THE BEERSHEBA SPRINGS MEDICAL CLINIC
Garrett Adams, MD, MPH
We were on the porch of our summer home in Beersheba Springs, Tennessee. Our dear friend, Josephine, was bent over in pain holding the right side of her swollen, red face. I was alarmed; she had a serious sinusitis with accompanying cellulitis.“ Josephine, you must go immediately to get medical care. You have a serious infection,” I told her. Josephine was in her eighties. I had known her all of my life.
Before the Civil War, Beersheba Springs was a famous resort on the Cumberland Plateau, part of the Appalachian Plateau that extends from New York state to central Alabama. In Tennessee, it is a broad flat-topped ridge 1,000 feet above the valley.
My grandchildren are the sixth generation of my family at Beersheba. When my father’ s mother was 14 the family’ s summer plans were to stay home in Nashville, but she writes in her memoir that fate intervened.“… The Monday morning that final exams began in the Public Schools, the children were sent home; the schools closed; cholera was pronounced epidemic! Papa got home almost as soon as I did. I heard him say,‘ We will go to Beersheba tomorrow.’” 1
Josephine did get treatment for her infection. She went to a hospital 40 miles away which is part of a large for-profit chain with business in 22 states, LifePoint Health. Her bill was about $ 2,300; she didn’ t have Medicare, because in her working years she found it more necessary to have all of her paycheck for her family rather than to have some removed for her future health needs. All she had was her savings.
The bill was unreasonable. Lane and I went with her to speak with the hospital cashier; they reduced it significantly. The following is a quote from LifePoint’ s 2016 proxy statement:
“ When patients are experiencing personal financial difficulties or have concerns about general economic conditions, they may choose to:
• defer or forego elective surgeries and other non-emergent procedures, which are generally more profitable lines of business for hospitals; or
• purchase a high-deductible insurance plan or no insurance at all, which increases a hospital’ s dependence on self-pay revenue.
“ Moreover, a greater number of uninsured patients may seek care in our emergency rooms.
“ The occurrence of these events may impede our business strategies intended to generate organic growth and improve operating results at our hospitals.”
In 2015, LifePoint’ s CEO & Chairman’ s compensation was more than $ 15 million. 2
My wife, Lane, and I purchased a Beersheba cottage in 1984. Josephine was one of the local mountain people we came to know and to love. This incident drove home to me the dire economic circumstances of many of our friends. I resolved to help.
I went to see a longtime resident who knew the community leaders. I said,“ We need a medical clinic in Beersheba, what can we do?” We assembled a small group and met on his porch.
First, we sought to determine the current availability of medical care in our area. Aside from the Grundy County Health Department, all medical facilities within reasonable traveling distance were too expensive. There were three hospitals in the general area, two run by LifePoint and one“ not-for-profit,” St. Thomas River Park Hospital in McMinnville( 35 miles away). Cost was an insurmountable barrier to care. Residents of our community simply could not afford health care.
The Health Department was convenient, but there were restrictive regulations. For example, the Health Department could not serve anyone with health insurance. I recently saw a woman with a $ 6,800 deductible Humana plan. She was not eligible for services at the Health Department, because she had“ insurance.” Additionally, a cultural barrier exists between the mountain community and the Health Department. There is subtle suspicion,“ They ask too many questions.” Recently, St. Thomas River Park Hospital partnered with us in providing pro-bono diagnostic imaging studies for our uninsured patients— a wonderful boost for our clinical work. St. Thomas Health in Nashville also gave us a generous financial award, and we are cooperating with them in other areas.
We established organizing principles. First, the clinic was to be of, for and by the community; a population of 476 souls. It was to be secular, i. e., non-religious. We decided not to take insurance payments, thus avoiding the hassle and paperwork of billing insurance and allowing us to keep our staff size small. We wrote bylaws and secured a charter from the state as a volunteer not-for-profit medical facility, named the Beersheba Springs Medical Clinic. With the assistance of the Legal Aid Society, I wrote the 501( c)( 3) tax-exempt application.
We rented a double-wide mobile home and, with labor donated( continued on page 14)
12 LOUISVILLE MEDICINE