Losing patients

After learning that the nation’s poor had the highest incidence of cancer and the lowest survival rate, Dr. Clarence Vaughn went to work in one of Detroit’s most impoverished neighborhoods.

"I decided I needed to work in the city," says Vaughn, now 72, who had practiced medicine in the suburbs for 17 years. In 1985, he began working at Detroit Mercy Hospital on the city’s east side. To combat the cancer plague that prompted the move, he founded the Mercy Oncology Clinic in 1990. As a result, state-of-the-art cancer treatment and care became available to the people Vaughn says most needed it but could least afford it – poor African-Americans.

When financial troubles forced Mercy to shut down in January, the cancer clinic also closed.

It may be too soon to tell how the hospital closing will affect the community. But Vaughn predicts that the loss of the clinic alone will be devastating.

"I think cancer care will decrease as a result of the closing," he says. "I’m sure there will be a big change in the mortality rate."

Affording access

For the past decade Mercy Hospital has been awash in red ink, suffering $100 million in losses. Like other nonprofit hospitals in southeast Michigan, Mercy was hit hardest in 1997 when federal and state leaders slashed health insurance programs Medicare (for the elderly and disabled) and Medicaid (for the poor). With nearly 80 percent of its patients enrolled in these programs, Mercy lost between $10 million and $15 million annually for the last three years, forcing it to shut down. It had served between 40,000 and 50,000 patients a year.

Nearly all of the 300 or so patients treated at the Mercy Oncology Clinic each month were covered by either Medicaid or Medicare insurance, according to Mary Kay Klatt, the clinic nurse coordinator. Many could not even afford transportation to the clinic, she says.

Willie Mae Steen’s son, Sam, who has lung cancer and a brain tumor, is one of those patients. Steen, 70, cares for her son because he is too ill to care for himself. For the last six years, she has seen to it that Sam did not miss a single chemotherapy appointment at Vaughn’s clinic. The free transportation Mercy provided made that easy, says Steen.

Now she must get her son to St. John’s Detroit Riverview Hospital, near Belle Isle, where Vaughn has been working since Mercy closed. But this hasn’t been easy. Riverview also has free transportation, but patients must call 72 hours in advance. When Steen called twice for a ride last month, she was told that the van was full.

"So I paid $50 for transportation ... and I’m on a fixed income," says Steen, whose son had three appointments in one week.

According to Riverview spokesperson Leslie Rochelle, since Mercy’s closing requests for transportation have increased substantially. "We are re-evaluating our transportation service based on the new demand," says Rochelle.

Steven Walker, who worked for Mercy’s transportation department for two years, is worried about what will happen to the 50 percent-to-60 percent of clinic patients who relied on hospital transportation.

"If they have to pay $20 a day for five days for chemo treatments and if you are on a set income, you can’t do that," says Walker.

‘Like family’

Before Vaughn set up the oncology clinic in the poor Detroit community, advanced cancer care and cutting-edge treatment there was nonexistent.

"I’m sure that many patients would not be alive today without the up-to-date care we provided," says Vaughn.

Cancer rates run high in poor communities because of living conditions and lifestyles.

"Eating habits, smoking, drinking, pollution, exposure to carcinogens at the workplace, just general living conditions," says Vaughn about cancer causes.

Vaughn had intended to extend the clinic services with antismoking programs and other cancer prevention efforts. Though the clinic closing cut short those plans, Vaughn notes what he did accomplish, including trusting relationships with his patients.

"We treat our patients like family, very openly," he says.

Lillian Conway, who was treated for two years at the clinic for a blood disorder, was part of that family. When the clinic closed, she went to Riverview hospital.

"When you get older and get used to going to a certain place you don’t want to make those kind of changes," says the 64-year-old Conway.

She says that she misses the special attention the cancer clinic staff gave her.

"If you missed an appointment, they would call you, they were concerned," she says. "We needed tender loving care and they supplied it."

More closings?

"It’s hard. It’s like leaving family," says Klatt. She now works with Vaughn at Riverview, but does not know how many patients will follow her and Vaughn there. Medicare allows patients more flexibility to choose their health provider, but most Medicaid patients are enrolled in HMOs, which dictate where they will be treated.

Klatt says that some cancer patients’ chemotherapy may be interrupted because those with HMOs have to schedule appointments to see their primary physicians, who then refer them to oncologists. This can take weeks, she says.

"It can be critical in delaying treatment," says Klatt. "But the delay is also critical to their frame of mind. Anxiety levels will rise. Understand, many patients have been here a long time and now are going to new surroundings, nurses, doctors, and that’s enough to scare anyone. Put yourself in their place."

Unless funding is restored to state and federal health care programs, more patients will continue to experience the uncertainty Klatt describes.

Health care providers in southeast Michigan have lost about $400 million since the Engler administration revised the Medicaid payment policy three years ago and the federal government cut the Medicare program, according to a report released last April by the Southeast Michigan Health and Hospital Council. Though the health care community has pleaded with the governor to restore this funding, he has refused. Engler’s office did not return Metro Times phone calls.

Without this money, many predict that more hospitals will close.

Detroit Mercy’s former CEO David Spivey shared that view with a crowd of about 200 who met last month to discuss the best use of the empty facility.

Many voiced outrage about the closing. Some suggested boarding buses to Lansing to protest Engler’s Medicaid cuts.

Spivey warned of a ripple effect: "Much of what has been our problem will be shifted to other health providers in Detroit. Their existence is tenuous."

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