July 15, 2008

Free clinics proliferate across N. Texas and the nation

12:00 AM CDT on Tuesday, July 15, 2008
By DIANNE SOLÍS / The Dallas Morning News

PLANO – Alfredo Rivera winced slightly as Julia Grenier examined the stitches in his finger.

Julia Grenier, 72, runs a weekly clinic at the Plano Day Labor Center. A public health nurse, she buys supplies at dollar stores. She said that every visit to the free clinic is a potential emergency room visit at a hospital. 'We stop problems from growing here,' she said. "It's beautiful and it's healed," the nurse said.

The carpet layer was lucky, she said, that his boss brought him for treatment. Around her, more men in construction boots waited in her crowded clinic, tucked inside the Plano Day Labor Center. Some needed a bee stinger removed or salve for a rash. Others were heart attacks waiting to happen.

Charity clinics like this one are appearing all over the area. Over the last decade, there's been a tenfold increase in the number of such clinics identified by an association formed by the Dallas County Medical Society. The clinics, now numbering more than 40, are among the only option for growing numbers of people without health insurance, especially illegal immigrants who are fearful to use government-affiliated clinics or hospitals.

A few of the clinics have funding restrictions tied to immigration status. But doctors, nurses and clinic support staffers say checking for disease and injuries – not immigration documents – is their mission.

The need for these services is great. Texas leads the nation in its percentage of residents without health insurance. Nationally, legal and illegal immigrants make up about a fifth of the uninsured, according to the health-focused Kaiser Family Foundation.

The growth in charity clinics "really shows the alarming situation in our community of the uninsured growing," said Connie Webster, community health director for the Dallas County Medical Society.

There are as many as 2,000 charity clinics around the country.

"Free clinics are the best-kept secret in America," said Nicole Lamoureux, executive director of the National Association of Free Clinics. "Instead of waiting for the problem to be solved, free clinics are offering a solution right now," she said, noting the fierce political debate over health insurance fixes.

Curbing emergencies

The for-profit medical system needs paying customers, and Parkland Health & Hospital System is financially strained. So more and more doctors, nurses, social workers and translators are quietly volunteering at the free clinics, even as a crackdown on illegal immigrants continues.

"The hospitals totally ignore that we are saving their bottom line," Mrs. Grenier said as she bags supplies at her clinic. "Every visit here is a potential emergency room visit there. We stop problems from growing here."

Mrs. Grenier, a 72-year-old, Louisiana-born public health nurse who uses a cane and buys supplies at dollar stores, runs the clinic on Wednesdays at the Plano Day Labor Center.

She started her practice a decade ago from the back of a Ford pickup, performing what might be called guerrilla nursing. Now she runs the 5-year-old Collin County Adult Clinic as well, with about 25 volunteers.

Construction worker Rodolfo Ibañez arrived at the Labor Center clinic with an earache. In his homeland of Mexico, he'd self-medicate with a pharmacist's counsel. But, in the U.S., with only rudimentary English, "I don't want to because you can harm yourself," Mr. Ibañez said.

Another patient, Daniel Rodriguez, got some numbing salve for the gums near a sore tooth and the address of a dental school where charges are as little as $16. Soon, a fuss started. A stocky, 64-year-old man had high blood pressure: 182 over 114. As he left, Mrs. Grenier muttered, "He thinks he's above the law."

Whose law? Her law of cutting salt and fried foods from the diet, the nurse said.

Proof of residency

About half of the budget of the Collin County Adult Clinic comes from the county, with the stipulation that each patient show a Social Security number as proof of legal U.S. residency. The rest of the budget comes from the donations of individuals and churches, and that is used for patients without Social Security numbers.

County officials "want to make sure everyone we serve is documented and they know darn well that some of our people aren't," Mrs. Grenier said.

Added Dr. Paul Piper, one of the volunteer physicians at the adult clinic: Patients without documents "are just people who need our help."

Every Monday, Jerry Weis, the president of the board and a retired business manager, organizes the records and makes note of Social Security numbers for reports to funding agencies. "We are never short of patients, and the demand gets higher," Mr. Weis said.

All over North Texas, clinic activity is up. In some cases, the volunteer clinics are on overload and regularly turn away patients.

At North Dallas Shared Ministries, there are clinics nearly every night of the workweek. At a special screening clinic for women, "we can see 25 women in an evening but we turn away a like number," said Judy Rorrie, the executive director.

Anonymous donation

Recently, the organization received an anonymous donation of $210,000 to expand their services to daytime hours, Ms. Rorrie said. They plan to hire a staff physician.At the federally funded low-income Los Barrios Unidos Community Clinic in West Dallas, demand for discounted medical care has held steady. The clinic's chief executive director, Leonor Marquez, said she believes longtime clients are staying away, saving money for other expenses. But they are being replaced by new clients. At the Lone Star Association of Charitable Clinics, an Austin-based group, Executive Director Nettie Miller said the patient load is increasing as the economy sags.

"Everyone recognizes that Texas leads the nation in the uninsured. and many of the medical folk recognize that they need to have some conscience about the folks that can't afford to pay," Dr. Miller said.

Everywhere, clinic operators say, more volunteers are needed.

As Mrs. Grenier closed up, she wished for a replacement.

"God, please send me someone," she said. "I want to retire."

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