Free Clinic Sees Number Of Patients Skyrocket

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At the Augusta Regional Free Clinic in central Virginia, there's been a 40 percent increase in new patients compared with a year ago. Two textile mills have had mass layoffs, further increasing the number of uninsured. Host Jacki Lyden visits with the new patients and clinic staff and talks about how the stress of unemployment and reduced hours affect patient health.

JACKI LYDEN, host:

Welcome back to ALL THINGS CONSIDERED. I'm Jacki Lyden.

It's the beginning of what will be a long day for Jo Anne Brown. She's a nurse practitioner at the Augusta Regional Free Clinic in central Virginia. Unemployment has more than doubled since last year in this corner of the Shenandoah, and so has the clinic's patient line.

Jo Anne checks her schedule. She used to know almost everyone who came in, but now?

Ms. JO ANNE BROWN (Nurse Practitioner, Augusta Regional Free Clinic): This one is new. This one is new. This one is new. This one is new.

LYDEN: The Augusta Free Clinic has seen a 40-percent increase in new patients in the last year. One of those new faces is Kelly Jackson(ph). She worked at the local nylon factory. Her pink slip came in December.

Ms. KELLY JACKSON: I've always been one who, I guess, was independent. I like to do things on my own, wasn't one to much ask for help. But there are certain situations where you don't have a choice.

LYDEN: It used to be that the Augusta Free Clinic provided care only for the working poor who didn't have health insurance. Now, the unemployed are accepted too. There's no charge for services, and the waiting room is full of newcomers.

One of them is Brian Butilier(ph), a divorced father of two, aged 35, hoping to be seen.

Mr. BRIAN BUTILIER: I do landscaping, and I inhaled some mulch, and I became hoarse, and I went to emergent care, and he said that it seemed like I just damaged my vocal chords with dust, but it hasn't gone away, and I'm not really sure where to go. I don't have insurance. So I was told to come here and make an appointment.

LYDEN: Brian's been smoking for 18 years and immediately fears the worst: cancer. But before he can be seen, there's paperwork to do. He has to go over his income and finances with the eligibility volunteer, Lyna Harper(ph).

Ms. LYNA HARPER: Okay. Since you didn't file taxes, and, of course, we don't have any copies of your paystubs, you are eligible to see the doctor, but you cannot get your medication here.

Mr. BUTILIER: So the medication I get if I do have cancer may not be covered is what you're saying because I do not…

LYDEN: This may be the most anxious moment a newcomer has, whether or not he will qualify for care at all.

Ms. BECKY RADER (Patient Care Coordinator, Augusta Regional Free Clinic): You always worry that somebody is going to come in that you cannot figure out how to address their needs.

LYDEN: Becky Rader is a registered nurse. She tells a story about one man who came in. He'd had his hours cut, so he lost his health benefits. He said he needed his prescriptions for pain and anxiety. He was obviously distraught.

Ms. RADER: And I said, are you thinking about harming yourself? He said, absolutely. And he said, and I have a plan. And those are kind of the watchwords that you look for. And so, I couldn't let him leave, just leave here. He was - apparently, he had had a relationship with someone, and they had died not too long ago, and he had been their caregiver. And, you know, he did say at one point, I just need somebody to take care of me right now, and there's nobody in my life to do that.

LYDEN: The man is now stable and a patient at the clinic. Nurse Becky Rader is caring for 300 more patients than she did a year ago. Her desk is practically barricaded with patient folders. She has to stay on top of each case and cobble together free or discounted medications.

Mr. BENJAMIN PITTSENBERGER(PH): They said that they would eventually refill everything for me and…

LYDEN: Benjamin Pittsenberger is 28.

Mr. PITTSENBERGER: I'm on all kinds of things: Glyburide for my blood sugar; Tricor for my cholesterol; my Metformin for my blood sugar; Insulin and lisinopril for my blood pressure.

LYDEN: Pittsenberger hasn't seen a doctor in six months. A mountain of a man, he's married with two kids. His wife doesn't work, and neither does he, though he's looking. He was laid off from a company that installs satellite dishes. The diabetic man was told there was no ladder strong enough to hold him.

Mr. PITTSENBERGER: I got pancreatitis, and I stayed in the hospital for a week, and I learned insurance is very important because that cost me -I got a bill for about $34,000 for one week.

LYDEN: Are you - you're not trying to pay that, are you?

Mr. PITTSENBERGER: I haven't been, but that's just because we haven't had the money. And we - I probably, just myself, owe close to $50,000, $60,000 in medical bills just since then.

LYDEN: And how much do they (unintelligible), not to put too fine a point on it, come after you? How much do they try and collect?

Mr. PITTSENBERGER: Well, they just - they send me garnishments in the mail, and that's fine. It's to the point where I don't even open them anymore, just throw them in the trash because I know what they are.

LYDEN: Did you ever think you might be in this situation?

Mr. PITTSENBERGER: No.

LYDEN: And why not? Why did you think it couldn't happen?

Mr. PITTSENBERGER: I had too good of a job, and things were going good. We had money in the bank. At the time, I had a brand new car.

LYDEN: If there's one thing the workers at the clinic know, it's that life can change on a dime, and that's happening in Augusta County. Two major textile plants had big layoffs last winter. Fifteen thousand people, about one in five, are without health insurance here. So far, the August County Free Clinic has managed, but it depends on volunteers, more than 200 of them, to help keep it going.

(Soundbite of laughter)

Unidentified Woman: (Unintelligible). Shame on you.

LYDEN: Today, there's a lunch to honor the volunteers with potluck salads and gift baskets of Hershey's Kisses. All the volunteers are being asked to work more. The clinic's also cutback appointments from 30 minutes to 20 to see more people, but even that is not enough.

Ms. JEAN HARRIS (Office Manager, Augusta Regional Free Clinic): We're not a clinic to fit everyone, but we try our best to have an alternative plan for them before they leave.

LYDEN: Jean Harris has been known to run after people in the parking lot when she thinks of something that might help them. She's the clinic's office manager and much more. She's the one who finds ways to navigate the system, bending and twisting rules when life and illness demand exceptions.

Recently, a family came in with a 15-year-old daughter.

Ms. RADER: I was at the front office when the parents came to the window and wanted assistance for their child. We do not see children in our clinic, but I thought, okay, where are they going to go if they don't have any insurance, and he had just lost his job. So I brought them both into the office and found out that their daughter had a lump in her breast, a young lady, and they were unable to do the biopsy that the doctor, the surgeon, had said was required. The mother was just very talkative, but the father was just - he looked and sounded shell-shocked.

LYDEN: Shell-shocked and slumped over, says Nurse Becky Rader. She and Jean spoke with a local surgeon and strategized.

Ms. RADER: And once we started talking about the possibility of this working, you know, you could just see - visually see him kind of perk himself up a little bit, and the mother started to cry, you know? And that just affects us all, but that's just one instance right there.

LYDEN: Every day, there's a different challenge. As we get ready to leave, one volunteer nurse cancels.

Ms. HARRIS: Joan(ph), this is Jean Harris at the Augusta Free Clinic. I am in a desperate need of a nurse for tomorrow night, Thursday.

LYDEN: Four calls later, Jean has found somebody.

Ms. HARRIS: Oh, yeah. Yeah. And you can leave early if you need to. All right, thank you, dear. And then you'll be here for dinner. Okay. Thank you. Bye-bye. Got one.

(Soundbite of laughter)

LYDEN: One final crisis averted this day. The next day, another three-dozen patients will walk through the door of the Augusta Free Clinic.

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