Monday, May 15, 2006

"Tough Healthcare Situation Grows for Latinos, Rest of Metro"

La Clinica on Lake to Close
Tough Healthcare Situation Grows for Latinos, Rest of Metro
by José Pérez , La Prensa de Minnesota (Minneapolis-St. Paul)

The North American continent is unique among similar land masses in the world for the distinction of having the smallest number of sovereign nations relative to Africa, Asia, Europe, et cetera. With all due respect to the proud nations of Central America and the West Indies, North America is essentially comprised of Canada, the United States, and Mexico. Because of the size of each of the three North American giants or perhaps in spite of their vast territories, Canada, the U.S., and Mexico are all quite different from one another in terms of social, political, economic, and cultural aspects.

Perhaps the biggest difference concerns access to healthcare. At polar opposite ends of this spectrum are Canada, with universal health care as guaranteed as hockey in winter, and the U.S., with private healthcare rivaling one of Jennifer Lopez' engagement rings in cost to workers in the land of the free and the home of the brave.

No where is this "so-near-and-yet-so-far" disparity in affordable and therefore accessible healthcare more evident than here in Minnesota where we are closer in distance to Canada than we are to Chicago.

With the number of uninsured and underinsured people in the United States rising constantly (approximately 50 million in the U.S. with no health insurance at all), access to medical care that will not turn a poor working stiff away because he or she does not have a valid insurance card and/or a credit card is rare and valuable – in more ways than one would think.

In the raging sea of rising healthcare costs where a serious illness can capsize even an affluent family into bankruptcy, places like Minneapolis' La Clinica on Lake Street are vital to community health. Because it refuses to turn away for financial reasons any patient in need of medical services, however, La Clinica on Lake will cease to exist at the end of this summer.

Mavis Brehm, executive director of West Side Community Health Services, parent organization of La Clinica, informed La Prensa de Minnesota that La Clinica's Board of Directors finally decided last week to euthanasize the popular and respected South Minneapolis provider "because of mounting financial pressure."

In 2005, La Clinica saw over five thousand patients (which is a significant figure for a facility that is only open from 8 a.m. to 5p.m. on weekdays) and approximately 80% of those patients had absolutely no form of insurance.

While not an emergency or urgent care clinic, La Clinica does a great deal more than putting a band-aid on a scraped knee or wrapping a twisted ankle. Among the services offered to its patients, La Clinica offers primary care and preventative services, women's healthcare including breast and cervical cancer screenings, teen pregnancy prevention, diabetes prevention and treatment, mental health services, lab services, and more. La Clinica, along with its partners at community organizations like C.L.U.E.S (Chicanos Latinos Unidos En Servicio, an adult outpatient program which also works with victims of sexual abuse), offers programs such as the Aquí Para Ti (Here for You)Youth Development Program which offers preventive services targeting various healthcare issues including but not limited to tobacco, alcohol, & drug use, immunizations, exercise and nutrition as well as free health fairs.

The total amount budgetary shortfall for last fiscal year totaled $900,000.

According to Brehm, the transition period of the next few months for La Clinica will focus on trying to get as many of the existing staff and services from Lake Street absorbed into WSCHS' flagship clinic in West Saint Paul. While acknowledging that there are still some important funding possibilities that could have kept La Clinica open beyond August 2006 (when its current lease expires), Brehm stated that "the long term solution" compelled the Board to consolidate WSCHS' services which were utilized by over 36,000 Minnesotans last year alone.

This latest unfortunate development is not the end of the story. It actually marks the continuation of an ongoing struggle. Closing La Clinica on Lake Street "doesn't take away the pressure in the future …the needs aren't going away," said Brehm of the reality of limited reimbursements and increasing demands on an already overwhelmed" safety net." In a stoic effort to maintain resolve, the soft-spoken head of WSCHS expressed a hope that the closing of La Clinica on Lake will raise "awareness of how vulnerable providers are."

In fact, according to Brehm, if the 80% ratio of uninsured patients transfers to the West Saint Paul site without appropriate and realistic adjustments, the future of WSCHS itself will become bleak. If the future of WSCHS itself is threatened, the entire Metro Area will feel and have to bear a heretofore unacknowledged burden of Katrinaesque proportions.

The cost to the Twin Cities if La Clinica shuts its doors will not be so easy to measure – largely because the figures will be much, much higher than what it would have cost to keep it open. This has a lot to do with the fact that La Clinica is not your average everyday clinic. In addition to demonstrating that adhering to the sacred tenets of the Hippocratic Oath is non-negotiable by not turning away poor patients, La Clinica, which opened its doors on September 10, 2001, is also the only place that Minnesotans of Latino descent can go for culturally competent medical care in Minneapolis. 

