August 20, 2014
Vol: 21 No: 34


Public Health proposes cutting four clinics that serve low-income women and children

By Hart Hornor / Editorial Intern

Photo Google Earth

Map by Jon Williams, Real Change

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Nadia Bucio, 36, a mother of four, depends on the Auburn Public Health Center. About once a month, she gets help from Spanish-speaking nurses with issues ranging from birth control to her child’s anemia. She is low income, but because of her immigration status, she’s not eligible for Medicaid.

Luckily, the Auburn clinic doesn’t require insurance — or any payment.

It’s one of four free or low-cost clinics serving mostly women and children in King County.

But a $15 million budget deficit at Public Health- Seattle & King County means Bucio and some 32,000 other low-income women in South King County could lose their only access to health care.

On July 9, public health officials proposed closing four of its 12 clinics: Auburn, Federal Way, White Center and Northshore, in Bothell. It plans to cede primary care units at two other clinics, in Columbia City and Northgate, to Neighborcare, a private provider.

Most of the clinics’ patients are pregnant women, new mothers and their families. They get food vouchers, parenting tips and referrals for other services, such as domestic violence shelters and health insurance.

Many of the patients are homeless, have mental health or subtance abuse issues, and they can’t get similar treatment from other providers, nurses at the clinics told Real Change. The were speaking on behalf of themselves, not their employer.

In Federal Way and Auburn, the clinics are especially popular.

The Federal Way clinic alone serves nearly 14,000 women annually, according to Chris Carrel, a spokesperson for the City of Federal Way.

“You’re talking about cities where the need is the highest for these services,” he said.

Patty Hayes, interim director of Public Health, said patients will have a hard time getting to other Public Health clinics because many patients don’t have cars.

Proposed bus cuts would add to the blow. Metro plans to cut routes that go from Federal Way to Kent, the site of the nearest clinic. 

“These cuts are horrible because there isn’t a backstop,” Hayes said. “Nobody wants to make these cuts.”

Public Health has been struggling for more than a decade, she said. In 2000, it lost an important source of revenue: the Motor Vehicle Excise Tax, which was repealed by voters. Since then, state and county funds have come in a steady trickle. Inflation, meanwhile, has risen.

Although Public Health has each year shed services, including free dental sealants for school kids, reimbursement from the federal government has lessened the impact. But this year, the extra help dried up, she said.

Meanwhile, private clinics are staying afloat. Neighborcare has received more revenue as more people sign up for health insurance through the Affordable Care Act, said Mark Secord, Neighborcare’s executive director.

Neighborcare is set to absorb Public Health’s primary care patients in Columbia City and Northgate. Its Northgate clinic will move into a new 45,000 square foot clinic in Fall 2015, raising the clinic’s capacity by 50 percent, Secord said.

Some of Public Health’s services are also well-funded, spokesperson Hilary Karasz said. But many of the department’s 200 sources of revenue can only be used for designated purposes. A levy provides money for emergency medical services, for instance.

Much of Public Health’s federal funding requires that the department maintain two primary care centers, Hayes said.

Clinics that offered dental care were spared from cuts because they draw enough revenue to support themselves. That left four clinics to be cut, enough to save about $10 million, Interim Director Hayes said.

If a different group of clinics had been chosen, Hayes said, the department would have to close five clinics, rather than four, to save the same amount.

Still, the plan has sparked criticism from everyone from the Washington State Nurses Association to the mayor of Federal Way.

“As someone who was raised by a single mother, I cannot accept that the county’s best proposal is to abandon these low-income moms and their kids,” Mayor Jim Ferrell said in an Aug. 13 press release.

Christina Enriquez, a nurse at the Auburn clinic and a former patient of public health services, said she knows the closures will hurt.

First as a pregnant nursing student at Seattle Central Community College and then as an unemployed single mother, she met with a public health nurse twice a month, .

Now she spends her days driving down dirt roads in Buckley, Enumclaw and on the Muckleshoot Reservation to meet women living in trailers and on other people’s couches. She said many don’t have computers, telephones or even addresses, so it’s nearly impossible for other service providers to reach them, she said.

Tina Maestas, a nurse at the Renton

clinic, said many of her patients find her through word-of-mouth. She said she does more than help women with medical issues.

A non-native speaker recently came into the clinic grinning. “I think I might be pregnant,” she told Maestas. Maestas gave her a pregnancy test, which turned out negative. Then, she noticed two Band-Aids on the woman’s arm.

“She said, ‘Oh that’s from my kidney dialysis,’” Maestas recalled. In the ensuing conversation, Maestas learned that the woman had high blood pressure. “I said, ‘So did you talk to your doctor about getting pregnant? She said, ‘Yeah. He said fifty, fifty.’”

The woman thought that meant she had a 50 percent chance of getting pregnant, when in fact it meant she had a 50 percent chance of living through a pregnancy, Maestas said.



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