EXCLUSIVE REPORTS

From the January 23, 1998 print edition
1998 American City Business Journals Inc.
Man with a mission
A quixotic retiree's quest for the poor
Rob Kaiser
Staff

Dr. William H.M. Finney can get a patient brain surgery for $5.

Finney isn't a miracle worker, nor is he an HMO's dream come true. He's a sharp-tongued, retired neurosurgeon with connections who runs Shepherd's Clinic, a medical center for the working poor in midtown Baltimore.

The 73-year-old Finney runs the place on a shoestring annual budget of $77,000, taking care of people with diabetes as well as leaky sinks.

"It's a long way from neurosurgery," Finney said.

Be that as it may, Finney believes he's caught onto an idea that can help solve two problems. By working out a referral agreement with a nearby hospital, Finney said, a clinic such as Shepherd's can give consistent care to uninsured people, while freeing the hospital's waiting room of patients in need of prescription refills and treatment for minor ailments such as twisted ankles.

The problem of treating the working poor is a very real one.

About 18 percent of Baltimore's population -- 126,000 people -- can be classified as working poor, said Dr. Peter Beilenson, the Baltimore City health commissioner. And that number should grow as the impact of welfare-to-work legislation is felt.

Despite this, Shepherd's Clinic doesn't quite fit into recent trends in the city's hospital community. Indeed, some Baltimore-area hospitals encourage patients in need of less-than-urgent care to come to their emergency rooms -- in a sometimes frantic bid for patients and their money.

It's part of the reason why Finney's clinic, while successful, hasn't been duplicated.

Where the poor get care

Finney didn't have the idea to start Shepherd's Clinic, which is on the corner of St. Paul Street and North Avenue, but few would dispute that he's the force behind its continued success.

The doctor himself credits the generosity of nearby Union Memorial Hospital, where he worked until 1990. The hospital treats the clinic's patients free of charge if they need more care than the clinic can offer.

"I don't know what we'd do without Union Memorial," Finney said.

The physician's grandfather founded Union Memorial, and his father, uncle and three cousins have worked there as surgeons.

William Finney retired from the hospital in 1990. Bored a week into retirement, he got a degree from the Johns Hopkins University's School of Public Health, where the closest student to his age was 34 years younger.

Finney then got involved with the clinic, which was started by Seventh Baptist Church in 1991. He set up the referral arrangement with the hospital, but even with the hospital's help, the clinic barely gets by.

Most of the money to run the clinic comes from area churches and foundations. Doctors and drug companies donate medication samples.

Patients pay for their care, but that is done more to promote personal responsibility than to support the operation. Patients with jobs pay an hour's wage per visit; others pay $5 to see a doctor.

Patients are required to make appointments and are expected to keep them. Anyone who misses three appointments is not allowed to return for six months.

The 25 doctors and 15 nurses who work in the clinic are volunteers. The only paid employees are the clinic's administrator and a part-time receptionist, who are both patients at the clinic and invaluable in being able to talk straight with other patients about keeping appointments and paying their bills, Finney said.

"They will give them a stamped envelope and really give them hell," Finney said. "We couldn't get to first base if we didn't have the right people out there to talk to them."

While visiting patients, Finney can be simultaneously gruff and caring.

One patient Finney recently saw was weak on his right side, limping and slurring his speech. The man, a welder at Beth Ship in eastern Baltimore County, believed his condition developed after someone came up behind him and struck him on the head. Finney thought he suffered a seizure.

When the man objected, the doctor said, "Don't tell me. I'll tell you."

The woman in the next room, a regular patient who is homeless, smiled and laughed and talked throughout the visit.

"Now don't talk for a minute, for a change," Finney told her half jokingly.

At the end of the check-up, Finney patted the woman on the back. "You'll live," he said, eliciting another smile from her.

For one patient, Finney arranged an operation to remove a brain tumor, but she went on medical assistance, making her ineligible to get care through the clinic.

"I had her lined up for a $5,000 operation for nothing," Finney said in disbelief.

In deciding who to help, the clinic avoids complications.

The clinic doesn't take people on Medicaid and Medicare, government programs for the poor and elderly because of the paperwork and oversight that comes with them, Finney said. The physician also asks patients if they have hired a lawyer as a result of their injuries.

Debating the merits

Despite Shepherd's limitations, health officials said the medical facility can make a difference.

"It's a very important public health role," said Beilenson, the city health commissioner. "They're filling a gap in the system. Basically, they are the primary care doctors for the uninsured in northern Baltimore."

Dr. Martin Binstock, vice president of medical affairs at Union Memorial, said having a clinic near the hospital helps determine whether a patient needs hospital care.

"We would provide care for them either way," Binstock said, adding that by coming from the clinic, patients arrive at the hospital properly screened and referred.

"It's a win-win situation," added Dr. Mark King, medical director of Union Memorial's emergency department. "It's good for patients, and it helps to reduce overcrowding in emergency departments."

But officials at other Baltimore hospitals said the best place to operate such a clinic may be in emergency departments.

"I'm not sympathetic to the argument that the emergency room is a bad place for care," said Dr. David L. Meyers, chief of the department of emergency medicine at Sinai Hospital. "We've always seen these kind of patients."

Sinai, which opened a new $16 million emergency department in December, included a fast-track area for patients with twisted ankles and minor burns or lacerations who don't need emergency care.

Meyers expects about 10 to 15 percent of the patients who visit his hospital's emergency room this year -- 5,000 to 7,000 people -- will be directed to the fast-track center.

Looking to the future

Dr. Gabe Kelen, chairman of the department of emergency medicine at the Johns Hopkins University School of Medicine, said his hospital may start a trial program to see primary care patients -- in the emergency room.

It is an "absolute myth" that emergency rooms are too expensive, Kelen said. Most of an emergency department's expenses are the fixed costs of equipment and keeping personnel on hand, so starting a primary care operation is more of an issue of whether there is enough space, he said.

One other big problem in trying to get somebody to duplicate Shepherd's Clinic is that neither Finney nor officials at Union Memorial can gather hard numbers to support the doctor's theory that the clinic eases emergency room overcrowding.

"The clinic is not big enough that we're going to be able to track that," said Binstock, of Union Memorial.

Officials from Helix Health, which owns Union Memorial and four other hospitals, visited the clinic last summer, but none has contacted Finney about starting a facility.

No other doctors have stepped forward to try to start a clinic in another part of the city.

Finney reacts to the lack of interest sardonically. "It's probably because years ago in Scotland they invented golf," he said.

Finney isn't just disappointed that nobody has appeared on the horizon to take on the challenge of starting another clinic. He's worried about Shepherd's, as well.

"I still have a concern at times that this clinic will be a one-generation operation," he said, "because who in the hell knows Finney when Finney is 6 feet under."


1998 American City Business Journals Inc.