Patching the Safety Net
Stimulus Money Extends Md. Clinic's Operation, for Now

By Megan Greenwell
Washington Post Staff Writer
Saturday, April 18, 2009

One in a series on how the recession is touching lives.

Deborah Foerter is a first responder, whether the problem is a broken ankle or an empty pantry at home.

On the table in Foerter's tiny exam room, Barbara Pickle describes numbness in her toes as Foerter, a nurse practitioner by training, checks her vital signs. A day earlier, an illiterate patient needed Foerter's help filling out an application for food stamps. Last year, an 85-year-old woman who broke her ankle walking to her outhouse was given indoor plumbing after Foerter called the local Christmas in April program.

In one of the world's most advanced medical systems and one of America's wealthiest states, Foerter and her clinic are a lifeline for hundreds of poor and working-class residents of Nanjemoy, an isolated peninsula in rural southwestern Charles County. Dozens of people here live without running water, some in unheated trailers or shacks, just 37 miles from Washington. There is no grocery store and no gas station, no Laundromat or restaurant.

This spring, Foerter told them that the clinic's services almost certainly would be ending in the next few months. The recession has hit nonprofit health clinics hard. This one had lost $150,000 during each of the past 14 years, and other grants were drying up. The board of Greater Baden Medical Services, which runs the clinic tucked inside the Nanjemoy Community Center, decided it no longer could be sustained and voted to close it.

And then, just as some patients had given up on the idea of affordable medical care within their reach, they received word of a small miracle: Two weeks ago, the federal government announced that all but a handful of the nation's health clinics would receive a total of $2 billion through the federal stimulus package. Greater Baden was awarded $270,372, enough to keep Nanjemoy Health Services open for two years.

"The fact that someone stepped in and did something about the crisis that this was going to cause is reason for celebration," said Rick Campbell, a longtime patient who has multiple sclerosis. "It doesn't solve Nanjemoy's underlying issues, but it's a start."

At some point, Greater Baden will likely have to move the Nanjemoy clinic to a more central location, where it might attract walk-in patients with private insurance or the ability to pay more out of pocket. But for the moment, Pickle is receiving diabetes treatment just down the road from her house.

"I think for a lot of us, losing the clinic would be losing an important part of our lives," she said. "It's not fair to take it away from people who don't have any other options."

Most of Foerter's patients have no health insurance, unless they receive Medicaid. Their oasis is the clinic, with its harsh fluorescent lighting, uncomfortable waiting room chairs and well-worn equipment.

The scale isn't digital. The exam tables don't move up and down at the push of a button. A doctor is available only on alternating Fridays. But for the clinic's 750 patients, there is simply nowhere else to go.

"My patients are people who feel beaten up by life after so many years of not having the typical standard of living," Foerter said. "The clinic is the only connection a lot of them have to some basic services."

Greater Baden runs six other clinics in Prince George's and St. Mary's counties. If Nanjemoy closes, its patients would have to travel more than 30 miles to Oxon Hill, or 15 miles to an overcrowded clinic in La Plata, the closest facility that accepts Medicaid.

The trip to La Plata can take as long as 45 minutes by car, and appointments must be booked months in advance. Many of Nanjemoy's patients can't afford cars. The bus ride can take more than two hours.

County officials said they recognized Nanjemoy residents' concerns but couldn't afford to save the clinic. Greater Baden board members said they don't want to pull out of Nanjemoy, but its losses are hurting the whole system.

Without the clinic, Foerter said, many people wouldn't go to the doctor at all, whether out of stubbornness or a lack of transportation, or they would wait until they needed an ambulance. Without the clinic, patients tell her, they might as well start making funeral arrangements.

The recession has worsened conditions at rural clinics such as the one in Nanjemoy, many of which had barely enough money to cover expenses before the economy started its downward spiral. Mary Wakefield, administrator of the U.S. Health Resources and Services Administration, which oversees the nation's 1,128 federally qualified nonprofit health clinics, said it is not uncommon for such providers as Foerter to play social worker as well as medical professional, and to do it on a shoestring budget of federal grants and private gifts.

"Many of these clinics were already stretching every dollar as far as they could, and then the recession caused a huge increase in demand from people who have lost jobs and health insurance," Wakefield said.

Community health centers serve 18 million Americans, many in underserved rural areas such as Nanjemoy, others in poor urban neighborhoods. They are generally equipped to practice only basic medicine but often will cover the costs of a patient's visit to a specialist. Prescription medications are offered at drastically reduced prices thanks to partnerships with pharmaceutical companies or the clinic's willingness to take a loss on the cost of drugs.

Many of Nanjemoy's patients were struggling before the economic downturn. Just 10 percent have private insurance. More than 50 percent don't qualify for Medicaid or Medicare, so they pay according to a sliding scale.

Calvin and Joyce Eller are uninsured. They ran an auto body shop for years, making too much to qualify for Medicaid but too little to buy health insurance. They sold the business nine years ago, after Calvin Eller had end-stage emphysema diagnosed and was told he had six months to live.

Today, Calvin Eller sees Foerter every few weeks and a takes a handful of medications to keep the disease under control. Joyce Eller receives regular checkups for her high blood pressure and chronic obstructive pulmonary disease. The clinic has treated both -- and Joyce's mother -- for 14 years, absorbing thousands of dollars of losses because the Ellers can't afford more than $10 or $20 a visit.

"I just don't think we'd find a doctor in La Plata who would be willing to squeeze us in if we call the day of with a problem," Joyce Eller, 59, said. "But to our family, that's necessary."