Monday, Nov. 02, 2009

Doctors willing to help in S.C., but clinic hits roadblock

Editor's note: This is the first in an occasional series that will examine health care needs and the impact of reform proposals on residents and businesses in our area.

Stan Brock wants to bring Remote Area Medical to South Carolina.

His nonprofit has traveled throughout the country providing free medical services. In Roan County, Tenn., hundreds began lining up on a Thursday for a Saturday-Sunday clinic.

"And it rained all weekend," said Matthew Johnson, a pre-dental student at the University of South Carolina who volunteered during the event. "Oh, God, it poured."

No one left.

Brock said that scene would repeat itself if RAM were allowed in South Carolina, where 16.1 percent didn't see the doctor last year because of high costs.

His push comes as Congress nears floor debates and votes on comprehensive health care reform legislation, the closest such reform has come to passage in the country's history. As Washington officials hammer out details of the proposals for a national solution, Brock simply seeks to bring RAM to South Carolina next year.

If Brock is successful, RAM would complement the state's free clinics and nonprofits, which serve some of the roughly 1 in 5 non-elderly adults who don't have insurance.

It won't happen without a change in state law, which says certain types of out-of-state medical professionals have to be licensed with South Carolina even though South Carolina medical professionals have volunteered for RAM in other states where exceptions have been made in licensing requirements. Tennessee, where RAM is based, has enacted an "open borders for doctors" law.

"I get a lot of requests from South Carolina," Brock said. "Until they change the law, we can't come there."

Good care, unhealthy residents

But RAM, which could provide thousands of S.C. residents needed care, wouldn't be a panacea for a health care system that is more eclectic than comprehensive. The state ranks high for delivery of services yet is among the nation's unhealthiest.

A higher percentage of South Carolinians than the national average receive the correct care for heart attacks, smoking cessation and have good hospital experiences. Yet the state's infant mortality, obesity, heart disease, cancer and low-birth-weight rates are among the nation's worst.

The state's high number of uninsured are also at greater risk of premature death, according to a recent Harvard University study. As many people die due to a lack of health insurance annually as those killed by breast cancer.

And the number of uninsured is rising. Families USA found that 88,900 S.C. adults lost health insurance in the economic downturn. The percentage of private employers providing coverage has been dropping nationally since the early 1990s, down from more than 60 percent to less than 40 percent now.

Pizza Hut has a plan available for employees like 55-year-old Shelley Williams. But she can't afford the medical portion and doesn't work enough "shift" hours to qualify for dental coverage.

She and her husband have been relying on a free clinic for the past few years. Before that, "We'd rinse our mouth with salt water until the pain went away," Williams said. "But my husband got so dizzy one day, I had to take him to the emergency room. That's when we found out about his diabetes."

In addition to problems among the uninsured, health care costs for those who have insurance have doubled the past decade and are projected to have another significant rise next year, all while the number of doctors who are financially able to provide charity care is falling. The number of doctors who donated their services fell to 68 percent in 2004-05, an 8-percentage-point drop from seven years earlier, according to a Kaiser Family Foundation study.

"I wish there was an easy fix," said Dr. Reggie Daves, a retired OB/GYN and one of the medical professionals who volunteer at Friendship Medical Clinic in Conway, where Williams went for help. "It has to do with poverty. It has to do with obesity. It has to do with smoking. It has to do with the economy as well. What we try to do here is put our finger in the dike."

Free care saves lives

Cynthia Smith believes programs such as RAM and the state's free clinics and volunteers like Dr. Daves are doing more than putting their finger in a dike. Friendship has given her husband Ronnie a chance at life again, she said. Two years ago, he spent 49 days in the McLeod Hospital trauma unit after a car accident.

"He had to learn to walk again, talk again," Cynthia Smith said.

Before the accident, they rarely received health care. Her husband worked for a construction company that couldn't afford a plan. In South Carolina, 80 percent of the uninsured are from working families.

"Ronnie never went to the dentist, and I'd only go when I had to get a tooth pulled," Cynthia Smith said. "He pulled his own teeth. He would take a drink of liquor. He got pretty tanked up first."

The Smiths' medical bills after the accident reached $1 million, an illustration of why a medical emergency is the No. 1 reason for personal bankruptcy filings.

Now they pay "$10 here, $10 there, whatever we can," for care, she said.

The prescription drugs Ronnie Smith requires would cost them up to $1,400 a month. At Friendship, they pay $36. Friendship relies on donations and volunteering professionals. Conway Medical Center Foundation, the United Way, churches and businesses support the clinic.

