Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, June 1, 1994 TAG: 9406010065
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: BETH MACY STAFF WRITER
DATELINE: LENGTH: Long
``It wasn't hard because I was asking for kids, and that has never been a problem for me,'' the 62-year-old pediatrician says. ``Everybody loves kids.''
Ask Peggy Balla how Pierce worked to sway physicians and dentists to join the Child Health Investment Partnership, and she says the doctors really had no choice: ``Doug is so well-respected that no one can say no to him,'' says Balla, CHIP director.
``To say no to children is hard, but to say no to Doug is hard, too. Everybody loves Doug.''
The dean of Roanoke pediatricians, Pierce was honored recently for his own refusal to say no to the needs of underprivileged children. He and seven others across the country were chosen among hundreds of nominees to receive the annual ``As They Grow'' awards, sponsored by Parents magazine.
Featured in the magazine's June issue, the recipients were chosen for their contributions to health, the environment, education, social action, humanitarianism, the arts and inner-city neighborhoods.
Since Pierce founded CHIP in 1987, the grassroots program has become better-known outside of Roanoke than in it. Eleven other Virginia communities have used CHIP as a model for their own child-health programs, and Pierce and Balla have spoken at poverty conferences across the country.
For the 700 Roanoke Valley families served by CHIP, Pierce's efforts mean no more episodic health care, no more going to the emergency room for the flu. Both preventive check-ups and sick visits are provided - by the same doctor every time. And CHIP boasts an immunization rate of 95 percent among its 2-year-olds, compared to an overall rate of 64 percent in Roanoke.
What's so rare about CHIP is that it not only provides medical care for the child, it also deals with the social aspects of the family. A nurse and outreach worker are assigned to each family to head off medical and social problems early.
If a family needs help filling out the Medicaid paperwork, they handle it. If they don't have a ride to their doctor's appointments, they're there in the CHIP van. CHIP workers have helped clients earn their GEDs and get jobs, and make sure they follow doctors' orders.
Before CHIP began taking patients in 1988, only one Roanoke pediatrician accepted new Medicaid patients, which meant many families went to the emergency room - or nowhere at all.
Pierce and Total Action Against Poverty founder Cabell Brand knew the barriers to regular, preventive health care were more than financial when they convened a meeting with area leaders in pediatrics, mental health and social services to lay the groundwork for CHIP.
With Medicaid reimbursements arriving late and at a rate of only one-half, ``we used to lose money for every Medicaid patient that walked through this door,'' Pierce recalls. And without the case manager reminding their clients or giving them rides, they frequently didn't walk through the doors at all.
``It doesn't matter how good a job a physician does in diagnosing a child if the parent doesn't even get the prescription filled on the way home or come back for a re-check,'' Pierce explains.
With the help of a $1.5 million grant from the W.K. Kellogg Foundation and $200,000 a year in annual funding from the state health department, CHIP was able to provide the intensive case management. Medicaid also expanded its reimbursement rate as well as its coverage, targeting families with incomes below 133 percent of the poverty level.
Before she joined CHIP, Joyce Artrip had been shuffling her son Cory around to different doctors - her family doctor when she could afford it, and the Bradley Free Clinic when she couldn't. Two years old at the time, Cory wasn't yet walking or talking. Even though he was extremely underweight, doctors kept assuring her he was fine.
Finally, a doctor at the free clinic who also participated in CHIP recommended she joined the program. Now 4, Cory has been diagnosed with mild mental retardation and development delays.
CHIP workers transport the Artrips to frequent therapy sessions and visits with Pierce. They helped her apply for Supplemental Security Income and Medicaid for Cory - neither of which she knew she was eligible for.
``Without CHIP, we'd definitely be in the poor house. And finally we go to somebody who listens to me with Cory's problems.
``He's really made a lot of progress'' under Pierce's care, Artrip says, adding that Cory now walks and makes eye contact. ``There are some doctors who just come in and look at him and that's it. But [Pierce] really pays attention and treats him friendly.''
In fact, Pierce, who sees both regular and CHIP patients at his Physicians to Children office, is so popular with kids that he sometimes has to kick them out of his practice once they reach college-age.
One-third of Pierce's parents were previous patients themselves. And nurses love him, too, voting him the valley's No. 1 doctor in a survey conducted by Roanoker magazine in 1992.
``He's just a different breed,'' says nurse Donna Patton, who's worked with Pierce for 16 years. ``I've never once seen him lose it - not with a patient, a parent or me.''
Patton says Pierce develops an amazing rapport with patients, from newborns to adolescents. ``A lotta these little kids come in extremely fearful, and it's like a spell when he comes in the room. He has these children eating out of his hand.''
Parents of rebellious adolescents often call Patton to schedule an appointment, saying, ``If only Dr. Pierce could talk to him, maybe he would open up.''
And they do, Patton says. ``If you can deal with everything from a new mother to an adolescent, I'd say you're pretty flexible.''
Pierce is well-known for his expertise in handling school problems such as learning disabilities and Attention Deficit Disorder. One mother, a CHIP client, comes to his office for reassurance about her son's learning disability - every day.
Looking back on his career, Pierce says he is most proud of his CHIP work. ``With most things we doctors do, there's a return. But this is a very unselfish thing.
``We've seen people who were obviously not used to sustained medical care become very good patients. We've seen young mothers with small babies get into health maintenance and become sophisticated mothers who know how to take care of their babies. And that is very rewarding.''
With the Kellogg grant coming to an end and 1,100 children still on CHIP's waiting list, the program is entering a crucial period. Because it's hard for established programs to get grants, CHIP will be asking the community - governments, businesses and individuals - to help out.
Not only is CHIP humanitarian, CHIP leaders are sure to emphasize, but preventive care that saves money in the long run is also practical.
``Salem gave us $40,000 last year, but Roanoke city gave only $5,000 - even though 65 percent of our enrollees are Roanoke city residents,'' Pierce says. ``We feel like the city as well as private citizens and corporations need to rise to the occasion.''
If they don't, Doug Pierce will start making house calls again. And as 40 doctors found out seven years ago, it's hard to say no - not just to his cause, but to Pierce himself.
``Children really need advocates,'' he says. ``You look at the federal money spent on children: 50 percent of the Medicaid recipients are children, but less than 15 percent of the total money is spent on them.
``Unlike adults, no one is out there lobbying for children,'' he says. ``If us big folks don't look out for them, they'll continue getting the short end of the deal.''
by CNB