ALL KINDS OF PEOPLE COME TO CROSS TRAILS MEDICAL CENTER

Jari Southard looked over a patient's chart in the reception area of the Cross Trails Medical Center.

When Nancy Mosley, a pediatric nurse practitioner, worked for the Cape Girardeau County Health Department, she saw a lot of children every day.

Now that she's working for Cross Trails Medical Center, a local private not-for-profit primary care clinic, she still sees a lot of children.

"But now there's some place for the moms to go as well," Mosley said. "I was seeing Mom there with the baby, but with no provider for themselves."

The clinic has been open three weeks in what used to be the county health department's pediatric primary care clinic.

A Cross Trails site is also operational in Bollinger County in Dr. John Englehart's office, and a third site is planned for Stoddard County under a cooperative project aimed at increasing access to primary care in the three counties.

Health department administrators in the three counties teamed to write the grant proposals that secured about $400,000 to fund the three sites.

Mosley estimates she sees an average of 25 to 30 children a day, saying: "I see sick and well kids from age two weeks to 18 years. Before Cross Trails, they were all low-income, Medicaid kids. With Cross Trails, we can see all income kids."

Vicki Smith, who oversees the project, said an average of 40 people come to the clinic every day, and she expects the clinic's clientele to "grow and grow" as more people learn about the facility.

"I hope it does increase," Smith said. "We are in the process of recruiting a full-time physician, but we haven't had any luck yet." Smith hopes a physician will be available through the National Health Service Corps by next July.

Under that program, physicians just out of residency can repay student loans and scholarships by working in facilities like Cross Trails in medically underserved regions.

Cross Trails now contracts with Regional Primary Care for physicians services.

The majority of Cross Trails' clients will probably be non-insured families or families who qualify for Medicaid or Medicare, but private insurance is accepted, and a sliding fee scale is available for patients with no insurance, Smith said.

"We've seen all kinds of people in here," Smith said. "We've seen people who come in with low-income and Medicaid. We've seen people who are low-income and non-insured. We've seen people who have come in and written checks who just can't wait six weeks to see a doctor."

As the Cross Trails program grows and demand increases, clients could have to wait for appointments, too, Smith said.

"There's such a need out there," she said. "We know this isn't the answer itself. It's just a step toward the answer."

County health director Charlotte Craig says the clinic provides much-needed access to health care in the community.

"It was unavailable to the largest segment of people that we're going to end up serving," Craig said. "There was no portal providing access to the system."

According to figures from the Missouri Department of Health, 29 physicians in Cape Girardeau County accept some type of Medicaid or Medicare insurance and see an average of 138 Medicare-Medicaid patients each. Of the 6,200 Medicaid recipients in the county, only 1,900 received medical care locally in 1994, according to state health statistics. Countywide, there is one primary care provider for every 1,861 patients.

Technically, the clinic operates independently of the county health department, but services are "intertwined through and through" between the two facilities, Craig said. County health personnel refer patients to Cross Trails and provide medical follow-ups, or case management, to patients treated at Cross Trails.

Cross Trails currently does not offer specialized medical care or emergency medical services, Smith said, but the future is wide open.

"We want to get the door open, offer primary care, assess what's out there and determine what needs we have," she said. "We'll attend to these people's illnesses, but we'll also educate them about health care while we're at it."