St. Luke's serves South Jersey poor but is strapped for cash
Kim Mulford, Courier-Post
Once a month, Carmen Caban uses a walker to make her way up the concrete steps of 511 State Street in North Camden, home of St. Luke's Catholic Medical Services.
When it rains, she navigates past a leaky ceiling near the front door. When it's freezing, she sits in a waiting room warmed by space heaters.
Since she was injured in a car accident, the 51-year-old rarely leaves her Camden home, not even to attend church. Diabetic and hypertensive with other complicating health issues, she needs a hip replacement, one she can't get until the open, infected sores in her feet heal.
Caban's monthly visit with her primary care physician, Dr. Lesly D'Ambola, usually lasts an hour. The internist manages Caban's severe chronic pain and always asks about her family. Nine years ago, Caban's 18-year-old daughter was killed in a city shooting, leaving behind a 3-month-old son. Caban has been raising the boy, who has autism. D'Ambola often prays with her.
"She's not the same as the other doctors I've been seeing. She's got a nice heart," Caban said. "When you go there depressed, she helps you."
St. Luke's is paid $23 for such visits.
Opened 30 years ago by Jesuit priests to serve the poor in North Camden, the private medical practice is in serious financial straits. Though it draws patients from as far away as Washington Township, it attracts mostly older, Spanish-speaking patients with complex medical conditions. Few have private insurance, and some don't even have public health coverage.
Housed in a row home donated in 1983 to the local parish, St. Luke's is directed by a physician whose salary is paid by Rowan University School of Osteopathic Medicine, where D'Ambola is an assistant professor of medicine.
The school also pays the malpractice insurance premiums and its foundation has donations to cover the cost of a nurse-practitioner. Both are former Jesuit volunteers.
The Diocese of Camden covers St. Luke's budget shortfall, an average $154,855 annually since 2012.
Even with such support, the practice is strapped for cash. The government-mandated switch to electronic medical records means the nurse practitioner spends one day a week inputting patient data into free, ad-driven software on a donated computer.
Little money is available to maintain the building. At the end of a hallway, outside one of the four exam rooms, a bucket sits on a chair to catch water leaks.
A supply closet sits unused, its shelves and crumbling plaster walls left long without repair.
"It's a struggle to remain here," admitted D'Ambola, 53. "We want to stay, but we urgently need a new building."
That's not the only concern, according to diocesan spokesman Peter Feuerherd. Since the Jesuits left North Camden a dozen years ago, the practice has required an increasing amount of money from the diocese, he said.
"The ability of the diocese to subsidize it at a level that would allow it to continue is a problem," Feuerherd acknowledged. "The previous subsidies were relatively small. Now, they've become bigger.
"The diocese supports the concept. But whether the diocese can continue to support that level of involvement financially is another question."
The same cost pressures shut down other private medical practices in poor, urban areas, including one owned by Dr. Jeffrey Brenner, founder and executive director of the Camden Coalition of Healthcare Providers.
During public speaking engagements, the MacArthur Fellow often talks wistfully about his four-room practice, and shows slides of the building, now boarded.
"There may be a special place in heaven for doing the right thing, but there's not a business model," Brenner mused.
"That's tragic. You make money from hospitalizing patients, even if it's unnecessary. You make money from doing procedures and giving pills to people, but you don't make money from taking great care of them, like Lesly does up in North Camden.
"That's a problem of the American health system."
Dr. Thomas A. Cavalieri, dean of Rowan SOM, said his school is a strong supporter of St. Luke's, where medical students come to work alongside D'Ambola. Part of the school's mission is to serve the underserved, the dean explained.
"It's a tremendous service to this community, and we are a part of it," Cavalieri said, calling St. Luke's staff "all Mother Teresas."
"But by no means are we able to say the good work that's going on there is sustainable."
In a small kitchen used as an employee break room, Violetta Olavarria of Camden dabbed tears from her eyes as she talked about the practice where she has worked for three decades.
The office manager keeps track of appointments, how much money comes in, and how much is needed to stock such things as immunizations or to resupply the soap and paper towels that keep disappearing from the bathroom.
"Sometimes, it's very difficult to express the needs we have, because not much is coming in," Olavarria said, her voice quavering. "It's coming to a situation that I'm very concerned about St. Luke's.
"(We're) trying to get something set up where people could open their hearts and help us to survive here."
At its height, the practice once handled nearly 8,000 patient visits annually; today, it's about 3,000 mostly time-intensive visits. Reimbursements also fell as the state moved Medicaid patients into private managed care organizations.
While the Affordable Care Act temporarily lifted reimbursement rates for primary care, St. Luke's hasn't seen that translated into an improved bottom line.
"You get a certain amount a month, no matter if that patient's here every single day," Olavarria explained. "I see what comes in and it's really sad.
"I understand the government wants to control the health care and make sure the doctors are really taking care of these people. But they don't understand situations like at St. Luke's. We have a lot of people with complicated conditions. Fifteen minutes is not going to go.
"Right now, we're not bringing anything in. We're called poor, poor, poor."
Besides their physical conditions, many patients struggle with mental health issues. A former crisis worker, D'Ambola weighs her patients' need for behavioral health and addiction services. She nags them to manage their diabetes and hypertension, among the most common conditions she sees.
It all takes time.
A member of Sacred Heart Parish in Camden, the Pennsauken resident views her work as a ministry.
"There are patients who are very anxious, very stressed out, dealing with deaths in their family, murders in their family," D'Ambola explained.
"Doctors are not paid to listen," she added. "Being compassionate is not cost-effective."
Brenner, a longtime friend and colleague, called D'Ambola a "great doctor" working in an "incredibly challenged place."
"I think Lesly is out on the cutting edge, which is how you combine behavioral health, social work and health care," he added.
"She's going to need some help. It would be absolutely tragic for Camden to lose another primary care office. It would be tragic for North Camden to lose such an important resource."
Reach Kim Mulford at (856) 486-2448 or email@example.com. Follow her on Twitter @CP_KimMulford
If you go: St. Luke's Catholic Medical Services, 511 State St., Camden: (856) 365-4642
|Date Published:||Friday, May 30, 2014 - 08:45|