March 20, 2006

Three Decades of Free Health Care for the Needy at the Potrero Hill Health Center

By Clifford Agocs
Special to the Neighborhood Newswire

Thirty years of sunlight has faded the wooden façade behind the brassy letters that read “Caleb G. Clark Memorial Health Center.” Poised on top of Potrero Hill overlooking San Francisco General Hospital, a lot has changed for the Center, including its name. Now called the “Potrero Hill Health Center,” it’s become the clinic of last resort for some of San Francisco’s neediest.

The Health Center offers what Michael Drennan calls “lean and mean” medical services. For the last 22 years Drennan’s been the medical director of the family clinic, which provides neonatal care, dental services, urgent care, substance abuse counseling, access to psychiatrists, hospital referrals and nearly everything in between.

“Rather than spending all of our money pulling people out of the river, we’re trying to spend it upstream to prevent them from falling in,” says Drennan, who also serves as the San Francisco Department of Public Health’s Director of Community-Oriented Primary Care.

Over the last five years the Health Center’s two million dollar budget has been steadily shrinking. But that may finally be changing. “For the first time in a long time a mayor is talking about pumping money into the system,” says Drennan, referring to Mayor Gavin Newsom’s recent proposal to invest $51.6 million to make health care available to all San Franciscans. There are upwards of 100,000 uninsured residents who are in need of primary care. Currently, the Department of Public Health has a total budget of $45 million.

More than half of the 11,000 patients who visit the Health Center are uninsured. These individuals pay anything from nothing to $45 a month for Center services. On average the Center recovers just two cents for every dollar of medical care provided to their patients. The other 98 cents is paid by the City. Still, the Health Center plays a critical role in keeping overall medical costs down – without its intervention uninsured patients would more likely end-up in even more costly emergency rooms.

Seventy percent of the Health Center’s patients are African-Americans or Latinos between the ages of 18 and 65. The Center’s focus has shifted away from families, who have steadily moved out of San Francisco due to increased cost of living, and towards homeless individuals with one or more major non-medical issues that confound their health care problems. “Fifty to seventy-five percent of our patients are strung out on alcohol, street or prescription drugs,” says Drennan, who talks about expanding the definition of primary care to address these problems. Over his two decades he’s overseen the Center’s expansion into providing anything that falls under the rubric of Community Behavioral Health Services, including nutritional counseling to manage diseases like diabetes and high blood pressure, substance abuse intervention and homelessness prevention.

“There’s an effort to integrate mental health and substance abuse care into our services but there are privacy issues, and right now counselors are working out of medical exam space,” Drennan explains. That means that doctors are forced to spend less time with patients, and counselors are working with them as time and space affords. “We’re bursting at the seams,” says Drennan, who’s talking with the Department of Public Works about a construction project that would add three new exam rooms and more counseling space.

The Potrero Hill Health Center is one of fourteen public health clinics in the City that provide care for roughly 200,000 visits a year. Some of these patients qualify for larger publicly-funded programs, like Medi-Cal or Medicare, but require the assistance of a social worker to navigate the system and deal with other life challenges, such as transportation and housing.

This is the population that Newsom is talking about serving when he refers to “all” San Franciscans’ right to quality primary care. Determining who and how many they are, and finding the best ways to use City money to manage their care is the charge of the Universal Healthcare Counsel, a group of 41 doctors, medical directors, and health and City officials that was formed earlier this year. The Counsel is about a third of the way through its 100 day charter to draft a health care coverage plan and corresponding budget. At the top of their list is reliance on existing clinics to work with the communities they serve to meet their unique needs.

“If you get a million dollars you don’t just buy a million dollars worth of doctors,” Drennan explains. “A lot of care is delivered by nurses and social workers.” For example, expanding into more hours of the week “really depends on the nursing staff,” according to Dr. Sushma Magnuson, who oversees the Center’s treatment program and, after thirteen years, is the newest permanent doctor at the clinic. “If I spend extra time with a patient and miss my lunch or I’m here until seven that’s my choice.” But being open depends on the availability of nursing staff, which requires more money.

“Our reason for being is the belief that everyone has the right to care, regardless of financial ability because we all need good health to compete equally in the world,” says Drennan. “The idea of funding primary care is to prevent suffering and early death and to lower costs.”
One barrier to adequate care is wait times. According to Drennan, there’s a two-month average wait for a new patient appointment. Patients waiting for dental care face up to a nine-month wait, because the Health Center is one of only three clinics that provide free dental care.

Another critical element of the Health Center’s work is exposing medical students to publicly-funded care. A family practice resident works at the Center for a two-year span, and several UCSF students on six-week work-study assignments are usually on hand. “Many of our clinics are staffed by graduates of our programs, so it does pay off to spend some of our time teaching,” says Drennan.

“I became emotionally attached to this clinic,” says Magnusson, who began working there after a residency at San Francisco General Hospital. Several years ago she moved to an East Bay clinic for a few weeks but came back to the Health Center because she felt that she had better resources available for helping her patients. “Very few counties have this level of care for everyone,” she says. “As long as it’s open I’ll be there.”