My Experiences with being Indigent in Missouri: County/Federally Funded Clinics

If you are new to this blog, you may not know that I was in an accident almost two years ago that resulted in a broken nose and concussion as well as other injuries. The concussion was not one of the “good” kind, meaning, I have still not completely recovered.

This deterioration in my health caused me to run through my savings and unemployment benefits in California and have to rely on others. Finally, I am privileged to benefit from my mother’s having space and a generous heart, allowing me to move in with her in St. Louis about 18 months ago.

Missouri, however, is not a great place to live if you are indigent. This post is the first in a series about my experiences here. This one is on health care for indigent people in Missouri.

What makes Missouri so bad for poor people? For one thing, this state is very Republican-dominated. Among other horrors, this means its idiotic legislature refused to approve the expansion of Medicaid in 2013, 2014, 2015 or 2016 for the new USA health care systems (Affordable Care Act, or “Obamacare”) that some other states, like California, were smart enough to utilize.

Missouri’s unfortunate and lethal combination of machismo, arrogance, obstinacy and ignorance have caused millions of Missourians who cannot afford even the minimal payments (over $200/month plus co-pays, for me) to be without any health care or insurance if we are not over 65 and/or disabled or under 18, because these the only groups Medicaid and Medicare cover in Missouri at this time.

St. Louis is somewhat Democratically dominated, which means some of its legislators and leaders applied for and received federal and state funds to create a health insurance “work-around,” called “Gateway to Better Health.” https://www.stlgbh.com/programoverview

They are quick to tell us that this is NOT an insurance plan because it is not “portable” excerpt for emergencies, and even then, not so much. What it does do is entitle its few qualified users to avail ourselves of its paltry network of federally qualified health care clinics located within St. Louis County and surrounds.

The closest clinics in these networks to where my mom lives are minimally (with no traffic) about a 30-minute drive in any of three directions, and only one houses the pharmacy (the furthest one, of course). I chose the one that was “closest,” which is about 28 minutes from our condo. It is in Ferguson.

Yes. That Ferguson.

Despite having been only a few months since the demonstrations, riots and protests surrounding the murder and announcement of the appalling lack of indictment of the murderer of Michael Brown, I decided to utilize this clinic solely because of its location. However, I didn’t understand until I got there that Ferguson is very spread-out, geographically. This clinic is not located close to the site of any of the disturbances. Even so, this clinic has an unarmed (at least, no visible gun) guard. I found out later that all the clinics have guards; the pharmacy has two.

Prior to this set of experiences, my only contact with federally qualified health care clinics had been as a volunteer reception clerk/translator for the Jewish Community Free Clinic in Sonoma County (no guards) in the mid-2000’s which served many farmworkers and other newly arrived immigrants with little English and no health insurance, and as a co-writer of a grant to start a regional clinic in southwestern New Mexico in the early 2000s (which was funded and is still running but which I never visited because I moved to California before it opened). I had never been a patient in such a clinic before 2014.

Here are some of my experiences as a patient, 2014 – 2016, in the Betty Jean Kerr People’s Health Center on West Florissant, in the city of Ferguson, and the main BJK PHC clinic in St. Louis city on Delmar Boulevard (to access the pharmacy). http://www.phcenters.org/

Some are positive, many negative, some neutral.

Let me start by saying I am grateful for many aspects of this stop-gap health care coverage (NOT insurance), such as:
—- to have access to three necessary prescription medications at no or low-cost (the BJK PHC pharmacy does not carry my alternative thyroid medicine, even though CVS does)
—- to have a clinic to go to when I need to check on my health status for chronic conditions (hypertension, hypothyroid)
— to have regular blood work done and reviewed to make sure my medications are the right dosage and are working (hypertension, hypothyroid; very nice and competent phlebotomists whom I found out are NOT clinic employees but located on site from another agency; the internist never discusses my results with me at the time and rarely provides any follow-up from these results until three months later, so what is the point of that?)
— to get a referral from my “primary care doctor” (whom I saw four times, then switched away from because he was awful) to a neurologist to continue my care and get further diagnoses/prognoses for the after-effects of the concussion/Traumatic Brain Injury (very useful)
— to have another colonoscopy procedure (I turned 60 in 2014, and since my grandmother had died of colon cancer, I was supposed to have had my second check-up last year but had missed it due to having moved and having had no health care for a while) (thankfully, clear)
— to have a biannual mammogram (thankfully, clear, but the technician was rough with me and cut my skin which caused a stubborn infection that took months to heal)
— to have a triannual pap smear and gynecological check-up (thankfully, all clear as well, but with an awful ob/gyn who insulted me and treated me disrespectfully; won’t be seeing her again; see below)
— to have a dental check-up and cleaning (thankfully, no problems) up to twice a year (I have gone twice but the second visit was horrendous and did not result in my having services; see below)
— to have a clinic to go to when I need to check on my health status for acute conditions (which I haven’t done and probably would not use it for, since I use homeopathics and herbs for most viruses and infections).

Here is the main problem: this clinic (and probably many others like it) are health care “mills.” They get reimbursed for procedures, not time. If doctors order blood work, diagnostics that require machines or surgery to provide the data for the diagnoses, like urinalysis, the clinic gets paid for each component. If they just talk to a patient, very little money comes to them.

So, guess what?

