More uninsured lean on low-cost care

The Baltimore Sun

When Carroll County resident Donna Hanson went to see a doctor about chronic gastrointestinal pain in October, she discovered that her misery had been triggered by a life-threatening heart condition. Doctors unclogged a right artery that was more than 90 percent blocked and inserted a stent.

Then they sent Hanson, who had no medical insurance, away with a new lease on life - and no bill.

Instead of going to a doctor or emergency room, the Westminster resident visited Access Carroll - a medical nonprofit organization that offers free health care to county residents with low incomes and no health insurance.

Hanson joined a growing number of people with no insurance - particularly those who have been laid off during the recession - who have turned to medical nonprofit organizations instead of traditional institutions that often leave them with crushing debt.

"I worked in the medical profession for 30 years," said Hanson, 52, a former medical receptionist who now earns a meager living providing day care for her grandchildren.

"I know enough medically not to ignore symptoms, but when you're uninsured and you don't have the money, what can you do? I had been ignoring [the stomach pains] for quite some time."

That is, until she read about Access Carroll in a local newspaper.

Founded three years ago, Access Carroll provides primary medical care with volunteer physicians and nurses and provides such services as laboratory and radiology testing, referrals to specialists and medications.

The organization is funded by grants and donations from individuals and local businesses. Also, several area medical specialists treat Access Carroll patients in their offices.

The number of patients treated by Access Carroll more than doubled between 2006 and last year, when more than 2,300 patients were seen in 5,700 visits.

"The last several months, people have been coming to us literally saying, 'I can't afford my health insurance anymore because I just lost my job, and I'm a diabetic,' " said Tammy Black, executive director of Access Carroll.

And with the economy projected to continue its downward spiral this year, organizations such as Access Carroll will be in greater demand, Black said.

"Seventy-five percent of our patients are chronically ill, meaning they've been on medication for more than six months for diabetes or heart disease or lung disease or asthma or depression," she said.

To receive care from Access Carroll, county residents must have a household income that is less than 200 percent of federal poverty guidelines. For example, a family of four must have annual income of no more than $42,400 to be eligible.

Access Carroll is one of several nonprofit organizations in the area that offer free or low-cost health care to the uninsured. Another is the Baltimore-based Shepherd's Clinic, where patients pay an hour's wage for an office visit. Those who are unemployed pay $9 at the time of the visit.

The Community Free Clinic in Hagerstown offers free services such as gynecologic, pediatric, podiatry, teen pregnancy, family planning and mental health care. And the Fairfield, Pa.-based Mission of Mercy offers a free mobile medical clinic (services include cardiovascular, respiratory, gastrointestinal and genitourinary care). It visits Reisterstown, Frederick, Mount Airy and Westminster.

The number of patients treated at Mission of Mercy's seven Maryland sites has increased over the past few years, said Linda Ryan, the organization's executive director.

Many people also turn to federally qualified health centers, which charge for services on a sliding scale. Others who are unemployed use such facilities as Access Carroll while awaiting eligibility for federal programs.

"It's a huge problem facing our nation," Black said about the gaps in health care.

More than 45 million Americans were uninsured in 2007, according to the most recent Census Bureau figures. That number was down slightly from the year before, but the number and percentage of people without medical insurance has increased over the past two decades. In Maryland, 761,000 were uninsured, according to the most recent numbers.

Because of the increase in patients, Access Carroll's operating expenses for the past quarter were about $80,000, an increase of about $15,000 from the previous six months.

Still, the nonprofit remains committed to serving 2,400 patients with services from 70 specialists and 200 clinical and clerical volunteers.

"It makes me feel good to be able to do it," said Dr. Charles Cummings, a cardiologist who has been volunteering his services at Access Carroll for nine months. "It's not a miracle of medicine but a miracle of the system - a lot of people in the business community donate money to this thing, and it helps to save lives."

It did for Hanson, a single mother who for years had experienced chronic gastrointestinal pain. In October, the pain became too severe to withstand any longer.

Although electrocardiogram testing revealed no abnormalities, doctors at Access Carroll still weren't satisfied that Hanson's pains were gastrointestinal in nature - in part because for women some heart abnormalities manifest themselves as stomach and back pain.

Moreover, Hanson, a smoker, has a history of heart disease in her family. Both her mother and grandmother died from heart attacks.

She was administered a heart stress test and about four minutes into the test, she said, her heart began beating abnormally.

"It felt like an elephant was standing on my chest, and I couldn't breathe," Hanson said.

The attending physician called 911 and had Hanson rushed to a hospital, where a catheterization revealed a blocked artery. Cummings performed an angioplasty and inserted a heart stent.

"She quickly got a diagnosis that saved her life," Cummings said.

Hanson, who still has some gastrointestinal problems, now has some insurance to cover procedures for that ailment for up to a year. Yet she shudders to think where she would be had she not turned to Access Carroll when she was uninsured.

"I probably would have put it off even more, that's the scary part," she said. "There are so many families in my position who work hard and are barely able to meet the bills. Unless you're with a company that offers insurance, it can be very difficult.

"If I had insurance, I never would have ignored the symptoms. I would have gone to the doctor immediately. But what happened was a strong lesson for me. I won't be ignoring symptoms anymore."


* Access Carroll offers free health care to uninsured, low-income residents of Carroll County who meet eligibility requirements. 410-871-1478,

* Shepherd's Clinic in Baltimore provides health care to individuals who do not have health insurance and are not eligible for government-assisted health care. 410-467-7146,

* Mission of Mercy is a nonsectarian organization that provides free medical and dental services and prescription medications to the uninsured working poor, homeless and economically disadvantaged through a mobile clinic that visits Reisterstown, Frederick, Mount Airy and Westminster. 301-682-5683.

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