A county fund that helped pay for speciality health care for uninsured patients is $4,000 in the red, leaving a clinic that refers them with no options.
"These people have very serious conditions and need immediate help and we don't have the ability to do those things," said Donna DeLong, chief financial officer for Premier Community HealthCare Group, a nonprofit primary care clinic based in Dade City and Zephyrhills. "Some people are in very dire straits."
When Premier saw uninsured patients who needed serious surgeries or tests, they referred them to the county's Human Services Department, which has money reserved to pay negotiated fees to specialists who agree to provide care. The clinic typically refers about 25 patients a month, DeLong said, but is seeing more as people hit hard by the recession lose jobs and health benefits. About 60 percent of Premier's patients have no insurance.
But this month, county officials told them the money for this fiscal year had all been spent. Because the county's fiscal year begins Oct. 1, that could force some patients to wait seven months for the tests or procedures they need.
The situation prompted Premier CEO Kim Schuknecht to e-mail each county commissioner pleading for help.
"This decision will be detrimental to the health and well being of our community as a whole, not to mention each individual," she wrote. "There must be a better solution."
Community Services Director Adelaida Reyes said the county's funds to help uninsured patients shrank from $43,000 to $34,000 this fiscal year.
She said she could possibly shift some money from other department funds, but the county has access to only about $16,000 that is discretionary. The rest is restricted by federal or state law for other purposes.
"It's difficult, but we'll do what we can," she said. "I'm afraid we will run out."
Commissioner Ann Hildebrand said she's worried the situation will worsen as county's economy continues its downward spiral.
"It's just a tragic web that is out there," she said. "And it's only going to escalate. I'm scared to death the county's not going to have the funds for outside (social service) agencies this coming year."
Hildebrand serves on the board of Good Samaritan Clinic in west Pasco, which uses volunteer primary doctors and specialists. Unlike Premier, which is federally funded, it does not accept Medicaid, Medicare or privately insured patients.
So why can't Premier send its specialty patients to Good Samaritan? The west Pasco clinic's rules prohibit it.
"In order to be treated at Good Samaritan, you can't have a primary care physician," DeLong said. "So we can't refer our patients to Good Samaritan."
Plus, she said Good Samaritan is clean across the county, a far trek for most needy folks to go for help.
"It's a 30-mile trip," she said. "A lot of these people don't have transportation or the money to get there."
Indigent care funding
Pasco County has lagged behind other places in dealing with indigent care. Hillsborough County approved a half cent on the dollar sales tax in 1991 to pay for indigent care. Polk did the same.
Fasano, who also works as a lobbyist for Florida Hospital Zephyrhills, helped Premier get a state grant for a pilot program to expand its hours to evenings and weekends. The goal was to keep patients with minor illnesses and injuries out of hospital emergency rooms.
The grant has run out, though Premier has still remained open during the extra hours.
Why not just get doctors to volunteer in East Pasco?
It's not that easy, said Dr. Marc Yacht, former executive director for the Pasco County Health Department and a board member at Good Samaritan. Doctors are reluctant for fear they will be sued. And a lot of specialists won't even accept Medicaid because of the red tape and low reimbursement rates.
State law lets them work as volunteers for the health department and be protected from lawsuits. Good Samaritan doctors also are protected because they are volunteers.
When a practice like Premier, which has paid primary physicians, asks for specialists to volunteer, those doctors may balk.
"A doctor wonders, 'You're paying your doctors why aren't you paying me?' " he said.
And malpractice relief isn't enough.
"They've been cut back in fees and the paperwork is a hassle. They feel they're doing enough."
Ultimately, Yacht said, free and low cost clinics won't fix the health care crisis. Universal care will.
"A lot of ugly things are going on right now," he said "Free clinics are a Band-Aid.