Local Matters
Politicians gave celebratory speeches at the Community Health Centers of Burlington on Monday to mark the completion of an $11 million rebuilding project. The 36,000-square-foot structure, which includes a medical lab and a suite of spacious examination rooms and dental operatories, replaces a century-old building that once housed a grocery store on the ground floor and the busy health center above it.
What has yet to undergo reconstruction is the common misperception that the CHC provides second-rate care to a mainly marginalized population.
“There’s a stigma that needs to be addressed,” says Alisha Laramee, a patient at the Riverside Avenue center. “There’s an impression that it’s a 24-hour emergency room, sort of chaotic, with physicians who are fulfilling some kind of requirement by working there.
“Friends always wonder why I choose to go there when I could go anywhere.”
Laramee says she began using the center a few years ago because, as an adjunct instructor of writing, she had no health insurance. Now married to a University of Vermont professor, Laramee has access to “an excellent plan,” but continues to rely on the center because “none of those impressions is valid.”
She describes the new facility as “spacious and very calm, with privacy.” She can easily make appointments to see her regular physician, Laramee adds. “It’s like what you’d find at any private practice — maybe better.”
The Riverside Avenue facility now has a lab that can process about 95 percent of the tests administered on-site, which means fewer patients have to schedule a second appointment to receive treatment based on the results. If they do have to return, there’s plenty of parking in the new 75-space underground garage.
The CHC is actually open only during typical working hours and a few evenings — not late into the night. And with its wood-paneled floors and gleaming machines, the center gives off a homey, high-tech vibe. The soothing décor and updated equipment are products of a $10.5 million federal grant awarded to the Burlington facility in a competition that included 600 other community health centers around the country.
The green-certified, clapboard structure also offers stunning views. With the adjoining Intervale in full leaf, a visitor experiences the illusion of being in the heart of rural Vermont rather than a working-class neighborhood in the state’s largest city.
The 41-year-old Community Health Centers — the title was made plural after the addition of a youth clinic on Pearl Street and a facility for the homeless on South Winooski Avenue — do continue to treat large numbers of poor people.
Roughly half of the centers’ 14,000 patients qualify for Medicaid, the federal insurance program for low-income individuals and families. About 20 percent lack health coverage entirely, says Jack Donnelly, the director of the centers. Many of the Medicaid recipients and uninsured are recent immigrants to the United States, and some of them suffer from post-traumatic stress disorders, Donnelly notes. They get treatment as part of the psychological counseling services that the centers also provide.
Anyone without insurance and who falls below the federal poverty line receives treatment for a nominal fee of $10. Those with incomes up to twice the poverty level qualify for a sliding-fee scale that tops out at about $80 per visit, Donnelly says.
Chittenden County residents covered by Medicare, the federal program for the elderly, account for 15 percent of a 16,000-person patient roster that has nearly doubled in recent years. The same percentage has private insurance. The center would like to attract more of those patients, in keeping with its aim of “serving all kinds of people in the community,” Donnelly says.
But that probably won’t happen as long as “a lot of those with private insurance think they can’t come here,” observes Alison Calderara, the centers’ director of community relations and development. The stereotype of the centers as catering solely to the impoverished is rooted in the institution’s origins.
The predecessor of today’s multifaceted set of facilities opened in a North Street storefront in 1971 as the People’s Free Clinic. “It was an outgrowth of the commune movement,” recalls Richard “Bunky” Bernstein, a Charlotte physician who volunteered there while completing his residency at the UVM-affiliated hospital. True to its title, the free clinic specialized in no-cost care to itinerant hippies and Burlington’s homeless community.
From the perspective of today’s more materialistic, less idealistic culture, such an innovation might be regarded as an amusement — even an embarrassment. Bernstein, along with Donnelly and other current centers staffers, don’t see it that way. “The whole point of the free clinic was to be a different way of organizing health care,” Bernstein points out. “It was an experiment in nonhierarchical organization. It functioned as a collective, as an expression of those who wanted to take control of their health and their lives.”
Donnelly adds, “It was about neighbors taking care of neighbors.”
Although much has changed, that spirit does live on at the centers. The 135 employees — including 10 physicians, 10 nurse practitioners and physician assistants, four dentists, and half a dozen dental hygienists — all receive market-based salaries, Donnelly notes. “Doctors don’t make a sacrifice to work here,” he points out. But, he adds, almost all of the centers’ staffers share the institution’s stated belief that “quality health care is a human right.”
Central to the centers’ mission is its national accreditation as a “patient-centered medical home.” That means everyone using the centers, regardless of financial standing, can be assured of continuity of care delivered in a culturally and linguistically appropriate manner.
The centers also offer services keyed to each stage of the human life cycle. A bulletin board in a corridor lined with examination rooms features photos of some of the 140 babies born to obstetrics patients during the past year. The exam rooms themselves were designed with enough space to allow family members to be present. Some of the African immigrants who use the center want to be on hand when, for example, an elder is being treated, Donnelly notes.
“Having a consistent doctor throughout life is very important so that care can be delivered in a more comprehensive manner,” Calderara remarks. “It allows for regular follow-up on chronic conditions, and it enables a provider to understand who, exactly, they’re treating.”
Margaret Russell, a physician’s assistant, says she still sees some patients whom she first treated 15 years ago when she began working at the centers. “I have a full range — from couch surfers to UVM professors,” Russell recounts. “It’s great to be working in such a uniquely supportive environment.”