La Clinica's entire staff is bilingual and bicultural offering a critical form of bedside manner to Latino residents of Hennepin, Ramsey, Dakota, Anoka, Scott, Carver and fifteen other counties in the area (when La Clinica first opened, no one expected patients to travel from as far as Maple Grove or Brooklyn Park but "if you build it ….").Of the over five thousand patients seen at La Clinica last year, over 90% were Spanish speakers and a significant number were recent immigrants.

Cultural compatibility is conducive and critical to clinical success.

The potential costs to local resources already under pressure from tightened budgetary strings at the local, state, and federal levels could very well be alarming. The likelihood that a Minnesotan in crisis will go a facility that is culturally intimidating is very slim. The social and financial ramifications here, such as the possible spread of untreated infectious diseases such as avian flu or the mumps or a traumatized teenager shut off from his therapist reacting inappropriately to a police officer, are hard to measure before they happen and impossible to prevent after they have happened.

Potential costs can also skyrocket from residents no longer having access to preventive wellness visits waiting until an otherwise preventable condition deteriorates into an emergency room visit at an always-overwhelmed Hennepin County Medical Center E.R.

Of course, the aforementioned represents what could be the tip of an immense iceberg. Indeed, for example, unreported critical health statistics also pose grave dangers to everyone.

Current funding for La Clinica comes from a variety of sources including the West Side Community Health Services of which La Clinica is just one location and several much-needed grants. Only a third of WSCHS's revenue comes from Medicaid, a fifth comes from federal grants, a small percentage from patients' private health care providers – revenue from cash payments from uninsured patients are actually higher than those of patients with insurance.

Grants such as those from Eliminating Health Disparities Initiative funds from the Minnesota Department of Health, Office of Minority and Multicultural Health and the Maternal & Child Health grant (which made it possible for La Clinica to serve almost four hundred pregnant women in that grant's first year) certainly help but they do not often cover medical expenses, drugs, operational expenses, labs, et cetera.

This is more than troubling for the staff at La Clinica; it is terrifying for its patients who receive treatment for rape, dehydration, stress, depression, post-traumatic stress disorder, anxiety, urinary tract infections and other serious conditions that cannot go untreated.

In rent alone, La Clinica pays $200,000 annually for the 9,000 square foot facility located at a mass transit crossroads where bus lines and the Hiawatha light rail line all converge.

Like many of its patients, it certainly appears that La Clinica is also underinsured and, unfortunately, altruism does not pay the bills in Minnesota.

When one looks at the potential catastrophic larger picture, finding a way to keep La Clinica open would have been much more cost effective than allowing it to close.

After all, that $900,000 shortfall last fiscal year works out to about$173 per patient seen.

Considering how much La Clinica is doing for the greater Minneapolis-Saint Paul Metro Area and beyond, that figure comes out to a bargain relative to some of the inevitable costs directly and indirectly associated with allowing it to close.

Or in simpler terms, it is cheaper to buy a new battery for your smoke detector than to pay the deductible for your fire insurance after your house burnt down.

This, of course, dovetails into the growing call for a more democratic healthcare system that guarantees that, as Brehm stated on a stormy afternoon last week, "all people have access to the most basic of services." While it a rather sad statement about a society that politicizes basic human welfare, it is an undeniable reality that healthcare is a hot button political issue during this mid-term election year. With recent news that employees of UnitedHealth Group(which is headquartered in Minnetonka) are disgusted with UnitedHealth's consumer-driven worker health plans among other harbingers of growing consumer frustration with the increasingly apparent ineffectiveness of the American healthcare status quo, more and more people in the U.S. are calling for a paradigm shift towards the Canadian and even the Cuban models.

While reactionary attempts to scare Americans away from even thinking about "socialized medicine" are intensifying, so are the realizations that universal public healthcare is no more ridiculous of a proposition than universal public education. The misguided rationale that says that Americans should have to pay for the basic human right to receive quality health care makes as much sense as reinstituting archaic and elitist poll taxes to make people pay for the right to vote.

If the right to an education and to vote do not require copayments and premiums, why should the right to feel better require them?

Before finishing her interview with La Prensa, Brehm stated that "we need a system that works differently." Thinking back to New Orleans and Hurricane Katrina and thus looking at how easily a disaster can reveal a Third World reality here in this G8 country, it would behoove Minnesota's leaders (elected and non-elected) to pay heed to Ms. Brehm's statement without delay.