Norfolk clinic's aim is to fill a void

NORFOLK

Jenny Greco has heart failure. It's a chronic condition. And she's got back pain. That's chronic, too. Both conditions need regular medical care so they don't get out of hand. What Greco doesn't have is health insurance, until recently, she also didn't have a doctor she could call her own.

"Over there, you never knew who you were going to see," said Greco, referring to the part-time clinic at Bon Secours DePaul Medical Center. The Ocean View resident, who needs to have her blood regularly tested to assess the effects of a blood thinner, also relied on local emergency departments.

Treating "that kind of patient in an emergency room is just nuts," said Daniel Duggan, executive vice president/administrator of DePaul. "We're getting a medical home for people who desperately need it."

Bon Secours' goal is to make Park Place Medical Center in Norfolk, which is affiliated with the federally funded Portsmouth Community Health Center, a "medical home " for low-income, uninsured people. The effort is aimed at those with chronic conditions - such as congestive heart failure, diabetes and high blood pressure - that could be more effectively, and less expensively, treated with ongoing care from a designated primary care physician.

In the fall, DePaul began referring patients from its low-income medical clinic - which closed earlier this month - and emergency department to Park Place, about a mile down Granby Street, on the bus line. More than 200 patients from DePaul so far have been scheduled for appointments.

Along with the patients, Bon Secours gave a grant of nearly $400,000 to hire more staff and expand the clinic's hours to include some evenings and weekends, to make it easier for the working poor to make appointments.

"They can't just take a day off to take a kid to the doctor," Duggan said.

In February, Bon Secours will also team up with The Southeastern Tidewater Opportunity Project, an umbrella group for several non profit organizations that provide aid and advocacy to people with low incomes, to put two "life coaches" in DePaul's emergency department.

The life coaches will be licensed practical nurses who will be trained to help patients with medical and other issues, said Edith Jones, president and CEO of STOP.

"Low-income people don't just have one issue. They're bombarded with multiple problems," Jones said. Health care usually ranks fourth or fifth in their concerns. "It's do they have a roof over their head, kids in good schools, finding jobs."

The life coaches will work with patients who have chronic conditions in DePaul's emergency department to "assess their whole condition." Jones said they might, for example, in the course of counseling a diabetic patient, find out they can't afford their medicine and that "your light bill needs to be paid. Let's see what we can do about that."

The Bon Secours effort is part of a larger proposed hospital reorganization that - if approved by the state health commissioner - would lead to a new, but much smaller, DePaul facility. Bon Secours officials are proposing that DePaul be downsized from a 238-bed hospital to one with 64, with the other beds transferred to new proposed facilities in Virginia Beach and Suffolk. A decision is expected in the spring.

Duggan has said that if the state doesn't approve the hospital plans, Bon Secours will have to close the financially ailing DePaul. But even if that happens, he said the Bon Secours partnership with Park Place and STOP should continue.

"This has to keep going," Duggan said. "This needs to exist."

Bon Secours' reorganization plans raised concerns that the nonprofit Catholic health system was leaving behind low-income people in favor of more prosperous locales in the suburbs. The Park Place initiative has been one of Bon Secours' answers to that.

"I was apprehensive," said Yvonne Price, who was coordinator of the DePaul clinic and now works in Park Place's homeless outreach program. " Were my patients going to be taken care of? "

One of Price's patients, Mimi Eisman, was more than apprehensive when she heard the DePaul clinic was closing. "I was crushed. Crushed, " she said.

Eisman is a 52-year-old with diabetes and high blood pressure, two of the most common chronic conditions that can best be treated with ongoing care from a primary care physician. Untreated, complications from the two conditions include heart attacks, stroke and limb amputations.

"I really liked them," Eisman said of the DePaul clinic, but after her first Park Place appointment about a month ago, she realized that the DePaul clinic was stretched too thin on resources. "But I love it here."

The DePaul clinic was open only two days a week. It could take several weeks to get an appointment, and once there, waits could be two to three hours long, Price said. At Park Place, patients can generally get an appointment within a week, sooner if there is an urgent need. Once there, the wait time is usually less than 30 minutes.

Price said that because there are not too many patients being crowded into too few hours, it has also meant doctors have more time to spend with individual patients.

"I like coming over here. I just like the whole ambience over here," said Greco. "They do take good care of you and learn what your situation is."

The logistics of the transition from DePaul have included such intangibles as getting people who haven't had - or have gone years without - a steady primary care doctor used to the idea of making and keeping appointments, said Dr. Subir Vij, Park Place's medical director.

There's also an intimidation factor.

"It's 'I don't have insurance. I am going to a doctor's office. Will I be treated with dignity and respect?' " Vij said.

Vij said that so far the transition has gone very smoothly.

"My goal is to keep you from the emergency room as much as I can," Vij said. "We want this to be an ideal model for the rest of the nation."

Eisman said her doctor is helping her with a weight-loss program and will monitor her other conditions during monthly visits.

"This seems like a regular, real doctor," Eisman said. "There's this new medicine I'm trying. I'm very excited."

Nancy Young, (757) 446-2947, nancy.young@pilotonline.com