Breaking down barriers
St. John’s Health Center makes medical care accessible to poor in New Brunswick
By Scott Alessi
Staff Writer
NEW BRUNSWICK — Each day, St. John’s Health Center answers the calls of people with nowhere else to turn.
“The people that are making those phone calls most of the time are the ones that are the poorest, the sickest and have the least resources,” said Daughter of Charity Sister Margaret Palmer, nursing director at St. John’s. “They certainly can’t afford to go to the emergency room.”
For many low-income families, particularly those who do not have insurance, health care is only sought in the case of an emergency. For the poor in New Brunswick, however, St. John’s provides the comfort and care of a private physician at a cost that makes treatment accessible to everyone.
“We’re the local doctor’s office,” said Sharon Oshatz, division director of health services for Catholic Charities, Diocese of Metuchen. “We don’t run ourselves like a clinic. Our main service is to provide ongoing health care.”
Located on Abeel Street, St. John’s is one of two health care centers run by Catholic Charities in the Diocese of Metuchen.
Unlike most health clinics, St. John’s, does closely resemble a private doctor’s office. Each patient is required to have an appointment and the waiting room is rarely crowded, making a more orderly and comfortable environment for the patients. Through a partnership with Saint Peter’s University Hospital, the center has its own full-time physician, Dr. Steven Levin, offering patients the opportunity to schedule regular visits with the same doctor.
“Our patients face a whole lot of challenges in the community,” Oshatz said. “One of the things that we focus on is keeping the barriers down.”
Special care
Founded in 1984, St. John’s has grown from a small clinic run exclusively by volunteers to a fully-staffed medical facility that handles nearly 9,000 appointments each year. Dr. Levin, whose salary is paid by Saint Peter’s, joined the center in 1989.
The center was initially established with a goal of offering medical treatment to the uninsured with no access to health care. The staff soon discovered that not only did individuals in the community need care but that years of untreated illness had left many with severe health problems.
“A lot of our patients are sicker than your typical suburban doctor’s office patients because they let it go for years and just couldn’t do anything about it,” Sister Margaret said.
“Most of the people we see have multiple medical problems,” added Michelle McWeeney, who has worked as a physician’s assistant at St. John’s for the last eight years. “A lot of them are coming from other countries and they have never really been treated, or they’ve been living in the U.S. without any medical care for a long period of time.”
To meet the needs of a community with so many varied medical problems, the clinic has had to expand its services into more specialized areas, including treatment of patients with HIV. The center also operates an outreach program and utilizes case workers to reach out to those in the community with HIV who may be resistant to seeking treatment. Currently, the center treats 106 patients with HIV, although the number varies each month.
“Basically, the philosophy of the clinic is to provide care to the people most in need, and that includes people who are homeless, children and certainly patients who are dealing with HIV,” said Dr. Levin, who in 2006 was named Family Physician of the Year by the American Academy of Family Physicians.
McWeeney, the 2005 New Jersey Physician’s Assistant of the Year, has brought several women’s health programs to the center. As a result, women are able to receive on-site gynecological exams and other specialized procedures without having to visit another office.
Through a state-funded program, the center also obtains vaccines for children, which helps them to immunize those who could not otherwise afford to receive the shots. The center also operates an outreach program to ensure that children in the community are receiving their immunizations at the proper time, greatly increasing the number of children being vaccinated.
“We’ve more than doubled our immunization rates here,” said Arlene Patrick, program director and nursing coordinator of health services for Catholic Charities. “We’re always working within the community for access to things other than primary care.”
Common vision
Providing a variety of low-cost services and care to the poor does not come without a price. Thankfully for St. John’s, they are not alone in their mission to improve the health of the community’s residents.
Saint Peter’s University Hospital has been an instrumental partner in supporting the work of St. John’s. In addition to providing the health center with a full-time physician, the hospital subsidizes several programs, including the funding of an on-site laboratory and providing a part-time pathologist to supervise lab work. Saint Peter’s financial support totals roughly $500,000 each year.
“Our thinking was that Saint Peter’s University Hospital and Catholic Charities should work closely together,” said Tab Chukunta, director of community outreach for the diocesan hospital. “We have a common mission. We’re all assisting and working toward the restoration of hope for people who are in need.
“Saint Peter’s has been a consistent, unwavering supporter of this clinic since its inception,” said Dr. Levin. “Saint Peter’s understands their role as a major health institution in the community to take care of the entire population, not just the people that have insurance.”
Oshatz explained that by supporting St. John’s, Saint Peter’s helps to improve the overall health of the entire community, limiting the number of people who turn to the hospital for emergency care due to a lack of preventative care.
“One of the things that clinics like us do is keep people out of the emergency room,” Oshatz said. “Emergency visits are very costly to a hospital and a lot of them are not reimbursed by insurance companies. The cost to the hospital for keeping our work going is actually less than it would be if all those patients were coming through the emergency room.”
Patchwork funding
Although the aid of Saint Peter’s goes a long way in helping to further the efforts of St. John’s, the continued costs of day-to-day operations at the health center provide an ongoing challenge.
“The cost of providing the service goes up all the time,” Oshatz said. “It’s a real struggle. Unfortunately, it is getting tougher and tougher because there have been federal [funding] cuts.”
Much of the funding for the center’s work with HIV patients comes through the Ryan White Program, both on the state and federal level. The remaining funds to the center come through various grants and donations from sources such as the Daughters of Charity and the United Way. An annual 5K run often raises as much as $10,000 to be used for subsidizing lab costs, buying medication and paying for equipment.
“It’s a patchwork, and it is ongoing,” said Oshatz. “We constantly have to look for operating expense funding.”
For the first 12 years of its existence, St. John’s managed to survive as an entirely free clinic, but the cost of paying its medical staff and covering day-to-day costs led them to begin charging patients a fee for their visits.
“It was a hard change,” said Sister Margaret, who served as director of the center from 1988 to 1993 before returning as nursing director in 1994. “We really agonized about that first time we asked [a patient] for some money.”
Through government programs, the center is able to obtain free medications and vaccines, which they offer at a minimal cost cost to patients. The clinic treats patients covered by Medicare and Medicaid, who often have a difficult time finding health care institutions that accept such coverage. Of the patients who visit the center, however, only 30 percent have insurance of any kind.
“I’d say that of those 30 percent, a large number of them are children 18 and under,” Sister Margaret said. “The adults still have the biggest problem getting coverage. They also have the highest cost in terms of medications.”
In the face of decreasing funding, space limitations and a growing need in the community, the staff of St. John’s remains dedicated to eliminating the obstacles that keep many of the poor from seeking medical treatment.
“We’re constantly rethinking what we’re doing and how we’re doing it, and we’re constantly trying to be more efficient,” Sister Margaret said. Still, there are many additional medical problems that St. John’s is currently unable to treat.
“This community and the surrounding area have so many unmet medical needs,” added Dr. Levin. “Our goal would be as much as possible to increase the services that we offer to come closer to meeting the needs of the community.”
*The attached/referenced article was originally published in The Catholic Spirit, the official newspaper of the Diocese of Metuchen, and is protected under U.S. and international copyright law