Non-profit is Not
Synonymous with Good Health Care-Anti-Consumer Practices at a Federally
Subsidized Community Health Clinic
On October 31st, I took my teenage son to
Peninsula Health Clinic in Bremerton, for evaluation of a clinical
intervention for depression. My regular readers will recall the trauma center
blog I posted in October 2012, when my son was hit by a pickup truck and sustained a traumatic
brain injury. Head injuries can take a long time to heal and depression often
follows. As a healthcare advocate I am compelled to share my experience to
illustrate the complexity and failings in primary care in the U.S.A.
Teen Denied Care at State
and Federally Financed Community Health Clinic
Arriving at the health clinic after a 2 hour commute walking
and via public bus in a driving rain storm, I went to the counter to get my son
checked-in for his appointment. There was no queue of patients standing in
line, and I was informed we were 6 minutes late for our appointment. I
explained that we had traveled by bus and we got to the clinic as soon as
possible, and we were still within 10 minutes of the scheduled time. After
several minutes, the administrative staff informed me that the doctor was
unwilling to see my son, even though he was not a new patient and this had been
his primary health care location for over 5 years. At this point, I was
incredulous that we were being urged to leave and stated my son was there for
evaluation for depression, which had been discussed with the school nurse. What
happened next will floor you.
Clinic Staffer
Encourages Dumping Practice of Referring Patients to the Local Hospital for Non-Emergency
Treatment
Peninsula Health Clinic which actually denied care for my
son, which was not of an unusual nature, encouraged us to use the emergency
room of the local hospital. My son’s health did not merit an emergency
intervention, which is why we were at a primary health care clinic or in layman’s
parlance, the doctor’s office. This behavior is referred to as “dumping” when
patients are unable to get care at appropriate primary care facilities and sent
to the ER of hospitals. In Chapter 9, of Unraveling U.S. Healthcare-A Personal
Guide, I explain how people in the United States should access health care
wisely from an economic and health outcome basis. The emergency department of
hospitals is the most expensive place to obtain primary health care and is thus
to be avoided. Patients are often derided for over utilization of the “ER”, but
there is more to this picture than meets the eye, as the options for obtaining
health care are limited in many areas of the country. If the clinics which
receive government funding to provide primary health care are insolent and
unwilling to serve their community members, what choice do these folks have but
to go to the hospital? In my son’s case we elected to defer treatment because
he had to get back to school. As a parent I am concerned about his health and
we do have a follow-up appointment scheduled at Seattle Children’s Hospital In
December.
How Money Impacts
Treatment
Peninsula Health is a designated federally qualified health
center located in Bremerton and other sites in the county.[1] In 2014, Peninsula Health received $1,572,083
from our federal government to provide primary health care.[2] This
means that the clinic is charged with serving patients who may not have access
to other health care options or for which there are obstacles, such as lack of
transportation, or clinicians who refuse to treat them. The community of Bremerton has a
disproportionate share of low income residents, in large part due to zoning
laws which allowed less restrictive housing per parcel from World War II.
Harrison Medical Center is the hospital for nonmilitary personnel in Bremerton
and the Franciscan Order, which acquired the publicly financed facility wants
to close the hospital. The reimbursement mix just doesn’t work for their bottom
line, religion or not. Consequently, the
ability to obtain health care for those who are most in need is becoming more tenuous in this
community. As a federally funded facility the clinic must adhere to certain
practice standards, which in theory, should provide basic or primary health
care more effectively than other options.
As a healthcare insider some of you may wonder why I choose
Community Health Plan’s Peninsula Health Clinic and the answer is, we
ended up there as a last resort. Briefly, over the course of the past eight
years the following circumstances gave us no choice but to use the Sixth Avenue Clinic or take the longer commute into Seattle for health care:
- In 2006, when my son and I relocated to Bremerton, largely due to the walk-on ferry access to Seattle, we initially sought care with a private practice physician. With each appointment the doctor complained about his reimbursement, the staff wasn’t very nice, and getting there required a 10 mile round trip bike ride and a ferry trip to Port Orchard. Still, we persisted until the clinic was closed, meaning the doctor moved his clinic to a more lucrative location.
