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