Bowling Green Clinic Reflects Wasted Resources in Health-Care Reform

Michelle Obama at the opening of the Caroline Family Practice in Bowling Green.
Michelle Obama at the opening of the Caroline Family Practice in Bowling Green. (By Dean Hoffmeyer -- Associated Press)

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By M. Stephen Mandell Jr.
Bowling Green
Sunday, August 23, 2009

On July 27, first lady Michelle Obama cut a ribbon to herald the opening of a community health clinic in rural Bowling Green, Va., about 40 miles north of Richmond. Her appearance was designed to showcase President Obama's passion for health-care reform, demonstrating one of his strategies for greater health-care access for the poor and underinsured. But this new community clinic was just three blocks from a practice opened by National Health Service Corps physicians 24 years ago. Because of its status as a rural health clinic, this practice -- where I am the senior partner -- is still sustained by federal support.

Our practice has been seeing 1,300 to 1,400 patients a month in a county that, though more than 500 square miles, has a population of only about 27,000. It has three board-certified physicians (two internists, including me, and one in family practice) and one physician's assistant. We serve the community and its nursing home and continue to care for hospitalized patients, seeing the insured, uninsured, Medicare and Medicaid populations. Does the president not know where his health-care dollars are being spent?

Because of the absence of local oversight of the county's health-care needs, and because of the financial leverage that comes with $1.3 million in stimulus money, the Central Virginia Health Services group was able to place its new clinic where it duplicates services already being supplied -- leaving unmet the health-care needs of the most underserved part of Caroline County.

I was confused as to why more tax money would be spent to add a health-care provider in the same area that we were already serving, so I contacted the grant writer. I was informed that the more needy portion of our county was ignored because it wasn't a "financially viable" area. Subsequently, I spoke with the planned clinic's administrator, who told me Bowling Green was chosen because it had buildings that could be renovated for the clinic, allowing a faster opening. I inquired of the Caroline County Board of Supervisors, whose members conceded that needs were greater in the southern part of the county, 10 to 15 miles away. But because the new health service group did not want to use that area, the supervisors feared the grant money would be spent elsewhere. Their conclusion? "It's hard to turn down $1.3 million for the county," the board's chairman said.

Enter the first lady. As a result of all this, Mrs. Obama came to town to showcase a community health clinic that cost taxpayers $1.3 million, in a deserving county but positioned in the least needy area of that county -- an area with four health-care professionals at a clinic already supported by federal money.

Now this new community clinic is open. It is served by one nurse practitioner and a part-time doctor. Tax money has been misspent. Expediency and financial viability have trumped the needs of the medically underserved.

Clearly President Obama is proud of this effort; he sent his wife to emphasize his endorsement. One fears that these values and practices foreshadow our president's health-care reform. If the waste and lack of planning associated with this clinic are any indication, how much more wasteful and expensive, as well as poorly designed and controlled, will Obama's government health-care program be?

The writer is the senior partner at Virginia Primary Care Associates in Bowling Green.


© 2009 The Washington Post Company

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