Patients need patience

If you want to get in for a first appointment to see Dr. Gail Baldwin, medical director at the Lake Superior Community Health Center, you'll have to wait. She's booked up until February.

That's not something she's happy about. She'd like to see patients as soon as possible, but there simply are too many of them.

The growing demand for services at the Lake Superior Community Health Center reflects the scarcity of health care for those who can't afford it.

"There's such a tremendous amount of unmet need," Baldwin said. "If someone with chronic disease can't afford to do early care, or delays their care, it could result in that person having a stroke, a heart attack or their illness getting worse. It puts them in a state they don't need to be."

Staff members at the center have charged themselves with no easy task: provide a full range of health care, from primary family care to counseling to dental services, to anyone -- regardless of ability to pay.

It's a task the center's leaders say they don't have the resources to keep up with.

Wende Nelson, the center's executive director, said the Community Health Center clinics in Duluth and Superior are at capacity, serving about 4,600 patients a year. But Nelson estimates that 8,000 to 12,000 people within driving distance of the center don't have health insurance.

Then there are the under-insured -- those who have only basic insurance for catastrophic events and typically don't get preventive care and diagnosis of disease. There's no way to accurately count those numbers, Nelson said.

But their desire to get into the center is constantly felt.

"If I had 10 more doctors," Baldwin said, "I'd fill their appointments up."

Said Nelson: "Does it sometimes feel like we're putting our finger in the dam while water gushes over our heads? Yeah, it does."

CAPACITY DOUBLES

Still, Nelson prefers to look at the glass as half-full, pointing to thousands of uninsured and underinsured patients the clinic has helped. And the center's capacity and services it offers have grown significantly, especially over the past six years.

In 1991, when Nelson first joined the center, she oversaw a budget of $370,000 and nine staff members. Now she oversees 52 staff members who work under a $5 million budget.

In 2000, thanks mostly to grants, the center opened another clinic at 3600 Tower Ave. in Superior. Then last year, the Duluth center moved from a 4,000-square-foot house at 2 E. Fifth St. to a 12,000-square-foot West Duluth clinic at 4325 Grand Ave., which is on a bus line.

Since those changes were made, patient visits have nearly doubled. In 2001, both clinics saw a combined 7,950 visits. In 2005, 12,236 visits were made.

In 2005, the Superior site was the first in the region to offer dental care on a sliding-fee scale.

That's a long way from when the center first opened in 1972 as a free clinic. Then, Nelson said, doctors and nurses volunteered their time and turned a basement of a then-Catholic residence into a temporary clinic one night a week by throwing sheets over desks to turn them into exam tables.

Even with the increased growth and funding, that creativity to help patients on a relatively small budget remains.

"Sometimes we have to cobble things together to make sure patients get everything they need," Baldwin said.

To help patients pay for prescriptions, the center provides free samples whenever possible. When those aren't available, Baldwin said two staff members work full-time signing patients up for reduced-cost or free prescription programs run through drug companies.

Other patients are put into grant-funded voucher programs used only for medications that are considered life-sustaining. Baldwin said those patients are put on a sliding-fee scale and pay only for a small portion of those medications.

"The voucher program is very expensive," Baldwin said. "We have to write for extra grants to make that happen."

If patients can't afford to pay for clinic visits but don't qualify for financial aid, Nelson said the center works with them to set up affordable monthly payment plans.

Not once in the center's history, Nelson said, has any patient's bill ever been sent to collections.

ADVOCACY

Despite what the center has been able to provide, Baldwin and Nelson still fret over the patients who aren't being seen, which is why both advocate for universal health care.

For now, the Lake Superior Health Care Center is as close to universal health care as can be found in the Northland. But beyond not having enough resources to see those in need, some patients Baldwin believes would visit the center don't, because they don't want to admit they don't have enough money to pay for health care.

"People have pride. They don't want to say they don't have enough money or don't have insurance," Baldwin said. "They're still hard-working people who are trying to make ends meet."

Even though an average of 56 percent of the center's clients over the past five years have been employed, an average of 78 percent were uninsured.

Most of their patients simply can't afford health insurance, Baldwin and Nelson said. Since 2001, more than60 percent of the center's clients have had an income at or below the poverty level, meaning a family of one earns about $9,800 a year and a family of four earns $20,000.

"If you live [at 100 percent of poverty] and pay for rent, food and gas, that pretty much takes away your ability to pay for health care," Nelson said.

Nelson said she has seen firsthand how not having immediate access to health care can have deadly consequences.

In 2000, the day before the Superior clinic opened, Nelson was diagnosed with breast cancer.

Though she survived it, she attributes that to having insurance, access to care and early diagnosis.

"In the years before and after, I buried clients and friends who didn't have access. Had any been diagnosed earlier, they would probably be alive today," she said. "The reason I took this job and the reason I'm still in this job, I really want us to achieve universal access to health care. I really think we can do it. That's really what lights my fire."

BRANDON STAHL covers health. He can be reached at (218) 720-4154 or by e-mail at bstahl@duluthnews.com ..