LOW-INCOME CHILDREN TO BE AIDED BY CLINIC

Children of low-income families in Cape Girardeau and Bollinger counties will have access to basic medical care through a new clinic at the Cape Girardeau County Health Department.

The clinic opens Nov. 9.

Nearly 2,500 children in Cape Girardeau County have no doctor, except through hospital emergency rooms, according to the department.

Children who have minor acute illnesses, like ear infections or colds, may be seen at the clinic. Director of the health department, Charlotte Craig said wellness screenings and preventive care will be an emphasis at the clinic.

Craig said, "We will operate very similarly to a doctor's office."

The big difference is that the clinic doesn't have to make a profit, or even break even, as private practitioners must, Craig said.

"In fact, I'm sure we will lose money. The difference is that I have a funding base that private doctors don't have," she said.

The department received a 5-year grant from the Missouri Department of Health to start the clinic. For each of the first three years, the department will receive $30,000, $20,000 the fourth year and $10,000 the fifth year.

But Craig said operation of the clinic the first year is expected to cost about $120,000. The clinic will bill Medicaid and will receive some money from that federal program.

Initially the clinic will be open Monday through Friday from 8:30 a.m. to 4:30 p.m. at the public health center, 1121 Linden.

Craig said times will likely change to better fit work schedules of parents.

"We will probably have a day when we are open later and a day when we open earlier," she said.

The program is open to low-income families only, basically those who qualify for Medicaid, Craig said. Proof of income is required.

"After six months we will go back and see if we need to expand our requirements," Craig said.

About a dozen primary care clinics are operated in the state. Cape Girardeau is one of just three in the state targeting children.

Planning for the clinic has been in the works three years. The need, Craig said, has continued to grow all that time.

Many local doctors who treat children are not taking new Medicaid patients.

According to figures compiled by the hospitals, Craig estimates that 2,200 to 2,500 children age 18 and under on Medicaid are going to hospital emergency rooms for medical care.

"The problem is there is no follow-up, no prevention or intervention, no teaching and guidance," Craig said. "Also those patients are plugging up emergency rooms with non-emergencies.

"This bottleneck is not peculiar to Cape County," she said. "It's a problem statewide and no doubt nationwide."

The local medical community has supported the idea.

"The doctors recognize the problem, the void in the medical care these kids are receiving," Craig said.

Pediatrician Sarah Aydt is a member of the clinic's advisory board. Other doctors on the board are James Hoffman, Michael Wulfers and Charles Crist.

Other participating doctors are David Catron, Jean Diemer, James Dinkins, S. Kent Griffith, Ramiro Icaza, Mark Kasten, John Russell, Deborah Thomas, James Fletcher and Chris Rosenquist.

"Most people are aware of the need for more primary care," Aydt said. "We have such a huge patient population that comes to Cape for medical care, there just aren't enough doctors to take care of them."

She said indigent families or those on Medicaid often get squeezed out of the system.

"Unfortunately, because of the way Medicaid reimburses, which is less than 25 cents on the dollar, we really can't afford to take care of those patients. It's a tragedy. These children need the care," she said.

Nancy Mosley, a certified pediatric nurse practitioner, has been hired to see the children; 14 local doctors are available to back her up, consult with her and admit children to the hospital if needed, Aydt said.

Certified pediatric nurse practitioners have received added training and are specialists in screening, Aydt said. "They can find and identify problems and treat minor problems."

If a child has a major health problem, the child would be referred to a physician.

Mosley previously worked in private practice with Dr. Jesse Ramsey in Cape Girardeau.

In addition to Mosley, a community health nurse and a clerical person have been hired to work with this program. Members of the existing health department staff will also help. The 14 participating doctors will be on call on a rotating schedule.

In addition to the individual physicians involved in the program, Craig said the local medical community in general has supported formation of the clinic.

Southeast Missouri Hospital has made a financial contribution toward start-up costs. St. Francis Medical Center is providing laboratory services for clinic patients and a courier service to help patients avoid making extra trips to the lab.

Members of the medical society organization voted to support the clinic and to make a donation towards its operation, Craig said.

In order to receive the state grant funds, the clinic must serve patients in more than one county. Cape Girardeau teamed with Bollinger County.

After Jan. 1, a clinic will be held in Bollinger County one day a week. Children from Bollinger County may also come to the Cape Girardeau office.

The clinic is open to residents of Cape Girardeau and Bollinger counties only. Proof of residency will be required.

Even with its limited service area, officials are concerned the response may be huge.

"Our greatest concern is that they will be overwhelmed," Aydt said.

Craig said, "I think everything we do will mushroom because of this program."

The health department already offers an immunization clinic once a week and a child health conference for well-child care once every two weeks.

This clinic will be open every day and will treat sick children as well as provide screenings and preventive health care.

"A long-term goal would be, if this works out, to expand it to include adults who are indigent or on Medicaid," Aydt said.

The services of the clinic are limited. Children with chronic illnesses, like cerebral palsy, juvenile diabetes, or cystic fibrosis, cannot be monitored through the clinic. If a child with a chronic illness catches a cold, the clinic staff can treat the cold. No sexual or physical abuse cases will be followed through the clinic, Craig said.