A medical oasis

For area residents who are working but have no insurance, Shepherd's Clinic is their chance for affordable health care

April 14, 2006|By JONATHAN BOR | JONATHAN BOR,SUN REPORTER

Maxine Smith has a hard time imagining how she could manage her thyroid condition without Shepherd's Clinic, Baltimore's only health center expressly for uninsured working people.

A nanny who earns just under $10 an hour, Smith pays $9 for each medical appointment and receives free medications through a local nonprofit. Yet, for all the financial advantages, she is quick to mention something that matters just as much.

"The Shepherd's Clinic gave dignity to who I was," said Smith, 55, who came to the clinic a decade ago after being treated at a medical practice where no one addressed her by name.

"I was amazed by the behavior of the staff," she said, recalling her first visit to Shepherd's in 1995. "They were just so kind."

Michael Rice, who was laid off in October from his job operating a forklift, agreed. "They treat you real good here," he said.

These aren't ordinary times at the clinic, established in 1991 in a basement off St. Paul Street and relocated a few years later to an old bank building where medicines were stored in the vault.

Two months ago, the clinic moved to a low-slung building behind City College that used to house an adult day care center. Visitors are met with a muted color scheme, spaciousness and a flow-through floor plan.

But much hasn't changed. As before, practically everything is donated: the examining tables, blood pressure cuffs, ultrasound machine and filing cabinets. So, too, are the services of the primary care doctors and specialists who handle 3,000 to 4,000 patient visits per year.

Courtesy remains a guiding principle, along with a determination to offer nearly free care to the working poor, a population left out of the federal and state programs offering free or reduced medical assistance.

Household income must be no greater than twice the federal poverty threshold, which is $20,000 for a family of four, yet patients generally earn too much to qualify for Medicaid. Also, the clinic does not accept the elderly, who qualify for Medicare, or children younger than 19, who are covered through federal and state programs.

To qualify, patients must have a job or live with someone who does. (There are exceptions, such as Rice, who is collecting unemployment while looking for work.)

"It's a safety net image that we have," said Meg Boyd Meyer, the clinic's administrative director. "If people don't fit into the system, then we try to pick them up."

To keep its patient population under control, the clinic draws only from 13 city ZIP codes, most of them on the north side.

Whether to charge a per-visit fee has been a continuing philosophical debate, but the rule has never changed: Patients must agree to pay a fee pegged roughly to their hourly wage.

"We are of the school of thought that when people contribute something, they use services better," Meyer said. "They are more likely to show up or call when they can't come. They become partners in their own health care."

Shepherd's Clinic was started in 1991 by members of the Seventh Baptist Church, who found cozy if cramped quarters in a basement across the street.

With a current annual budget of about $330,000, it receives donations from churches as well as private individuals. It accepts patients and volunteers of all backgrounds and doesn't push a religious agenda. A carved wooden sign bearing a cross and a reproduction of Jesus cradling a lamb are about the only reminders of the clinic's religious origins.

Just as prominent as that picture is a photograph of the late Dr. William H.M. Finney, a public-spirited neurosurgeon from Union Memorial Hospital who retired in the early 1990s and soon became the clinic's medical director.

"It wasn't his idea, but it meshed perfectly with his idea of how to cut through red tape," said his grandson, David Finney.

When patients needed medical services that were beyond the expertise of clinic doctors, Finney called specialists until he found one who would help. Once a week, he went door to door at Union Memorial, asking doctors to donate pharmaceutical samples they weren't likely to use.

"He'd usually fill up one big trash bag with medications," David Finney said.

Finney died in an automobile accident almost three years ago with a trash bag full of medications in his trunk.

After his death, several physicians established a foundation in his name, and its board went to work locating and purchasing the one-story building on Kirk Avenue that is the clinic's new home.

Today, the staff recalls with some affection how doctors in the old bank building held conferences in the same room where people grabbed coffee. In another room, patients had their blood drawn in the same space where nurses called other patients with results.

"Privacy wasn't so good," Meyer said.

As before, Shepherd's Clinic relies on retired or semi-retired doctors who volunteer a few hours a week, and a staff of largely volunteer nurses and clerical workers.

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