A calling to care

Retired neurologist James Pugh wears a white lab coat on Mondays and Tuesdays when he volunteers at Charlotte Community Health Clinic (CCHC). The lean, white-haired doctor says his father practiced medicine for 50 years, “so I have another six years until I match him.” In his regular practice he saw elderly patients struggling with Alzheimer’s and Parkinson’s. Now he sees younger patients with epilepsy, back problems, and multiple sclerosis.

Like many physician volunteers, Pugh became involved with CCHC because another doctor asked him to. He has continued because he finds the work rewarding: “Everyone is super nice, and the patients are very appreciative. Everyone feels like they are doing good.”

Without volunteers like Pugh, the dozens of free and charitable clinics our reporters visited—some with hundreds of volunteers, some with a few—could not operate. According to the Kellogg Foundation, almost 80 percent of care to the uninsured is provided by private physicians: More than 260,000 doctors provide at least some charity care. Christian belief motivates some of them, but others just want to give back.

Dr. William Grimes, director of RotaCare in Bellevue, Wash., a secular clinic funded by the local Rotary clubs, says, “Most doctors inherently want the ability to give help to people who need it. We just provide the infrastructure.” All he had to do to recruit volunteers was put up a few fliers at the major hospitals. RotaCare’s weekly Saturday clinic depends on about 70 volunteers who come once every four to six weeks.

Hilton Head Island, known for its 24 golf courses, miles of oceanfront beaches, and 250 restaurants, is a desirable place to retire. When Dr. Jack McConnell retired there, he expected to play lots of golf. But the co-inventor of Tylenol soon tired of the game. As he drove around the island, he noticed pockets of poverty. When he picked up hitchhikers, he’d ask where they went for medical care. He discovered that the island’s many employed but uninsured service workers—the people who tended golf courses, staffed hotels and restaurants, and made Hilton Head a nice vacation or retirement destination—weren’t getting care at all.

Motivated by Christian faith and compassion, McConnell decided to do something about that. He explained to the Savannah Morning News, “My father and my mother together taught me the value and the joy of a deep faith in Christ. They are my inspiration.” McConnell also mentioned Dr. Albert Schweitzer, “an inspiration to anyone in the healthcare field to go out and help those who had no access to healthcare.”

McConnell recruited retired doctors, nurses, and other medical professionals to start the first Volunteers in Medicine clinic as a part-time, walk-in clinic. Now, 20 years later its campus provides behavioral health services, a dental clinic, and healthcare across 23 specialties.

Volunteers in Medicine staffer Ginger Allen says volunteers hear about the clinic from friends. They volunteer because they see the vast need and have a skill that can help meet that need. Eager to keep up with their professions, even after they retire, volunteers also like the camaraderie of being with other medical professionals. The typical volunteer comes in once a week, although some people volunteer seasonally when they are on the island. A further draw: They don’t have to bother with the business of medicine. No insurance, no billing codes.

According to the Association of American Medical Colleges, America faces a doctor shortage. As the country’s population grows and gets older, demand for health services will grow. That trend will intensify as the newly insured (as a result of “Obamacare”) seek doctors and the free preventive and diagnostic tests the law promises. Meanwhile, one-third of doctors are 55 or older and will retire over the next decade. These older doctors tend to work longer hours than newcomers to the profession, so as they retire the gap will grow. Even with more doctors in training, supply won’t keep up with increasing demand.

But what if many doctors in that new pool of retirees volunteered their skills? That would help close the gap, especially for the poor who are most likely to have trouble getting in to see a doctor. Concern about potential liability holds back some volunteers. Ginger Allen says in the early days of the Hilton Head Volunteers in Medicine clinic, potential volunteers asked, “What would happen if something went wrong?” Since many of them were licensed in other states, could they even volunteer in South Carolina?

McConnell took those concerns to the legislature, which passed a law providing for a special volunteer license available to medical professionals from any state or Canada. South Carolina also passed a law granting immunity from civil liability to any licensed healthcare provider who provides voluntary uncompensated medical care.

The American Medical Association on its website has a listing by state of licensing provisions and liability laws for senior physicians who want to volunteer their services. Laws vary greatly from state to state, but one trend is clear. Blue states like California, Connecticut, Massachusetts, New York, Vermont, New Mexico, and the District of Columbia are more likely to make “no provisions for volunteer or retired” in licensing, and “no provisions for non-emergency volunteer or charity medical care” in liability law.

Malpractice concerns affect active physicians also. Hospital employees may not have insurance that covers them outside the hospital. Even physicians who carry their own policies worry that rates might go up if a patient from a free clinic sues them. Even when states offer immunity from civil liability, some doctors are skeptical—especially when a law is untested. Many clinics provide malpractice insurance for their doctors, but it isn’t cheap. Hope Clinic in Ypsilanti, Mich., pays $17,000 a year for malpractice insurance even though Michigan has a law offering volunteers immunity.

