Cherry Health’s Heart of the City Health Center is the closest FQHC to the now-closed Heartside clinic. Photo by Justin Dawes
Since the Mercy Health Heartside Health Center closed over a month ago, other organizations are working to address the needs of displaced patients.
Though there largely seems to be adequate services in the area, some community leaders are worried about how the clinic’s former patients, some in extreme poverty, are adjusting.
The Heartside clinic, formerly at 359 S. Division Ave., served more than 3,200 patients last year, Mercy Health said. As a federally qualified health center (FQHC), the clinic served uninsured and underinsured patients, charging on a sliding scale according to income.
These people are among the most vulnerable in the community, and many have trauma and trust issues that come with homelessness experiences and unstable backgrounds, said Marge Palmerlee, executive director of nonprofit Dégagé Ministries.
“Relationships are paramount in the work we do,” Palmerlee said. “It's being there day-in and day-out, walking alongside them through the good times and the bad, and just affirming that their past doesn't define them.”
Because of that, it takes a great deal of trust for this population to open up to doctors due to the intimate nature of medical relationships. Palmerlee said many of the patients had found that kind of trust in their providers at Heartside, seeing them as a sort of stabilizing force within otherwise unsteady life circumstances.
One of Dégagé’s clients, who suffers from anxiety and other issues, became so anxious following the clinic’s closure that she had to receive services at Pine Rest, Palmerlee said.
“Sometimes, we don't realize how traumatic something like this is,” she said.
The GVSU Family Health Center, at 72 Sheldon Blvd. SE, hasn’t seen a large influx of new patients from Heartside, maybe a couple dozen, said Tamara Van Kampen, practice manager. Serving a similar population, the staff understands many of the patients face issues others do not. Plus, many have very complicated health backgrounds, so going over those issues again with new staff can be frustrating, Van Kampen said.
For that reason, she said the GVSU clinic schedules longer appointments of about 30 minutes or up to an hour in some cases.
“It’s a very vulnerable population, so building those relations they’ve had so long is going to be a challenge,” Van Kampen said. “They don’t want to open their lives up to someone else.”
Heartside offered several unique services, such as showers patients could use before seeing their doctors, as well as people who could help manage prescriptions.
Dégagé, which offers multiple services to about 400-500 people per day, does have showers and prescription management services these patients could use instead, and the nonprofit’s staff nurse works closely with patients to ensure they can access the resources they need.
That doesn’t cover everything, though, and there still is concern that Heartside’s closure left a hole in services, or, at least, eliminated access to a range of services in one location.
Daniel Drent, a formerly homeless Heartside neighborhood resident, receives disability payments and is a former patient of the Heartside clinic. His doctor also works at Mercy Health’s Clinica Santa Maria, at 730 Grandville Ave. SW, so the transition was easy for him in that respect, albeit now appointments are two bus rides away rather than a short walk.
For a knee issue, Drent’s doctor had suggested physical therapy, one of the former clinic’s unique services. Not many clinics offer physical therapy, so when Drent was forced to visit a private practice following Heartside’s closure, it was suggested he attend three sessions per week for six weeks. At a copay cost of $40 per session, it’s a luxury Drent simply cannot afford.
Mercy Health told the Business Journal in December it chose to close the Heartside clinic after being informed by the federal Health Resources and Services Administration agency that it could no longer overlook noncompliance of grant requirements related to clinic governance.
Rather than continue operating several FQHCs, which is not traditional for health systems, Mercy Health determined it would be best to partner with other organizations to transfer patients and continue financially supporting the community in other ways. Mercy Health, therefore, forfeited $1.7 million in competitive HRSA funding, as well as $2.3 million in “wraparound” funding from other organizations for the FQHCs. The competitive funding now is available for application by other local organizations.
Mercy Health had been in discussion with other organizations for about a year but said it informed its patients a month before closure, then helping them transition to other Mercy Health locations or providers in other systems.
Because many of the patients have no regular home address and limited phone and internet access, some people didn’t get the memo, said Drent, who is a board member for the Heartside Downtown Neighborhood Association.
“To only do 30 days’ notice was, in my opinion, not adequate,” Drent said.
Drent said he has spoken with some former patients who hadn’t known the clinic had closed until they showed up and knocked on the door.
Jim Norton, a homeless man and former Heartside patient, said he knew about the closure, but he’s well-informed as another board member of the neighborhood association.
Norton, who says he is an advocate for fellow homeless citizens, knows that is not the case for some other former patients.
“Our concern was that we were going to have a massive amount of people that didn't get the news, and all of the sudden, they're going to realize they don't have a doctor anymore,” Norton said.
Norton and others are working to spread the news among other homeless people, particularly to people who seem particularly vulnerable, and guide them to a new clinic if needed.
“We're just going to try one person at a time. Scout the neighborhood,” Norton said.
For people who have found themselves in health care limbo, Drent said he worries they will end up in emergency rooms for simple issues, draining resources needed for actual emergencies.
Cherry Health’s Heart of the City Health Center, at 100 Cherry St. SE, is the closest FQHC to the former clinic, offering medical, dental, vision, behavioral health and pharmacy services.
Julie Tatko, Cherry Health’s chief operations officer, said the location has added about 85-100 new patients each month for the past several months. Prepared for this change following the year of conversations with Mercy Health, she said Mercy Health has been quick to respond to requests for medical records.
Even with that increase in patients, she said Cherry Health still has the ability to take more. She said staff closely monitors scheduling, so provider hours can be increased if needed.
“Everyone that we are seeing is coming into our system pretty smoothly,” Tatko said.
Even though Cherry Health doesn’t offer walk-in appointments — as Heartside did — staff has been able to find room for new patients who have been walking in, informing them how to schedule appointments in the future. The clinic always offers same-day appointments, she said.
“They're getting connected to a new provider, so we understand,” Tatko said. “It takes some time to get used to a new system.”
Van Kampen of the GVSU clinic said the same.
Spectrum Health did not grant an interview request but said in a statement that its Community Medicine Clinic, at 75 Sheldon Blvd. SE, has not seen a significant increase in new patients in the past month but is ready to accept new patients.
Norton, who has federal insurance, said he was able to get right in at the Spectrum clinic without hassle.
Cherry Health does have a policy of discharging patients for a “window of time” for a number of reasons, Tatko said — another concern of Drent’s.
Some of these reasons are to protect staff, such as when someone acts in a threatening way, Tatko said. Other reasons could be abusing medicine or not showing up for appointments.
Just because patients are discharged does not mean they are banned forever, she said. Each discharge is evaluated on a case-by-case basis, Cherry Health said.
“We are taking people back,” Tatko said. “That is a policy we have in place, but we have a lot of flexibility there because our goal is to be the safety net.”
Tatko said she is not aware of any former Heartside patients with discharge cases that would keep them from returning to Cherry Health.
To health care providers meeting vulnerable patients for the first time, Palmerlee would caution them to remember how significant the change could feel for them.
Some people don’t read well and are intimated by lots of activity in large places like Cherry Health’s Heartside location. Simply not knowing which door to enter was why one Dégagé client hadn’t visited Cherry Health after being referred, Palmerlee said the client told her.
It’s still early in the year, so it will take a bit of time to see exactly where patients land. In the meantime, Tatko said Cherry Health, as well as other organizations, is working to make sure its services are available to anyone who needs them.
“Ultimately, I think that our community is going to be able to sort it out,” Tatko said.