Will CommUnityCare clinic closures help or hurt?

The shuttered AK Black Clinic Thurday June 16, 2016. JAY JANNER / AMERICAN-STATESMAN

The shuttered AK Black Clinic Thursday June 16, 2016. JAY JANNER / AMERICAN-STATESMAN

Editor’s Note: This blog entry has been updated.

The fallout continues over CommUnityCare’s decision to close two public clinics in Austin last month and shuffle services around at others. It’s worth noting that CommUnityCare receives property tax support from Central Health. The American-Statesman’s Julie Chang reported that although CommUnityCare officials  attempted to call and mail all patients information about the closures, the changes have left some of the area’s neediest patients surprised and looking for alternatives.

I reached out to Latino HealthCare Forum president Jill Ramirez via email for her thoughts and further insights into the closings. I’ve also reached out to Central Health officials for their response and hope to post those comments later.  Here’s the full text of responses provided by Ramirez:

How does closing these clinics — and sending patients to alternative clinics — improve the service level and quality of healthcare to the community?

Closing clinics and sending patients to alternative clinics can be beneficial if these clinics meet service gaps in access and whether the gaps are related to specific populations, specific areas of the community, specific health care services, etc. A community health assessment should be done to help identify those gaps. Once the gaps are identified, the community will be able to determine what model of care will address the community needs. The community must be engaged from the start and be involved in the discussions of service discontinuance and there should be a transition plan. In Central Health’s case, they have not typically engaged the community in services planning. Most of the (negative) issues they have brought on themselves have been the lack of involving the community.

Will transportation be an issue for any of the communities affected by the clinic closings?

Access barriers create discrepancies in the number, type, and timing of health services leading to poorer health status. Transportation is a commonly identified barrier to care but is understudied in terms of the detail needed to address more direct health and transportation policy interventions. Central Health has underestimated the impact of transportation in their service planning (see discussion of closing of Northeast Clinic closing below`). Central Health has not provided any information about the impact of clinic closings, transfer of services in terms of transportation. Typically they draw a linear line and estimate miles driven and don’t incorporate that a large part of the service population use the bus and don’t own cars and are elderly. Studies have shown that barriers such as distance, access to an automobile, and availability of someone to drive them to a clinic are potential major problems. Their lack of business planning with regard of transportation has been consistent.

Aside from transportation, what additional hardships might patients experience because of the closings?

Other barriers include disruption of treatment, loss of providers with which they are familiar, cultural and language issues, and personal experiences. More broadly, non-financial barriers are distributed unequally across the population and are felt in greater extent and depth in the poor, minority and other vulnerable populations. This may be due to not only the amount of care they receive but also the content, quality, and continuity of what care they do receive.

What type of communication did patients and the community as a whole receive prior to the closings? How could communication been improved?

Communication was always non-existent. Central Health has not learned from the best practices used in the development of the Southeast Health and Wellness Center in working with community health leaders that are trusted community members in understanding the service changes and assisting in communicating changes if warranted.

Are there any other clinic closings scheduled? If so, do affected communities know of the planned changes?

As discussed above, Central Health proposes to continue to close clinics, again without any discussion with community stakeholders. The most recent clinic is the Rosewood Zaragosa clinic.

Other thoughts on changes regarding clinic closures:

Central Health has not dealt with the community and neighborhoods in a transparent, collegial and respectful manner. Their track record reflects this:

  • Intrusion into the Gracywoods neighborhood in the development of the North Braker Lane Health Clinic. Central Health bought the land, initiated re-zoning in an established neighborhood without any prior notice to the neighborhood organization(s) resulting in community strife over a clinic that could have been planned in an effective manner.
  • While planning the North Braker clinic, Central Health closed the Northeast Health clinic at 7112 Ed Bluestein, the only clinic serving Northeast Austin. Central Health forced many patients to have to travel further north to meet their clinic needs. The closure was also without notice. As a result, the community protested as this created hardship for many patients to make the trek with two to three bus transfers. The Northeast area had been without health clinic services until the recent opening of the Peoples Community Clinic in the Northeast area. But, because there has much growth to the northeast, the area is still underserved.
  • In 2105, Central Health and CommUnityCare staff announced that they were closing the Rosewood Zaragosa clinic and moving resources (s) to the clinic  planned at Huston-Tillotson less than 2 miles away. The staff’s official reason was that the Rosewood Zaragosa clinic required facility improvements. Rosewood Zaragosa is one of a few clinics where community members have access to the clinic’s medical services on one side of the site and access to public health resources on the other side. This is a one-stop for the community where patients can get healthcare and health services in one location. This is the type of best practice that Austin has been striving for and it is already functioning through the Rosewood Zaragosa clinic and center. Last year, the community mobilized when it learned of plans for this closure and sent a strong message. The Central Health Board heard that message loud and clear and the proposal was withdrawn. Yet, the CommUnityCare clinic director continues to plan for this closure and has begun talking about it. It is also important to note that this clinic serves a Latino population.