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Category: Uncategorized
Niki Richardson
By Monica Simmons
Communications Coordinator
In 1973, Niki Richardson moved to Austin, pregnant with her second child. She searched for a doctor’s office that would accept a patient who planned an at-home birth. At the time, less than 3% of births in the U.S. occurred outside of a hospital, and doctors were unfamiliar with the practice. After several rejections, she found People’s Community Clinic, whose doctors and nurses wanted to support her in a home birth.
“I met Phil Zyblot, MD, Mary Barnett, CNM, Ken Blair, MD, Marie Draudt, and so many more who gave me great prenatal care when other clinics had immediately said ‘no, can’t help you,’” Niki said.
After a happy at-home birth, Niki set out to establish a collective of midwives. That collective, eventually known as Austin Lay Midwives, would become the first in Austin. People’s Community Clinic was their go-to clinic for prenatal care.
“People’s support was invaluable in helping us establish a strong home birth option in Austin in the early 70’s,” Niki said. “Without People’s, our mothers would’ve had a very difficult time finding a doctor willing to care for them.”
Today, as always, People’s care is focused on empowering patients and enabling them to take charge of their own health.
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This year is BIG for People’s Community Clinic. In 2020, People’s marks 50 years of providing affordable, accessible health care to Central Texans in need. That’s 50 years of serving Central Texas communities with dignity and respect; 50 years of collaborating with other area non-profits for integrative care; 50 years of working for #healthequity and #affordablecare in Central Texas. #Peoples50for50. https://www.austinpcc.org/make-a-gift/
Dr. Steve Crow
By Monica Simmons
Communications Coordinator
Dr. Steven Crow, People’s longest tenured employee, celebrates his 27th year at the clinic in 2020. His People’s story started in the basement of the Congregational Church, where the first clinic was held. Dr. Crow (then just an undergraduate at UT) began volunteering in 1983 during the beginning of the HIV epidemic, a time when little was known about the virus. People’s was the first location in Austin where patients could get anonymous testing. While working up to 90 hours a semester, Dr. Crow was immersed in a way of caring for patients that was distinct.
“This was long before HIV treatment, but that didn’t matter to [People’s doctor] Dr. Blair,” said Dr. Crow. “He’d spend as much time in the room as the patient needed. Sometimes that meant clinic would run really late, but that wasn’t as important as giving good care.”
The experience of working at the clinic inspired him to become the compassionate provider he is today. Dr. Crow says that the original ethos of People’s, to treat patients with dignity and respect, has remained the same throughout the nearly three decades he’s been a doctor.
“While many things have changed (new buildings, new technology, new faces), kind culture has always propagated over the years,” said Dr. Crow.
Thanks, Dr. Crow, for teaching us kindness and togetherness through your work.
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This year is BIG for People’s Community Clinic. In 2020 People’s marks 50 years of providing affordable, accessible health care to Central Texans in need. That’s 50 years of serving Central Texas communities with dignity and respect; 50 years of collaborating with other area non-profits for integrative care; 50 years of working for #healthequity and #affordablecare in Central Texas. Keep making stories like Fred’s possible with a donation to People’s.
Black Lives Matter
Statement of Support
People’s Community Clinic is committed to treating all people with dignity and respect. This charge embraces working against institutional racism in all its forms. The senseless killing of George Floyd goes against everything we hold dear. His brutal and inexcusable death was just the most recent in a long history of violence against Black people in America going back to 1619. It is a bitter reminder of all those—including Sophia King, Daniel Rocha, Kevin Brown, Nathaniel Sanders, Byron Carter Jr., Larry Jackson, David Joseph, Morgan Rankins, Javier Ambler, Mike Ramos, and others—who have been killed by police.
People’s will continue to expand our anti-racism efforts knowing that real change takes consistent, ongoing work. As the saying goes: “We have our own porch to sweep before we can sweep others.”
As a primary care clinic we know that systemic racism is a public health emergency – a driver of the health disparities that exist in this country, including the disproportionate impact of COVID-19 on communities of color, especially the African American community. Many of our country’s policies, which often lead to poor physical and mental health, were built on this same systemic racism.
