The Free Clinic Movement

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: I am Margaret Flinter.

Mark Masselli: Margaret, I know we were both very impressed last week
with our guest Congressman Cao. His life’s journey was quite remarkable
coming to America as a young child at the height of the Vietnam Conflict.

Margaret Flinter: And growing up to defeat the Democratic incumbent in
the City of New Orleans, the most Democratic District in America.

Mark Masselli: Well, he is only 42, he’s really accomplished so much.

Margaret Flinter: And he hasn’t been in lockstep with the Republicans on
many issues. He was one of seven to vote to Center Representative Joe
Wilson for his outburst against the President during the State of the
Union address.

Mark Masselli: And he made headline news everywhere as the alone
Republican to vote in favor of the A ! ordable Health Care Act for America
th
on November 7 . He is di ! erentiating himself and attracting lots of
attention. It’s hard to believe that he was only sworn into o " ce in
January of this year.

Margaret Flinter: We heard from many listeners about our interview but
the sentiments were best captured by Dr. Manohar, President of the Asian
American Caucus of the American Psychiatric Association. He was worthy
of inclusion in a new addition of profiles and courage.

Mark Masselli: We couldn’t agree and we’ll be keeping our close eye on
Congressman Cao.

Margaret Flinter: Now, let’s take a moment and reflect on that Historic
House Vote for Health Care Reform. Charlie Cook, the political analyst,
had a piece in his weekly blog and he said “No matter how you view the
vote, you have to give credit to the Speaker of the House Nancy Pelosi
and White House Chief of Sta ! Rahm Emanuel.”

Mark Masselli: Yes, he made the observation that few of Pelosi’s
detractors understand that behind her big smile and stylish looks is a
Baltimore-bred pol who is tough as nails and knows which veteran Blue

Dog can ultimately be persuaded to vote her way on any given piece of
legislation.

Margaret Flinter: She is tenacious. And credit also goes to Rahm
Emanuel. It’s not just that he has the all powerful Chief of Sta ! position,
more importantly, he was chairman of the Democratic Congressional
Campaign Committee and helped to get many of the house members
elected and he still knows their districts. That’s a very important part of
the puzzle when you are asking members to take votes that will have an
impact on their reelection.

Mark Masselli: But the chess match moves back to Senator Harry Reid
and he is contemplating his next move. He is awaiting that all important
financial scorecard of his proposed legislation from the Congressional
Budget O " ce.

Margaret Flinter: The role of the CBO looms large. As the budget deficit
increases, their scoring is all the more critical as public mood seems to
be shifting to controlling spending. Reid’s going to have to thread the
eye of the needle and time is working against them.

Mark Masselli: It might be but there are many within the Democratic
Party saying that if we want to win in 2010, they will need to get things
accomplished this year.

Margaret Flinter: Right, and we saw the former president Bill Clinton
talking behind closed doors to democratic senators reminding them they
lost control of the House in ’94, he believes they lost in part because they
failed to get Health Care Reform done in that first term.

Mark Masselli: But they have to worry about the filibuster in the senate.
And without the consent of 60 senators, a super majority of the chamber,
any senator can object by filibustering to halt the bill with the
Republicans nearly lockstep in their opposition to the largely Democratic
Health Care Reform bill. Senator Reid is crafting, the majority of leader
needs every vote at his disposal from a 60-senator caucus.

Margaret Flinter: Mark, I think most Americans would be surprised to
know that the first big hurdle is that Senator Reid needs to get the senate
to agree to debate the bill, it’s called the Motion to Proceed and that vote
hopefully will be coming up this week. Conversations on Health Care will
keep you informed.

Mark Masselli: And now we turn our attention to this week’s topic, the
Free Clinic Movement, which was in the news this weekend when
thousands turned out for a free clinic in New Orleans, just another
example of growing population of uninsured Americans.

Margaret Flinter: This week, we interviewed the Executive Director of the
National Association of Free Clinics, Nicole Lamoureux.

Mark Masselli: Founded in 2001 and headquartered in Washington, DC,
the National Association is an advocate for the issues and concerns of
free clinics.

Margaret Flinter: Mark, this must seem like déjà vu to you. In your
younger days, weren’t you involved in the formation of an earlier free
clinic association?

