The Enid News and Eagle, Enid, OK

January 26, 2013

Free clinic microcosm of Oklahoma's health coverage challenge

By Warren Vieth
Oklahoma Watch

SHAWNEE, Okla. — Inside a cramped clinic office, Dorthea Copeland prepares for the weekly pilgrimage of poor people seeking free health care. They’re already lining the hallway, trading tales of sore throats and bum tickers.

“Some of these people just lost their insurance. Some of them work, but don’t make very much. Some of them are self-employed,” said Copeland, a feisty 85-year-old who’s been running Pottawatomie County’s free clinic since it opened 14 years ago.

“You can usually tell by looking at them that most of them really need the help.”

Copeland is in charge of recruiting doctors, nurses, pharmacists and other helpers who donate their time on Thursday evenings to help Pottawatomie County residents who don’t have health insurance and don’t qualify for government assistance.

Coincidentally, she’s also the aunt of Gov. Mary Fallin, who grew up in Tecumseh as Mary Copeland. In November, Fallin rejected an Obama administration offer to finance much of the cost of expanding Oklahoma’s Medicaid program. If Fallin had accepted, many of the people filing into the clinic this evening would be eligible to participate.

Pottawatomie County’s free clinic is a microcosm of the health coverage challenge facing Oklahoma policy-makers. Fallin’s decision to reject the Medicaid expansion has left an estimated 130,000 or more low-income Oklahomans in a coverage crater that offers few options for affordable health care. The problem tends to be more pronounced in smaller towns and rural areas, where incomes often are lower and employers less likely to offer benefits.

Asked to comment on the clinic operation, Fallin praised the work Copeland and others are doing, describing her aunt as “a wonderful lady who has spent much of her career dedicated to helping other Oklahomans.”

The governor said she is looking for ways to address the coverage crater, but remains convinced the Obama initiative is “unaffordable and unworkable.” Even with the federal government picking up much of the tab, Fallin’s office contends the expansion would increase state spending by $689 million over 10 years. Advocates of expansion counter that the cost to the state would be minimal.

Fallin said she would propose a “substantial increase” in health funding when the Legislature convenes in February. State health officials, meanwhile, have hired a Utah consultant to make recommendations for possible legislative action this year.

For several thousand uninsured people in Pottawatomie County, Copeland’s free clinic is still the best thing going.



‘Trying to survive’

Standing at the head of the line in the clinic tonight is Brad Trice, 45. He’s divorced and lives with his father in Tecumseh.

Trice said he has been coming to the clinic for free prescriptions since his blood pressure skyrocketed to 250/170 several months ago, landing him in the hospital emergency room.

Trice said he hasn’t worked since 2010, when he lost his job as a certified nursing assistant at a Seminole nursing home. He hasn’t had health insurance since 2005, when he was working at a Walmart store.

“I’m just a human being trying to survive,” he said. “But we’re all doing that.”

On a previous visit, Trice asked the clinic for help with a badly ingrown toenail. He was referred to an outside physician, who wanted $250 to fix it. The clinic doesn’t offer surgical services.

Trice said he couldn’t afford to pay that much.

“It still hurts like a son of a gun,” he said.



Expansion plan

About 28 percent of Pottawatomie County residents between the ages of 18 and 64 had no health insurance in 2011, according to the U.S. Census Bureau. That compared to 26 percent statewide.

Many of them would be eligible for government-paid health care under the Obama initiative, which would have expanded Oklahoma’s Medicaid program to all working-age adults with incomes up to 133 percent of the poverty level. That equates to $14,856 a year for a couple and $30,656 for a family of four.

Under existing law, Oklahoma’s Medicaid program excludes adults unless they have dependent children living at home and their income falls below a relatively low level — $4,368 for two people and $6,996 for a family of four.

Pottawatomie County is not as poor as some places in Oklahoma, but it fares worse than the state as a whole in most key economic indicators. Eighteen percent of the population falls below the poverty level.

Fallin grew up in Tecumseh, a community of 6,443 just south of the county seat, Shawnee. Both her father and mother were mayors of Tecumseh, and Fallin attended Oklahoma Baptist University in Shawnee, before graduating from Oklahoma State University.

In a 2011 interview with the Tecumseh Countywide newspaper, Fallin said her original career goal was to be a social worker. She said she was inspired by her mother, who worked as a district supervisor for the Oklahoma Department of Human Services.

‘I need a job’

Marking time about half-way down the hallway are Jason and Linda Popielarski of Tecumseh. They are here to see a doctor about Linda’s sinus infection and to get her blood pressure prescription refilled.

