By Scott J. Krischke
For people like Arlington resident Dora Del Castillo, an immigrant from Bolivia who is part of the growing number of Northern Virginia residents without health insurance, getting adequate health care isn't simple.
Del Castillo and other patients in Northern Virginia who do not have health insurance have been turning increasingly to the three community free clinics in Arlington, Fairfax and Loudoun counties.
Virginia ranks second among states for the total number of free clinics, with 48 clinics operating at 61 sites with about 64,000 patients receiving health services last year, according to Mark Cruise, the executive director of the Virginia Association of Free Clinics.
This growing number of free clinic patients is indicative of a state that falls in second to last in terms of residents without health insurance who qualify for Medicaid, Cruise said.
“Historically, the need for health care access among low-income, uninsured Virginians has been very significant in part because our state Medicaid program for Virginians between the ages of 19 and 64 has not been very well covered,” said Cruise, who pointed out that state-sponsored health care for children and seniors has been “very good.”
“Virginia has always been a very … fiscally conservative state and won’t put much money into Medicaid for people who fall within that [age] group.”
“When you combine that with the large numbers of small businesses struggling to provide health care to their employees, you can start to see why Virginia has such a bad problem with this,” he added. “That’s the downside, on the upside, Virginia has a very proud tradition of health professionals and volunteers willing to donate their time and skills in our 48 clinics that we have statewide.”
FOUR FREE COMMUNITY clinics serve the Northern Virginia region: the Arlington Free Clinic, the Herndon Free Clinic, the Loudoun Community Free Clinic and the Prince William Area Free Clinic.
Del Castillo is a regular patient at the Arlington Free Clinic, located in the Ballston Medical Center in Arlington.
“I’ve been coming here for six years,” said Del Castillo, a mother of two. “They’ve been giving me so much attention and so many of the things that I have needed for my health.”
“I don’t know what I would do if the clinic didn’t exist,” she added. “I cannot afford health insurance.”
The Arlington Free Clinic is staffed by volunteers which include several area doctors from a range of backgrounds and specialty practices. The clinic also has been able to track down specialty physicians who had never before volunteered to see Del Castillo, she said.
“We have a very loyal group of volunteers … and specialist doctors,” said Paula Potts, development officer for the Arlington Free Clinic. “We see patients who are so incredibly grateful to have the medical attention and we see doctors who continue to come back and help out. When I look and see the reactions of the people who come here … we seem to be meeting a real big need in the community.”
The Arlington Free Clinic is the largest free clinic in Northern Virginia with more than 10,000 patient appointments, 18,000 filled prescriptions, 150 volunteer doctors and a budget over $1.3 million last year, according to Potts.
“When we talk about the uninsured, many of these people are below the poverty line and have never been able to get the proper health care that they need and they get pretty contemporary and professional treatment here,” said Dr. Michael Mattina, a fertility specialist who volunteers as an obstetrician-gynecologist once a month at the Arlington Free Clinic’s special women’s clinic. “This is not second-rate medical care, [patients] are getting the top-tier treatment.”
WITHOUT FREE CLINICS, the uninsured have the option of ignoring a medical condition or showing up in a hospital emergency room, two choices that hurt all Virginia residents — both those with and without coverage.
“If [our patients] weren’t seeing us for their primary care they wouldn’t have any place else left to go,” Potts said. “They would either ignore the condition, which puts them at risk, or end up in the emergency room … and that could put a huge burden on the community.”
“Without the presence of the free clinics, our [insured residents’] health care costs would be substantially higher,” Cruise said. “If a free clinic can see and treat a patient with diabetes, for instance, before the condition becomes out of control and that person ends up in an emergency room, we’ve saved a big part of our health care system resources.”
That added financial burden is then passed on to the medical coverage plans of insured patients who visit the hospital, which causes the already inflated price of health care to increase further, Cruise said.
A large portion of the patients who visit the clinics throughout the area are diagnosed with such conditions as diabetes and hypertension, which requires not just continual care, but also a regular regimen of prescription drugs, making the continual presence and attention of the clinic that much more integral to the lives of its patients, Potts said.
The rise in the number of new immigrants to Northern Virginia in recent years has further underscored the need for the free clinics, according to Cruise.
“This is a population — illegal or not — that disproportionately lacks health insurance,” Cruise said of new immigrants to the United States. “Without the free clinics they would just go to the hospital emergency room … and we absorb those costs.”
The Arlington Free Clinic estimates between 80 and 85 percent of their patients are foreign-born.
“In some cases, it’s not only about stopping the added costs … but it could be the difference between life and death for these people,” Cruise added. “In many cases it can at least mean the difference between these folks being able to work … and provide for their families or not. It means the world for these people to be able to come out to the free clinic.”
RESPONDING TO THE GROWING need for medical coverage for the uninsured, the Loudoun Community Free Clinic, located in Leesburg, has grown in leaps and bounds since it became a full-time service in 2002, according to Lyle Werner, the clinic’s executive director.
The Loudoun Community Free Clinic “gives [our patients] a medical home,” Werner said. “People with insurance can go to the doctor and get whatever they need, but these are the people who have not had that medical care or have had very poor medical care and have been mismanaged throughout their medical histories.”
According to Lyle, about 70 percent of the patients who came to the clinic over the course of the last year have been either immigrants or ethnic minorities.
“Health care is enormously important because people need to be able to manage their diseases, their conditions,” she added. “They need to be able to pay for their rent and support themselves so they’re able to lead normal lives.”
Last year, the Loudoun Community Free Clinic broke their record in number of visits served for its fourth consecutive year with over 3,500 visits from over 1,000 patients. Its overall budget last year, including donated supplies and medical services fell in just shy of a $1 million, Werner said.
“We’ve grown every year,” Werner said. “We are always growing, always trying to be able to service … the [approximate] 30-to-35,000 people in Loudoun County who do not have medical insurance.”
LOOKING TO ESTABLISH a medical oasis for the approximate 82,000 medically uninsured residents of Fairfax County, the Herndon Free Clinic has been attempting to expand its services, according to Meagan Ulrich, the new executive director of the Herndon Free Clinic.
Right now, the Herndon Free Clinic — the only one of its kind in Fairfax County — operates as a temporary clinic that offers two adult and two child clinics a month out of the Herndon Neighborhood Resource Center. Because of limited space and resources, volunteers at the clinic are only equipped to see between 25 and 30 patients per session, Ulrich said.
Its small size has not deterred the clinic from its goal to reach as many of Fairfax County’s uninsured as possible.
“We’re in mega-growth mode here,” said Ulrich, who has worked for the American Red Cross and the American Cancer Society. “We’re looking for a permanent space that will allow us to have more clinics and see more patients.”
“The need alone in the community is only going to continue to grow,” she added. “We need to have more clinic services because we are not meeting the demand by any means.”
Ulrich hopes that the group, whose fiscal year 2006 budget equaled just $120,000, will be able to find a permanent base of operations from which it can begin expanding within the next six to nine months.
“I’d like to be able to serve all the people who need” medical attention, Ulrich said. “Obviously we won’t be able to do that.”
“We don’t even know how many people are out there.”