We want our patients to know that People’s is here with both physical and mental health support. Our clinic offers a wide range of primary healthcare and our Integrated Behavioral Health team is here to help with mental health needs. For other resources in the community, people can search for a therapist whose location, identity, expertise and fees work for you at: https://www.inclusivetherapists.com/.
People’s Community Clinic sees anti-racism work as a journey, not a destination. We pledge to serve our patients and our community with dignity and respect while continuously striving to do better. We welcome your feedback.
Declaración de apoyo
People’s Community Clinic se compromete a tratar a todas las personas con dignidad y respeto. Este compromiso abarca el trabajo contra el racismo institucional en todas sus formas. El asesinato sin sentido de George Floyd va en contra de todo lo que valoramos. Su muerte brutal e inexcusable fue la más reciente en una larga historia de violencia contra los negros en Estados Unidos que se remonta a 1619. Es un amargo recordatorio de todos aquellos, incluidos Sophia King, Daniel Rocha, Kevin Brown, Nathaniel Sanders, Byron Carter Jr., Larry Jackson, David Joseph, Morgan Rankins, Javier Ambler, Mike Ramos y otros, que han sido asesinados por la policía.
En People’s continuaremos expandiendo nuestros esfuerzos contra el racismo, porque sabemos que el verdadero cambio requiere de un trabajo constante y continuo. Como dice el refrán: “el buen juez por su casa empieza.”
Como clínica de atención primaria, sabemos que el racismo sistémico es una emergencia de salud pública; un elemento impulsor de las disparidades de salud que existen en este país, incluyendo el impacto desproporcionado de COVID-19 en las comunidades de color, especialmente la comunidad afroestadounidense. Muchas de las políticas de nuestro país, que a menudo se traducen en una mala salud física y mental, se construyeron sobre este mismo racismo sistémico.
Queremos que nuestros pacientes sepan que People’s está aquí entregando apoyo para la salud física y mental. Nuestra clínica ofrece una amplia gama de atención médica primaria y nuestro equipo de atención integral de salud conductual, está aquí para ayudarlo con sus necesidades de salud mental. Para acceder a otros recursos en la comunidad, usted puede buscar un terapeuta cuya ubicación, identidad, experiencia y honorarios sean los adecuados para usted en: https://www.inclusivetherapists.com/.
People’s Community Clinic mira el trabajo contra el racismo como un viaje, no como un destino final. Nos comprometemos a servir a nuestros pacientes y a nuestra comunidad con dignidad y respeto mientras nos esforzamos constantemente por mejorar. Agradecemos sus comentarios.
New Rules to the Public Charge Test Expected to Cause Confusion for People’s Patients*
By Monica Simmons | Communications Coordinator
In August, the Trump Administration announced a change to the public charge test, designed to discourage immigrants from accepting government benefits. (A “public charge” is a legal term that refers to a person who is dependent on the government for support.) The Administration’s new guidelines are written to target immigrants in three instances: those who are in the process of applying to 1) enter the country, 2) receive a green card, or 3) extend a work visa. However, these changes will likely discourage many more immigrants from seeking and accepting services for which they or their family members qualify. The new public charge rules go into effect February 24, though any applications in before that date will be subject to the old public charge test.
“The first thing to know about this change,” said Keegan Warren-Clem, JD, LLM, Managing Attorney at People’s Medical-Legal Partnership, “is that information put out by the administration, including a leaked memo and a leaked draft of the new rule, has created a lot of confusion.” In the Administration’s effort to limit disbursement of aid, “they created misunderstandings that have resulted in people staying away from public benefits—even when they are entitled.”
Warren-Clem notes that the final rule contains an estimate that 382,264 legal immigrants nationwide annually will be affected, but that the financial impact includes the 334,070 others who are expected to disenroll or forego enrollment in a public benefits program.[1]
So what are these controversial new guidelines? In addition to the existing limitations on SSI (Supplemental Security Income), TANF (Temporary Assistance for Needy Families), and long-term care Medicaid, immigrants already in the U.S. who are extending their visa or applying for a green card may also want to think twice about accepting the following benefits: SNAP (food stamps), Section 8 housing vouchers, and some types of Medicaid.
Another point to keep in mind: immigrants would only be subject to the public charge test if they are the individual receiving the benefits. For example, the rule does not apply to the parent of a child who receives Medicaid benefits.
