[Congressional Record Volume 140, Number 51 (Tuesday, May 3, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


[Congressional Record: May 3, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                              HEALTH CARE

                                 ______


                           HON. CHARLIE ROSE

                           of north carolina

                    in the house of representatives

                          Tuesday, May 3, 1994

  Mr. ROSE. Mr. Speaker, while we continue to strive toward improvement 
of America's health care system, to serve all of our citizens better 
than today's coverage, I wish to call attention to a report in the 
Washington Post dated May 2, 1994.
  The Post tells of the dedication of Beverly Spivey, MD, to the 
uninsured poor people who are sick and disabled in Cumberland County. 
It relates how Dr. Spivey's heroic efforts serve those unfortunate 
citizens who have fallen between the cracks of our present health care 
system.
  This report demonstrates the urgency of covering all of our citizens 
not only with emergency care, but also preventive medicine.
  Dr. Spivey cannot meet those overwhelming needs alone. She deserves 
our appreciation and our assistance.
  The Washington Post accurately depicts the situation in my district 
and, I am sure, the problem throughout our Nation. I ask that the 
report be inserted at this point in the Record.

                [From the Washington Post, May 2, 1994]

 Poor Patients Left With Little Choice--Informal Rationing Is Fact of 
                Life at Public Clinic in North Carolina

                         (By Kenneth J. Cooper)