These doctors order a lot of unnecessary diagnostics:
— annual X-rays for dental patients even when we don’t need or want them and national and regional guidelines do NOT recommend having X-rays every year any more for anyone without serious dental problems that require them (I do not have any serious problems, luckily); they would not give me an exam, a cleaning or a polishing of my teeth because I refused to allow X-rays 12 months after the first set were done
— blood work every three months to “qualify” me for my prescriptions even though the results are NOT used to determine whether I receive them nor what dosage to provide for me; I cannot get my prescriptions refilled unless I submit to these blood tests
— urinalysis every three months even though I have no symptoms and have had none for problems that these diagnostic could analyze and I never hear about the results then or later; however, patients are not allowed to use the urinalysis rest room while still in the waiting area, and because many of us need to use the rest room while we are waiting for our appointments (which are never on time), we therefore, can’t provide a usable sample by the time we are called
— annual mammogram (which I will not do that frequently, since biannual or triannual are now recommended for my age group and health status) and annual pap smear (ditto) when national and global guidelines do NOT recommend doing these so often for any women without history of cancer
— X-rays for muscular problems which show nothing, since X-rays cannot show muscles well; my former internist insisted I get an X-ray prior to getting any other diagnostics when I told him I was having pain in the muscles and nerves of one hip; my bones are fine and have been for many decades, but he wouldn’t listen to my patient-provided information at all (another reason I ditched him); then he “forgot” to order the other diagnostics for six more months (two more visits; another reason I switched internists last fall)

Is it relevant or irrelevant that I was one of only two Caucasian-looking people in the entire clinic— staff and patients included—for all of my 10 visits, to date? FYI, the actual population of St. Louis County, demographically (2010 and updated census) is: 70% “White,” 24% “Black,” about 4% “Asian,” 3% “Hispanic,” and about 1% “other.”

How significant is it that I have to wait more than 20 minutes every time I go, even when my appointment is supposedly the first one scheduled? For about 5 minutes or fewer per visit with my internist, I have to be at the clinic for over 2 hours, mostly waiting: between blood work and being seen, urinalysis and being seen, nurses checking my vitals and being seen, etc. Who, besides those who are under- or unemployed or on salary (and wouldn’t be here, then) has time for this insult to our value?

The doctors I have seen are almost without exception disrespectful to the patients: they don’t listen to or regard the information I provide with careful consideration.

For example, even when I told him I had no interest in getting any unnecessary medications, even for pain, this internist insisted on putting unnecessary and unwanted prescriptions into my record and making those recommendations in a print-out they gave me after each visit (which I did not fill).

Worse, the ob/gyn doctor was mean-spirited in her language (which I won’t repeat here) when describing my genitals and tried to scare/threaten/shame me into getting an unnecessary procedure. Luckily, I am informed and I remembered what my previous ob/gyns had told me about my body, so I felt fine about ignoring her, but what if I hadn’t been so fortunate?

Third, and what prompted this blog post, the dentist was horrible. This dentist insisted that I get X-rays. I told her that I didn’t need or want them after only one year since the last set and that the current guidelines agreed with me. She then adamantly refused to clean or examine my teeth if I did not agree to having these unnecessary X-rays. She claimed this was the clinic’s “policy,” but when I asked to see this supposed policy in writing, she refused to provide it. She then went to get the guard, who threatened to call the police if I didn’t immediately leave. According to him, even though this was during my appointment time, this dental chair was “needed for another patient” (!?). I told them both I was not leaving until they showed me this X-ray requirement in writing.

They started yelling. I yelled back. Despite my lack of fear and not feeling intimidated, I was finally so disgusted and frustrated that I no longer wanted her or anyone else there even to touch my teeth.

I left.

What kind of “health care” clinic tries to force unnecessary procedures, medications and diagnoses on its patients and then threatens us when we refuse to comply?

USA federal clinics, I now know. So do many others. Want to know more? Have a read:

From May, 2015, New Yorker magazine: “Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?” by Atul Gawande http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

and, from the MinnPost, also in May, 2015: “How an ‘avalanche of unnecessary medical care’ is harming us — and what can be done about it,” by Susan Perry
https://www.minnpost.com/second-opinion/2015/05/how-avalanche-unnecessary-medical-care-harming-us-and-what-can-be-done-about-

And, right here in good ole’ Missouri, August 13, 2015: “Missouri Hospital Agrees to Pay United States $5.5 Million to Settle Alleged False Claims Act Violations”
http://www.justice.gov/opa/pr/missouri-hospital-agrees-pay-united-states-55-million-settle-alleged-false-claims-act

Furthermore, recent nation-wide problems: “Top 5 Healthcare Fraud Cases in 2015”: http://www.medicfp.com/top-5-healthcare-fraud-cases-in-2015/
This is so awful: “Even though the amount of money recovered in 2015 is impressive, that is just a drop in the bucket for the amount of healthcare fraud that occurs, and is never reported or recovered each year. The U.S. spends over 3 trillion dollars on healthcare benefits each year, and according to a recent FICO study, roughly 10% of healthcare expenditures are fraud. This means that our country loses over 300 billion a year to healthcare fraud, nearly 1 billion dollars every day!”

From Florida to California, including almost every state, here the “worst offenders of 2015”:
http://www.healthcarefinancenews.com/slideshow/biggest-healthcare-frauds-2015-running-list

Users, beware.

Next in this series: Food Stamps and Food Issues for Poor People in St. Louis http://wp.me/p2bP0n-1BL

This first one is on health care, published on February 9, 2016, http://wp.me/p2bP0n-1By.
The second is/was on food for indigent people in Missouri (to be) published on February 16, 2016, http://wp.me/p2bP0n-1BL.
The third post is/was on advocacy and intersectionality, (to be) published on February 23, 2016, http://wp.me/p2bP0n-1C2.