Doctor faces gut-wrenching decision over patient care

SANTA CRUZ -- Jennifer Hastings didn't become a doctor to close doors. Her goal has always been to care for the down-and-out.

But last month, at a management meeting for the downtown Santa Cruz Planned Parenthood, where she works as medical director, Hastings found herself discussing a proposal to refuse new Medicare patients. They required such frequent appointments and had such complex medical needs -- and the clinic already was stretched so thin.

It was difficult for Hastings and her colleagues to stomach the idea of turning people away, especially elderly and disabled people who couldn't find doctors elsewhere.

"We'll become like the other offices who can't take Medicare," Hastings lamented. "And that breaks my heart, to have a door close."

In the end, the clinic's management team decided not to do it. They thought that caring for those in need was simply too fundamental to their mission.

Still, Hastings' worries reflect the growing pressures on the county's health safety net -- clinics and emergency rooms that care for patients who would otherwise fall through the cracks. Even as the economic downturn is forcing growing numbers of uninsured patients to their waiting rooms, those clinics also see more Medicare patients turning to them for care.

Almost universally, Dr. Hastings' patients adore her. She remembers the sensitive details of their personal lives. She's quick to hug them, or hold them when they cry. She still occasionally makes house calls.

Hastings, 53, didn't start her medical schooling at UC San Francisco until her early 30s, having spent her 20s painting and teaching art to low-income elementary school kids in a dying mill town in western Massachusetts. During her medical residency in Santa Rosa, she and her future husband helped found a community clinic for that city's poor.

In 1998, they moved to Santa Cruz. The Planned Parenthood job seemed a perfect fit.

Hastings arrives at the crowded downtown clinic around 8 most mornings. She shares a tiny office, crammed with desks and files, with several other clinicians. Fridays she performs abortions. Other days, she sees a steady stream of patients, male and female, young and old.

Many have Medicare: There's 60-year-old Dirk Reed, who suffers from disabling depression and has christened Hastings his "Woman of the Year." There's 90-year-old Elba Carrasco, who had a stroke two years ago, and proudly calls Hastings "mi doctora." There's 76-year-old Joan Armstrong, who brings gifts of quilts and crocheted potholders, and credits the doctor with saving her life three different times.

One result of the clinic's decision not to limit the number of patients is that Hastings has less time for each visit. For elderly patients with half a dozen or more complex ailments, 15 to 20 minutes a month hardly seems sufficient.

At least some, she believes, "should be in other medical homes."

Her colleague, Morgan Stryker, a physician assistant at the clinic who's provided care to the community's low-income residents for decades, is more blunt about his frustration with private doctors.

"So lobby for better reimbursement," he said. "Who's going to see your neighbor while you're telling them you won't see them?"

"I'm happy to see them as a physician assistant," he added. "But, come on. They deserve better."

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