change into a glass jar. Some bring homemade food. Children bring their dolls as gifts.
Patient surge after 9/11
Like most primary-care clinics, Mission of Mercy can check on-site diagnostics for blood sugars, blood pressure, cholesterol, respiratory rates and electrocardiograms. When a patient's need exceeds the clinic's capability, doctors refer them to hospitals or other organizations. Some hospitals, such as St. Joseph's, have agreed to provide up to a certain amount of pro bono care a year.
Several women who came to Mission of Mercy were found to have breast cancer. A grant from the Susan G. Komen Foundation arranged for their care at St. Joseph's.
Several charitable clinics reported they have not only seen more patients but sicker ones.
"It stared with booms and busts in real estate and, after 9/11, so many people were hit hard and couldn't afford to go to doctors anymore," said Amiot, director of Mission of Mercy. "We started seeing people who had put off getting care. They were sick and been sick for a long time."
Dr. Brad Smith, the clinic's main physician, recalled one patient with severe diabetes. "He had symptoms for several years but didn't have the money to do anything about it," Smith said. "We became his primary-care doctor."
He also recalled a man who came in for treatment too late. "One guy came in several years ago. He looked horrible. He was in his mid-30s, very anemic. He ended up dying of metastatic colon cancer. ... That's pretty rare for being in your mid-30s, but he didn't try to get care soon enough."
Smith said he is seeing more people with jobs swallowing their pride to seek care.
"Our mission is to restore dignity through love," he said. "We're not judgmental."
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