Despite Affordable Care Act, free clinic still in demand

It’s a Thursday afternoon in May, and there are 24 people waiting in the lobby at the former McKeesport YWCA when the 9th Street Free Clinic opens.

Nathan Hite is seeking pain medication for an ongoing hip problem. He just lost his job as a firefighter and his health insurance. He doesn’t qualify for Medicaid and is awaiting a ruling on his disability claims. All of that brings him to the free clinic.

“It’s just sad,” said Mr. Hite, 40, of McKeesport. “There are just so many of us who fall into this gap.”

On this day, clinic founder Bill Markle and volunteer physicians, nurses, pharmacists and clerks will see 48 patients like Mr. Hite with problems ranging from asthma, to digestive disorders, to requests for basic physicals.

That’s been the average patient load since he opened the one-day-a-week clinic seven years ago.

“I’d be happy to close up tomorrow if we weren’t needed,” said Dr. Markle, 67. “There was huge hope with Obamacare that that would happen. But there’s still a huge need. We’ll be here for the foreseeable future.”

The clinic has seen a small dip in patients since the Affordable Care Act was enacted earlier this year and helped formerly uninsured people get coverage.

But Dr. Markle, a Monongahela Valley native who worked in the steel mills to put himself through school, hopes that all of his patients will eventually get some coverage for the simple reason that his clinic can only provide basic care. It has no X-ray machine or other diagnostic tools. If the clinic doesn’t have a patient’s medication on hand from donations from pharmaceutical companies, many patients can’t afford to get it from an outside pharmacy.

Lining up enough volunteers — Dr. Markle is often the only physician available during the first four hours of the clinic’s operations — is often difficult.

“I just feel like we shouldn’t have to struggle like this with health care,” he said. “We essentially have a whole group of people who get Third World medical care. And it shouldn’t be that way.”

Dr. Markle’s goal all along was to provide at least the basic care to patients he knew were not getting it.

Even though most of his volunteers, like himself, work for UPMC, the free clinic is not part of UPMC, which did not want the clinic operating in a health system building or at the physicians’ office.

“If you give free care, you’ll be inundated,” Dr. Markle said.

UPMC officials would not comment. The health system donated equipment, medication and furniture to the free clinic. And even if there were “definite issues” between UPMC and Dr. Markle when he first proposed the idea, he said they have been largely smoothed over for a very basic reason.

“At least some [of the UPMC administrators] are happy now because [the free clinic] does keep people out of the emergency room,” he said.

That’s important because UPMC McKeesport already provides uncompensated care (that’s a combination of bad debt and charity care) at 5.2 percent of net patient revenues, which is more than almost every hospital in southwestern Pennsylvania and more than double the region’s average, according to state data.

Anything the free clinic can do to help keep that number down helps reduce the fear that UPMC McKeesport might close — a very real fear in the Mon Valley.

“When Braddock Hospital closed [in 2010], we thought it could have been us,” said Michele Matuch, the executive director of the McKeesport Hospital Foundation, which provides an annual $20,000 grant to support the free clinic. “We will fight to keep this hospital open.”

The foundation had tried to support some health clinics with nurses in the past, but had hoped someone would start a free clinic that it could support. “And Dr. Markle came along and has done it right,” she said. “He deserves a national award for what he’s done. He’s just amazing.”

He sees his work at the clinic as simply a logical decision to fill a need. Rippling with an energy level that would make a 20-something medical resident look sluggish, he has the kind of calm and non-judgmental nature that also makes him suited to dealing with a patient population that faces multiple health issues.

Though officially semi-retired, he still works three or four days a week at his UPMC office in McKeesport and puts in 20 hours a week running the clinic. His shift on Thursdays typically runs from noon to midnight.

After the clinic closes at 8, he lugs home a large plastic bin filled with the files of every patient seen that day — just to make sure “everything is filled out right,” he said.

His wife, Mary, a registered nurse, volunteers with him, helping to organize the volunteers and assisting with patients.

One of their longtime nurse volunteers, Darlene Basic, a friend of the Markles, said they really do function as a team at the clinic.

“They run this place together,” she said. “And these people really need this care. You see it every week.”

Dr. Markle believes there is a new challenge looming: Former patients who now have some form of coverage under the Affordable Care Act say they are still strugging with health care because of high deductibles and high co-pays they can’t afford.

“We may have to consider taking people with insurance,” he said. That would lead to new challenges for the clinic. For the first time staff would be liable to malpractice claims and extra staff time would be needed for all the extra paperwork.

Still, he said: “You don’t want to turn away people who need care.”

Photo credit: Michael Henninger/Post-Gazette

This article was originally posted in the Pittsburgh Post-Gazette.