Who wants the next big free health clinic? There's money and no lack of need

I spent the afternoon roaming the floor at the second and final day of the massive free health clinic sponsored by the National Association of Free Clinics with support from viewers of MSNBC's "Countdown with Keith Olbermann." More than 2,200 uninsured Americans, most of whom looked like they could be my neighbors or yours, were processed and many more simply had to be turned away. Walk-ins were closed after 1:30 this afternoon. My last sight at 6:30 was of Kansas City Free Clinic director Sheri Wood and National Association of Free Clinics executive director Nicole Lamoreaux heading to the lobby to work out appointments for 50 people at area clinics. These 50 walk-ins had simply refused to leave after being turned away. They needed the care that much.

The good news is that for what the organizers asked them to do, Kansas City's medical community and hundreds of other volunteers were up to the challenge of meeting the seemingly endless needs of America's uninsured — 83 percent of whom have jobs.

I ran into one of them while walking over to Bartle Hall. "Is this the Convention Center?" asked a woman on the street as she pointed to the back of Municipal Auditorium. Kathy M., an eight-year resident of the area, was heading to the free clinic for a dental appointment. Dentistry is a new addition to these mass free clinics, which began in September in a partnership with the "Dr. Oz" show, and have continued in Houston, Little Rock and New Orleans. The latter two clinics, and Kansas City's, were funded in large part by 25,000 individual donations from "Countdown" viewers, after MSNBC producer Rich Stockwell was so moved by Mehmet Oz's appearance on the show that he urged Olbermann to throw his efforts behind more clinics.

I spoke with Stockwell today:

As Stockwell noted, there is money left over, and there are going to be more of these mass clinics. The NAFC leadership will be picking them out soon for first quarter 2010.

Back to Kathy. As we walked toward Bartle Hall, she told me she works one of those wonderful new downtown nightlife jobs — and her moneybags employer doesn't offer insurance. She hadn't seen a dentist in years. She showed me the infected gum above one of her front teeth. "And I have a couple that need to be pulled, but they aren't hurting now," she said. (Extractions, I found out later, were an emphasis at the clinic because the uninsured go for so long between dentist visits, the care providers don't want to take any chances.)

Despite never having done something on this scale before September, the mass free clinic in Kansas City had a system that seemed to work flawlessly. People were checked in downstairs, then were called up in groups to a waiting area, where they were given a folder for their case with a number on it. (When I left, they were handing out folder #2200.) When their number was called, they were escorted to a triage "pod," each with a dozen exam areas. Each pod had one EKG, one HIV screening area, and one pharmacist on duty. A local charity had donated their mobile unit so that gynecological exams could be conducted in greater privacy than the exam rooms, which were just four blue scrims in a square.

Three people had to be transported to area hospitals yesterday, and today a man with a giant tumor on his head showed up, which reminded me of Steven Cantrell, the man with the horribly infected lip featured on the "Dr. Oz" show. Still more people will need follow-up care, and this is where the role of the "safety net" — hospitals and physicians that agree to see patients referred by the clinics at reduced or no cost — comes in. The national association chose Kansas City because of the extensive safety net that its free clinic, led by Sheri Wood, has woven.

But it's more than that. The clinics themselves are going to come under increasing pressure in the weeks ahead because of all of the publicity surrounding the mass clinics. They are adding extra shifts, like the ones for the 50 walk-ins who weren't served today. The clinics want this. They want people to know that they don't have to stay home and not get treatment for care. They don't want 23 percent of people to only use the ER when they need medical care — which was how many people who took the inpatient survey at the two-day clinic said they use the ER when they need medical care.

Amazingly, many ordinary Americans without health insurance have no idea they have options. I spoke to one named Greg. He's on furlough at his industrial employer. He has not been to the doctor in 10 years, since getting out of the military. Did he know he had veterans' benefits? Until today, he did not. Did he know he had diabetes? Until today, he did not. Did he know free clinics are there for them? Now he does. He came because Ed Schultz, the MSNBC host, said on his show yesterday that he would be originating from Kansas City today. He came because he's a fan of "The Ed Show"!

I spoke with Craig Dietz, medical director for the KCFC, who seemed to be everywhere on the floor of the mass clinic. "It's been an overwhelming outpouring of volunteers," said Dietz. "One hundred doctors, and they all showed up, which is amazing." Some MDs came from as far as Arkansas. Not only was the KC clinic the first to offer dental, including a mobile X-ray unit, but behavioral care as well. "They've been coming in with depression and other untreated medical conditions," said Dietz. "I call this a brief intervention where patients are identified and told what they need to do next. Many of them are afraid to go to the ER. And many patients are finding out that they're OK," at least mentally.

Dietz said that there is a virtuous circle at work here: volunteers become aware of the need for free clinics, and patients become aware that free clinics exist. "FOr one day," he said, "this is what it would look like if all of Kansas City had health insurance. People who do this all the time know that knowledge is power. Knowing how bad it is. Knowing what your blood pressure is. Knowing what services there are in town. It's all therapeutic. This has to be done more because just in the last few months the awareness has gone way up. I mean, this is a uniquely American way of doing things, voluntarism and taking care of your neighbor. Any plan that doesn't include voluntarism and free clinics is missing the point."

Dietz persuaded several of his med-student volunteers to work the clinic. It's part of his larger strategy to get more medical students to choose primary care over a specialized practice. "I want them to see that primary care can be fun, interesting and rewarding," he said. It sure looked that way to me.