In reality, Warren-Clem estimates that most of those who will be affected do not live in a state like Texas, where benefits are largely not available to non-citizens. Additionally, there are many exceptions to the rule. For instance, there are a variety of Medicaid benefits that would not be a mark against someone seeking a visa or green card. Certain kinds of Medicaid—for recipients who are pregnant, under 21, needing emergency services, or youth receiving school-based Medicaid— will not put someone at risk.
“The rule ultimately affected a fairly narrow population,” said Warren-Clem. “But, understandably, the initial confusion caused fear and people are afraid to apply. Clinicians are unsure; patients are unsure. The MLP is available and will continue training staff and the community on this issue as well as counseling individuals.”
Before the new rules go in to effect on February 24, 2020, here are the big takeaways to know:
- At People’s Community Clinic, we do not collect immigration information from our patients.
- The rule applies to only immigrants who themselves receive the benefit.
- The rule does not affect undocumented persons or those seeking citizenship.
- Immigration applications and petitions received before February 24, 2020, will not be held to the new rule. It also means that any newly included benefits—SNAP, Medicaid, and housing—that were received before this date are not counted.
- It is possible that accepting benefits will not disqualify someone from receiving their green card or work visas. The new public charge test creates a threshold: if a benefit is received for more than twelve months in a thirty-six month period, an individual is likely to be denied immigration status. Each benefit counts separately; in other words, if two benefits are received in one month, it counts as two months. But the test considers many factors, including private health insurance, income, resources, age, family situation, and health. Individuals with health conditions, low incomes, or who are very young or old, for example, can present other positive factors to demonstrate that they are not likely to rely on the government in the future.
- Sometimes getting help is all that matters. Each family should consider their own situation and weigh the benefits of getting help versus not getting help. For example, temporary receipt of public benefits might provide the kind of stability that allows a family better long-term prospects.
*The information provided in this article does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available are for general informational purposes only.
[1] 84 Fed. Reg. 41463 (Aug. 14, 2019), available at https://www.govinfo.gov/content/pkg/FR-2019-08-14/pdf/2019-17142.pdf.
High-Quality Care Earns People’s Community Clinic Recognition as Top 10% Leader
(Austin, TX – October 17, 2019) — People’s Community Clinic has been recognized by the U.S. Department of Health and Human Services for exceeding federal health center standards in 2018. Specifically, People’s is distinguished for its excellence in the categories of: Advancing Health Information Technology (HIT) for Quality Care, Increasing Access to Care, Health Center Quality Leaders (top 10%), Reducing Health Disparities, and Achieving Patient-Centered Medical Home (PCMH) Recognition.
“For nearly 50 years, People’s has provided access to affordable and high-quality health care for those in our community lacking insurance or unable to afford medical services they need,” said Regina Rogoff, CEO of People’s Community Clinic. “We are especially proud that People’s is acknowledged as a leader, in the top 10%, in addressing health disparities across racial and ethnic groups. This recognition is very meaningful as we work to deliver health care with dignity and respect to our diverse community.”
Rogoff continued, “Millions of Americans, including thousands of Central Texans, rely on health centers for their primary medical needs. These quality improvement awards will support health centers working to deliver superior health care that engages patients, improves care coordination and bridges overall access to care.”
The Health Resources and Services Administration (HRSA) also released new data showing that in 2018, nearly 28 million people — about one in 12 Americans — relied on a HRSA-funded health center for affordable, accessible primary health care.
For a list of all organizations that received Health Center Quality Improvement awards, visit https://bphc.hrsa.gov/programopportunities/fundingopportunities/qualityimprovement/index.html.
To learn more about HRSA’s Health Center Program, visit http://bphc.hrsa.gov/about.
Fred Blackman, Board Chair
By Monica Simmons
Communications Coordinator
Fred was standing in the shower getting ready for work when suddenly he felt a sharp pain in his back. He fell as his legs collapsed beneath him. He was rushed to the hospital where, it was discovered, a slipped disk had shot out and damaged his spinal cord. A five month stay in the hospital and just as many surgeries later, Fred had lost his job— along with his medical insurance. That’s when doctors at St. David’s referred him to People’s Community Clinic.
Disabled from the spinal injury, Fred came to People’s unable to walk and had difficulty speaking. Before, he had always been successful at supporting his family of seven children, but with the deterioration of his health and the subsequent loss of his job, Fred found himself in a dark place.
