Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, June 20, 1995 TAG: 9506200089
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
DATELINE: LENGTH: Long
"We had to find a doctor or drive back up there," Mae Duncan said as she waited recently for an appointment with Dr. Karen Miller at the Roanoke City Health Department.
The Duncans have private health insurance, but didn't know any doctors other than their regular physician on Bent Mountain, so they gravitated to the Health Department for care.
Mae Duncan began getting checkups from Dr. Miller first, and then encouraged her husband to see her.
Once again, though, the Duncans are searching for a doctor.
The Health Department held its last general medical clinic Thursday, and Carl Duncan was there getting his monthly B-12 shot from nurse Rickey Green.
"I've got this big thick book of doctors that Blue Cross sent me, but we don't know any of them," Carl Duncan said. "I guess we'll have to find one, though, before I need another shot."
"You're in good shape because you have insurance," Green told him. "You can go to any doctor."
Specialty services, such as pre- and post-natal, well baby and family planning clinics, will continue at the Health Department. But the clinics where adults could come for general medical care have fallen victim to budget and staff crunches.
In March, the state introduced the Workforce Transition Act that offered buyouts to employees, and 35 workers in the Roanoke and Alleghany Health districts took it. The buyouts forced a re-examination of services by the health departments, especially Roanoke city district, which lost 25 from its staff.
It was generally understood that workers who left probably wouldn't be replaced, so the departments set out to decide what to keep doing and what to let go.
The general medical clinics were a likely candidate to be discontinued because similar services are available through all the local hospitals.
At the headquarters on Eighth Street Southwest, and at satellite sites such as Lansdowne Public Housing Community in Northwest and the Presbyterian Community Center in Southeast Roanoke, Health Department workers saw 381 patients from January through March. In a year's time, as many as 2,000 used the Health Department as their "family physician."
Sixty-eight percent of the clinic patients were white women over 45 who suffered from a variety of chronic ailments such as hypertension and diabetes. Two-thirds of them also had some type of insurance, either private or Medicare, and had access to almost any doctor. But they found a nurturing family at the Health Department.
In addition to the blood pressure and insulin checks, the Health Department patients got help with filling out forms or appealing claims to Medicare. They also got medications for low prices, which was often the incentive for coming there in the first place.
Patients whose incomes were at poverty level accounted for only 15 percent of the clientele, but still the clinics operated in the red. Projected losses for this year were $38,000-plus, said Green, who compiled a report on the clinics' operation.
Green is a 26-year veteran of nursing who has spent six years with the Health Department. With the general medical clinics ended, she will spend more hours in the specialty clinics providing health education for patients. Other full-time staff will also shift into areas that lost workers in the buyout. Miller, who was a part-time employee, has taken two new jobs. She will work with a Roanoke city employee wellness program and with city jail inmates as an employee of Correctional Medical Services, the jail's new health care contractor.
"I told Dr. Miller I'd follow her wherever she went, but I sure don't want to go there," joked Marie Jones on her last clinic visit.
Jones, a widow, is not old enough for Medicare, and she doesn't have health insurance. But she is diabetic and has hypertension and needs checkups every four months.
"I can't just quit and not go," she said. She has $514 a month in income, but owns her home.
The reasons the patients came to the Health Department's clinics ranged from need to convenience.
Mattie Rose, who works at the Northwest Child Development Center, said she always went to the clinic at Lansdowne because it was easy to get to. She said she probably will transfer to a private practice near Burrell Adult Care Center for the same reason.
Clinics operated at Roanoke Memorial Rehab Center and Community Hospital of Roanoke Valley likely will get the bulk of the Health Department patients. Others will find a private physician, and some might go to the Free Clinic of Roanoke Valley Inc., although most don't fit the "working poor" category of patients that clinic is set up to serve. The Free Clinic doesn't take patients insured by Medicaid or Medicare.
"There might be some confusion about where they can get medical care," said Estelle Nichols, executive director of the Free Clinic. "The main dilemma, though, will be where they will get their medicine and lab work."
Medications will still be sold through the Health Department, but details on how and to whom won't be available until July 1. Also, the department has plans to provide some lab services, but is not ready to announce those, either.
Dr. Molly Rutledge, director of the Alleghany and Roanoke City health districts, has submitted the new "Public Health Service Plan" for review by the localities it will serve. In it, Rutledge notes the intention to "provide for a smooth transition" of the general medical patients into the "private medical community."
Rutledge said she knew the reduction in primary care services would be perceived as a "loss," but that the Health Department also hoped to "facilitate the development of an improved system of indigent care delivery throughout the Fifth Planning District and assure better services as a result."
by CNB