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Hospital district balks at taxpayer funding for 'We Care'

STORY BY MEG LAUGHLIN (Week of January 16, 2014)
Photo: Dr. Ralph Rosato treats a We Care patient.

Obamacare may have allowed a lot more people to get health insurance, but many of the indigent poor are still falling through the cracks of the healthcare system nationwide and in Indian River County, causing new financial strains.

The local hospital district, at its Monday meeting, faced a request to fund, with taxpayer dollars, the salary of a full-time physician for a non-profit organization known as We Care, which provides vital pro-bono healthcare for indigent patients after they’ve been released from the emergency room.

While praising its mission, the seven hospital district trustees were reluctant to grant the request from We Care in its present form because several other organizations had been turned down for similar requests and trustees felt it might set a dangerous precedent.

“We are sympathetic but we have concerns,” said Hospital District Chairman Tom Spackman. “Once the camel’s nose is in the tent with paying doctors’ salaries, we don’t know where it will go from there. It could be huge in the future.”

It’s a big issue in the county as well as across the country: How to provide qualified physician care for the poor. A study in the Health Affairs journal recently reported that 41 percent of doctors in Florida were unwilling to treat indigent patients, as opposed to 31 percent nationwide.

We Care, which operates on a shoestring budget, has enlisted over 120 specialists and primary care doctors in the county to volunteer a few hours a month to treat indigent patients, without charge.

“We are intrigued with the opportunity to help you, but we have to ask if we’re opening a huge door requiring us to cover doctors’ pay,” Trustee Gene Feinour told We Care leaders, physician Dennis Saver and county health department chief Miranda Hawker.

Previously, the Hospital District turned down an Indian River Medical Center request for $1 million in property tax dollars to help pay for doctors employed by the hospital to treat the poor. Furthermore, requests from independent physicians for partial reimbursement of indigent patient care have also fallen on deaf ears.

Saver explained the typical scenario that causes gaps in care for indigent patients: A person who qualifies as indigent – let’s call him John Smith – goes to the emergency room and is hospitalized with pneumonia and treated by a physician salaried by the hospital.

When Smith gets out five days later and needs follow-up care, he must either wait for an available health department doctor or an available pro-bono doctor through We Care.

“That wait can take months,” said Hawker.

With a full-time We Care primary care physician, housed at a renovated area of the Gifford Health Center (which has just become available), John Smith could get follow-up treatment within days from a doctor in close contact with his hospital physician.

“We would have much better continuity of care,” said Saver, who added that the current linkage to indigent outpatient follow-up care is “clunky and not good.”

Saver started We Care in 1991 and, despite operating on “spider webs and gossamer wings,” the organization currently arranges for more than 117 specialists and primary care doctors to see indigent patients without charge. In 2012, over a million dollars in physician services were provided, pro bono, to the poor through We Care.

To illustrate how We Care works, patient Ron Shaulis described his experience to Vero Beach 32963:

Over a year ago, Shaulis, then 53, went to the county health department because of a ping-pong ball-sized tumor that had quickly formed on his face. Shaulis had been laid off a few years before from his job as a chef at Bent Pine Country Club and had a low-paying part-time job, which placed his income below the poverty level. He lost his home and was scratching around to pay small bills.

“I was a mess,” said Shaulis. “Not only was I worried over what the tumor was, I was embarrassed because I looked like a freak.”

The county health department referred him to We Care, which arranged for Shaulis to see both a dermatologist and a plastic surgeon, and in June surgeon Ralph Rosato operated on Shaulis and saw him several times after, without charge.

“I’m fine, after seven months of misery. My life has improved 100 percent,” said Shaulis, who now has two part-time jobs and is hopeful for the first time in years.

Stories like Shaulis’ are what keep Saver and Hawker inspired and motivated to expand We Care, and what took them to the Hospital District to ask for funding. “It’s simple; we need to help more,” Hawker told 32963.

At the conclusion of Monday’s meeting, the Hospital District trustees were not willing to approve the We Care request to hire a physician, but asked We Care to come up with “an alternative plan.”

“There must be a way this can be worked out,” said District Trustee Alma Lee Loy.

“We’ll be back,” said Saver.