By: Chelsea Gow
At the Clearwater Free Clinic (CFC), a 58-year-old cook, William Jordan, sought care for what appeared to be a large blister on the bottom of his foot. Lacking health insurance, William put off seeing a doctor for months as his wound increased in size and severity. “I was terrified of what my ER bill could be, so I just prayed it would get better on its own.” William learned about the free clinic,admitted himself and received treatment from Dr. Allan Rothschild, a podiatrist of 48 years.
After an examination, Dr. Rothschild discovered that Jordan’s blister was an ulcer resulting from uncontrolled diabetes: a wound so severe, Dr. Rothschild admits he was “afraid he was going to lose his foot.” With the help of the clinic, William not only received the regenerative skin treatment that avoided amputation, but also the medication to prevent it from happening again.
Unfortunately, cases like these are not uncommon. Nearly 2.7 million Floridians under the age of 64 were uninsured in 2019 — 8% of which were children. Emergency rooms currently operate as a primary point of contact for thousands of uninsured individuals. The sole relief for emergency rooms and hospitals are the approximate 100 free and charitable health clinics scattered throughout the state, which save taxpayers billions of dollars in medical care every year. Pinellas County capitalizes on this relationship with an established network of hospitals and free clinics, which increases both the flow of patients from hospital to clinic and taxpayer savings.
Almost $2.6 billion dollars funded uncompensated care in Florida hospitals in 2017. Whether due to acute, non-emergent conditions or exasperated outcomes of chronic disease, many uninsured individuals use the emergency room as a form of primary care. Ignored hypertension or diabetes can result in heart failure, stroke, or kidney failure. With nowhere else to turn, the emergency room is often viewed as the quickest remedy. The costly nature of these hospital visits—impossible to pay without insurance—leaves the hospital and, ultimately, the taxpayer to foot the bill.
Ninety-four free and charitable clinics in Florida provided $178 million dollars in care last year. Volunteers and the state’s $9.5 million dollar State Funds Grant provided more than 459,000 medical, dental, mental health and pharmacy visits to uninsured patients. While some clinics focus on specialty care or secondary referrals, almost all clinics function as primary and preventative care. Each clinic has tailored services to fit different community needs. The state-wide need for chronic disease management has encouraged many clinics to offer nutritional and diabetic educational programs, in addition to free prescription services. This management of chronic disease has successfully prevented thousands of escalated conditions.The biggest obstacle to clinics’ impactfulness, according to Jeannie Shapiro, director of the Clearwater Free Clinic, is “people’s awareness of [the clinic’s] services.”
Beginning as a grant-funded pilot program, the Hospital Referral Program is now a permanent network of local hospitals affiliated with the Clearwater Free Clinic (CFC). The initiative allows hospitals to schedule uninsured patients for follow-up and chronic care management appointments at the CFC. A designated hospital team member educated on the CFC’s services and eligibility meets with identified patients and assists them with their transition. The team member communicates with the clinic to schedule an appointment and assure the discharge summary is available to CFC staff. In its first year, 67 patients remained active patients in the CFC of the 78 that were referred; only 12 readmissions occured after the transfer of care, 7 of which were from 2 patients alone. The program saw a radical decrease in hospital readmissions for referred patients and a significant improvement in overall community health.
The success of the program raises the question of its universality. While every community has different needs, the success of the referral program in Pinellas County suggests that wider adoption of this model for providing health care to the poor and uninsured should be considered. The benefits extend to hospitals, taxpayers, and those in desperate need of health care. As stated by William, “I really don’t know where I’d be [without the clinic.] I’m just happy I found them.”