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Free-care clinic in Butler views mission to help low-income patients as priceless
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Leonard Zadecky looks at blood vessels in patient Joe Lema's eye as intern Cara Moses observes at the Community Health Clinic of Butler County. -
Diabetic nurse educator Linda Reichart presides over a banquet of plastic food showing exactly the proper serving size for patients needing information on diabetes at the Community Health Clinic of Butler. -
Dentist Rick Bennett, a volunteer, sees a patient at the Community Health Clinic of Butler County.
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America may be on the road to major health care overhaul, but Cecelia Buechele Foster believes her Summit health clinic is an example of what real health reform looks like.
Ms. Foster is executive director of the Community Health Clinic of Butler County, which treats patients for free but takes no insurance and receives no state or federal funding.
The clinic does it with a legion of volunteers: 35 physicians, 30 to 40 nurses, nine dentists, two pharmacists and a dietitian/nutritionist on the clinical side. There is also the retired CPA who helps with the books, retired social workers who counsel patients and retired teachers who help with case management.
Not accepting federal funding allows the clinic some freedom; it has medical liability protection under the Federal Tort Claims Act, for example. But that also means it is entirely dependent on donations of money that, except for a major fundraising event in the fall and another in the winter, do not come in consistent or predictable waves.
Tax records show the clinic collected $589,518 in grants and contributions in fiscal 2011, but $389,709 in 2010 and only $151,990 in 2009. Not knowing how much is coming from year to year makes budgeting a challenge, Ms. Foster allowed, and the specter of coming health care initiatives has complicated that task.
Already donors have inquired about the need to continue giving now that there's a federal mandate that people purchase health insurance, she said.
But, Ms. Foster points out, that change is still nearly 18 months away and there's no clear picture yet of what the health care landscape will look like by then. Pennsylvania, for example, is among the states still deciding whether to expand its Medicaid program to reach more low-income residents.
"There are so many variables over 2014" when the major initiatives such as health exchanges and Medicaid expansion go into effect, she said. "It's why I don't sleep at night."
The organization itself is apolitical; its mission is solely to provide care for those falling through the cracks because they don't have insurance and don't qualify for any government program such as Medicare, Medicaid or the Children's Health Insurance Program.
And, regardless of what Pennsylvania does about the Medicaid program, she knows there will still be a need for the clinic.
While expanding Medicaid would increase eligibility to those at 133 percent of the federal poverty level, the Butler clinic sees uninsured adults earning within 200 percent of the poverty level, or equal to an annual household income of $46,100 for a family of four, or $30,260 for a couple.
The Butler clinic --which only does primary care, so there are no narcotics on site -- currently treats about 2,000 county residents, but Ms. Foster estimates that 10 times that number might meet the income eligibility requirements.
The facility is one of only two clinics in southwestern Pennsylvania that is free to patients while operating without government funding. The other is the Catholic Charities Free Health Care Center, Downtown, which opened in November 2007 and is in the process of renovation and expansion thanks to a one-time $200,000 grant from the Allegheny County Redevelopment Authority.
Like in Butler, contributions to the Downtown clinic have fluctuated, from just under $700,000 in fiscal 2009, to $2.17 million in 2010, then $856,000 in 2011, according to tax records. Although a partner with Catholic Charities, the clinic is financially independent.
"We are responsible for securing our own funding to be able to cover the operating costs of the free health care center," administrator Annette Fetchko said. The Catholic Charities clinic provides primary medical and dental services for about 8,000 uninsured, low-income patients, she said.
Despite the funding uncertainties, Ms. Fetchko remains optimistic. In addition to the redevelopment authority grant, the Pittsburgh clinic secured a partnership with the University of Pittsburgh dental school earlier this year to provide dentures for the clinic's clients at no charge, and the Highmark Foundation has offered its support with a two-year, $1 million grant.
"I just think we will continue to be able to identify and secure the funding required to be able to provide the current level of services," Ms. Fetchko said.
In many respects, finding medical professionals to volunteer their time is the easier task. "I find that the best way to get the physician to volunteer is to get them here," Ms. Foster said. Once they see what the clinic does, and how much it helps, they're hooked.
William DiCuccio, a retired physician and chairman of the Butler clinic's board, said his colleagues like the prospect of treating patients without having to handle insurance forms or bother with malpractice insurance. "Health care professionals just want to practice medicine. It takes them back to their roots."
Ms. Foster is one of only three full-time employees, and eight others work less than half time. The backbone of the Butler clinic is the 150-strong volunteer force that provides care in a converted and remodeled 42,000-square-foot warehouse that was renovated by volunteer plumbers, electricians, carpenters and contractors.
The clinic opened in January 2008, just months before the national economic collapse, and the early estimates of the community need nearly doubled after that. When the clinic began offering basic dental care, such as exams and extractions, it quickly had a waiting list of 1,800 people, some of whom had not seen a dentist in years.
Of the 2,000 people they currently see, Ms. Foster said, two-thirds have full- or part-time jobs but no health benefits. About half of the patients are either diabetic or pre-diabetic and the clinic provides monitors, testing supplies, insulin and dietary counseling. The real, but unknown, savings is how many trips to the hospital emergency room have been prevented because of the clinic's program.
Portersville resident Joseph Lema, 58, is one of those patients with diabetes. He worked only part time because of a back injury, and he lost the last of his health benefits in February. He went to the Butler clinic, where the doctor also diagnosed his low testosterone. His diabetes is under control now, and he comes by the clinic for a testosterone shot twice a month.
"Within three visits, they had me feeling like a new man," Mr. Lema said. "I'm ready to take on the world again."
Just last month, the clinic was one of five recipients nationally that won a $15,000 grant from the American Medical Association Foundation for diabetes education.
But Ms. Foster is equally grateful for the recent $1,743 donation from the local Prospect League Butler Blue Sox baseball team, which joined with a local podiatrist and Brookville Wood Products to pledge a dollar for each of the 581 Blue Sox hits this summer.
"We are very frugal with the money we have," she said. "I'm just aware on a daily basis of what we can do on less-than-a-shoestring budget."
First Published August 19, 2012 12:00 am
