Regional Free Clinics Provide a Vital Safety Net

by

Gracious Living

Navigating the complicated healthcare landscape can be difficult for anyone, but especially so for those facing financial hardship and lacking the ability to afford even the most basic medical services or insurance. The region’s free health clinics fill in the gaps that the healthcare system leaves exposed and provide a vital safety net for those who are most vulnerable.

The Ledwith-Lewis Free Clinic, formerly Tappahannock Regional Free Clinic, was formed in 2005 with the help of the Tappahannock Memorial United Methodist Church and other community members to address the lack of healthcare available to those in the region without insurance or the means to access quality healthcare services. Dr. James Ledwith, a family medicine doctor in Tappahannock at the time, was the “founding father” of the free clinic. Initially, with the help of his church group and other volunteers, Dr. Ledwith opened his office once a month to provide free services to those who could not afford to pay. Quickly, the need for services became greater than expected and the number of clinic days grew to once per week, then twice a week, and expanded to the current 12 clinic days per month and two patient screening days per week.

In 2006, Dr. Ledwith left the region to pursue professional options in Boston, leaving the free clinic in the hands of several local, volunteer physicians. In 2007, Dr. Richard G. Lewis, retired cardiologist and Essex County resident, became the volunteer medical director and continues to serve in the position today. In January of 2016, the clinic’s board of directors decided to rename the Tappahannock Regional Free Clinic to the Ledwith-Lewis Free Clinic, in celebration of ten years of service to the region and in honor of the two gentlemen who continue to transform the lives of those in need, through love, leadership and generosity.

Although the clinic serves clients throughout the Northern Neck and Middle Peninsula, any Virginia resident can seek services there. “We turn no qualified applicant away,” said Michael H. Faulkner, executive director. Ledwith-Lewis offers treatment for chronic medical conditions like diabetes, heart disease, and thyroid disorders, among others. Services also include acute care for illnesses like strep throat or flu, women’s wellness clinics, with checkups, cancer screenings and mammograms, as well as specialist referrals and flu shots. A healthy living/healthy eating program offers lifestyle and wellness coaching, walking opportunities, and nourishing food (40 percent fresh produce) through a partnership with the Northern Neck Food Bank. A new clinic program is a patient lounge, offering an outlet for social interaction as part of overall wellness — where clients can gather to talk, have healthy snacks, play games or read. Also, the clinic is set to incorporate telehealth/telemedicine into its lineup of services. Through affiliation with Bay Rivers Telehealth Alliance, Ledwith-Lewis will soon offer health services using telecommunication and information technology to provide clinical healthcare from a distance, permitting two-way, real time interactive communication between patient/clinician for care, advice, reminders, education, intervention and monitoring. “We are really excited to be the first free clinic in the region clinic to offer these services,” Faulkner said. “Telehealth allows us the ability to overcome distance barriers, cultivate more volunteer providers, which we desperately need, and provide access to behavioral health.”

The NNMFHC Dental Clinic provides about $1 million annually in low cost dental care, including a denture program operated by the staff dentist.

“It’s really nice they could save my teeth,” Everton said. “Now, I don’t even need dentures. I am really pleased with the competence of the students who treated me. And, now, my diet is so much better because I can chew.”

“I could not be more pleased,” said Everton. “I had no idea I could regain my ability to chew and enjoy food,” he said. “The Clinic really helped me. I am so grateful.”

In 2017, Ledwith-Lewis Free Clinic served 697 patients during 2,928 visits, with a 99 percent volunteer staff — 33 physicians, 18 other healthcare professionals and 42 non-medical volunteers. With total cash operating expenditures of $290,000, the clinic provides more than $8 million in services per year. Patients receive free prescriptions through a partnership with the Virginia Health Care Foundation — 7,185 prescriptions with a retail value of $3,788,000 were given to patients from 2017 to the present. Riverside Tappahannock Hospital is another valuable partner in service, providing more than $3.5 million per year in emergency care, lab work, radiology and specialty care at no cost to the clinic.

There is a comprehensive screening process necessary for a client to qualify for services. In general, qualifying clients have incomes equal to, or below, 200 percent of the federal poverty guideline. In other words, low income is a criterion, but not necessarily so low that it’s below the official poverty level, which is $12,140 for individuals and $25,100 for a family of four. So, 200 percent of the federal poverty guideline would be $24,280 for individuals and $50,200 for a family of four.

“There is such a misunderstanding of who is a free clinic patient,” Faulkner said. “Anyone can face a financial crisis that puts them in need of our services,” he added. “In fact, 61 percent of our clients are employed and still living below poverty guidelines — that means working two or three minimum wage jobs while trying to feed families and pay bills.”

Ledwith-Lewis sponsors several signature events annually that support the clinic’s mission, while hosting the wider community in fun and fruitful ways -- Wine on the Water, Bunny Hop for Health 5K, Sippin’ & Shuckin’ and the New Year’s Eve Gala are all greatly anticipated events for the community. “The success of our programs and services is due to the commitment of our volunteers, the support of our communities through local government funding and local foundation grants, and the community’s goodwill,” Faulkner said. For more information about Ledwith-Lewis Free Clinic, including volunteer opportunities, call (804)443-9590 or visit ledwithlewisfreeclinic.org.

