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Asbury Park Press

Clinic Provides A "Full Spectrum Of Health Care"


March 24, 2004
Copyright ©2004 Asbury Park Press. All rights reserved.

FREEHOLD TOWNSHIP - For the past nine years, Sandra Muralidharan has been the clinic physician at Family Medicine Center, and the Freehold-area Latino community has awarded her honorary status.

"They call me Dr. Morales," Muralidharan, 42, says. "They changed my name. They consider me one of their own."

In the waiting room at this health clinic, Spanish-language children's books and health brochures line the tables. The bathroom is known as the bano to most.

And the secretary often leaves her computer terminal to help translate in the exam rooms.

At the center at 1001 W. Main St., about 95 percent of the patients are Latino, medical officials said. The clinic, part of the CentraState Healthcare System, is a neighbor to the hospital.

"Everybody goes there," says Cecilia Reynolds, publisher of the Spanish-language monthly9 Nosotros in Freehold and an advocate for the Latino community.

The 3,300-square-foot facility opened about 15 years ago as a health care alternative for the growing, low-income Latino population living in nearby Freehold, says Dan Messina, senior vice president and chief operating officer for CentraState.

More than 12,150 people visited the center in 2003, an increase of 13 percent over the previous year, hospital officials say, which reflects the recent influx of Latino immigrants into the area.

"The clinic was developed especially for this population to make sure we can meet the demands of the group," Messina says.

"They feel like they're home," says Family Medicine Center secretary Noemi Caraballo, 42, a native of Puerto Rico who often offers translation services in one of the clinic's five exam rooms.

"My English is getting so bad," jokes Caraballo, one of CentraState's approximately 200 bilingual employees.

Full range of services

The five-day-a-week center only treats patients who pay for themselves or use Medicare, Medicaid or the state's charity-care program, says Liz Donahue, director of the Family Medicine Center.

The center covers treatment in a wide array of medical areas, including dermatology, podiatry and sexually transmitted diseases. Patients also can receive diagnostic testing, check-ups and health education.

"We don't shunt them off," Donahue says. "They come here, and they get the full spectrum of health care they're entitled to."

The center's OB/GYN clinic sees hundreds of pregnant women each year, many ranging in age from 18 to 23, Donahue says. Two hundred and fifty of CentraState's 1,650 births in 2003, or 15 percent, were once patients at the Family Medicine Center, according to hospital statistics.

Muralidharan says many Latinos she treats lacked proper medical care in their native countries. Latinos who visit the center for the first time sometimes get diagnosed with illnesses they never knew they had, such as diabetes and high blood pressure, she says.

According to state law, hospitals have an obligation to treat whomever walks through their doors, regardless of a person's ability to pay, Messina says. And CentraState is feeling the out-of-pocket effects of providing free hospital care for the Latino community, statistics show.

"We're trying to meet the needs of a population which is uninsured and has a need for medical services but cannot appear on the doorsteps of a (private) physician's office," Messina says.

To be eligible for charity care, one does not have to be a U.S. citizen, says Ron Czajkowski, a spokesman for the New Jersey Hospital Association, a trade group that represents 108 hospitals in the state. To qualify, people must prove they meet certain income requirements and must present proof of residency in New Jersey, a valid identification and proof of bank assets.

"Their alien status has nothing to do if they qualify or not," Czajkowski says.

But many undocumented immigrants, who make up about 3.2 percent of the state's population, are not eligible for charity care because they do not meet the criteria or choose not to present the required credentials, he says.

"Technically, they (illegal immigrants) could qualify," he says. "Realistically, most don't."

The cost of charity care

Hospitals this year will provide an estimated $200 million worth of free care to undocumented men and women in the state, which falls under bad debt.

The hospital's subsidy to the Family Medicine Center increased from $461,856 in 2001 to $500,383 last year, an 8 percent hike.

The total community benefit at CentraState, which includes charity care, bad debt - bills that are never paid - and the subsidy, climbed 17 percent from 2001 to 2003, increasing from $5.9 million to $6.9 million.

"It's a challenge," Messina says. "It's dollars that come right out of the bottom line. If everybody was insured, you'd be looking at a whole different picture."

CentraState is in the same boat as most hospitals, Czajkowski says.

New Jersey hospitals are expected to provide $778 million in charity care for the current fiscal year, which ends July 1, he says. The state is expected to offer about $381 million in reimbursements to those hospitals, creating an approximately $400 million shortfall that will come out of hospitals' bottom lines, he says.

Non-citizens are not the only source of bad debt, Czajkowski says.

"There's people out there making a quarter-million dollars a year and just stiff hospitals," he says.

Rodolfo Lazo, 22, a native of Mexico, is not one of those people.

The day laborer from Freehold visited CentraState's emergency department last March because he passed out while working due to dehydration.

Doctors pumped fluids back into his body, and he was fine. Days later, he received a $250 bill from the hospital, which he hasn't paid.

"I don't have any money to pay this," says Lazo, adding he might have applied for charity care if he knew about it.

Marcelino Aguilar, 22, also a day laborer, says he is using the charity-care system to help pay for his 22-year-old wife Fausta Analco's gallbladder treatment.

"It's a good help," he says through a translator.

Aguilar was not yet approved for the program last year when his wife visited the Family Medicine Center about 12 times, leading up to her Dec. 23 delivery of the family's second baby, Jesus.

Aguilar says he was able to pay for the approximately $3,000 in hospital pregnancy bills, but since the closure of the muster zone, finding work has been difficult, and he now is very low on money.

Hospitals must balance the state's mandate that hospitals offer free treatment for people such as Analco with their desire to have a profitable fiscal year.

The undocumented immigrant population is "beginning to put a greater strain on hospitals' bottom line," Czajkowski says. "The bottom line is eroding."

He says first-quarter state hospital profit margins this year have dropped about a half-percent from the previous quarter.

The hospital association is working to get more state and federal funding for hospitals, he says.

"It's going to have to be addressed because (charity care) continues to drain services and hospital revenues," he says, adding that about 5,000 state hospital employees were laid off last year due to rising costs in areas such as charity care.

However, the storm has not yet hit CentraState, Messina says.

The 261-bed hospital has not been forced to cut back on staff or services because administration is running "a tight ship with a continuing focus on quality and patient satisfaction," Messina says.

"It's a balance between cost and quality," Messina says.

The hospital finished with a positive bottom line last year, but he did not know specific figures,he says.

But as the western Monmouth County area grows, CentraState must meed the demands of the population, officials say.

To accommodate increasing volume and expedite visits, work has begun on a $10 million project to nearly double the size of the emergency department.

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