OUR MISSION:
We embrace health and wellness as the foundation for quality of life, and we dedicate ourselves to providing the highest level of health care to all those who ordinarily lack access to it within our community.
An old business adage-- find a need and fill it-- seems appropriate when reflecting on the genesis and mission of the nonprofit Northern Neck-Middlesex Free Health Clinic, whose headquarters and primary clinic are in Kilmarnock, Virginia.
According to CEO Jeannie Nelson, who has been with the clinic since its beginning in the early 1990s, Kilmarnock’s local hospital emergency room began getting jammed and people without a regular doctor flocked to the emergency room seeking medical care. When the Clinic opened in 1993, eligibility for Medicaid was limited only to the poorest of the poor. That left many residents uninsured and without a health-care home, unable to afford private insurance. Their recourse was to use the emergency room for primary care, at a time when a physician shortage also was developing.
The Clinic at the time was geared entirely to the uninsured.
Bill Jewell and Drs. Richard Baylor and Steve Glessner (all now deceased), along with Dr. Rocky Tingle, saw the need for a clinic that could provide free or reduced cost medical services for those who lacked health care in the community. In 1993, the Northern Neck Free Clinic began operations in borrowed space at Lancaster County’s Health Department.
“I was the only paid person in the beginning. And 96 percent of local physicians participated by volunteering their time in the clinic,” Nelson recalls.
The volunteer component has remained a vital part of the clinic’s mission since the beginning. Today between 80-100 volunteers augment the current staff of 28 paid employees; volunteers include not only volunteer medical staff, but volunteers who fill a range of facility needs, including reception/administrative, eligibility screeners, data entry, publicity and fundraising and a clinic dinner program where volunteers prepare or solicit meals for clinic volunteers.
“When you volunteer here, you are working with teams of volunteers… what stands out [with our volunteers] is passion for the mission,” Nelson says.
The mission is emblazoned on a wall in the medical treatment area of the clinic: “We embrace health and wellness as the foundation for quality of life, and we dedicate ourselves to providing the highest level of health care to all those who ordinarily lack access to it within our community.”
From modest beginnings, the clinic has grown to an operation that the clinic describes as “the health care home for low-income, under-insured residents,” serving Lancaster, Middlesex, Northumberland, Richmond and Westmoreland counties. Kilmarnock hosts the main facility and an auxiliary office there, as well as an outreach office in Middlesex County that debuted in 2009. By 2010, the clinic was fully accredited by the Virginia Association of Free Charitable Clinics.
The clinic’s first annual operating budget in 1994 was $75,000 and in 1995, Phyllis Smith, the clinic’s first major donor, gave money for the clinic’s first home on DMV Drive. Today that facility serves as a dormitory for student dentists who volunteer their services at the operation’s Dental Clinic.
An outreach clinic in Montross in Westmoreland County opened in 2002 at the Andrew Chapel United Methodist Church. In 2020, the clinic was closed due to COVID-19, but it is in the process of reopening. Kilmarnock’s current primary clinic in the Mary A. Graham Building at 51 William B. Graham Court opened in 2003, boasting 10,000 square feet of space. The main clinic includes a spacious lobby, office and administrative space, meeting rooms, lab areas, pharmacy operations (beginning in 1995), the Medical Clinic and a Dental Clinic.
By 1997, operations had expanded to five days and two nights a week, including specialty care clinics. In 2001, the clinic partnered with the VCU School of Dentistry and opened its Dental Clinic in 2004.
In 2021-2022 17,500 individuals were served by the clinic. By fiscal year 2023, the annual budget had swelled to $1,986,346, with officials noting that an annual budget of $2.2 million dollars will be needed in the future. The nonprofit clinic operates via donations from individuals, churches, businesses and county jurisdictions, as well as grants, some state funds, and Medicaid reimbursements.
Services offered include chronic and acute care, specialty referrals, lab tests, X-rays/CT scans, physical therapy, vaccines, mammograms, school and sports physicals and specialty clinics such as well-woman clinics, nephrology clinics and urology services. Income eligibility is based on federal poverty level and family size: for example, a one-person household income limit is $3,138 per month and a two-person household income limit is $4,258 per month for the Medical Clinic. Income eligibility limits for the Dental Clinic are $3,765 for a one-person household and $5,110 for a two-person household.