Slowly but surely the People’s care team helped turn his life around. People’s has provided Fred an array of services including doctor visits, acupuncture, diet counseling, and legal intervention. Fred also sees a licensed master of social work who has helped him navigate his new reality. Thanks to the integrative medicine that took care of his medical, legal, and behavioral health needs, and Fred’s own determination, he is walking, talking, and living a full life. Now, he gives back to the community as a minister and serves on People’s Board of Directors.
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This year is BIG for People’s Community Clinic. In 2020 People’s marks 50 years of providing affordable, accessible health care to Central Texans in need. That’s 50 years of serving Central Texas communities with dignity and respect; 50 years of collaborating with other area non-profits for integrative care; 50 years of working for #healthequity and #affordablecare in Central Texas. Keep making stories like Fred’s possible with a donation to People’s.
Nancy Lozoria
By Monica Simmons
Communications Coordinator
The first time Nancy Lozoria walked into People’s Community Clinic she was 15, pregnant, and without secure housing.
“The reason why my husband and I kept coming back to People’s was because they never made us feel like young, dumb teenagers,” said Lozoria. “They gave us relevant information about birth control and pregnancy, but we always knew the choice was ours.”
After suffering two miscarriages, Lozoria was comforted to learn from Health Educators that many women experience multiple miscarriages before having a viable pregnancy. At 18, she decided to take hormonal birth control to avoid pregnancy until she graduated from high school, and until she and her husband could afford their own place.
People’s helped Lozoria get up to date with her immunizations so that she could return to high school. Financial counselors worked with them to connect them with support services. Social workers counseled Lozoria and husband Hondo through the uncertain period of time when both their families had kicked them out of their respective homes.
Seeing so many sides of the organization, Lozoria said to herself, “one day I’d like to be one of the people helping. One day, I’d like work here.” Little did she know exactly how her dream would come true.
Eventually, Lozoria did have her much-hoped-for baby, daughter Araceli. A new chapter in her life began as she asked herself the big question: “what kind of life do I want my kids to have?” That’s when she decided to quit working retail jobs and start her career as a Dental Lab Technician. She went to school and was hired for her first job at a private dental practice. Then Lozoria landed at St. David’s program, where she was the Dental Assistant on a van dubbed “T4.”
Fast-forward to 2018, when St. David’s Foundation donated the same fully equipped van to help People’s jumpstart its dental program. Lozoria was hired to bring the program to life, fulfilling her wish to give back to the organization that helped her through her tumultuous teen years.
Responsible for getting People’s Dental Department running, she worked carefully with the People’s operations team to design the program, oversaw the installation of the van where patients receive care, and helped find a dentist who was “just the right fit” for People’s. Lozoria also coordinated the special design of the van wrap, which now stands out in the Camino La Costa parking lot. Lozoria made sure that the tag “T4” painted near the door of the van remained visible, a token to remember how new beginnings are always possible.
“We try our best to show patients that they are in control of what goes into their mouth,” Lozoria said with a laugh. “Just like any other department at People’s, we’re all about empowering the patient with options.”
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This year is BIG for People’s Community Clinic. In 2020 People’s marks 50 years of providing affordable, accessible health care to Central Texans in need. That’s 50 years of serving Central Texas communities with dignity and respect; 50 years of collaborating with other area non-profits for integrative care; 50 years of working for #healthequity and #affordablecare in Central Texas. Keep making stories like Fred’s possible with a donation to People’s.
Nurse Candice Trulson
By Monica Simmons
Communications Coordinator
This week we’re kicking off our #Peoples50for50 project with a story from Nurse Candice Trulson, who has been at People’s Community Clinic since 2001.
Candice is one of those people whose doesn’t call her job a “job,” rather, a calling. When she was a little girl—an immigrant from Vietnam—she had an experience that changed the course of her life. As the family awaited entrance into the U.S., her mother endured terrible suffering in a refugee camp where she was unable to receive medical care. It was then that Candice made it her personal mission to do what she could to undo the injustice and inequality in the healthcare system.
“Health care should be blind,” said Candice. “There is no creed, color, no race, and certainly there is no monetary value when you deliver medical, dental, any services that help to heal that person.”