"Ronnie's had a 90 percent turn" because of Friendship, Cynthia Smith said. "Now he can actually live a normal life. He'd probably be in a nursing home; we'd be on welfare. They are like angels there."

Teaching and treating

Friendship is one of at least 40 free clinics in the state. In 2007, those clinics treated 340,000 patients and filled more than 323,000 prescriptions. Patients are charged on a sliding scale, according to what they can afford. The cost of the average visit is $68, the equivalent of $1,600 in a hospital emergency room. Medical laboratories and doctors and nurses at area hospitals supplement Friendship's expenses with donated services.

Free clinics treated 4 million uninsured patients nationwide last year. Government-funded public community centers, which are slated to receive $2 billion in federal stimulus funds, saw 7 million uninsured patients.

"Healthy and employed persons are able to provide for their families and enjoy some quality of life," said Terri Harris, Friendship's director. "Also, at some level, each person has to take responsibility. I think it leads back to education. Once a month we do a 'How to cook good inexpensively' class. We call and beg people to come, and maybe six or seven people show up."

That's one of the primary complications in the struggle to provide care for the poor and uninsured: Personal lifestyle choices that make people unhealthy are hard to regulate. Up to $150 billion is used to treat preventable chronic conditions, making unhealthy lifestyles a major factor in rising health care costs, according to a variety of estimates, including a study published in Health Affairs.

Magnolia Gore, a 41-year-old Socastee resident, is convinced she's alive because of healthy changes.

She ate poorly and seldom exercised. The 5-foot, 4-inch woman weighed 356 pounds. She began experiencing sharp chest pains. A colleague told her about Friendship.

"My doctor said, 'Young lady, you are too young to be that big; you need to lose weight,'" Gore said. "I didn't know how to eat. I used to eat fried chicken every day, anything greasy."

She asked the volunteer doctor at Friendship for advice about nutrition. She joined a gym and began working out daily for two hours. She replaced table salt with sea salt and cooking oil with olive oil. Vegetables, grapefruit juice, shrimp and fish became staples of her diet. She lost 186 pounds. Her newfound discipline removes her from the damaging statistics that illustrate the unhealthy state of the average South Carolinian. But it doesn't necessarily remove her from those at increased risk of premature death - because she lacks health insurance.

That factor alone contributes to the deaths of almost 45,000 Americans between the ages of 18 to 64 annually, roughly nine times the number of teenagers dying in car accidents every year, according to the Harvard University study. The annual deaths from lack of insurance has more than doubled since 2001.

"Even after accounting for lifestyle or health habits, we detected an increased risk among the uninsured," Andrew Wilper, one of the study's authors, said through e-mail. "Extending health insurance would undoubtedly help, but there are other systemic problems that also need to be addressed, such as the lack of access to primary care physician services, widespread use of health care resources of little or no value, and the quality of care patients do receive once they are in the doctor's office."

Reaching rural patients

Free medical clinics and government-supported centers treat 11 million uninsured every year, leaving about 34 million uninsured people without consistent care. Volunteers provide transportation for some of Friendship's clients, Harris said, while thousands of others in poor, rural pockets of the Grand Strand aren't able to make it to the clinic. She envisions future coordination between RAM and free clinics in South Carolina, with RAM providing initial treatment and the clinics follow-ups.

Between 1985 and June 2008, RAM treated more than 360,000 people, handed out more than 70,000 glasses and extracted 110,000 teeth, about $33 million in free medical services. That's why Thornton Kirby, who heads the S.C. Hospital Association, plans to lobby to clear the way for RAM.

Former S.C. Rep. Robert Walker, R-Spartanburg, began pushing for a change two years ago, but the legislation didn't get out of committee before he left office.

"The way our law is drafted, they've got to be licensed even to come in to do volunteer work," he said.

The legislation hasn't been re-introduced, said Mary Cauthen, director of research for the Medical Military, Public and Municipal Affairs Committee.

RAM would likely make its way into South Carolina six months after a new or tweaked law goes into effect.

"Other states have modernized their state laws to permit out-of-state professionals who show their out-of-state license so they can participate in these kinds of programs for a set period of time without being paid," Kirby said.

"There just aren't that many places giving away free dental and vision services. You can't go to the emergency room to get a pair of glasses. I'm not sure we would ever get to the point that there were no people who were uninsured or couldn't get care. There are a lot of people in this country who are working but wouldn't be covered by the [health care reform] proposals in Congress. There would probably be millions of people who would still need [programs like] RAM."