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Uninsured Americans get care at Swedish clinic

'Swedish model' outranks 'American dream'
Swedes eye Somali success – in Minneapolis

Stan Wells, a former actor relocated from Los Angeles, was just getting back on his feet when he slipped on a stair and broke his ankle.

For about a week, Wells tried to convince himself it was just a sprain. Teaching improvisation and directing shows a few days a month, he's a man with no spare cash and no health insurance.

"I was in a complete panic when I realized that it wasn't a sprain," said Wells, 55.

One of his acting students -- a doctor -- suggested he go to Country Doctor Community Clinic on Capitol Hill. From there, he was referred to the new Swedish Community Specialty Clinic, and a volunteer orthopedic surgeon who fixed his break.

For free.

The operating room was free, too. And so were the X-rays and other services.

Surprising as it may seem, officials at Swedish Medical Center, which picks up costs for the clinic space, operating room and in-house diagnostic work, say it's less expensive to care for uninsured patients who need specialty services through a coordinated system than to wait until a crisis brings them to the emergency room on a Saturday night.

Because of federal law, hospitals with emergency rooms are obligated to provide emergency services to all, notes Dr. Joseph Engman, an orthopedic surgeon who coordinates orthopedic services at the clinic, which held an open house last week. "So then it becomes a question of: 'Can we do it better and more economically?' "

Recruited by a nonprofit known as King County Project Access, 650 specialists from hospitals and clinics in King and Snohomish counties volunteer "because it's the right thing to do," says Dr. Jay Fathi, the new clinic's medical director.

Project Access, a private, nonprofit that worked with Swedish to develop the clinic, arranges all the details behind the scenes for the specialists. Then, says Engman, the doctor is left with a simple question: "Am I willing to donate an hour of my time to do a surgery?" That, he says, is "very manageable."

The new, 4,000-square-foot clinic, located in the Heath Building adjacent to the Swedish hospital entrance, expands and combines free care formerly given at the smaller Mother Joseph Clinic at Swedish's Cherry Hill campus and a tiny space at its First Hill campus.

The clinic expects to see about 2,000 patients for nonurgent services that require a specialist in general surgery, hand surgery, dermatology, orthopedics or podiatric surgery. Some clinic patients will see specialists such as cardiologists, gynecologists, neurologists, ophthalmologists, urologists and occupational and physical therapists in offices in the community.

Project Access serves working poor, uninsured or underinsured patients. They must be referred by a primary-care physician, typically through a community clinic or family-practice residency program.

For years, primary-care doctors have complained that they can't find specialists for patients who can't pay. Busy specialists don't like emergency calls at odd hours for unfamiliar patients who may require a procedure they haven't done for years.

Many have been reluctant to see uninsured patients in their offices, as well, because some may not show up or comply with instructions or may require translators and coordinating records and services can be difficult.

Project Access, which is funded almost completely by hospitals, foundations and individuals, has a single mission: help low-income uninsured and underinsured patients access specialty care.

To do that, Executive Director Sallie Neillie has maintained a clear focus: It's all about the doctor -- those specialists she refers to collectively as "L-M-N-O-Pologists." Sort of like a car salesperson -- but with a do-good motive -- Neillie asks them, essentially: What would it take to get you into that operating room?

The answers boiled down to "less hassle." Arrange interpreters. Make patients show up for appointments and follow instructions. Coordinate records and diagnostic information. Arrange for free lab and radiology support. In essence: Take care of everything outside the operating room. So Project Access does that.

Neillie even got national manufacturers to donate expensive joint-replacement hardware and lenses for cataract surgery.

These days, she says, it's easier to recruit docs now that middle-class patients have joined the rolls of the uninsured. "Now there's a 'There but for the Grace of God go I' attitude."
Engman, who is paid a stipend by Swedish for coordinating and teaching at the clinic, said he believes specialists have an obligation.

"We have had the benefit of receiving a wonderful living and benefits from the community, and this is a way of giving back and taking care of people," he said.

For his part, Stan Wells, still recovering from surgery, said he's been very pleased with his care at the clinic. Though he can't pay, he's been treated with dignity at every turn, he said. "They're amazing here."

To see more of The Seattle Times, or to subscribe to the newspaper, go to http://www.seattletimes.com. Copyright (c) 2010, The Seattle Times. Distributed by McClatchy-Tribune Information Services.

Last Updated (Thursday, 28 October 2010 15:58)


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