As an adult, Candice worked at several health centers before coming to People’s where she found the mission and culture aligned with her own.
“People’s provides services that I don’t see in other clinics,” Candice said. “We offer wrap-around care that makes a big difference in our patient’s lives.”
Nursing, she says, is a noble career, but one that is often invisible. Still, she wouldn’t change a thing about the path she’s chosen.
“Nurses are the ones who manage patients over the phones. We’re the ones on the receiving end of a patient’s amazing story that causes pain, anger, fatigue, sometimes joy,” said Candice. “We are privileged to be trusted with their deepest moments.”
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This year is BIG for People’s Community Clinic. In 2020 People’s marks 50 years of providing affordable, accessible health care to Central Texans in need. That’s 50 years of serving Central Texas communities with dignity and respect; 50 years of collaborating with other area non-profits for integrative care; 50 years of working for #healthequity and #affordablecare in Central Texas.
The Doctor – and Lawyer – Will See You Now: Medical-Legal Partnerships [News from Texas Medical Association]
Originally published on TexMed.org.
Elderly woman. Low-income. Chronic pain. Needs to see a rheumatologist. Needs physical therapy. Struggling to pay rent. Has no insurance. Has no disability coverage.
As a family physician at a federally qualified health center (FQHC) in Austin, Sharad Kohli, MD, sees a lot of cases like this. In similar health care settings, the patient might face two bad choices: wage bureaucratic war to obtain better health care benefits or simply give up.
At People’s Community Clinic, Dr. Kohli referred her to an in-house lawyer who successfully appealed her denial of disability insurance.
“[The lawyer] got her a significant income, which allowed her to pay her rent and also helped her get insurance through Medicaid and Medicare,” Dr. Kohli said. “And then she was able to see the rheumatologist and the physical therapist.”
This kind of success helps explain why medical-legal partnerships (MLPs) like the one at People’s Community Clinic came about in 1993 and began expanding nationally after 2001. Texas has 10 MLPs – all in large or medium-size cities and all tied either to hospitals or FQHCs like People’s Community Clinic, according to the National Center for Medical-Legal Partnership in Washington, D.C. Texas MLPs stand among 333 nationwide.
Given the relative scarcity of MLPs, most Texas physicians have no experience in coordinating patient care with a lawyer.
“This is the first place I’ve ever worked with a lawyer, and to me it’s been mind-blowing,” Dr. Kohli said. “A lot of times in the past I was just frustrated. I didn’t know what to do. And now we can have a lawyer here who can say, ‘Here’s what we can do. Here’s the next step.’
“These are lawyers who are really a member of the health team,” he added. “For me, it’s an opportunity to have [the patient’s] needs met, to have good communication, and it’s another team member that I trust in the clinic.”
An MLP can form when at least one medical entity creates a formal relationship with at least one legal entity in an effort to improve health care, says Tanweer Kaleemullah, a lawyer and policy analyst with Harris County Public Health who has been co-leading a statewide coalition of MLPs.
Some MLPs, like the one at People’s Community Clinic, have full-time lawyers on staff who work directly with physicians (tma.tips/PeoplesClinic). Usually the doctor-lawyer relationship is looser, however, and the legal help often is done part-time or with the help of volunteers.
Despite their diverse structures, MLPs tend to do similar types of legal work on behalf of low-income patients, says Mr. Kaleemullah. Some issues are tied directly to a clinical visit, like preserving health insurance or fighting the denial of prior authorizations. Others can include housing, transportation, wills, and guardianship.
The physicians are familiar with the lawyers, and that makes it much easier for both the physician and patient to trust that the legal work will help the patient, says Celina Beltran, MD, a family medicine specialist and medical director at the El Paso FQHC Centro San Vicente Family Health Center.
“Since we’re the primary care provider, [patients] feel comfortable coming to our center, and they feel comfortable letting us in and letting us know what’s going on in their lives,” she said. “So this enables us to take that one step further and help them from a medical and legal perspective. And overall that has a huge impact on their daily lives and, of course, ultimately on their health.”
Beyond the exam room
MLPs often help physicians cope with the social determinants of health – the factors outside the clinic that affect a patient’s well-being. Most cases deal with public benefits, housing, education, and guardianship, along with immigration and special education. (See “IHELP,” page 38.)
