08/24/2008

By TOM MARINE  / Associated Press

Carol Jenkins walked into the Greenville Community Shelter Clinic on a recent Monday night with a noticeable limp.

Her left knee was swollen, she said, and a sharp, shooting pain ran around her knee cap every time she put pressure on the leg.

"Do whatever you can do for me," Jenkins told the clinic staff in her New York accent. "This knee has been giving me a lot of trouble. It's stiff all the time."

Jenkins, who has been living at the Greenville Community Shelter for nearly two months, spent the next two hours being examined by medical students and doctors before leaving with a half-filled bottle of generic pain relief medication.

The Daily Reflector of Greenville reported that eleven patients, most of them from the shelter, would come to the clinic that night seeking medical attention. For Jenkins and the rest of the homeless population, they say nothing is easy — not even getting pain medication for a body ache.

"Their problem is they don't have access to care," said Lynda Bridges, a medical student at the Brody School of Medicine and member of the board of directors for the clinic, which provides free, basic medical services. "We have (treated) people that were hearing voices and not getting the medication they need."

Due to the limited number of health care options available to them, Bridges said many in the homeless population must get their medical treatment from local clinics or at the emergency department at Pitt County Memorial Hospital, where federal law requires health professionals to admit all patients.

The Emergency Medical Treatment and Active Labor Act requires all hospitals that receive funds from Medicare and Medicaid to provide emergency health care to everyone who needs it, regardless of their ability to pay.

"They go to the emergency room when we are closed because they can't be turned away," Bridges said. "It is a problem. It's a waste of resources and it frustrates the emergency room doctors."

Dr. Timothy Reeder, clinical director of the Pitt County Memorial Hospital emergency department and associate professor of emergency medicine at East Carolina University, said he is not aware of PCMH keeping track of its homeless patients. However, he said that information could come up during the discharge process when the hospital staff identifies where patients live and what ability they have to pay for their medical treatment.

"Sometimes we know because they tell us," Reeder said. "But it is not something we ask on a regular basis, unless it is related to what we are treating."

Reeder said homeless patients are not much different from other indigent patients who are either uninsured or have no means to pay for their medical care. In fact, he said most times the hospital staff doesn't even know what insurance or medical coverage patients may have until they are discharged.

In some cases, Reeder said he suspects there are patients that stay longer in the hospital because they do not have a permanent place to stay.

"The hospital wouldn't put anybody out if they didn't have a safe, secure place to go," he said.

Statistics provided by PCMH show uninsured patients make up about eight percent of the total patient population while Medicare and Medicaid patients constitute more than 60 percent. During the 2007 fiscal year, University Health Systems of Eastern Carolina provided $57 million in unreimbursed indigent care for uninsured and underinsured patients.

Of that figure, $42 million was written off as bad debt by PCMH and $15 million was considered outright charity care. These costs, which are essentially free health care, are expected each year and the hospital plans to absorb it, a PCMH spokesman said.

Similar to PCMH, the Public Health Center does not keep records of patients who are homeless, said Dr. John Morrow, Pitt County public health director.

"If we know a patient is homeless, we certainly take that into account for their treatment options," Morrow said. "Again, if the patient doesn't reveal those things to us, we have no way of knowing."

Morrow said one of the biggest public health concerns in the homeless population is communicable disease control, which can include tuberculosis, HIV-AIDS and other sexually transmitted diseases.

"It is not necessarily the fact that they are homeless that concerns us," he said. "It's the factors that led them to be homeless, such as the lack of a social support structure or the lack of medical insurance.

"It's unstable. That is the key thing that defines it."

According to the National Resource and Training Center on Homelessness and Mental Illness, between 20 and 25 percent of the single adult homeless population suffers from some form of severe and persistent mental illness. That means there is a disproportionate number of mentally ill people among the homeless population when compared to the general population.

"If you don't have a strong mind, you would lose it over there," said Jenkins, referring to her time in the shelter. "You'd be discouraged too if you were looking for housing and employment and nothing was coming your way."

Reeder said when looking at the entire homeless population, meaning both short-term homelessness and long-term homelessness, the No. 1 cause for people to be chronically homeless is mental illness. Substance abuse also can play a large role, he said.

To help provide health care and gain some experience, students from the medical school are volunteering at the clinic, which is scheduled to operate every Monday and alternating Thursdays.

Jennifer Vu and Bobby Scott, both of whom are medical students at the Brody School and board members for the clinic's board of operations, said there is a huge demand from both the Brody students and the local homeless population to keep the clinic open every week.

"There are pre-med students and Brody students that want to do this," Scott said. "Anytime a doctor signs up, within a day the volunteer list is full."

However, they said getting a trained physician — who must be present to supervise the medical students and write prescriptions for the patients — to volunteer has become a problem.

"It's very frustrating because I feel like I'm begging doctors to come supervise us," Bridges said about running the clinic, which was only open two times during May and June.

Because of this inconsistency, Bridges said they have been forced to turn people away because so many show up for medical care. Keeping the clinic open every week, she said, would help the entire situation because the patients will wait to seek treatment if they know the medical students and physicians are coming back.

"They experience the exact same problems as other people in eastern North Carolina, it's just that they don't have insurance," Bridges said in reference to the homeless population. "They come to us for ibuprofen and aspirin. That four dollars may be dinner for them."

In addition to the clinic, the James D. Bernstein Community Health Center provides primary care, dental care and pharmacy services for low-income people in Pitt and surrounding counties. The 15,000-square-foot facility is owned and operated by Access East, an independent, charitable, nonprofit organization.

"They are extremely grateful," Bridges said of the shelter's residents. "They are very thankful because they know we are trying to help them and it gives them a sense of pride that they are helping with our education."

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Information from: The Daily Reflector, http://www.reflector.com