Tension Between Doctors, Free Clinics Rise After Katrina

By MICHAEL KUNZELMAN

LONG BEACH, Miss. – When Clifton Davis hurt his eye recently, he went to a free medical clinic in this hurricane-wrecked community. For Davis, and others with health insurance, getting free care is easier than figuring out if regular doctors are still around.

"I don’t even know who’s open," said Davis, a 49-year-old landscaper. "Everything got torn up by the storm."

Nearly six months after Katrina, there are still a half dozen free clinics in coastal Mississippi seeing hundreds of patients a day. At the same time, hundreds of doctors whose offices were destroyed are struggling to rebuild their practices.

Some complain that jump-starting their businesses will be tougher as long as clinics are providing free care and free medicine.

"We are very appreciative of what they’ve done, but it’s time to move on," said Dr. Douglas Lanier, who treats kidney diseases at Memorial Hospital in Gulfport.

The Long Beach clinic is one of the region’s largest, with several doctors treating around 170 patients a day. Under a big tent set up in an Episcopal school’s parking lot, patients wait on folding chairs and school desks. Doctors use picnic tables for desks and examine patients in areas screened off by plastic tarps.

For patients with no insurance and no transportation, the clinics often are the only option, said Jennifer Knight, a registered nurse who serves as the Long Beach clinic’s medical services director.

Knight estimates about half her patients either have insurance or lost coverage after Katrina. She said she’s aware of the resentment of some local doctors. "My answer to that is, ‘Come to the area and open your office.’ … It’s not my pleasure to serve people in a tent. It’s not optimal care."

Her clinic is the target of fewer complaints, she says, because the staff includes some local doctors – and they’re getting paid for their work.

Some of the visiting physicians at the clinic were sponsored by out-of-state institutions. Others came on their own. Some stay a day or two, others remain for as long as two or three weeks. Many have used vacation time.

Catherine May, a psychiatrist with a private practice in Washington, D.C., said she relished the chance to apply her training in emergency medicine and came on her own.

"They needed the help," May said. "I also find the work intensely gratifying and interesting."

In less than two weeks, Knight plans to merge her clinic with a nearby medical center, Coastal Family Health, and operate out of a trailer instead of a tent. Many patients will continue to get free care, but others will be charged according to their ability to pay, she said.

Tension between local doctors and the free clinics is more pronounced in Bay St. Louis, which before Katrina wrecked it was a quaint resort town about 40 miles east of New Orleans. Less than three-quarters of Bay St. Louis’ pre-Katrina population of 8,200 has returned.

The Virginia-based Loudoun Medical Group opened a free clinic in the historic train depot. Despite complaints from some area doctors, city officials have asked the group to stay until April.

Harold "Buz" Olsen, the city’s community and economic development director, said between 40 and 80 patients a day visit the clinic for a variety of injuries and illnesses, including the nagging respiratory ailment locals have taken to calling "Katrina crud."

"It fills a need. It really does," Olsen said of the clinic. "This is a place that’s helping those who don’t have the wherewithal to pay."

A day after Katrina demolished his Bay St. Louis office, Dr. James Crittenden raised a tent in his parking lot and started treating patients – both those who could pay and those who couldn’t. His income has dropped around 40 percent since the storm, but the internist said he views free care as an investment, not just a public service.

Still, he wants local doctors providing the care – not the clinic.

"The only way we can get back up and running is to put the patients back in the system, whether they’re free or paying," Crittenden said.

Faith-based groups run many of the free clinics, including one at Bethel Lutheran Church in Biloxi, farther east on Mississippi’s coast. Judy Bultman, who worked at a Veterans Affairs hospital in Gulfport that was leveled by Katrina, now spends her days managing the clinic.

Many of the patients who visit her clinic are newly unemployed but have annual incomes that disqualify them from Medicare, she said. Those patients, she added, wouldn’t help pay private doctors’ bills.

"I’m not doing battle with anybody to keep this clinic open," she said. "We’re trying to respond to the needs, the unmet needs, of the people."

Dr. Rowe Crowder downplays the friction between local physicians and the free clinics. Still, the 41-year-old internist has grave doubts about staying in his native Bay St. Louis.

At least once a day, he fields a phone call or e-mail from a recruiter dangling a job that would take him far from the devastation. The offers tempt Crowder, who lost his home and two offices to Katrina.

These days, Crowder lives in a donated trailer home and treats patients in another trailer parked outside Hancock Medical Center in Bay St. Louis. He works for the hospital now, earning a salary less than half of what he made before the hurricane.

"Going to work for the hospital was a way for me to stay here and be part of the rebuilding," said Crowder, whose post-Katrina office attire often includes an untucked polo shirt, shorts and sockless loafers. "But I’m not in a position to do a kamikaze run and wipe myself out financially."