It’s hard to believe the Front Street Clinic was once in danger of closing.
On Wednesday, two Filipino patients waited in the clinic’s lobby and chit-chatted in Tagalog as they waited to be seen. Office workers ran back and forth, looking at charts. The nurse practitioner treated several patients.
“It cracked so bad that I had to pull it out, but it won’t crack back in,” Michael John Townsend, one of the clinic’s patients, said of the bruised thumb on his right hand in one of the clinic’s examination rooms.
“OK, well, it’s a good thing I have an X-ray order for you,” Cynthia Mattoni, the nurser practitioner, responded.
The future of the clinic, once on shaky ground, is finally looking bright. They have a new head nurse, a new status as a nonprofit, a new organization to handle management issues and accounting, a new federal services grant, and there’s even a new sign outside above the sidewalk.
All they need is just a little bit more money.
The clinic recently launched a fundraising campaign, with a goal of raising $100,000 by the end of the year. But instead of seeking donations just to keep the doors open like last time, now they’re doing it with their future in mind.
“We have a little bit of a budget hole that we’re trying to fill,” Carl Heine, the president of the clinic’s board and an emergency doctor at Bartlett Regional Hospital, said in an interview. “But we’re also trying to develop a little bit of a small cushion that allows us to not have to struggle with cash flow issues, so that we can make sure that we can always pay rent and pay salaries.”
“The goal is not for the clinic to be having to fundraise regularly,” he added. “But we need to do some fundraising to, again, stabilize our existence.”
The Juneau community raised around $120,000 to save the clinic from closing in October 2013. Its parent company, SouthEast Alaska Regional Health Consortium (SEARHC), had pulled funding for the clinic in a cost-saving measure, saying it cost between $300,000 to $400,000 a year to operate.
A plethora of social service related agencies (to name a few: the Juneau Coalition on Housing & Homelessness, the Glory Hole, Aiding Women in Abuse and Rape Emergencies, Catholic Community Service, Juneau Alliance for Mental Health, Inc., and REACH Inc.) banded together in response to figure out what to do.
The stakes were high: the clinic serves Juneau’s most vulnerable populations — the poor, the homeless, the uninsured. Without the clinic, which provides cost-free health services, they would have nowhere to go to receive affordable healthcare, except the emergency room.
“For some people, we’re the only alternative in town,” Laura Lucas, the clinic’s office manager and clinical services coordinator, said.
Through their respective organizations, the agency leaders were able to raise the $120,000 from the community — enough to keep the clinic operational for the next six months. SEARHC devoted $90,000 in federal grant money, as well.
The newly formed group of community members and doctors managed to keep the clinic afloat since that time, but it wasn’t an easy transition. Services were slashed in order to make ends meet, such as dental and behavioral health services. Later on, there were staffing issues; the head nurse departed and the interim executive director left in December 2014.
The clinic began hiring temporary physicians to treat patients, but sometimes patients would go days or even weeks without a provider. It was frustrating for patients, who were treated by an unfamiliar face each time they went to the clinic. At each visit they had to recount their entire history, if anyone was available to see them at all.
“For a period of time, we had to turn people away because we were in between providers,” Lucas said in an interview Wednesday.
And of course, there was the biggest issue: lack of funding.
The clinic successfully re-applied for the major federal grant that funds it, known as the Health Resources and Services Administration (HRSA) grant, within those first six months. By August 2014, the clinic received its official 501(c)3 federal nonprofit status.
That was good news, but it actually presented another issue: No one on the newly formed board had any experience running a federally funded community health center.
“There’s a lot of hoops that have to be jumped through for that, and there’s also just a lot of issues just in running a clinic,” Heine said. “So we did the best we could, but we kind of fell short in a few places in terms of keeping track of the money and keeping all aspects open.”
Earlier this year, the clinic fixed its management problem by contracting with Alaska Island Community Services, which specializes in running federally funded community health centers. AICS is now helping Front Street Community Health Center (its knew name, although the old name still sticks) meet all its grant conditions, and with administrative tasks such as accounting and payroll.
Last month, the staffing shortage eased as well. The clinic hired one of the temporary locum physicians, Cynthia Mattoni, of Cleveland, Ohio, as its new nurse practitioner.
Mattoni, who worked at a Wrangell clinic last winter for six months, said she decided to stay during her second work visit in September.
“I was supposed to leave the 20th but by then, I said, ‘You know what? I’m going to throw my resume in (for the nurse practitioner job),’ and I never left,” she said.
Mattoni treats about eight to 10 patients a day at the clinic. Sometimes, it can be as many as 16. The clinic has treated 600 patients since last November.
Diabetes, high blood pressure and alcoholism are the most common ailments she sees on a daily basis, she said.
“Eating healthy is very expensive,” she explained, adding many of the patients can only afford junk food. “And when you don’t have anywhere to cook a hot meal, you’re getting what you can.”
She tries to encourage patients to make healthy life choices, something that can be hard for those without many resources. There’s a social component to patient visits as well — many go to the clinic for free socks and personal hygiene products.
“If we can get them in here — anybody — we will do whatever we can: help them fill out their Medicaid information, try to keep them healthy, overall as a person not just medically, the wholistic care, as a person,” she said. “That’s what healthcare should be.”
She said she likes to develop a relationship with patients. She tells them “I’m here, and you’re not going to be without a provider again.”
“Everybody needs healthcare,” she said. “If you’re breathing, you need healthcare. And this is a very vulnerable population.”
Having a permanent nurse practitioner is a “happy” relief, office manager Lucas said. Other things fell into place as well.
Lucas said the clinic will soon be able to once again offer behavioral health services. The clinic just last month received that funding through an expanded services grant, $220,000 from the federal Health Resources and Services Administration. The grant will also fund case management services.
Unfortunately, the same can’t be said for dental services, although that remains a huge demand among patients. She said the clinic is holding onto its dental equipment, should they receive more funding for that.
With the management structure at the clinic for the past two years and having to hire temporary healthcare providers for the past year, the clinic exceeded its limited budget.
Heine said he hopes the community can help them out. So far, they’ve already raised $31,890. And they have a $50,000 match from Northern Light United Church.
“We’re actually pretty far along the way, with the $50,000 match,” he said.
Those interested can donate by visiting the clinic in person, (it’s inside the Mercantile Mall on Front Street, up the stairs and next to Grumpy’s Deli, Suite 202), or online at http://frontstreetchc.org/donate/
To ensure the money doesn’t dry up again, the clinic now serves everyone — not just those experiencing homelessness or those who have low incomes. Heine said that will make the clinic more financially stable in the future.
“The long-term stability of the clinic is going to require that we have a certain amount of income from taking care of patients,” he said. “The goal for the clinic is to have stable funding that’s a combination of grant funding and income from patient care.”
“We’ll take anybody, but we’re not trying to compete with the private clinics in town,” he added.
Heine noted the clinic’s mission will remain the same, and it will primarily serve the homeless, those with low-incomes and people who are uninsured or underinsured.