Filling in health care's cracks

For 10 years, a doctor has been the force behind a free clinic for Altoona's working poor

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ALTOONA, Pa. -- Hidden away in a two-story brick building, across a parking lot from Kopp Drug pharmacy, is the free clinic that Dr. Zane Gates believes will change Pennsylvania.

Taped to the clinic's door is a sheet of paper listing its hours. Inside, with a handful of employees, eight volunteer doctors and a yearly budget of $256,000, the office serves more than 3,500 people who earn too much to qualify for medical assistance but cannot scrape together enough money for health insurance: Altoona's working poor.

The clinic, Partnering for Health Services, subsists through an association with Altoona Regional Health System, which absorbs and writes off approximately $2.3 million more in costs per year for laboratory tests, X-rays and medication.

But it could not survive without Dr. Gates, who for more than 10 years has nurtured an idea for a better way to deliver health care, tending it as it grew to include two legislative bills, a pending health insurance plan and a clinic that has become one of the most critical safety nets in the Blair County community.

The idea -- which his supporters call simple but radical -- fosters cooperation between hospitals, insurers and health care providers. The result: a clinic that offers effective, timely and affordable care for poor patients. In recognition of his work, Dr. Gates recently was honored by as one of its Health Heroes for 2009.

"He's been a godsend to me," said Diane Koller, 52, an Altoona mother and a patient at the clinic. Ms. Koller, who is diabetic, works at two part-time jobs but cannot afford health insurance. She sees Dr. Gates regularly for blood tests and medication.

"Without him, I wouldn't even be here," she said. "I'm sure."

Dr. Gates argues that federal health care reform may expand insurance options for many Americans but will not change anything for people like Ms. Koller, who still cannot afford to buy a plan. For years, he has fought to create a medical home for the working poor -- a clinic with scheduled office hours, regular appointments and other benefits available to people with insurance.

Even as he weathers setbacks, he is turning heads across the state.

"He's indomitable," said Dr. Jim Withers, who founded Operation Safety Net, which provides health care for homeless people in the Pittsburgh area.

Dr. Gates grew up in Evergreen Manors, an Altoona housing project. He never knew his father. But he was propelled by the charitable ideals of his mother, who never hesitated to take in and care for troubled children from their community.

He attended the University of Pittsburgh at Johnstown, then transferred to Pitt's School of Pharmacy in Oakland. When he graduated, the entire class applauded, said Patricia Kroboth, the pharmacy school dean.

Dr. Gates -- who had once doubted that a child from a housing project could become a doctor -- enrolled in Pitt's medical school. He graduated in 1995.

As a resident at Allegheny General Hospital, Dr. Gates worked with Dr. Withers on the streets of Pittsburgh and was inspired by the then-revolutionary project for the homeless. After his residency, Dr. Gates returned to Altoona, saying he was hungry to give back to the community that raised him.

In 1998, he simultaneously created a free clinic and an after-school program named for his mother, the Gloria Gates Memorial Foundation. She died when he was 22.

He started with a van, some medical supplies and $23,000, traveling to community centers and holding Wednesday night clinics, he said. In 1999, he merged the clinic with the Altoona Regional Health System, which expanded his staff and started providing free ancillary services and access to specialists.

Today, Dr. Gates, 42, volunteers at the free clinic on Wednesdays and works full time as director of the Altoona Community Health Center, a federally qualified clinic that receives government funding to treat underserved, uninsured or underinsured people. He has expanded his foundation to serve more than 100 children in two housing projects. A broad-faced, broad-shouldered man with boundless energy, he is the father of three children, ages 3, 4, and 12. In his spare time, he writes medical thrillers.

He is a self-professed Democrat who collaborates with Republican politicians. When he looks at his work, he doesn't see a clinic; he sees a plan.

Last year, Dr. Gates worked with several state lawmakers on a Senate bill that would provide $50 million to support clinics like his across Pennsylvania.

"This should be a national model," said state Sen. John Eichelberger, R-Blair.

The legislation stalled, but Dr. Gates regrouped. He is currently collaborating with state representatives on an identical bill in the House.

He is also developing a hospital-only insurance plan that would give his free clinic patients access to a preventive wellness program and three emergency room visits each year, for which they would pay less than $100 a month.

"If you have a heart attack, or you break a leg, you get your gall bladder out -- all that stuff, it's all covered," said Dr. Gates. "No co-pays, no pre-existing conditions, anything."

The plan would save money for both the clinic's patients and Altoona Regional Health System, said Cloyd Beers, executive director of the Altoona Regional Partnership for a Healthy Community.

"Right now, if one of these patients can't come here ... they're going to end up in our ER, and it's going to be a much greater cost," said Mr. Beers.

"People go bankrupt from that stuff," said Dr. Gates.

Among his supporters is Patrick Reilly, who is helping Dr. Gates develop his insurance plan.

"When I heard what he is treating those 3,500 people for, and the price it costs the hospital, even I was like, 'How come no one in the country is looking at this?' " said Mr. Reilly, president of Impact Employee Benefits Solutions of Youngstown, N.Y. "I think he's ahead of the curve."

The plan is in its final stage, awaiting approval from the state insurance commissioner, he said. Meanwhile, Dr. Gates continues to cultivate the free clinic, which he and his supporters think is a model for caring for the working poor.

"It will work. It definitely works. He's proved it works," said Mr. Eichelberger.

Dr. Gates suffered a blow last week when a $3 million state budget allocation meant to fund clinics like his free center was swept up in a round of funding cuts at the Department of Public Welfare. But he remains optimistic, saying his clinic gives him a unique understanding of the nation's health care crisis.

"I'm not smarter than anyone else," he said. "All I've done is sit and just talk to these people and say, 'What's your life like? How much can you afford? How can we make the system better?' "

He said his free clinic patients get "more treatment and a larger drug formulary" than the patients at his federally qualified clinic, who receive medical assistance.

"Anything you would get at your doctor's office we provide here," he said.

Dr. Kroboth said she was most impressed with the way Dr. Gates's clinic operates like a typical primary care provider.

"The part that really appealed to me is the idea that the homeless, the uninsured, the working poor have the opportunity to make an appointment to see someone," she said. "They don't just have to show up and wait in line."

Mr. Beers said that Altoona Regional Health System is currently exploring larger spaces to house the clinic.

Dr. Gates now is turning his attention to the University of Pittsburgh Medical Center.

"If Altoona Regional Health Care System -- which is a considerably smaller health care system -- can provide this type of service, I think UPMC also can help," he said.

"I think he's not happy with resting on his laurels," said Dr. Withers. "I like the fact that he keeps pushing into arenas of policy and things that really will make, hopefully, big changes."

"You nail down Pittsburgh, then Philadelphia says, 'What's Pittsburgh doing?' " said Dr. Gates.

After Philly, he believes it is only a matter of time before even more heads turn his way.

Vivian Nereim can be reached at 412-263-1413. First Published January 17, 2010 5:00 AM


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