Government bureaucrats sometimes treat the nation’s health-care system the way the fictitious staff of TV’s ER treats its patients: Every ailment is met with the frantic and costly remedies of the emergency room. The latest example of Washington’s bedside manner is legislation, signed by President Clinton, to provide $24 billion in federal funds to bridge the insurance gap for needy children.
Lawmakers who want to help those without affordable medical care ought to realize, however, that a growing pool of medical volunteers throughout America is already finding effective solutions to serving the poorest of the poor. In fact, policymakers could help these efforts by removing barriers that discourage doctors and others from offering free or low-cost care.
They could, for instance, take a cue from the Good Samaritan Clinic, in Wichita, Kansas. Serving 300 patients a month from the city’s poorest neighborhoods, the clinic recruits doctors and other medical professionals from local church congregations to provide a wide range of medical services at no charge. Except for an administrator and a receptionist, all staff members--from specialists to nurses to medical school students--donate their time. Thanks to these volunteers, the 10-year-old clinic is fully staffed eight hours a day, five days a week.
"At last," says Pastor Elisha Verge of the nearby North Ash Church of the Nazarene, "doctors with the love of Jesus and a commitment to prolong life and relieve suffering won’t turn us away if we don’t have a nickel or an insurance card."
Posters on the clinic’s clean and cheerful walls offer both straightforward medical advice ("Know the symptoms of diabetes") and Bible verses ("A cheerful heart is good medicine. Proverbs 17:22"). They signal an institutional outlook that mixes common-sense preventive care with biblical wisdom about healthy, God-honoring lifestyles.
To spread this philosophy, the clinic recently launched a community health program. Doctors recruit and train lay volunteers to go into nearby neighborhoods, where they check that patients are taking their medication and counsel them about unhealthy behaviors such as smoking, overeating, and abusing drugs and alcohol.
Talking openly to people about their lifestyles and behavior is an important part of the clinic’s holistic approach to care, says Jeanie Peterson, a 23-year-old nurse. "I think a lot of the physical problems people have come from their spiritual and emotional problems. Through the lay health program, we can assess various factors in their homes, give them the resources they need, and help them live healthier lives."
All the clinic’s workers are evangelical Christians whose compassion extends beyond physical ailments to those that are emotional and spiritual. It’s an approach that appeals to the patients, many of whom say they have been shuffled from one cold, uncaring, government-run clinic to another.
Renetta, for example, suffered for 10 years with severe epileptic seizures that contorted her wiry body and ravaged her with pain. But she was unable to work or pay for necessary but costly medical care. At one clinic, Renetta was given prescriptions for two medications that caused discomforting side effects but did not diminish the frequency of her attacks.
When Renetta walked into the Good Samaritan Clinic, everyone--from the motherly receptionist to the medical staff--treated her with respect. Doctors listened patiently as she described her symptoms. They asked her questions about her lifestyle, her relationships with family, and her medication. They prescribed a third drug, which immediately reduced both the seizures and the side effects.
Now, as part of Renetta’s regular medical check-ups, clinic workers talk to and pray with her about personal struggles in her life. "The more I came here, the more my seizures left me," she says. "I thank God for this clinic. You feel peaceful here. You feel love here."
Much of the credit for that goes to Kim Snapp, Good Samaritan’s resident physician since 1989. Years ago she forswore practicing for-profit medicine in order to help the poor. When asked the reason, she replies simply: "You mean other than the fact that God said I should do this?" She receives no salary, but gets financial support from friends and others interested in her work, making her, in effect, a medical missionary in her own backyard.
Snapp, who teaches Bible studies to teenagers in her spare time, is vocal about her Christian faith, but her patients don’t seem to mind. "I haven’t found anywhere else where people treat me right," says Jackie, a 38-year-old, backsliding Baptist man struggling with diabetes and a severe weight problem. "They don’t force anything on nobody." Syed, a 70-year-old Muslim immigrant from Pakistan who has brought his wife and daughter to the clinic for years, says there’s no pressure to convert. "They treat you like a human being," he says. "They’re so open-hearted, so clean-hearted."
Much of the clinic’s funding comes from World Impact, a Los Angeles-based ministry founded after the 1965 Watts riots, which now runs schools, camps, and other programs in 12 cities. Good Samaritan accepts patients who have no money, those who can pay only a few dollars, and those with insurance, Medicare, or Medicaid. "If people who have been our patients for years get back on their feet and are able to afford medical care, we don’t feel we should have to tell them to go find another doctor," says clinic administrator Fred McLean.
The number of free clinics, church-based and otherwise, has grown rapidly in recent years. Each year, about 250 free clinics provide quality health care to tens of thousands of needy people nationwide. Unfortunately, says Mary Beth Savary Taylor, legal counsel for the American Medical Association, the network faces a major obstacle to greater expansion: the burden of liability insurance.
"The most effective response to date in providing care for the uninsured poor and working poor has been the free clinic," says Kevin Kelleher of the Free Clinic Foundation of America. "Based on voluntarism, there is certainly no thriftier solution . . . [but] the fear of malpractice is an impediment to recruiting volunteers."
The Liability Barrier
All states have laws allowing patients to sue medical volunteers for malpractice, so many neighborhood clinics have had trouble recruiting help. Kansas was no exception--until 1991, when the state enacted the Charitable Health Care Provider Program. Designed to increase the availability of health care, the law shielded volunteers from legal liability, one of the biggest obstacles to recruiting physicians.
The Charitable Health Care Provider Program indemnifies health-care providers who work with the indigent against claims of medical negligence. If a poor person sues a doctor for problems stemming from care at a free or low-cost clinic, the Kansas attorney general’s office will defend the doctor; if the defendant is found liable, the state’s Tort Claim Fund will be the payer of first resort. So far, no one has been sued.
"This law has made a major difference," says Sandra Lyon, the executive director of Wichita’s United Methodist Health Clinic and the founder and president of the Sedgwick County Association for the Medically Underserved. "The medical community had always told us that there was this barrier called liability that made it risky for them to give their time and service. But now, it’s been much easier to recruit physicians."
Kansas recently expanded its Charitable Health Care Provider Program to cover nurses providing free or low-cost health care throughout the state. According to Jane Faubion, a health-planning consultant for the Kansas Department of Health and Environment, the decision to include nurses in the program has helped a statewide project called Operation Immunization, which deploys 1,400 or so nurses to provide free injections for children. "Without this kind of protection," says Faubion, "you’re kind of hanging yourself out there when you volunteer to go to a grocery store or a local armory and invite the public to bring their children for immunization."
Lawmakers in Washington seem to have gotten that message. Senator Dan Coats, a Republican from Indiana, spearheaded the 1996 Medical Volunteer Act to encourage health-care professionals to donate their services to the needy. Intended to supplement state laws, the act extends federal tort claim coverage to doctors and others volunteering in private clinics. (Until the Coats legislation, only volunteers in government-funded clinics typically received coverage for liability.)
Despite liberal opposition, the bill passed last year as part of the Kennedy–Kassebaum Health Care Reform Act. It remains unclear, however, how much relief the new federal law will provide to medical volunteers: Donna Shalala’s Department of Health and Human Services is still writing the regulations to implement the legislation.
Meanwhile, workers at clinics like Good Samaritan keep the faith. Legal threats may slow--but not stop--their work of medical mercy. Says McLean, "God always shows up."