According to the Virginia Association of Free and Charitable Clinics, such clinics are “safety net” health care organizations that use a staff/volunteer model to provide medical, dental, pharmacy and other services to income-eligible individuals.
“We serve uninsured patients and some who have some health insurance. In 2019, the state [asked us] us to be a hybrid model—we also take patients with Medicaid and Medicare,” Nelson explains. The impact of Medicaid changed when Virginia expanded its eligibility – from 38 percent of the federal poverty level (FPL) to 138 percent. When that happened in 2019, the Clinic Board voted to become a hybrid clinic, meaning both the uninsured and those insured through the expanded Medicaid would be eligible for care.
An early issue for free clinics back in the 1980s was that most private insurance policies, as well as Virginia’s Good Samaritan Law, did not cover physicians volunteering in clinics, leaving doctors vulnerable to malpractice lawsuits and making it more difficult to recruit volunteer physicians. According to the Virginia Association of Free and Charitable Clinics, a group of clinic directors worked together to find an answer: extending Virginia’s liability coverage to free clinic volunteer doctors.
The free clinic “movement” traces its roots to the nation’s first free clinic, the Haight Ashbury Free Medical Clinic in San Francisco, California, which debuted in 1967 during the 1960s “hippie movement,” which had strong California roots. In 1970, Richmond’s Fan Free Clinic, now called Health Brigade, became Virginia’s first free clinic.
Board member Scott Graham (Kilmarnock’s main clinic is named for his late mother, Mary A. Graham), notes there are many misconceptions regarding what the clinic does and what it offers.
“Sometimes people think it’s just for people who are out of work. There are misconceptions about eligibility and where our funding comes from,” Graham says. “Others think we have some big amount of government funding.”
"When Medicaid expanded in Virginia, it created some reimbursement [for us],” Nelson notes. “But many people don’t realize they are eligible [for our services].”“The patients who come here often have multiple health conditions that require more hands-on management,” Graham adds.
Another misconception involves the level of care available to eligible patients at the clinic. Executive Assistant John Wilson says the care given at the clinic is not just “basic care.”
“The quality of care here is exceptional,” he emphasizes.
Nelson notes, “Most of our patients have three to six diagnoses… high blood pressure, COPD, etc. Often they come into the clinic sick.”
Nelson says people may have special situations where the clinic can help.
“An example: a patient who was $15 over the [income eligibility] limit didn’t tell us about a breast lump, so we went to our board for a special exception [for her situation],” Nelson explains. “We have been the gap and the voice of people in these situations.”
Nelson emphasizes that some of their patients have health insurance and some are also underinsured. In one case, they have a dental patient who needed help receiving a necessary medication for a medical condition valued at $42,000 a year that her insurance would not cover. The clinic was able to work with pharmaceutical companies so she could receive her medicine for free.
Graham explains that prescription drugs come with their own requirements.
“We work with nonprofit groups such as RxP[artnership], Dispensary of Hope, Direct Relief, and Americares, and individual pharmaceutical companies. We do not do [provide or deal with prescription] controlled substances,” he says.
Nelson observes, “This is a very sophisticated operation that partners with organizations and other clinics to provide patients with the best quality care.”
Many patients use Dental Clinic services only. The operation has a staff dentist, two dental assistants and senior year dental students who help staff the clinic. In September 2023, with funding help from the Virginia Health Care Foundation, the clinic was able to add its first registered dental hygienist employee, Antonia Kimble. Dental Clinic services include oral exams and treatment plans, cleanings, fillings, x-rays, sealants, extractions and dentures.
“We have dental students [working] here only during the academic year, or thirty-five weeks in this past year,” says clinic consultant Anne Bartron. Each rotation of VCU students is in their final year of school and work at the clinic under the oversight of the staff dentist, Dr. William Broas, DDS, who is also adjunct faculty to VCU School of Dentistry.