The Northern Neck-Middlesex Free Health Clinic (NNMFHC) in Kilmarnock is celebrating 25 years of service to clients in the region who have no insurance, or are underinsured, and cannot afford the costs associated with basic medical care. The facility opened in 1993, becoming Virginia’s 20th free clinic. In the beginning, it served clients one night a week in the Lancaster County Health Department. Jean Nelson was the founding executive director and continues to serve in that capacity today. Dr. Richard N. Baylor was a founder of the clinic and initially served as clinic president, as well as volunteer medical director for 13 years. The clinic’s service area includes Lancaster, Middlesex, Northumberland, Richmond and Westmoreland counties. Its first annual budget was $75,000.

From the outset, the demand for services grew quickly and as a result, the clinic added more hours to its schedule and expanded into new facilities. To accommodate the growing list of needs, the group added evening clinics, nurse consultations, a women’s clinic, a continued care clinic and pediatric services. Office hours expanded to five days and two nights per week.

In 2003, the clinic moved into its current 8,500 square-foot facility at 51 William B. Graham Court, which includes a full-service pharmacy and a dental clinic, staffed in part through a relationship with VCU School of Dentistry. Dental students rotate through the clinic, gaining valuable hands-on experiences working with practicing dentists. An auxiliary office in Kilmarnock and outreach clinics in Montross, Westmoreland County, and at the Freeshade Community Center in Syringa, Middlesex County, fill in the distance gaps for rural clients. The medical clinic offers chronic and acute care, diabetic clinics, women’s services, physical therapy, urology, patient education, dietitian counseling, specialty referrals, lab work and radiology, among many other services. Through a partnership with Healthy Harvest Food Bank, the clinic will soon sponsor a “food pharmacy” providing clients with nutritious food choices. There is behavioral health counseling available to clients — more than $7 million in care has been provided. The dental clinic is open four days per week and offers oral exams, treatment plans, cleaning, fillings, extractions, dentures, and other services as needed.

During difficult economic times, the NNMFHC has been a health safety net for hundreds of new patients who have struggled with reduced work hours or lost health insurance, or both. Meanwhile, the clinic is positioning itself to adapt to any changes brought about by healthcare reform and continues to be the medical home for those who do not have one elsewhere. “We are constantly evolving, and how we continue will depend on the needs of our clients,” Executive Director Jean Nelson said. “We’re out in front and have a lot to be proud of.”

In 2017, NNMFHC served 1,805 patients during 9,463 visits, as well as an additional 10,142 visits for diagnostic tests or for referrals to outside specialty services. With an annual budget of $1.3 million, the clinic provided an estimated $9.9 million in services — every $1 in the clinic budget results in $7.60 worth of healthcare delivered. Volunteers donated 15,952 hours in 2017. Patients received 35,014 free prescriptions, filled in-house at an estimated value of $6.1 million. Although demand has grown and clinic services are constantly expanding, the staff and budget levels have remained stable since about 2008. The clinic’s operating budget comes solely from donations (patients, state and local governments, businesses, individuals, organizations, churches) — no federal money is involved. The clinic maintains valuable relationships with several hospitals for lab work, radiology, scans and specialty care — Bon Secours, HCA Virginia, VCU, Riverside and Mary Washington. “The community has done this for us, and we are so grateful,” Nelson said. “There’s a lot more work to be done,” she added. “Our clients face complicated health issues, and we must build relationships to help them navigate the system. Free clinics must remain nimble, flexible and aggressive in advocating for their patients.”

Joan Ball says the Northern Neck-Middlesex Free Health Clinic saved her life.

When Joan was diagnosed with Stage 2 breast cancer last year, she had no insurance and no money.

The Clinic arranged for tests and eventually the mastectomy, chemotherapy, and then radiation. “The Clinic does not care who you are or where you come from. They just wanted to know what I needed. They helped me get to the right places for care.”

Compassionate and supportive is how she described the staff. “Never once did I feel like they did not care about me. They were loving, compassionate, and understanding."

Like Ledwith-Lewis Free Clinic, NNMFHC has a thorough screening process necessary for clients seeking medical services — low income equal to, or below, 200 percent of the federal poverty guideline. Nelson can make some exceptions for extenuating circumstances. The income qualification for dental services is low income equal to, or below, 300 percent of the federal poverty guideline. The clinic requests, but doesn’t require, a donation of $3 for prescriptions and a $25 fee for dental visits.

Dr. Charles Maresh has been NNMFHC medical director since 2013. He firmly believes the clinic setting is equal to that of any private practice, and he should know — he ran his own practice for 38 years. “I like it here because of what we are able to do for the hardworking people we serve,” Dr. Maresh said. “We’re helping people; we are shepherds; we are advocators. I think we’re making a difference. I enjoy every minute of it.”

For more information about the Northern Neck-Middlesex Free Health Clinic, including volunteer opportunities, call (804)435-0575 or visit nnmfhc.org.