       FAYETTEVILLE, NC.--The poor, disabled, uninsured and sick 
     of Cumberland County have little choice but to see Beverly 
     Spivey, the only full-time doctor at the county's public 
     health clinic.
       ``If they don't like me, tough. If I don't like them, 
     tough. They don't have any place else to go,'' Spivey said.
       So come they do, 30 to 40 a day. Private doctors have 
     turned away some of Spivey's patients because they cannot 
     cover the fees. Others have never tried to visit a private 
     physician, not wanting to subject themselves to the 
     humiliation of a possible rejection. Still another group 
     lacks insurance and has avoided going to any doctor until the 
     pain overwhelmed their fear of the cost.
       While Washington lawmakers working on health care reform 
     worry about preserving the choice of doctors that most 
     Americans enjoy, Spivey's patients have almost none today 
     because of gaps in insurance coverage and inadequate numbers 
     of family practitioners.
       While legislators talk about preventive health measures, 
     Spivey's patients demonstrate what happens when they are not 
     available.
       And although members of Congress rail at the threat of 
     rationed care, Spivey's patients face informal rationing 
     based on the price of medical services and prescription 
     drugs.
       This Fayetteville clinic, understaffed and inundated with 
     chronically sick patients, illustrates the difficulties of 
     overhauling the health system in areas with few doctors and a 
     great deal of poverty, illiteracy and illness.
       Spivey asked her patients to bring along to their 
     appointments any prescription drugs they take, and some 
     arrive with empty vials or lists of unfilled prescriptions, 
     hoping for free medication. For those suppliants, Spivey 
     said, the clinic has no pharmaceutical supplies other than 
     drug company samples.
       ``People think that government equals free, and that is a 
     big, big problem,'' she said. ``I can't give everybody who 
     walks in the door their medicine.''
       An afternoon in the Fayetteville clinic, one of about 1,500 
     public health centers across the nation, puts a human face on 
     the outside-the-Beltway problems of implementing health 
     reform.
       This clinic, an island of service for the poor, would 
     itself probably have to change and grow under many proposals. 
     Even if every American had guaranteed access to health care, 
     doctors would have to be recruited to provide it, and clinics 
     are thought to need at least four doctors--not one--to 
     provide coverage on weekends and throughout the night.
       Spivey has followed the health reform debate and joined it 
     recently during a forum hosted by first-term Rep. Eva Clayton 
     (D-N.C.), who represents part of Fayetteville. Spivey, one of 
     five local health executives on a panel, said she felt 
     relieved to speak out about the clinic's limits and argue 
     that any health care overhaul must provide for family 
     physicians and prescription drugs for poor patients like 
     hers.
       ``I am the medical clinic. The clinic is a one-woman show, 
     and I am the woman,'' Spivey declared. ``Obviously, I can't 
     provide care to all poor people. We need more providers for 
     the poor when there's universal access'' as various health 
     care plans propose.
       Clayton and Jesse F. Williams, Cumberland County's public 
     health director, agreed that simply extending health 
     insurance coverage to all Americans would not solve the 
     problems of the clinic's patients.
       ``Just opening the doors to more patients--Can you imagine 
     her having more patients?'' Clayton said.
       ``You can give some people all the [health insurance] cards 
     in the world, and they're not going to get into some of these 
     doctors' offices,'' said Williams, a physician who trained at 
     Howard University. ``They don't look right. They don't smell 
     right. They come from the wrong side of the tracks.''
       Spivey came to the clinic in 1986 after a stint in a local 
     hospital's emergency room. She was trained at Duke 
     University, a research-oriented medical center where she said 
     that, for some, ``family practice was a bad word.''
       The clinic once had two nurse practitioners and a 
     physician's assistant, but they were not replaced after one 
     retired and the other two left for higher-paying jobs. 
     Williams said the aides' salaries were used to hire another 
     doctor who spends a day and a half at the shorthanded clinic 
     each week.
       The clinic receives half its $500,000 budget from the 
     county and most of the rest from state and federal payments 
     under Medicaid for the poor and Medicare for the elderly and 
     disabled. It is located on the third floor of a modern 
     building, erected largely with federal funds secured by Rep. 
     Charlie Rose (D-N.C.), that also houses county health offices 
     and a clinic for children and pregnant women. For other 
     uninsured adults, the remaining health care option available 
     in Cumberland County is a clinic operated by volunteers two 
     days a week.
       About 75 percent of Spivey's patients receive Medicare, and 
     most need at least three prescription drugs. ``Hypertension, 
     diabetes and arthritis. That's my average patient,'' the 
     doctor said. ``We also cover the [county] jail.''
       Williams said that the county health department had reached 
     a working agreement with area doctors: The clinic provides 
     ongoing treatment to poor patients the doctors don't want, 
     and in exchange private physicians take care of clinic 
     patients when they are hospitalized.
       Despite their great medical needs, Spivey's patients are 
     generally uninformed about the health care debate. A survey 
     conducted a few years ago, she said, found about 60 percent 
     cannot read. Five interviewed recently expressed only a vague 
     understanding of the debate. Paying their basic living 
     expenses preoccupies them, their doctor explained.
       But asked what they thought should be changed about the 
     health care system, the five patients had a unanimous 
     request: They want coverage of prescription drugs.
       ``About the only thing that would help me would be to get 
     some help to pay for my medication,'' said Lourise McLaurin, 
     a disabled widow on Medicare. ``I have to make a choice: Do I 
     buy food, or do I buy medication . . . just about every 
     month.''
       McLaurin, 61, showed up for her appointment clutching a 
     sandwich bag with four brown vials sealed inside. One had 
     been empty for a week, and would not be refilled for another 
     week when her $360 disability check was due to arrive. 
     Prescriptions for arthritis, high blood pressure, a bladder 
     problem and water retention in her ankles run about $80 a 
     month. She also takes pain relief pills regularly for her 
     back, which she permanently injured pushing her late husband 
     in his wheelchair during the years he was disabled from 
     strokes.
       Arceola Davis is supposed to take more prescription drugs 
     than she can afford or remember. Chronic headaches have 
     affixed a pained frown on her face. Then there is her 
     arthritis, high blood pressure, backache, high cholesterol, 
     sinus problem and heart condition, all of which require 
     medication.
       ``Sometimes a member of my family helps me with my 
     medicine,'' said Davis, 63. ``Mostly I go without it.''
       James Simmons of Autryville, who has suffered three heart 
     attacks and a brain tumor in his 58 years, has come up with 
     another way to manage his ``six or seven'' prescriptions. 
     ``Sometimes I split them up,'' he said, meaning he buys a 
     week's worth at a time.
       Loomis Smith, 52, making his first visit to the clinic, 
     complained that a stiff shoulder shot pain through his right 
     arm. A month before, a hospital emergency room referred him 
     to a neurosurgeon who wanted $200 that Smith did not have for 
     a diagnostic visit. Unemployed and uninsured, Smith said his 
     last job as a construction laborer offered health insurance--
     but only for foremen. ``That's lousy,'' he said.
       Last year, Smith did consult a private doctor who 
     prescribed medicine for his high blood pressure.
       ``It cost me $45 to see a doctor, then I got to get my 
     medicine, and I made $48 a day,'' he said. ``So to get around 
     it, you get around it. But now it's catching up with me.''
       Williams, the public health director, cited the need to 
     stress preventive medicine. ``There's a belief that as long 
     as you're not hurting, it's okay,'' Williams said. ``That 
     holds true for people who are educated. If you think they 
     spend a lot of time going to the doctor, it's not true.''
       Nearly every lawmaker engaged in the health care debate has 
     emphasized the need for preventive care. President Clinton's 
     plan would encourage the training of more family physicians 
     and other primary-care providers. His plan would also cover 
     prescription drugs.
       ``As I look at the existing plans, somebody has addressed 
     most of my concerns. But I understand politics, and I know 
     something has to be compromised,'' Spivey said. ``I hope it's 
     not something detrimental to my patients.''

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