Mark Masselli: It’s still a vivid memory. It was January 1972. A group of
free clinics from around the country convened in Washington, DC, the
most well known of them was the Haight Ashbury Free Clinic from San
Francisco. But there were free clinics that identified with all of the forces
that were on the rise within our society, Women’s Clinics, Farm Workers,
the Black Panther Party and groups like our own from Middletown,
Connecticut where a group of Wesleyan University students and
Middletown community activists came together in 1971 to start a free
clinic. We came with no financial resources but shared larger vision that
health care was a right and not a privilege. The time had come for people
to demand a voice in their own health care.

Margaret Flinter: Let me read a section from a book The Story of the
American Free Clinic Movement by Greg Weiss. It sets a stage for the
struggle that you and everyone else faced. He writes “Imagine what it
would have been like to create a free clinic in the late 1960s and early
70s. You recognize that there is a significant problem in the country and
that many young people feel unable to access or to trust the private
health care system or you recognize that many members of racial or
ethnic minority groups are unable to a ! ord or find accessible primary
care in their community. Perhaps you have one or two allies or a small
group of activists who share your belief that this is wrong, and you all
want to do something about it. You conclude, yes, you lack the power to
change the entire system but you think it might be feasible to create
small cases within communities to provide care to those left out of the
private system. You are committed to the idea, you are passionate about
it. But to start with, there is no money, no location for the clinic, no

equipment and no providers. Perhaps just as importantly, no models to
emulate, no one with experience or expertise to o ! er guidance, no
manuals or literature on the subject. What a daunting task!”

Mark Masselli: Right on, George. He is right. We were a passionate
group but we were also optimistic. We believed that whatever we did we
would be successful at because the need was so great. It’s clear that out
of those early days, you can hear the voices few in number that are laying
the groundwork that is now being heard in the nation’s capital around
Reform.

Margaret Flinter: And we’ll hear more about that in our free clinic story
later in the show.

Mark Masselli: No matter what the story, you can hear all of our shows
on our website Chcradio.com. Download the podcast or get transcripts
of our show and we have some interesting links on the folks we interview.

Margaret Flinter: And as always, if you have feedback, email us at
[email protected] , we’d love to hear from you.

Mark Masselli: Now, let's hear background report from Margaret on free
clinics.

Margaret Flinter: The notion of providing charity care has been with us
almost as long as organized medicine. America has a tradition of health
care services organized for the poor that have ranged from public health
clinics to the hospital dispensaries that also serve these training sites for
young physicians. Religious orders have often made health care their
focus. And of course providers have often quietly provided free care to
their own patients as they fell on hard economic times. The modern
notion of what we now call free clinics represents something di ! erent,
not just free care in terms of dollars but also what Dr. David Smith
describes as free of red tape, free of bureaucracy, free of judgment.

David Smith: I first went to the city and then the city said “Well, you can't
have a clinic for hippies.” So this was an old Dennis o " ce and it was
licensed properly. And I said “Well, the city won’t let us, as we start
giving ourselves these outlaws civil rights doctors trying to take care of
the poor, police were against this, government was against this, we will
do it on our own.

Margaret Flinter: Dr. Smith is considered the Founder of the Modern Free
Clinic Movement, a young physician who is also studying pharmacology
and toxicology in San Francisco during the 1967 Summer of Love. He
was a firsthand witness to the explosion of young people who moved into
Haight Ashbury and frequently ran into health problems. 40 years later,
Dr. Smith talks about why he started the free clinics and what it
represents.

David Smith: To deal with the acute medical problems, we are operating
24 hours a day. It's about 100 volunteers. There was a line around the
street of people who found out about the clinic because we were a
community’s clinic.

Margaret Flinter: Free clinics quickly spread to other California cities and
to the rest of the United States. In 1972, a meeting was held at the
Shoreham Hotel in Washington, DC where organizations and sta ! from all
over the country gathered to listen to speakers, including Dr. Smith. It
was at this meeting that the slogan “Health Care is a Right and Not a
Privilege” emerged as a central theme for the Free Clinic Movement. Over
the next 20 years, individual communities continued to establish free
clinics. Well, some survived the lack of any reliable funding made long-
term success i ! y at best. And over time, many transformed from the
original free clinic model into clinics with sliding fee schedules and the
ability to bill insurance. Others took the path of becoming community
health centers, later federally qualified health centers. This allowed
clinics to receive some federal grant funds and to bill Medicaid and other
payers, but it also met a much more traditional organized approach to
health care than that envisioned by Dr. Smith. But the Free Clinic
Movement never faded from the scene. Driven by the commitment of
volunteer sta ! and an open door policy for patients, the National
Association of Free Clinics, the successor organization to that one
founded in 1972 says that there are now 1,200 free clinics operating in
America. They are defined as private nonprofit community-based
organizations that provide free medical care, sometimes dental and
behavioral health care as well, at little or no cost to low-income,
uninsured and underinsured people. They accomplish this through the
use of volunteer health professionals and community volunteers along
with partnership with other health care providers, and they range from
small storefronts to multimillion-dollar organizations. Free clinics have
caught the attention of the media recently in part because of their
sponsorship of large public free clinic events held in cities around the
country. MSNBC’s Keith Olbermann was so impressed by the Houston
Free Clinic event that he announced on his show he was contributing

$50,000 to the cause and he was not shy about making the connection
between the site of hundreds of Americans needing to line up for free
health care and the current Health Reform debate.

