Free clinic grows beyond founders’ vision

Photo by Michael Bailey

Erika Viccellio, executive director of the Charlottesville Free Clinic, manages 400 lay and professional volunteers from local hospitals and the community, who provide thousands of hours of free health care to the region’s working uninsured each year.

By Lauren Fischer

Mo Nadkarni witnesses firsthand the medical nightmares of the uninsured.

During his residency at the University’s School of Medicine, Nadkarni and fellow medical resident Paul DeMarco met a graduate student with a serious heart infection, gravely ill because he had delayed seeing a doctor. No longer financially dependent upon his parents, the student lost his student-based medical coverage and couldn’t pay for both a new heart valve and tuition. He was forced to withdraw from school.

Nadkarni and DeMarco considered packing up their medical bags and heading to the local Salvation Army to help others who were working and uninsured. Instead, in 1992 they recruited a handful of dedicated volunteers from the U.Va. Medical School community, and opened the Charlottesville Free Clinic.

While the case of the uninsured graduate student was unusual then, the numbers of the working uninsured have grown so that such cases have become more common now and underscore the importance of the clinic’s mission.

The clinic is a nonprofit, community-based organization that offers free health care to individuals and families who have no access to medical insurance and who do not qualify for free health services, such as the federal-state indigent care program, which serves lower-income clients. During the 2002-2003 fiscal year, the Free Clinic provided 9,300 hours of service to treat approximately 1,220 patients — an estimated value of more than $1 million, according to the clinic’s annual report.

Since its founding, approximately 400 lay and professional volunteers from U.Va. and Martha Jefferson Hospital, plus many others from the Charlottesville community, have donated time in the waiting and examination rooms of the Thomas Jefferson Health Department on Rose Hill Drive, where the Free Clinic operates three nights a week.
The clinic is one of 55 centers within the Virginia Association of Free Clinics, the largest such organization in the country. The service is vital to Virginia, which ranks 50th out of 50 states in terms of Medicaid services provided to adult uninsured, according to the Kaiser Family Foundation. About 25 percent, or 1.6 million Virginians, lacked health insurance for all or part of 2001-02, Kaiser research shows.

“ We believe that everyone should have someone to go to,” said Erika Viccellio, the Free Clinic’s executive director.

At the Charlottesville Free Clinic, no income cap determines which patients qualify for care, Viccellio said. Even if a household earns $50,000 a year, the family may be eligible. Sixty percent of the Free Clinic’s clients are women who bring home annual salaries ranging from $10,000 to $25,000, she said.

Nadkarni, now an associate professor of internal medicine at U.Va., initially envisioned the clinic as a “one-stop shopping” option for local residents: an uninsured patient suffering from a cold or an acute illness could receive a referral to a doctor at either U.Va. or Martha Jefferson for follow-up care.

But the Free Clinic quickly evolved into more. For example, nine of the top 10 diagnoses in the 2002 fiscal year were for chronic conditions, such as depression and hypothyroidism, which require more appointments per patient than other disorders.

“ More maintenance illnesses have changed the nature of what we do,” Nadkarni said.

Of the almost 11,000 prescriptions filled by the clinic in 2002, the value of medicine for illnesses such as diabetes and high blood pressure totaled $182,880, an increase of 40 percent over the year before.
The growing demand for services — there is currently a waiting list of 200 people seeking gynecological, dental and psychiatric services — shows the need for the Free Clinic is greater than ever. Which means that the clinic requires more support than ever, Viccellio said.

Private sources of funding, especially area individuals, civic organizations and businesses, footed the bill for 75 percent of the Free Clinic’s $381,000 operating budget in 2002, Viccellio said. Through the Commonwealth of Virginia Campaign, U.Va. and state agency workers pledged close to $60,000 to the Charlottesville clinic in 2003.

In addition, the U.Va. Medical School has donated up to $15,000 in free lab work and X-rays, and U.Va. medical students donate their time to help with triage, shadow volunteer doctors and make follow-up phone calls.

And night after night, at least six of the 22 medical professionals volunteering in the clinic are licensed doctors.

“ There are benefits of being in a community with a teaching college,” said Nadkarni, noting that more than 120 volunteers last year were local doctors, nurses, pharmacists and dentists.

Volunteer labor multiplies the benefit of financial donations — each dollar spent by the Free Clinic translates into $3 in health care services for patients, Viccellio said.

In addition to the medical volunteers, Nadkarni recognizes the dedication and support of many others in the Charlottesville community who have contributed to the success of the clinic. He noted the family that passed along a $600 tax refund last fall, and patients who return to the Free Clinic as office volunteers.

Over the years, the program has carved out a vital and respected niche for itself in the community. The clinic has become part of the health-care system in Charlottesville and receives referrals directly from local social service agencies and primary care doctors.

“ We’re not perceived as some ‘back alley’ free clinic,” said Nadkarni. “We provide good, if not better, care than that received at primary care centers.”