Two tiny towns struggle after their clinics close

Jeff Fleming contracted rhabdomyosarcoma, a malignant soft-tissue tumor most often found in children, at age 5. He spends most of his time in his temperature-controlled bedroom in Doyle. His parents provide 24-hour care, but when he's ill, it's a long rid

DOYLE – Just before the turnoff into this tiny community, near the shuttered Burger Barn, a sign announcing Doyle's existence also hints at its fade toward oblivion. Underneath the name of the local clinic, Doyle Family Practice, someone has added the words: "Temporarily closed."

Last summer, state budget cuts forced the Doyle clinic – along with five other rural health or dental clinics in far Northern California – to close. Since then, the isolated stretch of highway connecting this high desert community in Lassen County to Susanville, 42 miles northwest, and Reno, 46 miles southeast, has become a major obstacle for people in need of health care.

Many of Doyle's residents are elderly or poor, often unable to find a ride to either city and too broke to afford gas to drive themselves.

"We all depend on that clinic and it's a very big hardship not to have it," said Alice Sarmento, 61, a retired tow truck driver who suffers from a heart condition, asthma and chronic pain.

Sarmento said she cancels appointments on days she doesn't have gas money to get to Reno. If there's an emergency, she'll either need to find a ride or wait 45 minutes for an ambulance.

"I could be dead by then," she said.

Since last summer, in addition to Doyle Family Practice, medical and dental clinics have closed in Mendocino County, Humboldt County, Colusa County, Butte County and the little lumber town of Westwood in Lassen County. The Westwood clinic, along with Doyle Family Practice, had been operated by Northeastern Rural Health Clinics Inc. for three decades. Many other rural clinics have scaled back operations to remain solvent.

The closed clinics make up just a fraction of the more than 800 nonprofit clinics registered with the California Primary Care Association, but Sean South, the association's spokesman, says the past year's closures are abnormal and signal that residents have suffered a "significant loss in access."

"These are rural community clinics," he said. "It's not like there are options around the corner."

Last year's elimination of adult Denti-Cal funding, along with cuts in state grants aimed at improving rural health care, dealt a further blow to clinics already operating on extremely thin margins.

At the same time, a growing number of laid-off and newly uninsured workers sought services without the ability to pay their full cost.

South believes two dozen more rural clinics may be on the brink of closing as the state budget crisis drags on.


Community Lifeline Cut

Unlike urban clinics, which mainly serve the poor and uninsured, clinics in remote, rural towns serve everyone – from privately insured professionals to elderly retirees to schoolchildren.

In and around Doyle, many of those people now feel stuck. Public transportation is infrequent, so those who don't drive try to arrange carpools to clinics in Reno or Susanville. On days they can't manage that, they skip appointments, self-medicate and try to ride out illnesses in bed. Even middle-class residents with cars and health insurance are often reluctant to miss a day of work so they can drive to an out-of-town facility.

"I think some of them are just not coming in," said Patti Montgomery, who worked as a nurse at the Doyle clinic for 22 years.

Montgomery now commutes from Doyle to Susanville, where she spends a few days each month at Northeastern's remaining clinic and also works in private practice.

She recently examined a woman in her late 70s who formerly used the Doyle clinic regularly. The patient hadn't seen a doctor in more than a year.

"She said, 'Gas is too much,' " Montgomery said.

For nearly 30 years, Doyle was proud of its one-doctor clinic, located just down Highway 395 from the one remaining store, bar and large sign celebrating the community's "World Famous Lizard Races."

In 2008, 886 locals sought help there for everything from earaches to chest pains to chainsaw injuries. When people were unable to drive themselves, Montgomery had a list of people she could call. She or the doctor sometimes cared for the sickest patients in their homes.

"They treated us good, the people there," said Pat Sharp, 66, a longtime Doyle resident.

Last month, over their regular Tuesday lunch of boiled vegetables, meat and hard bread, Sharp and a dozen others at the local senior center lamented the clinic's closure.

"I credit them with saving my life," said Barbara Salamida, 76, who recalled rushing to the clinic while having a heart attack. Its staff stabilized her until she could be airlifted to a hospital in Reno, she said.

Gino Fleming, 76 – who has diabetes, arthritis and a few herniated discs – is most concerned about his seriously disabled adult son, who suffers from bouts of choking and severe nasal bleeding.

"What happens if he starts bleeding and I can't get it to stop?" Fleming asked.

Another Town Ailing

Janet Lasick, Northeastern's CEO, says that since the small satellite clinics in Westwood and Doyle closed, her organization has seen 1,300 fewer patients, a more than 8 percent drop.

She said as soon as finances and staffing allow, she intends to reopen both clinics – possibly in some reduced capacity. She's not certain when that will be.

"The mission of the health center is to serve these people," she said. "So if there's a possible way to do that, that's what we're going to do."

Lasick was not part of the management team that closed the two clinics. She took over in February, after the board kicked out the previous top managers.

Government audits from 2008 and 2009, before Lasick took over, identified serious concerns about the organization's financial statements. As a Federally Qualified Health Center, Northeastern receives federal grants and enhanced reimbursement rates.

While acknowledging issues with the previous management, associate medical director Dr. Paul Holmes said that what brought Northeastern to its knees last year was losing $500,000 from the state.

In Westwood, locals said the closure of their 30-year-old clinic feels like another nail in the coffin of a dying lumber town.

In the past year, the bank and pharmacy also closed. Much-discussed plans for a ski resort fell through – and with them, hopes for an influx of tourist dollars. Standing sentry in front of the preschool, a two-story redwood carving of hometown hero Paul Bunyan recalls Westwood's more vibrant days.

In 2008, 1,917 patients used the Westwood clinic. Now, the nearest health provider is 14 miles away in the town of Chester. Susanville is 23 miles away, over a pass. While access to care is easier than in Doyle, for those without transportation, such distances can seem insurmountable. Traveling becomes even more difficult when snow clogs the roads in winter.

"We don't go to the doctor when we need to; it's too much of a hassle," said Kathy Ferguson, 61, a computer teacher at the local elementary school.

She recently let kidney stones go four days without being seen. With no one in town to sub for her, she won't take the day off "unless it's absolutely necessary." When her granddaughter fell sick with mononucleosis, it took two weeks before they made it in to see someone.

Over at the senior center, 80-year-old Carrol Bollinger said he soldiered through a week and a half of abdominal pain, figuring he had appendicitis but not wanting to trouble anyone for a ride to the doctor.

He eventually wound up in the hospital, where doctors cleared a blockage and inserted a tube to pump out his stomach.

Without a clinic in town, Bollinger's game plan for the future is simple, if wishful: "You don't dare get sick."

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