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.
