Dr. June Henderson visits with patient Patricia Saunders.
It's 10:15 a.m. on a Wednesday in November, and Dr. June Henderson sits at a small table, updating patient files in the Fan Free Clinic, one of eight Richmond area centers offering free medical services. She just finished seeing her first patient of the day — a 58-year-old man who worked all of his life until the 2008 recession hit.
"It's hard for him," Henderson says of the patient's embarrassment about relying on charity medical care. "He apologized for being here … I handed him a tissue and said, ‘It's OK.' "
Henderson, who worked at The College of William and Mary's Student Health Center for 32 years, says the patient cut back on his blood pressure medication because he no longer has health insurance. "We were able to prescribe [his medication] at $4 per month at Walmart," she says.
Nowadays, many of the clinic's patients tell stories similar to his, Henderson and other physicians and assistants at the clinic say. For most of its 40-year-old history, the clinic off North Thompson Street treated extremely poor people and students seeking STD testing. But with the economy recovering at a glacial pace, doctors, nurses and assistants have seen a powerful shift in the type of people who turn to the clinic.
"The majority of the people that [used to] come in here were destitute," says Elissa Dragland, a medication assistance caseworker. "Now, we see people who used to make $90,000 per year. But now they have nothing."
The patients reflect a blend of chronically poor and newly poor people who've fallen into that category because they've lost jobs, homes, health insurance," says Karen Legato, executive director of the clinic. "There's a lot more of those folks."
The overall number of patients is increasing as well, she says. While the clinic treated 1,829 patients during fiscal year 2009-10, it's likely to handle more than 2,200 in the 2010-11 fiscal year, Legato says.
Robert Key, medical case manager, says that with so many people seeking help at the clinic, its system for handling patients had to be overhauled to make sure the neediest received care first. Instead of allowing people to come on a "walk-in" basis, the clinic now screens patients and then schedules them for appointments.
"If somebody doesn't think we need to do something about the health care in our country, they need to visit us and hear our stories," Henderson says.
A peek into the waiting room supports her point. It's only minutes since the doors opened at 9 a.m., and the room is already filling up. A clean-cut man, dressed in a bright blue athletic jacket, looks around impatiently as he waits. Nearby, a Hispanic woman, middle-aged and looking exhausted, drops her head onto her chest.
In the hallway lined with exam rooms, 10 volunteers and nine paid staffers prepare for the day. Among them is Dr. Mary Coeffer, a former ER doctor who handles gynecological appointments. She chats with her assistant, a Bon Secours nursing student, about what they'll do that day — most likely a lot of pap smears, and Coeffer will try to educate patients about birth control.
"Lots of other things come up because they have not been seen by someone on a regular basis," Coeffer says. "They will ask me about weight loss, diet, etc."
She has a warm countenance and bright eyes that greet patients from behind stylish glasses. She enjoys working at the clinic, she says, "because [patients] don't have insurance, I don't have that pressure to see someone every 30 minutes."
A door to the waiting room opens and a nurse calls out a name. A middle-aged African-American man struggles to get to his feet using his crutches, then makes his way into the first exam room.
"Have you eaten anything today?" the nurse asks.
"Some juice," he responds.
Another nurse, a volunteer, wraps a tourniquet around his arm while the staff nurse puts on gloves. They struggle to find a vein, while the man's wife watches. "Two [nurses] working on one patient!" she says, sounding incredulous.
It's nearing 11 a.m. and the volunteer pharmacist arrives, carrying 10 to 15 brown paper bags. Each is marked with a patient's name and contains medication that will be provided free of charge. Meanwhile, Dragland, the medication assistant, files reports for the pharmaceutical companies that provided the free supplies. In the 2010 fiscal year, she says, the clinic sent more than 1,000 requests to the firms, which, in turn, gave $936,124 worth of medication for free. That's up from $466,368 worth of medication provided in the 2008 fiscal year.
In the lime-green reception room, sunlight pours in as Sherzel Smith, a volunteer, searches for a patient's chart. From the Caribbean, Smith moved here to attend the University of Richmond; she plans to go to medical school. "Back home our health care system is not that great," she says. "I have seen worse [than here at the clinic]."