- When my son was in middle school we sought family health care in a neighboring community, but found the transportation options unworkable.
- Services to deal with pediatric or youth depression are extremely limited in Kitsap County, yet the State of Washington under Senate Bill 6312, has just approved a new plan to make the entire Olympic Peninsula and Kitsap County one service area.[3] The few services available for mental health are for adults and drug offenders in the area. My son and I have found it more efficacious to spend 2 hours on the ferry and 1 ½ hours busing to appropriate services in Seattle, for which I have paid 100% of the cost out of my pocket, as it is deemed out of our service area.
- Given that my son was in grade-school when we moved here, I felt it was prudent to seek health care that was local, hence the Sixth Avenue Clinic, located less than two miles from our house.
Increasingly Those
Providing Primary Health Care Are Getting Squeezed
Firstly, we don’t have enough primary clinicians in the
United States, so this creates a problem with patient access. Secondly, there
is high employee turnover in health care, which exacerbates the problem.
Thirdly, clinics serving a higher proportion of low-income patients are dealing
with grittier issues than in more affluent areas. It all comes down to the
money, Medicaid doesn’t pay enough for 46% of the doctors to accept Medicaid
patients.[4]
This means federally qualified clinics, public health departments, and the public
emergency room are where patients seek care.
But the fiscal situation of the clinic is not the fault of the patient,
nor should patients be refused treatment.
What You Should Do To
Advocate for Your Child to Get the Health Care They Deserve
Fast forward, Peninsula Health sent a letter to our house
indicating my son was a no-show for his appointment, which of course was not
true. As your advocate for patient rights, here is what I did; composed a single
page letter with our grievance on patient care, sent it to the local
clinic-Peninsula Health, to Community Health Plan of Washington the affiliated
insurance provider, and to the State Medicaid office which provides funding for
the clinic. Next steps- to date there has been no written response from any of
the clinic representatives, because they are demanding a HIPAA form be
completed first. If getting refused for health care doesn’t kill you, the paperwork
will.
A Little Respect
Having commuted by bicycle and public transportation in
multiple locations since 2003, my son and I have learned to be resourceful,
which is not always met with appreciation by health care providers. In an era
when a third of the nation’s children are overweight, getting regular exercise
is the surest way to maintain a healthy weight. And I am happy to say, I do not
take any medication, because of my diet and exercise regime. We are doing our
part not to add to the burden of the U.S. health care system, so rather than
being treated with derision, how about encouragement. Though I am loathe to
share personal information, this situation really shows how people are dumped
in the health care system and it is even worse for those patients who lack my education
and tenacity. As for the clinic admissions representative who refers to me as “the
mother,” even Safeway personnel manage to get my name right and add a
salutation. Yes, I am “the mother” who will stop at nothing to assure my son
and others like him get decent health care because that is the right thing to
do.
This is the healthpolicymaven signing off, encouraging
all of you to resource your health care wisely and stick up for yourselves. Don’t
think that everyone behind a desk has your best interests at heart. Feel free
to share this article virally but please provide appropriate attribution to the
author and Praevalere!
For more information on federally qualified health centers
and other resources read my book which is found in public libraries throughout
the land and of course, on Amazon, ranked #35 for health and medicine books.
http://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972/ref=sr_1_1?s=books&ie=UTF8&qid=1415590699&sr=1-1&keywords=unraveling+u.s.+healthcare-a+personal+guide
[1] *Peninsula
Community Health Services is a Health Center Program grantee under 42 U.S.C.
254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).
[2] http://datawarehouse.hrsa.gov/Tools/FindGrants.aspx
[3] http://apps.leg.wa.gov/billinfo/summary.aspx?bill=6505
[4] http://dailysignal.com/2014/05/08/medicaid-half-doctors-wont-accept-new-patients/