Washington state purchases liability coverage for retired doctors “who provide gratuitous care at approved clinics.” But as the AMA website makes clear, the state will only purchase insurance up to “the extent of the funds provided for this purpose by the legislature.” Last year, threatened budget cuts in Olympia caused Diane Steward of Puget Sound Christian Clinic, whose 90 volunteers make it the program’s biggest user, to sound the alarm.

Steward wrote on her blog that if the program is eliminated, “60-70 of our volunteers will need to resign because they will not have malpractice insurance. Clearly, we will have to reduce clinic hours if that happens!” She said the program saves the state “millions of dollars in health care costs that otherwise would be absorbed by hospitals and an already overburdened health care system.”

The Federal Tort Claims Act has provided liability coverage to health professionals volunteering at charity clinics since 2004 and “Obamacare” expands the coverage to staff and board members. Clinics must apply and go through a rigorous privileging process for each volunteer. The government then “deems” those volunteers public health service employees, so if patients sue they are suing the federal government. Many clinics don’t apply for the coverage because the application process is complicated. One requirement—that clinics can’t accept third-party payments from insurance or government programs—rules out clinics like West Virginia Health Right, which participates in a federally funded mammogram and cervical cancer screening program.

Some mission-driven doctors take the radical step of moving into poor neighborhoods and working full-time at Christian Federally Qualified Health Centers (FQHCs) that serve them. Dr. Joey Patrick works at the Orange Mound clinic, which is part of Christ Community Health Services in Memphis, Tenn. The clinic is in a poor, 98 percent African-American community with a reputation for gangs and drugs. His introduction to it came when he made a wrong turn and ended up there. “It was really scary. People came out and stared.” His oldest daughter cried, and a policeman pulled them over to give directions for getting out.

Now Patrick and his family live in the neighborhood, where they bought a house a short walk from the clinic. He plays basketball with neighborhood kids, who also come to his house for homework help, dinner, and Bible study. Patrick says living in the neighborhood allows him to provide better medical care.

The Greenville (S.C.) Free Medical Clinic has about 200 doctors, including specialists and dentists, who volunteer quarterly, allowing the clinic to see 4,000 patients a year—treating colds to cataracts. Dr. Pam Snape, the clinic’s volunteer medical director, started volunteering when the clinic opened a quarter-century ago. She was the only woman in her medical school class in 1964, and felt fortunate to be a doctor and have the chance to give back. She remembers growing up in a lower-income family and watching her mother struggle to pay for medical care: “We didn’t go as often as we should because we didn’t have the income to do that. That’s what motivated me to step out and give back.”

She says clinic volunteers appreciate not having “to figure out the cost for that visit and fill in a lot of paperwork for that visit, compared to a private office. … Nice not to have to worry about making money. Nice not to have to worry about the overhead.”

Clinics, especially those close to universities and medical schools, also rely on students as volunteers. Chris Catadal, now 26, was a 20-year-old college student waiting tables in Oregon when Dr. Bob Sayson came in for some shrimp fettucine and white wine. Sayson told Catadel about a Christian medical clinic he had founded in a dilapidated and graffitied building in one of Portland’s transient neighborhoods. Since the clinic offered on-the-job training for volunteers and Catadal was trying to get into nursing school, he decided to follow up.

Catadal soon was embedded in a real-life crash course in medical terminology. He had to sharpen his Spanish and listen when patients “poured out their heart and soul”: It was uncomfortable, but “a good kind of uncomfortable.” With that volunteer experience serving as a door opener to professional school, Catadal today is a registered nurse at Portland Veteran Affairs Medical Center. He says volunteering opened his eyes to great needs and prepared him to be the hands and feet of Jesus for veterans suffering from post-traumatic stress disorder and depression.

College students who want to go to dental school are a dependable source of volunteers at the Seattle Union Gospel Mission Dental Clinic (SUGMDC). Fifteen to 18 students per month volunteer at the clinic in the basement of the Gospel Mission, receiving in return training, experience, and a leg up in the dental school admissions process. The University of Washington accepts 65 students a year into its dental school, drawing from a pool of 12,000-15,000 applicants. One year 11 volunteers from SUGMDC got in. Last year six did.

The Gospel Mission dental clinic is not fancy. It has three mismatched dental chairs: Dentists use two for doing extractions and fillings, and a hygienist doing cleanings uses one. The clinic has an X-ray room, a sterilizing room, and a break room. Juanita Banks has been the clinic’s only paid staff member since she started working there in 1995. She says it has always been difficult to get dentists to volunteer, but recruiting the first one was the hardest. Some were nervous about volunteering at a mission clinic until they saw that the clinic was professionally run with up-to-date equipment.

Seventeen years later, finding enough volunteers is still a month-to-month challenge. Banks keeps track of the schedule on a big desk calendar, using yellow to designate when a doctor will be at the clinic and orange to signify the presence of a hygienist.

