FUNDING CUTS FORCE CLOSURE OF CLINIC

When Cross Trails Medical Center opened in October in Cape Girardeau, staff had high hopes the new clinic would provide much-needed care for families who otherwise might not be able to see a doctor.

But the federal budget impasse and cuts in funding are closing those doors. At the end of the month, the clinic will temporarily suspend operations, administrator Vicki Smith said.

"We're not closing," Smith stressed, adding that once the funding becomes available again, the Cape Girardeau clinic will re-open.

"I don't know if it's going to be four months or six months or a year, but we'll be back," she said.

In the meantime, patients who were using Cape Girardeau's Cross Trails site can use the Cross Trails clinic in Marble Hill, Smith said.

"It's just extraordinarily sad," said Charlotte Craig, administrator of the Cape Girardeau County Public Health Center and a member of the Cross Trails board of directors.

"We could not have predicted what happened in Washington, D.C. Had we had a crystal ball, we would have started with one site. But without a crystal ball, we were just cruising along," Craig said.

Craig said the county health department will re-establish its primary care program for children ages 19 and under to provide services for that portion of the Cape Girardeau clinic's caseload.

A number of factors contributed to the decision to close the Cape Girardeau site.

Craig and health department officials in Bollinger and Stoddard counties wrote the grant applications for funding the clinics.

The first year's federal funding came to $298,000 to operate the Marble Hill and Cape Girardeau clinics, with plans to bring the clinic in Advance on line later. Cross Trails also received some funds through the Missouri Health Department.

This year, delays in getting the federal budget approved and funding cuts meant Cross Trails initially received only $148,000 from the federal Health Resources and Services Administration.

"And that's for three clinics," Smith said.

Clinic staff kept waiting for word on how much funding would be appropriated, and nearly waited too long, she said.

"We went as long as we could on the hopes that any day we would get more funding, but there comes a time when you have to go with what's in your hands and not with what you hope you'll get," she said.

"We had to just assess the whole operation and look at what was best for Cross Trails as an organization without losing sight of what we wanted to do," she said.

Continuing operations at the Marble Hill site made sense for a number of reasons, Smith said.

In the first place, the Marble Hill clinic is staffed by two physicians, including Dr. John Englehart, a long-time practitioner in the clinic.

"At the Cape site, we've never had our own physician," Smith said. "So Marble Hill is where our major investment is at this time, and that was our major factor on where we would spend the funding we received."

The Marble Hill clinic already had an established patient base, she said.

At the Cape Girardeau site, she said, the majority of adults were what she called "$5 pay" patients, or patients who were able to only make the minimum payment for services.

On one hand, that was a good situation "because we're meeting the need, but we're not getting the federal support to keep the clinic open," Smith said.

She also pointed out that Englehart and his partner, Dr. Melodie Armstrong, are the only two physicians in Bollinger County, so closing the clinic would have a major impact on the community.

"Marble Hill was the area of greatest need," Smith said.

Getting patients from Cape Girardeau County to Marble Hill will be a problem, Smith said. There are no funds to provide transportation, so patients will have to find their own way to the clinic.

"Ideally, everybody should have access to health care and all the transportation they need, but that's just not the reality," she said.

The Stoddard County clinic opening has been put on hold until more funding is available, Smith said.

Matt Henk, a program manager for the Health Resources and Services Administration's field office in Kansas City, said about $500,000 will be left over this budget year to be divided up among public clinics. It's unlikely that any of that funding would be awarded to the Cape Girardeau clinic, he said.

The new budget year begins in January, and it's entirely possible the Cross Trails program will receive full funding then, Henk said.

Suspending services at the Cape Girardeau clinic will not affect Cross Trails' participation in a newly-formed network of public health clinics in medically-underserved rural communities around the state, Smith said. The Marble Hill clinic will participate in the network, and when the Cape Girardeau clinic re-opens, it will also be included.