The clinic operates on a fiscal year basis, which ends June 30 of each year. Bartron notes that in the 2023-2024 fiscal year, the Dental Clinic did over 800 fillings/restorations, 230 dentures and the new staff dental hygienist saw 698 patients since September 2023. Statistics show that the Dental Clinic had 1,476 “unduplicated patients” seen and treated in the Dental Clinic in fiscal year 2023-2024.
Nelson explains that Medicare does not include dental services, although some Medicare Advantage plans offer some dental services. So many Social Security recipients with Medicare may be income-eligible for dental services. Dental treatment can be a big issue for those on Social Security, particularly as the cost of dental treatments has escalated so much.
“Dental care really changes peoples’ lives,” Bartron notes. “It impacts their ability to eat, to be employed… it can be life-changing.”
The clinic also partners with other free health clinics, such as the Gloucester-Mathews Free Clinic. Bartron says that many free health clinics will not see Medicaid patients. She also notes that all the counties served by the Northern Neck-Middlesex Free Health Clinic “are federally-designated health professional shortage areas.”
“The biggest hurdle is finding people who want to move here and stay,” Graham says about the clinic’s recruitment efforts when it comes to paid health care staff.
Graham’s opinion regarding medical staff recruitment mirrors the challenges that rural areas have when trying to attract medical professionals. Some young medical professionals want “big city” lifestyles and are unwilling to live in quieter rural areas. On the plus side, for those who do relocate to rural areas, quality of life issues (generally lower crime, outdoor recreation opportunities, and in the Northern Neck and Middle Peninsula, the attraction of water activities like fishing, boating and sailing) can be pluses when it comes to recruitment.
On the medical side at Northern Neck-Middlesex Free Health Clinic, the medical director is Charles Maresh, M.D.; Tamara Hall is nurse practitioner; and Paul Sutherland, M.D. is a part-time staff physician. The Medical Clinic’s three registered nurses also do lab tech services, and pharmacy operations include one fulltime pharmacist and three part-time pharmacy technicians. Paid medical staff is augmented by volunteer doctors. Two of them, Dr. Vicki Kinsel and Dr. Greg Lockhart, are members of the clinic’s Board of Directors. Other key volunteer providers include Drs. Douglas Ludeman, Ralph Roberston, Chad Forrester and Matt Vogel.
The newest staff addition is marketing and communications manager Olivia Brocklebank. The clinic has a social media presence on Facebook and LinkedIn, but Brocklebank explains, “My job includes boosting [our social media presence] and adding Instagram, as well as working to ramp up and humanize the work of the clinic. I want to increase the visibility of the clinic.”
The clinic is making efforts to transition to electronic health records, making it possible to quickly track and report on health outcomes. The clinic also recently launched a new program called the HOPE Initiative that connects adults struggling with any form of addiction to treatment.
The HOPE Initiative is a free service to help people to recovery, with services driven by a Certified Peer Recovery Specialist (CPRS), a trained individual who also has their own “lived experience.” The clinic’s two Certified Peer Recovery Specialists work with people with PTSD (post-traumatic stress disorder), trauma issues, mental health challenges and addiction/drug abuse issues. The CPRS works with the clinic’s medical, dental, pharmacy and behavioral health treatment teams for comprehensive care that takes the needs of the whole person into consideration.
Nelson says the Northern Neck-Middlesex Free Health Clinic was selected to be the “first replication” of the original HOPE Initiative created at the Bradley Free Health Clinic in Roanoke. She calls the HOPE Initiative “a game-changer for our community.”
Other new health partnerships are also in the works, including one with Georgetown University to complement current partnerships with Virginia Commonwealth University and William & Mary.
Regarding the economy and its impact on the clinic, Nelson says, “People who didn’t need us are now back [as patients]. We have a small food pantry in the lobby, but in the past two years, pantry items may be gone in three or four days.”
“We will continue to do our best to meet the health care needs of those in our community,” Nelson says. “Our doors are open. Please pay us a visit.”
For more information:
Telephone (804) 435-0575.
Website: http://www.nnmfhc.org