Jason, a 37-year-old machinist, said he recently lost his job at Aero Components in Oklahoma City. Linda, 58, lost her job at Braum’s. The couple live on Jason’s unemployment benefits, which add up to about $18,000 annually, but which will run out before long.

“We’re barely surviving,” Popielarski said. “I need a job. All I have is my motorcycle to get around. I’m working on weekends in trade for a place to live.”

Popielarski said he hasn’t had health insurance in five years. Most machine shops nowadays don’t provide it, he said. “Or if they offer it, you can’t afford it.”



Free refills

The free clinic opens its doors at 5 p.m. every Thursday, when the Pottawatomie County Health Department’s paid staff goes home and Copeland’s volunteers take over. It’s supposed to shut down at 7 p.m., but that rarely happens.

Even though each Thursday’s two volunteer physicians are expected to take only 10 patients each, they generally wind up seeing more, and the pharmacy volunteers have their hands full dispensing drugs to 50 or so people who show up every week for refills.

Last year, clinic doctors saw 857 patients. The pharmacy team dispensed 5,362 prescriptions with a retail value of $186,000.

The clinic subsists on about $16,000 a year, of which more than $14,000 is used to buy medicine. Most of the money is donated by United Way. No government funding is involved, except for Copeland’s half-time wages at the Health Department.

Pharmacist Mike Vorndran oversees the prescription refills. Most of the medications are for chronic conditions like heart disease, high blood pressure and diabetes. The clinic doesn’t dispense pain pills or antidepressants.

Vordran gets some of the pills at no cost from doctors, who give him their free samples, and from nursing homes, which donate their residents’ unused meds. He buys the remainder from distributors at heavily discounted rates.

“We see people who literally have to decide between buying groceries and buying their prescriptions,” he said. “I just felt that this was a way I could help alleviate some of that.”



They keep calling

As 7 p.m. approaches, Lena Garvin still is sitting in the packed waiting room, waiting patiently to get her prescriptions refilled. She said she’s glad to be sitting anywhere, after the heart attack she experienced last July.

Garvin, 51, said she was preparing food at a Burger King franchise in Yukon when her heart seized up. Her half-time job there paid $7.50 an hour. She was not eligible for health insurance.

She was rushed to Baptist Memorial Hospital in Oklahoma City, where emergency room personnel inserted a metal stent in one of her coronary arteries. A few weeks later, they inserted a second one.

Garvin was told she was in no shape to return to work. Her doctor agreed to waive his charge. But she said the hospital is demanding $36,000 for her stay there. She has no way to pay unless Social Security approves her application for disability benefits. She figures that’s a long shot.

“I still get a call every day for the hospital bill,” she said. “Literally every single day. I tell them I’ve applied for Social Security, and I’m still waiting.”

Garvin, who lives in the country near Pink, also has diabetes and neuropathy, which causes numbness in her feet. She injects a half-dozen vials of insulin every month. She takes six or seven pills a day. She estimates the drugs would cost $700 to $1,200 a month if she did not receive free refills.

The last time Garvin went to see her heart doctor, she was told she needed a stress test. When she learned it would cost her $1,000, she declined.

“I won’t be having that,” she said.



Too many people

Copeland’s volunteer roster contains the names of about 80 doctors, nurses, pharmacists, technicians, clerks and other helpers. On any given Thursday evening, about 20 people pitch in.

But it’s not quite enough to keep up with rising demand. On this night, five people will be told they’ll need to wait at least a week to see a doctor.

“It’s getting worse all the time,” said Ty Johnson, who shows up every week to handle patient intake. She bustles about the crowded clinic with a clipboard, calling out names and handing out paperwork. “We’re getting more and more people.”

Not everyone makes the cut. To qualify, patients must be Pottawatomie County residents, must have no other form of insurance coverage, and must fall below income caps that are considerably lower than those contained in the Obama expansion plan.

“There is just more need than we can handle,” said Stephanie Scrutchins, who determines eligibility.

Copeland, for her part, doesn’t even mention her connection to the governor, acknowledging it only after a visiting reporter brings it up.

“She’s doing a good job,” Copeland said of her niece.

She also declines to discuss Fallin’s rejection of the Medicaid expansion.

“You know, I don’t get into politics,” she said. “I just run my little business here. Hopefully, we’ll do all that we can for the people that come in. Right now, I’m looking at all the returns I’ve got for next Thursday night, wondering how in the world we’ll get them done.”



Oklahoma Watch is a nonprofit organization that produces in-depth and investigative journalism on important public-policy issues facing the state.