понедельник, 17 сентября 2012 г.

FOR HOMELESS, A QUESTION OF ACCESS HEALTH CLINIC'S CUTBACKS PROVE TROUBLESOME - The Boston Globe (Boston, MA)

Paul Cheeba says he treated his pain with alcohol and cocaine for32 years.

Since sobering up last March, Cheeba, 43, has uncovered myriadhealth problems, including hepatitis C and bipolar disorder.

But what's bothering him lately is a spot on his lung. Cheebahasn't received results from a CAT scan in December because twoappointments have been canceled at Southside Health Center, a clinicMetroWest Medical Center operates on Concord Street to serve thearea's homeless, immigrant, poor, and uninsured populations.

'I could have cancer and not know it,' he said.

Cheeba, like many others who stay at the Turning Point soberhousing shelter in Framingham, seek free care at the clinic, down thestreet from the shelter.

But many at-risk patients and their advocates say services havebeen insufficient since a doctor and nurse who mainly catered to thehomeless population left Southside Health Center last year.

Appointments are now required at the former walk-in clinic. Waitshave increased. Night sessions for the homeless are no longeroffered. And doctor visits to more than 20 homeless and at-riskshelters in the western suburbs have been eliminated.

'Right now, the commitment by MetroWest to the homeless is only avery small part of what it used to be,' said Gerard Desilets,chairman of the MetroWest Community Healthcare Coalition and directorof planning at the South Middlesex Opportunity Council, which runsthe Turning Point shelter. 'We'd like to see the MetroWest MedicalCenter reaffirm its commitment to help provide health care servicesin a comprehensive way for the large population of at-risk orhomeless' in the western suburbs.

Dr. Thomas Treadwell, director of the residency program atMetroWest Medical Center, said he has not received any complaintsabout access to health care. 'We don't feel that the number ofhomeless patients who utilize the clinic require a full-timephysician,' Treadwell said.

Although Treadwell described doctor visits to the other sheltersin the suburbs as 'ideal,' he added that 'sending a physician toMarlborough is just something we are not going to be able to do.Right now, physicians we have are overwhelmed seeing patients in theSouthside [clinic].'

So inundated, Cheeba said, that he started heading straight to theemergency room for most medical treatment. He estimated that he hasvisited the emergency room 20 times in the last year.

The hospital is interviewing candidates to fill the positionvacated by the nurse last fall, Treadwell said, but the new nursewill coordinate the entire clinic, and not just concentrate on thehomeless patients. 'We lose tons of money on that clinic, but we seeit as an obligation to the community,' Treadwell said. He added thatthe medical center doesn't receive outside funding for the clinic.

'I feel badly. The people need to be taken care of in their ownsystem,' said Margaret Davitt, director of Turning Point shelter. 'Wewent from a program where there was a lot of interaction with doctorsand nurses who specifically attended to the homeless to none.'

Desilets said the homeless population, which SMOC estimates atmore than 250 in the western suburbs, requires special attention.These individuals often neglect their health for extended periods oftime, and frequently battle chronic or acute illnesses. Although theymay be living in family shelters or motels, those at-risk may beunwilling or unable to get to downtown Framingham. 'Having theclinic is not a bad idea, but the medical center needs to accommodatethe health care needs of people who don't live within walkingdistance,' he said.

But even Roberta Clark, who lives down the street from the clinicat Turning Point, couldn't get the medical attention she needed.Clark has an anxiety disorder, and panic attacks kept her fromleaving the shelter until the former nurse came and escorted her out.

'When the doctor and nurse were here, things got done, bam, bam,bam,' said Clark, who is trying to schedule a CAT scan for chronicstomach problems. 'Now it's a long, drawn-out process.'

Bringing patients to the clinic, rather than seeking them out, isMetroWest Medical Center's goal. 'It's more effective, and moreefficient,' Treadwell said.

He said physicians and nurses deliver the best care in the clinic,where medical equipment and private rooms are available. Treadwellsaid the initial intent of the health care program for the homelesswas to build bridges and let people know about the clinic. 'We'reproud of what we do, but we can't be all things to everybody,' hesaid.

For Linda Campbell, though, 'Everything has changed.' Campbell hasused the Southside clinic since she arrived at Turning Point threeyears ago. But in recent months, the 58-year-old has been reticent togo.

'It used to be a walk-in,' said Campbell, who has emphysema. 'Nowyou need an appointment. The staff there is overwhelmed and many ofus have kind of given up on going there.'

Jenn Abelson can be reached at abelson@globe.com.