RX for Change: Confronting the health care crisis in Kansas

By April Middleton

Salina Journal

Franklin Davis knew he no longer could ignore whatever it was that was going on with his body.

He was sleepy and fatigued, couldn't drink enough to quench his thirst and constantly craved sweets. Soon, he developed a sharp, nagging pain in his stomach.

Lacking health insurance and a local doctor, Davis, 52, of Salina, headed to the only place he could -the emergency room at Salina Regional Health Center.

"They did some tests, and the doctor came in and shook his head at me," Davis recalled. "He said he couldn't believe I hadn't went into a diabetic coma."

After being diagnosed with diabetes, high blood pressure and high cholesterol, Davis spent three days in intensive care.

"It was real scary, because they tell you all these things are wrong, but you don't know how you're going to be able to take care of it," he said. "I didn't have ... insurance."

Hospital staff told Davis about the Salina Family Healthcare Center.

There, he could see a doctor regularly and pay a reduced cost, based on his income.

"Just having someone to go to regularly and to talk to and help me learn what I was doing wrong helped," Davis said. "I was able to see a real improvement in my health. My weight and blood pressure all came down."

Can't afford insurance

More than 300,000 Kansans are without health insurance, according to the U.S. Census Bureau. Many can't afford insurance deductibles or premiums, so they go without.

Most of the uninsured either work or live in a family where at least one person works full time, according to the Kansas Health Institute, a nonprofit health policy and research organization based in Topeka.

The institute reports that while Caucasians make up the greatest number of uninsured, minorities - based on their percentage of the population - are more likely to be uninsured.

Those in the state who operate safety net clinics - such as the Salina Family Healthcare Center - agree there is a problem, and not just for those going without regular health care.

The uninsured drive up the cost of health care for everyone, said Marcia Hawkes, CEO of Salina Family Healthcare Center. And ailing employees who often are unable to work hurts the economies of communities, she said.

Living as the uninsured do is something most people can't understand.

"When we are sick, we go to the doctor," Hawkes said. "If we are diagnosed with a disease, we have options. These people don't have that. We don't have any concept of what it's like living from one crisis to the next and never getting ahead."

Chronic health problems

The uninsured develop chronic health problems and use hospital emergency rooms - the one place they are guaranteed care - as their doctor's office.

Clinics, like the one in Salina and others throughout the state, help improve access to health care, but many operate at capacity.

As more people call for appointments, revenues remain flat. Centers that qualify for federal funding receive a set amount each year. And there is only so much state money and other grants available, clinic directors said.

And some centers struggle to compete for staff with clinics that pay higher wages.

"The money trees have dried up, so to speak," said Sally Tesluk, executive director of PrairieStar Health Center in Hutchinson.

The clinic's patient load has increased in each of its 10 years of existence. Last year, it recorded more than 11,000 medical visits.

"And we know we aren't doing enough," Tesluk said. "Every single month, we have about 100 first-time visitors. We aren't turning anyone away yet, but how do you keep that up?"

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The need in Hays

In the three hours it is open one night a week, the First Care Clinic in Hays sees 10 to 12 patients.

"There's no doubt in my mind we could be here every single day," said Jolene Whitehair, a social worker at the clinic. "We are seeing more and more people that, for whatever reason, after they pay rent and buy food they can't afford health insurance."

First Care Clinic, funded by Hays Medical Center, sees only patients without health insurance, whose incomes are at or below 125 percent of the federal poverty guidelines and live in the four-county area it serves.

The weekly clinic is like a "mini-ER," Whitehair said.

Many of the patients have gone 10 to 12 years without seeing a doctor. By the time they make it to First Care, they have multiple health problems and need extensive follow-up.

Diabetes, high blood pressure, high cholesterol and heart disease are common ailments among the uninsured, Whitehair said. The most unfortunate thing about those illnesses, she said, is that they are almost entirely preventable.

Whitehair knows many in the four-county area are still going without care, and those in farther northwest Kansas, where there are no clinics, are really suffering.

A free weekly clinic on a small budget, though, can do only so much.

"What we can provide is pretty much phenomenal," Whitehair said. "At times, you wish you could do more, and you know it's needed. We just don't have the manpower."