Some nursing programs require students to volunteer in free clinics as part of their training. Nurse practitioner Martha Brinkso began volunteering at Charlotte Community Health Center when she was in graduate school. As an experienced ICU nurse, she feared that volunteering at a free clinic “might be boring, but I was wrong.” Now she works at the clinic full-time, her salary paid for by contributions: “I have never worked such long hours in any job I have had,” she said. “But it’s the most satisfying type of work.”

Doctors or nurses who feel called to serve the poor, and have a sense of what that means, are much more likely to practice medicine in underserved areas, says Steve Noblett of the Christian Community Health Fellowship: “If a Christian student does a rotation in a solid, well-run Christian clinic, that student stands a very high chance of eventually caring for the poor, either domestically or abroad.”

Spotlight on Seattle

Seattle is home to 70 nationalities whose members speak over 200 dialects ranging from Taishanese to Swahili. But some diversity is troublesome: Seattle is a global medical center, yet neighborhoods in Rainier Valley, five miles from the 76-story Columbia Tower downtown, share the same health status as communities in Africa.

For the one out of 10 Seattle residents who is uninsured, Federally Qualified Health Centers (FQHCs—see “Calling the Shots,” Sept. 22) and charity clinics provide a mix of coverage. Let’s take quick looks at three: Country Doctor Community Health Center, Swedish Community Specialty Clinic, and Puget Sound Christian Clinic.

Country Doctor, an FQHC, sees Medicaid/Medicare patients and also the uninsured who pay on a sliding scale. A potted vine hanging from the ceiling, and a nurse wearing a floor-length denim skirt, are part of its funky vibe: One June morning, a young hipster couple in skinny jeans and gauge earrings, a Hispanic mother cradling a newborn, and a bald, wrinkled woman in bottle-rimmed glasses wait to be seen. A gentleman in his 50s, sporting a gray top hat and an orange tie-dyed shirt, seems at home.

The clinic’s informality puts its immigrant and student population at ease, and the patients keep coming: Each year Country Doctor logs about 65,000 patient visits, relying on a paid staff and medical trainees. Country Doctor could become even busier under Obamacare as more people qualify for Medicaid. Even now patients wait for appointments, something they complain about on websites like Yelp.

One night a month Country Doctor holds a free clinic for street kids: They won’t come in during regular hours, so offering a separate clinic allows the staff to address issues of concern to them. The clinic has four Spanish translators and uses another organization for less common languages.

The walk from Country Doctor—in a neighborhood of small one-story houses, some with fresh paint and others with grass growing through chain-link fences—to Swedish Community Specialty Clinic takes 25 minutes and goes from graffiti to glam. Patients ride a silver elevator to the upper-level, 4,000-square-foot clinic, where local specialists offer free specialty care, including cardiology and general surgery to uninsured people referred by Project Access Northwest (PANW).

Director Tom Gibbon says some patients walk into the waiting area, which looks like a page from a design magazine, and walk out thinking they are in the wrong place. Patients wait in soft leather chairs. Exam rooms have views of Seattle that rival those from the Space Needle. Gibbon says the fancy decor is about dignity: He wants the free clinic to feel as nice as any regular clinic at Swedish Hospital, and notes that doctors are more likely to volunteer in a good-looking place.

The personnel are as striking as the decor, according to patient Darlene Alcaylea, who received a hip replacement at the clinic: “It was really hard for me to ask for charity. ... Everybody there, they were like angels. ... You can tell when someone is phony or from the heart. To me they are heroes.”

Puget Sound Christian Clinic (PSCC) doesn’t have the glamor of Swedish Community or the hipster charm of Country Doctor. It sees medical and dental patients on Wednesday evenings and Friday mornings from offices inside North Seattle Alliance Church, and offers counseling on Thursdays.

Started in 2003 by former missionary healthcare providers who saw an unmet need in their own city, PSCC relies on volunteer doctors, nurses, and other health professionals. It explicitly aims to show Christ to the uninsured “by providing quality, compassionate health care while asking the Holy Spirit for opportunities to share the Good News of Christ with them.”

In 2010 PSCC purchased a 40-foot mobile clinic—basically an RV outfitted with two examining rooms and a nurse’s station—that rotates among six locations hosted by different churches. The 10-year-old vehicle allows the clinic to provide care in different neighborhoods, using willing churches in those neighborhoods to support the clinic financially and find volunteer doctors and nurses to staff it.

On one typical day volunteer Page Campbell greeted patients as they arrived and offered them encouragement and prayer after their appointments. Six-months-pregnant Susan Baazak, an immigrant from Egypt who works in the church food bank, says her mother has heart trouble and no health insurance, so she comes to the mobile clinic: “It’s a bless.”

With reporting by Tiffany Owens, Christina Darnell, and Kira Clark