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Free clinics deliver basic care with a vision.

MINNEAPOLIS -- From 1887 to 1991, the Sisters of St. Joseph of Carondelet owned St. Mary's Hospital here, the only Catholic hospital in Minneapolis and at one time the city's largest hospital. Now, instead of one big hospital, the sisters have four small neighborhood clinics here and three more clinics in St. Paul.

The clinics provide everyday care -- physicals, flu shots, treatment for ear infections, skin problems and other minor ailments -- and they do so free of charge to people who have no insurance and sometimes no address, no telephone, no Social Security number. Twenty St. Mary's Health Clinics in the Twin Cities are the goal by the end of 1994.

"Poverty is the biggest deterrent to access to health care," and the poor "are used to being shoved around," said Sr. Mary Madonna Ashton, chief executive officer. "That's our real ministry, to let people know they really matter, and we care about what happens to them. If we can't take care of them, well do our best to find a place that can."

The clinics developed after Ashton became president of the clinics' parent organization, Carondelet Lifecare, in 1991. She had been state commissioner of health for eight years before that and previously a longtime administrator of St. Mary's Hospital.

Ashton called together sisters of the province to brainstorm about "where we wanted to go in health care."

"We were very satisfied" that high quality acute care was being provided in the Twin Cities, Ashton said. In St. Paul, the sisters are still affiliated with acute care at St. Joseph's Hospital through the holding company HealthEast, which owns several hospitals. Baptists, Lutherans and Catholics formed the company to own their hospitals. The sisters also still own a hospital in New Richmond, Wis.

In their brainstorming sessions, the sisters decided the priorities they needed to embrace were neighborhood clinics and health care advocacy and ethics.

Back to the basics

St. Mary's Health Clinics are in contributed spaces, including a church basement, the third floor of a mansion, and a first-floor area of a former elementary school, which a among senior citizen group also uses.

Only the newest St. Mary's Health Clinic is in an office building. "We wanted to place these clinics in buildings where people felt comfortable," said Ashton.

The clinics do not try to be all things to all people. They do not offer emergency or chronic care, referring people who need it to public health clinics. They do no invasive procedures, but have lists of volunteer specialists who at no charge will treat patients the clinics refer to them. St. Mary's centers diagnose pregnancy but do not offer pregnancy care.

Instead, they are doctors' offices for people who cannot pay and who have nowhere else to turn but hospital emergency rooms. In emergency rooms they are usually the last to be seen and typically by the lowest-level staff person, if theirs is not an emergency, Ashton said. If it is, it often could have been prevented had the person seen a doctor before becoming sick enough for hospitalization.

Laurie Knox, a nurse at North Memorial Hospital who volunteers in a St. Mary's Health Clinic, said patients "can get physicals through the county hospital, but they wait a long time."

Johnetta Porter was one of those patients. She used to go to the Hennepin County Medical Center, but was billed and could not pay. Now she brings daughter Sheena, 5, to the St. Mary's clinic in the Women and Children Center. "Here I don't have to worry about getting bills," she said.

Laborers are many

Kevin Kelly, a family practitioner with Riverside Family Physicians, practices at Fairview Riverside. Once a month he volunteers at the St. Mary's Health Clinic in the old mansion. He told NCR he feels lucky to have the opportunity. At the clinic he learns from many patients who "have a kind of survival spirit and energy" he said he does not see among patients in his private practice.

One of those survivors, Bill Hendricks, arrived at the clinic in early June to have his heart ailment, diabetes and high blood pressure checked.

Released from prison and living in a halfway house where "they refuse to buy me insulin or anything else," he said, he remains technically in custody and cannot apply for government assistance. "I'm broke as a church mouse," he explained, and the Bureau of Prisons can reincarcerate him if he becomes ill and cannot pay for his medical care.

Before the first clinic opened, Ashton met with retirement-age doctors, to see if they would volunteer their services provided their malpractice insurance was paid. Luckily, the executive director of the Hennepin County Medical Society, which serves the Minneapolis area, had been looking for just such a project for senior physicians.

Soon the new program had "many more volunteers than we could use," nurses and admissions people as well as doctors, Ashton said. Today, "we have 75 or 76 active volunteers in our clinics," including 14 sisters.

About 50 percent of the doctors are retired and the rest in active practice, she said. Some say they felt they should do something like this, Ashton reported, and others "simply say they are practicing medicine the way they always wanted to practice it," without a lot of forms and taking as much time as needed with a patient.

Logistics of health

Sometimes, what cannot be done pains the staff. Diane Peters, clinics coordinator, recalled a woman who was living in a van with her four children.

"It just breaks your head, but you can't take care of all the needs of all the people, so you take care of their health needs and try to steer them" to others who can provide other assistance, Peters said.

Just dealing with health needs has brought surprises to health care workers accustomed to more traditional settings. Chief operating officer of Carondelet LifeCare Stewart W. Laird said that at first people would not phone back to the clinics to obtain test results. Inquiries about why revealed that the person bad no phone and no money to pay for a call.

Now, staff give such patients a quarter with instructions about the time to call back. "Almost 100 percent of them return that call," said Laird, "which shows that if you can be sensitive to their needs, they are interested in their health."

Such sensitivity means explaining written instructions, he said, because "many of our people are illiterate." It can also mean being sure a patient can carry out instructions. "Little things like |soak your feet twice a day'" may be a major hurdle for someone who has no place to soak feet, he said.

Above all, "we have to develop trust in the neighborhood," among people who "don't have anybody they can trust," Laird said. When a clinic opens, word about it spreads best through talks to neighborhood groups, notices in church bulletins and posters in grocery stores, he and Ashton said. "A few people are brave enough" to come first, then they tell others, said Ashton, and "that's the way you build the best base in the long run."
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Title Annotation:neighborhood clinics sponsored by Sisters of Saint Joseph of Carondelet
Author:Gibeau, Dawn
Publication:National Catholic Reporter
Date:Jul 30, 1993
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