Keith Olbermann: In doing so, we can get us closer to health care for all,
but we can also support an organization that stages some of these fairs
in cities where they can do, not just medical good, humanitarian good,
but, as a sidebar, political good for the entire nation. Specifically, if these
fairs were to occur in states represented by those Democratic Senators,
like leader Harry Reid, not yet committed to opposing a Republican
filibuster of the public option, to ensuring that the public option gets an
up-or-down vote, so they can see for themselves what is at stake, the
faces of Americans, their Americans, their constituents, who need their
help.

Margaret Flinter: Just a few days ago and exactly one week after the
House of Representatives passed HR 3962, the Health Reform bill
designed to create universal insurance coverage and access to a ! ordable
health care for all Americans, the City of New Orleans was the site of a
massive free clinic day of care. As in Houston, hundreds lined up in
advance, this time at the site of the New Orleans Convention Center to
see one of 720 volunteer physicians, nurses and health care workers that
day.

And the Louisiana is the place to shine the spotlight because 869,000
people in this state do not have insurance and fully more than one out of
every four of the non-elderly adults don’t have insurance. We’re looking
at half a million people who work in this state who do not have insurance.

Margaret Flinter: Who sponsors free clinics? It's all over the map.
AmeriCares, a Connecticut-based nonprofit organization best known for
its relief e ! orts during natural disasters around the globe, also sponsors
three free clinics right here in Connecticut, often noted as the wealthiest
state in the country. Many free clinics are organized by university
schools of medicine and nursing such as the ECHO Free Clinic in the
Bronx or the University of Kentucky Salvation Army Clinic. Across the
country, state dental associations have teamed up to sponsor huge
missions of mercy for dental care, setting up hundreds of dental
operatories and school auditoriums, recruiting local dentists and
hygienists, and providing a full range of dental care to up to 2,000
people in a single weekend. A logical question is, “Will free clinic still be
needed if National Health Reform passes?” That question will be
answered in the coming years. But for now, free clinics appear to

continue to deliver on what Dr. Smith envisioned, not just free in dollars,
but free of bureaucracy, red tape and judgment. We’ll learn more about
free clinics in America from Nicole Lamoureux, Executive Director of the
National Association of Free Clinics.

Mark Masselli: Welcome Nicole to Conversations on Health Care. You’re
the Director of the National Association of Free Clinics, sounds like equal
parts health care community organizing and service, it's probably an
organization that most of our listeners aren’t so familiar with. Tell us
about your members, who they are and what the goal of the association
is.

Nicole Lamoureux: Sure. Thank you again so much for having me. The
National Association of Free Clinics is comprised of 1,200 free clinics
across the United States and free clinics are 501(c)(3) organizations,
volunteer health care organizations, and we provide quality health care to
the nation’s uninsured, those living 100% to 300% below the poverty
level, they have no insurance. So we also don’t accept any state or
federal funds. And 83% of our patients have a job, so uninsured does not
equal unemployed. And our clinics, in 2008, serviced four million
patients. In 2009, we will service eight million patients and we do that
with six million volunteers.

Margaret Flinter: Nicole, the free clinics have such an interesting past,
but what do you think about the future? We know you and your members
must be following the Health Care Reform debate very closely and to the
best of my knowledge, this notes specific mention of the free clinics in
the Health Reform bills that we have seen so far. So, what do you see for
the future? If Health Reform does come to pass, will the free clinics still
be needed?

Nicole Lamoureux: We will still be needed, I think that what we are
finding, you’re correct. We were not in the Stimulus Package nor our free
clinics included in definitely in the Health Bill and the House Health Bill.
So we’re hoping that in the senate, there will be some mention of free
clinics. From many of the uninsured in this country, the free clinics are
their medical home. So what we are trying to educate and work with
Congress about is saying that, by taking little to no state or federal fund,
this is a home and a place that patients can go. But even if Health Care
Reform goes through, we do know it's going to take some time to
implement the program. We also know that by 2019, by Congress’s own
estimation, there still will be 25 million uninsured and that’s based on a
zero population growth. So we do know that there will still be a need.