For instance, a typical MLP case might involve a low-income family living in an apartment where mold is making a young person sick, says Keegan Warren-Clem. She is an Austin lawyer and founding director of the Austin Medical-Legal Partnership, a collaboration begun in 2012 between two nonprofits – People’s Community Clinic and Texas Legal Services Center.
“If we have an asthmatic child whose physician is prescribing oral steroids and inhalers, and he’s still going to the pulmonologist, still presenting in the emergency room, still missing school, and mom and dad are missing work, what we need to be doing is looking at what is going on in the environment that is the root cause,” she said. “In this case, an attorney has tools to ensure that, for example, the landlord is following state and local laws that promise clean living conditions.”
The People’s Community Clinic MLP has three lawyers contracted to provide full-time legal care. Each lawyer sits in on patient conferences with the entire health care team made up of physicians, nurses, social workers and others, Dr. Kohli says.
Texas Children’s Hospital in Houston takes a different approach. It partners with the nonprofit Houston Volunteer Lawyers to provide one full-time and one part-time lawyer to help screen patients with legal needs. Those two lawyers handle some cases directly, but most of the work is handed off to area lawyers working pro bono.
Tom Mendez, the full-time lawyer, says this gives Texas Children’s two advantages: It can call on a large pool of legal talent, and it can find lawyers who specialize in the area of law that’s needed, such as housing or benefits.
Lawyers and physicians have to get used to working with each other, he says, and some physicians see lawyers as adversaries, not allies. So MLP lawyers say they take the time to train doctors and health care staff.
“Part of the work we do is educating the health care providers about the services that we offer – the types of issues that families often see that we can assist with,” Mr. Mendez said.
The cases that come up most frequently for Texas Children’s involve guardianship, physicians there say. For instance, when a minor with developmental disabilities turns 18, a family member may need to be named guardian to care for him or her, or the family may try an alternative to guardianship. In many cases, low-income families would not be able to afford to hire a lawyer on their own for this process.
Culture of advocacy
While helping individual families is important, MLP lawyers also allow medical practices to go a step further by influencing public policy. For instance, in 2018 the lawyers at People’s wrote a letter on behalf of the physicians there opposing the “public charge” rule, Dr. Kohli says.
That rule by U.S. Citizenship and Immigration redefines how immigration officials will classify many legal immigrants as a public charge, or dependent upon public services, when determining citizenship. The rule is widely expected to discourage legal immigrants and their families from seeking medical care. Virtually all physician professional groups – including the Texas Medical Association – have called for it to be withdrawn. (See www.texmed.org/PublicChargeRule.)
“If we really want to be addressing social determinants, which we know affect health in such an important way, we have to actually go further upstream, and the lawyer allows us to do that,” Dr. Kohli said.
People’s Community Clinic plans to hire more lawyers soon thanks to new partners and new funding. But keeping the lights on in the early days of the MLP was rocky, says Ms. Warren-Clem. Many MLPs still find it hard to generate funding.
For instance, Centro San Vicente in El Paso has partnered since 2009 with Texas RioGrande Legal Aid, which until recently provided a lawyer every Friday for patients to consult with. However, the lawyer can now come only every other Friday because of lost grant money, Dr. Beltran says, and that means fewer patients will be able to get assistance.
“It’s a service that’s very much needed,” she said. “It’s been a tremendous help to many of our patients.”
In 2018, Texas MLPs formed a statewide group, the Texas Medical-Legal Partnership Coalition. The group aims to increase the capacity of existing MLPs, says Mr. Kaleemullah, who helped organize the coalition. It also was created to help anyone starting an MLP and to influence public policy. (See “Starting a Medical-Legal Partnership,” below.) The group holds monthly meetings among lawyers and quarterly meetings that include physicians.
When People’s Community Clinic created its MLP, some board members expressed concerns that offering legal services constituted “mission creep” for a medical clinic, says Ms. Warren-Clem.
However, as with most MLPs, patient care comes first, and physicians have the final say, says Dr. Kohli. If legal services are deemed necessary, it’s the physician who makes a referral through the patient’s electronic medical record.
“It’s the same as if you made a referral to behavioral health in-house,” he said.
Tex Med. 2019;115(10):36-38
October 2019 Texas Medicine Contents
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