Free clinic sees surge in patients

MIDDLEBURY — Addison County’s Open Door Clinic is bustling with a new staff, a faithful cadre of volunteers and a surging patient load brought on by a sluggish economy and rising health care costs that are increasingly putting insurance coverage outside the grasp of citizens and employers.
The clinic, located at 100 Porter Drive in Middlebury, offers free health care services (by appointment) to income-eligible patients. It is run by a nonprofit organization called Community Health Services of Addison County (CHSAC). The clinic functions with an annual budget of around $200,000 and a paid staff of five full- and part-time health care professionals who work with a network of more than 130 volunteers, including 16 physicians, four nurse practitioners, 15 registered nurses, three physical therapists, five emergency medical technicians, a dietician and a pharmacist. Other volunteers staff the clinic’s intake desk, assist patients with insurance applications, provide translator services for patients and help with transportation.
“Providing health care is truly a community effort,” said CHSAC Executive Director Julie Arel. “While the clinic gets most of the attention, it is the volunteers who enable the work to happen, partners like Porter (Medical Center) provide assistance to the clinic and our patients, other providers in the community extend their services for free to our patients, and donors keep our doors open.”
The Open Door Clinic is open in Middlebury on Tuesday evenings from 6 p.m. to 9 p.m. as well as every other Friday, from 9 a.m. to noon. During weeks the clinic does not operate on Friday, it convenes a 6 p.m. to 9 p.m. session at the Little City Family Practice at 10 North St. in Vergennes.
All prospective patients must book an appointment ahead of time by calling 388-0137.
And a lot of people have been booking appointments, according to Arel.
She said the clinic has served 493 unduplicated patients so far this year, compared to 272 at this time last year. Total visits are at 660 so far this year compared to 454 at this point in 2011. But these statistics only tell part of the story. Clinic officials and volunteers also provide case management services and help patients apply for insurance programs for which they are eligible.
To be served at the clinic, patients must earn below 300 percent of the federal poverty guideline, which amounts to no more than $34,000 annually for a single person and no more than $68,000 per year for a family of four.
Arel said most of the clinic’s patients are employed, uninsured or under-insured. She said 46 percent have full-time jobs that do not provide health insurance, while 14 percent are part-time workers and 7 percent are seasonal. Only 14 percent of the patients are unemployed, according to Arel. Most of those served are from Addison County, but some come in from other counties and parts of New York. Arel noted 79 percent of the clinic’s patients speak English, while 21 percent speak one of five other languages.
Many of the non-English speakers are migrant workers toiling on farms throughout Addison County, Arel said. The CHSAC operates an outreach program for migrant farm workers, through which Julia Doucet, the clinic’s outreach nurse, goes out to farms to educate workers and owners about their health care options.
“We do a great deal of care coordination including arranging translators, rides and facilitating appointments to specialists,” Arel said. “There is a great deal of prevention and health education that occurs, including flu clinics on farms for all who work or live on the farm; farm safety training, including hearing tests and information about injury prevention; dental screening and education about dental care, and other health education efforts.”
CHSAC began diabetes clinics one and a half years ago with initial support from the Walter Cerf Community Fund. These are quarterly clinics for all diabetic patients and include a visit with the primary care provider who does an exam and provides guidance, reviews lab work and conducts regular foot exams. The patients then come together for group education with a diabetes educator who focused on key issues of self-management and allows time for group discussion and support.
Dr. Timothy Cope, recently retired after many years of practice in Addison County, signed on as CHSAC’s medical director this past December.
“(Cope) has been an integral part of our being able to offer more clinic hours and increased patient visits, since he works almost every Tuesday,” Arel said.
“Tim’s generosity of time allows us to maximize every clinic and expand from approximately eight primary care patients per clinic to 14 to 18 patients per clinic,” she said.
Helping the CHSAC’s cause has been a new partnership with the University of Vermont College of Medicine that provides experience for family medicine resident doctors who rotate through the clinic twice per month.
“This is a great opportunity for us to increase our patient visits and gives new physicians a different perspective of care,” Arel said.
CHSAC is always looking for support to help float the clinic, which has a budget financed by state and federal funds, the United Way, foundation grants, contributions from some Addison County towns, and private donations. For more information or to contribute, call 399-0137 or check out the clinic’s website at www.opendoormidd.org.
Reporter John Flowers is at [email protected].

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