There is always going to be a place for some person that unfortunately
falls to the cracks.

Mark Masselli: Very good observation. Nicole, as we speak, we
understand you’re traveling from New Orleans to Little Rock, and in New
Orleans, the National Association sponsored a one-day free clinic
attended by over 1,000 New Orleaners. One news report said that 90% of
the people who came left with the diagnoses. They hadn’t previously had
either blood pressure or diabetes, being two of the most common. These
are chronic conditions that need follow-up. What do you say to people
after they get these diagnoses of how to manage their health care?

Nicole Lamoureux: Well, one of the things that’s so very, very important
to the National Association of Free Clinic is what we spoke about at the
beginning when we started talking. There are 1,200 clinics there doing
this every single day across the United States. So these day clinics that
they are part of, we did one in Houston in September, this one in New
Orleans and now we are doing in Little Rock, just highlights what free
clinics do every day, what’s still critical to us. However, the one day free
clinics get people started on the first type of the help. But when every
single patient leaves this our clinic, they receive resources for those
follow-up cares, either appointments or information on how to get
appointments on one of the safety net providers in their state.

Margaret Flinter: Nicole, the free clinics certainly tap into a deep spirit of
volunteers in the community and I have noticed many seem to be run by
faith-based organizations, also quite a few sponsored by students,
especially health professional students at universities. As you know,
health care can be pretty complex, we would like to hear how you deal
with issues like malpractice, accreditation, standards of care. This is a
voluntary part time job, not a full time commitment for most of the sta ! .

Nicole Lamoureux: Well, I think those are great questions for us. First
and foremost, I think again, we have been doing this since the 1960s and
the one thing that I think is the beauty of the Free Clinic Movement is that
we are the community’s response to the health care need in that area. So
for example, in Biloxi, Mississippi, we had a clinic open right after
Hurricane Katrina and they understood that respiratory issues are going
to be their #1 issue. So it works with their community and now they are a
full-scale clinic. Some of the things that we talk about is that under the
Federal Tort Claims Act, all volunteers are covered under the Federal Tort
Claims Act for malpractice and we are hoping that that will change in our
site and our sta ! so the actual building in the people if we have someone

pay that they can get covered as well. But that is how we’re covered for
malpractice. But even more so the amazing part of this is many of our
physicians extend their own coverage to themselves, to the places where
they are volunteering. We obviously work with HIPAA and OSHA and all of
the other things that are requirements for a medical provider. That’s
what we do. And our standards of care, since we’re dealing with some of
the world’s leading specialists and we have a board that works with us,
many of us work with hospitals and the National Association of Free
Clinics has guidelines for each of our clinics when they get started as
well.

Mark Masselli: Nicole, free clinics may be the best example of community
organizing in health care that we have, tell us what you see as critical to
the success at the community level for your clinic members. And if there
is one of our listeners out there who wants to start a free clinic or who
wants you to come to their community, what should they do?

Nicole Lamoureux: Well, first and foremost, if he’d like information on
how to start a free clinic in your area, because again, as we talked about
before, these one day clinics are just the start of getting people healthy.
It’s the existing structures that are there every single day they will make a
di ! erence in their lives. On our website Freeclinics.us, under Resource
Publications, there is a way to start either how you can start a free clinic
or a free dental clinic. And that success is making sure you read those
documents because they give you some step-by-step ways to go about
working with your communities, your hospitals, even getting some
donors to come and help you. And then obviously, you call me and we
help you to get connected with your state association, but we have some
wonderful board members that help start free clinics when we have the
opportunity.

Margaret Flinter: Nicole, that’s spoken like a true community organizer.
Let me ask you this. A patient comes to one of the free clinics and then
needs care at the emergency room or in another practice in town. It
seems like free clinics would benefit from Electronic Health Records even
more than most doctors’ o " ces given the need to transfer health
information and coordinate care. Can you tell us what the free clinics are
doing in that arena? Do you have any plans or anticipate any support
under the stimulus funds for Electronic Health Records for free clinics?

