Print

A Day Of Triage For The Uninsured

Susan Campbell

February 07, 2010

The woman came in, short of breath, with dangerously high blood pressure.

Dr. Bruce Gould, medical director of the free clinic held in Hartford last week, stood over her as she tried to reach her family on a borrowed cellphone to tell them she was being taken to St. Francis Hospital.

Gould, who is also medical director of Burgdorf Health Center and Hartford's health department, has been delivering medical care to the disenfranchised for two decades, but things have changed. Despite his best intentions, Gould can no longer work the health care system, can't find ways around the rules to make sure his patients get adequate care.

The system has become heartless in the name of cost containment, he says. He's had to tell patients there was nothing he could do for them, and he's lost sleep over that.

Eighty-three percent of the people at Wednesday's free medical clinic at Connecticut Convention Center have jobs but no insurance, according to the National Association of Free Clinics, which organized the event. All told, 998 people went through 76 examination rooms cordoned off by blue curtains, cared for by 1,200 volunteers.

The system is broken, and here lie the pieces, in the form of a young man and a young woman getting to know one another in one of the waiting areas. She's had cancer twice. The last bout cost $68,000 — of which she was responsible for 10 percent. That was when she had insurance. She isn't covered now, and what will she do with the lump she's found in her breast?

Here sits diabetes next to hypertension. Both conditions are treatable if they're diagnosed in time, but if a person doesn't have insurance, the chance of a timely diagnosis shrinks exponentially.

By mid-afternoon, a handful of patients — like the anxious woman treated by Gould — have left on stretchers to be taken to area emergency rooms. Without insurance, their bills will be paid by we who are blessed to have insurance. The patients most likely will be hounded by bill collectors, but the hospital will be paid — by them or by us.

Victor — he has a last name but let's give him some privacy — watched one stretcher go by as he sat in a waiting area for his 2 p.m. appointment. An out-of-work machinist, he has severe high blood pressure and he's supposed to be on three different medications, but he's run out of two of them and is down to his last pills on the third. He's started to eat right, he exercises, and he's lost weight in the last few months.

Poverty, he says with a shy smile, can be good for you.

He was covered by insurance until he lost his job last March, and he can't afford to cover himself. He's got resumes and phone calls out all over the place, but so far, he can't find work closer to home in Wethersfield, where he's staying with family. He's done a few odd jobs, but those pay little.

In his youth, Victor was a lifeguard. He saved three people. Now, he exercises by walking. He's religious about it.

His number — 555 — is called, and Victor stands to follow a volunteer in a red T-shirt. As he waits for a nurse to strap the blood pressure cuff on his arm, he talks about his daughter and son, and his grandkids. It's good this clinic is here, he says. There are a lot of hurting people.

He theorizes that his cholesterol is up, but as soon as the nurse takes the cuff off, a doctor leads Victor behind a blue curtain. You can hear words like "dangerously high" and "kidney failure." Victor's in the cubicle for a long time, and the nurse, who doesn't want to keep people waiting, calls for another patient.

The doctor writes out prescriptions and tells Victor where he can get them for $50 less per month than he's been paying. He has a 90-day supply, and intends by the time his medicine runs out to be working, with insurance like he once had.

He's nearly out the door when he looks at the floor and says quietly, "I love this state." Maybe it's the fact that he got help with no questions asked. Or maybe it's the realization of how sick he really is, but Victor tears up, blinks, wipes his eyes, smiles again, and walks out to start the first of the 90 days he has left on the medication he can afford.