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Crossing their fingers

Hawkes said she is certain the clinic in Salina could provide the amount of care that is needed in this part of the state if it had more staff, more funding and more room.

The clinic was started in 1991 by three nurses who were concerned people were going without medical care.

Two patients showed up for the first clinic. Soon there were eight, and then there were 46 patients lined up.

Each night, staff crossed their fingers, hoping a volunteer doctor would arrive and there would be enough volunteers.

"We knew we had to do something different," said Anne Jung, director of development and community outreach for Salina Family Healthcare Center.

Resident doctors with Smoky Hill Family Medicine Residency Program, a program of the University of Kansas School of Medicine-Wichita, got involved. And as the clinic continued growing, officials knew it again was time to do something different.

A different model

The Salina Family Healthcare Center merged with the residency program. With a good model for providing health care to the poor intact, a stable staff and increasing demand for services, the clinic applied to become a federally qualified community health center.

It received that designation - and $650,000 each year in funding - in December 2004.

"It opened the flood gates," Hawkes said. "We started staying open five days a week, and we are up 20 percent on patient visits from just a year ago."

It's a unique model. Resident doctors provide care to the nearly 25,000 patients that come through the clinic's doors each year. The clinic employs about 75 workers.

For the clinic staff it means not begging for volunteers or struggling to pay doctors what they would make in a different setting. For the medical residents, it means real-world training.

The clinic soon will offer dental and mental health care and pharmaceutical assistance. But the center is nearing its capacity of 29,000 patients a year.

While the grant from the government is helpful, it amounts to just 14 percent of the clinic's annual budget of about $4.7 million, Hawkes said. Other funding is provided by state grants, the hospital, private donors, the Salina Area United Way and patient fees.

The clinic does not solicit patients with insurance, but accepts them "with open arms."

Doing so provides more revenue, said Hawkes, who often hears the clinic is a model for others.

It works because of the collaborative and cooperative efforts of the community, she said. Without help from others in the medical community, Hawkes said, the clinic couldn't operate at is does. Many specialists have stepped up and offered to provide care to the clinic's patients, at reduced costs.

"We are doing a lot, but it's not even a small drop in the bucket," Hawkes said. "We are capable of doing more. All it would take is some more funding."

Problems in Garden City

The United Methodist Mexican American Ministries in Garden City also is at capacity, said executive director Penney Schwab.

In 2004, the clinic provided 23,072 patient visits.

"Every year, we have more and more uninsured and fewer and fewer with insurance," Schwab said.

And some of those that have insurance are seeing higher deductibles and less coverage, she said.

One company in Garden City changed ownership recently, Schwab said, and the insurance provided to employees stopped covering family planning services.

"Things like that become a real problem," she said. "Yes, we still provide family planning, and the county health department does, too, but we have to charge something for the services, and not everyone can afford that."

The clinic increased access for thousands of people, but Schwab knows there are probably thousands more that aren't receiving care.

Those people inundate emergency rooms and develop serious illnesses," she said.

"You look at diabetes and heart disease, some of these things that are on the rise and those are huge problems among the uninsured," Schwab said. "Essentially, they are preventable and controllable conditions, but not for people who can't get care."

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Giving free care

The amount of charity care given away and bad debt incurred at Salina Regional Health Center is "increasing a little bit each year," said Cheryl Mason, chief financial officer at the hospital.

About 2.3 percent of the hospital's patients last year were self-pay, an indication they're without insurance.

While a small percentage, it amounts to a lot of dollars. People meeting certain financial guidelines are provided discounted care. Last year, the hospital gave away $3.9 million in charity care, Mason said. The amount of charity care and bad debt both have risen a bit in recent years, she said.

But without Salina Family Healthcare Center, Mason said, those numbers would be even higher.

"... We are managing.. At this point, it's not a factor as far as being profitable, but I think it's something everyone is concerned about."

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It saved his life

Davis, the patient who reclaimed his health with help from the Salina clinic, now has health insurance through his employer. But, he has no plans of finding a new health care provider.

He credits the clinic with saving his life. By managing his diet, Davis got off insulin and kept his weight, blood pressure and cholesterol down.

"I can't say enough about them," Davis said of clinic staff. "I'm still here because of them. They gave me help I couldn't get anywhere else. I'm not leaving now."