RURAL HEALTH CLINIC FILLS HEALTH-CARE GAPS

When Charlotte Craig got her start with the Cape Girardeau County Health Department 20 years ago, children got two kinds of care: developmental screenings and immunizations.

It was called "well-baby care," said Craig, now the director of the health department.

Once a month a pediatrician was on duty at the health center. Local doctors took turns "and stayed with us through thick and thin" doing basic physical exams.

Eventually, the pediatricians were on duty at the health department twice a month. The health department nurses did the developmental screenings.

The "well-baby" clinics worked fine as long as the children stayed healthy. If the children got sick or had chronic illnesses, they had to see private physicians.

That was a problem for some families if they didn't have private health insurance or qualified for Medicaid but couldn't find doctors who would accept Medicare patients. They wound up going to local emergency rooms for ear infections or other routine illnesses, Craig said.

"We had that antiquated system until six years ago," she said. "It worked, except it didn't take us very long to realize that some of these kids needed sick care, and then they needed follow-up care."

Many of the children at the "well-baby" clinics didn't see doctors otherwise, Craig said, and had no resources for routine, preventive care.

Then two things happened: The state began offering grants for counties to hire nurse practitioners, and Nancy Mosley, a pediatric nurse practitioner, became available.

Bollinger and Cape Girardeau counties teamed up for the grant and got it.

Mosley was hired, and Cape Girardeau County's Public Health Center became one of Missouri's five Rural Health Clinics.

Bollinger and Cape Girardeau counties are both designated as medically underserved areas. Bollinger County only has one physician. Cape Girardeau County has limited health-care access for Medicare-Medicaid patients.

The Rural Health Clinic, which now serves children and women, helps fill that gap for residents of both counties, Craig said.

Mosley and the county nurses were the clinic's only staff when it opened, and it was fully funded through the grant.

This year, the clinic is operating on its own, and its staff has grown to include two nurse practitioners and Dr. James Kinder, a longtime Cape Girardeau pediatrician who works part-time at the clinic.

"From day one, it took off. We went from two days a week to five days a week," Craig said.

When the clinic opened, Mosley would see 10 to 12 children a day. Now that total averages 25 to 30 children a day and may get as high as 50 or more.

About half of the children who visit the clinic are there for sick care -- ear infections, upper respiratory infections, etc., Craig said. And they also can receive follow-up care through the clinic.

Kinder joined the clinic last year, and brought a few of his private patients with him.

"When Dr. Kinder came, we were being maxed out on what we could offer," Craig said. "He went from seeing four or five patients a day to almost 20 a day."

Families with their own insurance make up 6 percent of the clinic's clients.

Medicare-Medicaid patients make up 66 percent of the total, and self-pay patients -- people with no insurance or Medicare-Medicaid benefits -- make up 28 percent, and pay sliding fees for care.

Children 18 and under receive sick and well-care at the clinic, including immunizations, exams and follow-up, although children with chronic conditions are referred to private physicians.

"I see them from two weeks all the way up to 18 years," Mosley said. "Sick, well; just about everything."

Mosley said when she started the clinic, none of the private providers were accepting Medicare patients.

"I did see children beginning kindergarten who had had no immunizations and no health care except the emergency room," she said.

Women can receive family planning care, physicals and routine tests at the Rural Health Clinic. Dolores McDowell, a family nurse practitioner, divides her time between the Rural Health Clinic and the health center's family planning clinic.

Last year, clinic visits totaled 7,035, Craig said, an average of 586 visits per month.

Of the total patients, 432 were referred to private physicians in Cape Girardeau or St. Louis for specialized care.

The children's clinic offers a wide-range of benefits, Craig said. Children get more comprehensive care, and they don't have to rely on the emergency room every time they get sick.

Less reliance on the emergency room means the public doesn't have to share the costs of health care for uninsured families, and it also means local emergency rooms aren't as crowded with non-emergency cases, she said.

The clinic also provides home visits and arranges transportation for patients who need it.