Free clinic has visions of community effort

It pains Lidwin Dirne that thousands of her neighbors in Kootenai County have no health insurance and no access to medical care.

Her relentless energy helped start a volunteer-run free clinic in Coeur d’Alene 16 years ago to serve the uninsured. For 15 years, the clinic turned away patients on Medicaid or Medicare and accepted people with insurance only if their deductible was ridiculously high, for instance $5,000. Nearly every patient who walked through the clinic’s doors had no insurance.

Volunteerism had its limits, though. The clinic was open only two nights a week. Sometimes only one doctor was available. On those nights, half the 40 people who typically waited for care left and hoped their ailments wouldn’t worsen before the clinic doors opened again.

“It had to change. We had too many patients,” Dirne said recently.

So the clinic board of directors sought and won federal funding in 2003 to become a community health clinic under a program designed to improve access to health care for people without insurance. With a new personality, the Dirne Clinic, which took on Lidwin’s name in 1999, opened its doors five days a week with a paid staff 15 months ago.

The federal money it receives – $650,000 per year – is supposed to cover the costs of care for the uninsured. The federal program allows the nonprofit clinic to accept patients covered by Medicaid, Medicare and private insurance to earn enough money to pay operating expenses.

But clinic directors have struggled to find the right mix of paying and nonpaying patients. To cover expenses, the clinic needs more people with Medicaid, Medicare and insurance than it expected and reaches fewer uninsured people than it hoped, said Joel Hughes, clinic director.

“The volunteer clinic was for the uninsured and we sent no one away unless we had too many patients,” Dirne said. “I know the (federal) grant was necessary to help more. But we still can’t help all and I worry about it. We need a grant twice the size, and that’s a dream.”

Hughes said he’s heard the rumors the clinic would close, but keeping the doors open isn’t the problem. Reaching all the uninsured people who need medical help is.

“I don’t know where the rumor got started,” he said. “We’re not desperate. We have a grant and it’s just a matter of managing it effectively.”

About 25,000 Kootenai County residents are uninsured. Last year, the Dirne Clinic saw 2,500 of those people in 6,500 visits. Clinic doctors also saw 1,200 insured patients in about 3,500 visits. Money was so tight that the clinic drained the bulk of its savings before it eliminated seven jobs, including a nurse and nurse practitioner, to free up about $300,000 for operating expenses, Hughes said.

But the waiting list for care persisted. It stands at 100 now. At the start of the clinic’s federally funded life, 70 percent of its patients were uninsured. That percentage is down to 63, Hughes said.

“I’ve worked in other community health centers and it’s never that high,” he said. “Forty percent is more common.”

Pat Schwartz, who works with nonprofit North Idaho Partners in Care to improve access to care for uninsured people, refers a steady stream of people to the Dirne Clinic.

“I do hear back that they can’t get in,” she said. “It seems they have to call early in the morning and still can’t always get in.”

Uninsured in Kootenai County have few other options. Some go to Kootenai Medical Center’s emergency room, which won’t turn them away. But they don’t usually head to the emergency room until their medical problem is bad enough to merit emergency attention.

Volunteer clinics operate in St. Maries, Sandpoint and Kellogg, and other federally funded clinics operate in Bonners Ferry and Plummer. The closest of those clinics is 35 miles from Coeur d’Alene.

But the Dirne Clinic is not giving up on reaching the uninsured. Hughes said the clinic is courting partnerships that will expand its services and attract more seniors on Medicare. Already, a program that helps diagnose people with memory problems is moving into the clinic. Hughes applied for a grant to start a mental health program for seniors in the fall.

Such programs would bring Medicare money to the clinic, particularly if seniors choose clinic doctors to provide their primary care.

Real Life Ministries in Post Falls had aspirations of opening a clinic years ago but was overwhelmed by the cost of malpractice insurance. Hughes said he envisions a future partnership in which the church could offer a volunteer clinic at Dirne or donate toward the Dirne Clinic’s expanded services.

“This is a community issue,” Hughes said. “We have the opportunity as a community to support appropriate health care as opposed to emergency room care. It costs us one way or another.”

He hired a fund-raiser and publicist to spread the word about Dirne’s needs and potential and attract donations to the clinic. Lidwin Dirne sat next to Graham Crutchfield, a Knights of Columbus member, at an event recently and discussed the clinic with him. Crutchfield has since raised $9,100 for the clinic, she said.

Hughes also is proposing that businesses that can’t offer health insurance to their employees donate to the Dirne Clinic to help it grow. The more money it has, the more it can direct to medical care to the uninsured, he said.

And that’s all Lidwin Dirne wants.

“In the beginning, I was very happy, but I was not realistic,” she said. “I thought all that needed help would be helped. It’ll take a community effort, the same as when we started.”