Nicole Lamoureux: We received zero funds under the Stimulus Package
for Electronic Health Records and you are correct. We understand that
Electronic Health Records are critical to the health of our patients because

we have so many partnerships. Do you know that for every dollar given
to a free clinic, we can make $5 worth of services given to our patients
because of the wonderful relationships we have? Electronic Medical
Records are very, very expensive, quite frankly. 44% of free clinics have
an operating budget under $100,000. So, having some funds to help us
have Electronic Medical Records is critical but free clinics can’t wait for a
Stimulus Package or some money like that, so many of them are raising
funds right now or working with their hospitals to have those Electronic
Medical Records in-house. We know that they are critical, we understand
that they are important and we will be moving to that direction, that is
the goal of the organization. Unfortunately, it just takes a little bit of
funds to get back going. So, we are finding creative ways to raise money
for Electronic Medical Records in-house.

Mark Masselli: Nicole, one of the biggest free clinics that we have seen
here in the northeast are the dental free clinics sponsored by the Mission
of Mercy. At their last clinic, we saw the all too familiar scene with
thousands of people lined up overnight, waiting to be seen by voluntary
dental teams, although it's not talked about as much. People face even
worse trouble getting dental care than medical, and it doesn’t look like
that will be addressed initially under Health Reform. Tell us what the
National Association of Free Clinics is doing in the area of dental care.

Nicole Lamoureux: Well, our free clinics, many of them have dental care,
they have vision care as well. In Kansas City, Missouri, when we are
th th
going there for our two-day clinic actually, December 9 and 10 , we
actually will be having dental care on sites in Kansas City, Missouri. As
you know, if your teeth aren’t healthy, then that just is a really pointer to
the rest of your health as well. Many of our clinics have dental. We either
partner with a dental school or we have it right in-house. It’s something
that we are talking about. Under the Health Reform legislation, we do
know that there are some things that are not addressed and free clinics
are looking at how do we expand our services in a way to address things
like dental and the mental health component which is very, very
important, how do we make sure that we’re answering the needs of the
patients after a Health Care Reform bill goes through, because it's not
just an access to an insurance card that’s important, but rather it’s access
to that quality care, it's that time with the doctor and the dentist that can
help you get healthy that we’re really looking forward. We’re a
nonpartisan organization. We just know that they have eight million
people right now that come to us for medical care and we want to make
sure that they are seen.

Mark Masselli: We have been speaking with Nicole Lamoureux, the
Director of the National Association of Free Clinics. Nicole, thanks for
speaking with us today.

Nicole Lamoureux: Thank you so much for having me.

Mark Masselli: Each week, conversations highlight a bright idea about
how to make wellness a part of our communities into everyday lives. This
weeks’ bright idea focuses on improving communication between doctors
and patients. But with the new twist, the internet, incorporating virtual
communication to health care can simplify the process for both providers
and patients. Many doctors have begun to use online applications to
facilitate better communication. One such website is Hellohealth.com
which connects physicians and patients through e-mail, instant
messaging and video chatting. Using this technology, doctors can follow
up with patients after appointments, verify treatment plans and even
share links to helpful website. Instead of waiting on hold, patients can
instant message specific questions to their doctors and receive timely
replies. Rather than stopping by their doctor’s o " ce to pick up particular
health records, patients can submit online request and receive these
documents as e-mail attachments. And whether they are out of town or
unable to drive, patients who can’t get to their doctor’s o " ce in person
can easily have a face-to-face conference by video chatting. Another
company eager to use the internet to bridge the gap between patients
and physicians is the Mayo Clinic. On its website, the Mayo Clinic has
posted helpful guidelines for patients thinking about using this
technology. Patients are urged to go over the specifics of the technology
their physicians use before jumping right in. Some physicians ask
patients to sign a release form which details the security measures in
place to keep health information confidential. In addition to learning
about these protections, the site recommends that people keep their
online messages concise to ensure that their doctors have time to
respond a ! ectively. The Mayo Clinic also reminds people of the limits of
this internet technology, telling them to seek traditional, immediate care
for severe problems like chest pain rather than their doctor an e-mail.
Increased access to their physician gives patients piece of mind. It makes
good economic sense too. By eliminating the gap between physicians
and patients, programs like Hello Health reduce the need for costly
middleman, like receptionists and other administrators. Hello Health now
boasts a 50% drop in traditional overhead cost. Many insurance
companies have also begun increasing coverage for virtual visits with
doctors because they are markedly less expensive than traditional visits,

saving time, money and taking care of your health. Now, that’s a bright
idea.

Margaret Flinter: This is Conversations on Health Care. I am Margaret
Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Margaret Flinter: Conversations on Health Care, broadcast from the
Campus of Wesleyan University at WESU, streaming live at Wesufm.org
and brought to --