A prescription for giving back
Medical students' free clinic provides benefits on both sides of the stethoscope.
By Lane DeGregory, Times Staff Writer
Published October 2, 2007
TAMPA - A half-hour before their new free clinic is supposed to open, the medical students stand outside, knocking.
The janitor won't let them. He's still buffing the floors.
"C'mon, man. This is for a good cause," Samuel Crane calls through the locked glass doors. "We'll hook you up too."
The janitor shakes his head and goes back to buffing.
Crane, a fourth-year medical student at the University of South Florida, turns away. He and three friends have been working toward this day for more than a year. He walks toward a conference room, where 25 students, social workers and doctors are waiting.
"We're hoping our patients show up," Crane confides in one of the doctors. "We have four people signed up for appointments."
The doctor scans the crowded room and laughs. "You have all these people for four patients?" he asks. "You're going to scare them to death."
Crane launched the idea last fall, on the way to a Gators game. He was driving with his buddy Shelby Kent, a friend since their undergraduate days at Florida.
Crane told Kent about his dream: To start a clinic. A free clinic, run by medical students, for people with no insurance.
It would be a way to give back to the community, Crane said. A way for medical students to work with real patients. A place where students from different schools - social work, physical therapy, nursing and medicine - could work together.
The clinic should be near USF, he said, in the transient neighborhood some call Suitcase City.
"He was so enthusiastic about it, right from the start," Kent said. "It was never a question of, 'Should we do this?' It was always 'How?' "
Later, Crane approached two other friends. He had met Omar Hammad during their first semester in medical school; they shared a cadaver. Hammad introduced him to Waldo Guerrero. Crane asked them both to help.
"I thought Sam was out of his mind," Guerrero said. "It seemed impossible."
- - -
Ten minutes before the clinic is supposed to open, Crane stands in the conference room, addressing the crowd.
Someone has brought him a key. He hopes the janitor has finished the floors.
"Okay, so they're out there right now, hanging our banner," he says. "Tonight we'll run this from the vitals right through the clinical part."
It's late August. The official opening of BRIDGE Healthcare is weeks away, but they're having this soft opening because the students want time to practice with real patients before they welcome the public.
They have already spent weeks at health fairs, recruiting the working poor - people who earn too much to qualify for Medicaid, but not enough to afford insurance. Tuesdays in September will be full of appointments, four patients a night.
In the conference room, everyone is shuffling to find the members of their team. Each team includes a patient coordinator, a social worker, a third- or fourth-year medical student, a first- or second-year med student, and a doctor who oversees the diagnoses. The students can't write prescriptions, so a doctor has to sign off on everything. A team of physical therapy students will also work with patients.
"Now, I don't expect everything to run smoothly tonight," Crane says. "But I hope in the next month we can get it down. I'm real excited."
He leads the caregivers to the clinic, unlocks the glass door. As he steps back to hold it open, he sees the two men on the sidewalk, waiting: Their first patients.
- - -
They started meeting a year ago. The four medical students would get together at one of their homes at 9 a.m. Sundays.
Shelby Kent is the oldest, 34 - he's married and more serious than his friends. Sam Crane, 32, is a former Peace Corps worker with a Hollywood smile. Hammad and Guerrero are both 25; Guerrero is married to another medical student.
All fall, the four friends researched other student-run clinics, found conferences they could attend, grants they could apply for. They learned about insurance obstacles, legal problems. They tried to finish their Sunday sessions by the time the first NFL game came on.
But as their to-do lists grew, the students found themselves working through football games - then Friday nights, too. They used to play basketball together, take their wives and girlfriends out to eat. Instead, they became consumed with the clinic, sharing 100-calorie Oreo packs for dinner.
"As soon as we thought we had one thing under control, something else would come up," Kent said.
One example: Dozens of students signed up to translate for Spanish-speaking patients - but most didn't know all the technical terms. Lawyers said that was a liability.
To represent themselves as USF med students, they had to get the university to sign off on their plan. "Our professors didn't discourage us," Crane said. "But they told us people had tried this before and never pulled it off."
Many medical professors said they'd help the students. But some doctors opposed the idea of the clinic. If do-gooders keep offering free services, they said, the government won't have to fix the health care system.
The four friends weren't trying to influence public policy. They just wanted to do what doctors do.
- - -
Twelve minutes after the clinic is supposed to open, Crane stands in the front room, looping a stethoscope around his neck. "So are we ready?" he asks.
Two dozen people grab clipboards and pads. They're crowded between counters and file cabinets, spilling into the back hall. The Hillsborough County Health Department has donated these offices for the student clinic. By day, the space is a pediatric unit.
"Okay, who doesn't need to be in this room right now?" Crane asks. "We need the first team. The rest of you can go wait in the conference room so it's not so crowded in here."
In the lobby, the two patients are slumped in blue seats. A student social worker steps timidly toward the men. "Hi," she says. "What's your name?"
The man's name is Louis Figueroa. He's 56. He has an appointment. He brought his friend, Benjamin Lebron, 48, to translate into Spanish. Figueroa has an ulcer. His friend has diabetes "or something." Neither can remember the last time he saw a doctor. Lebron wants an appointment too.
The social worker asks each man to sign a form. Then she walks them through the front room, past a dozen volunteers, and introduces them each to a student doctor.
She doesn't ask about insurance.
- - -
The medical school donated $10,000 for the clinic. The four friends formed a steering committee, flew to a conference in New York, signed up 30 more volunteers.
They wanted to call their project the WOSS-UP Clinic - an acronym for all their first names, plus the people they want to help: Waldo O(mar) S(am) S(helby)-U(nderserved) P(opulation).
Their classmates came up with BRIDGE: Building Relationships and Initiatives Dedicated to Gaining Equality.
All spring, they pitched their project to administrators, professors and lawyers. They met with the county's public health director, with the state's secretary of health. Quest Diagnostics agreed to process patients' tests for free.
"Their clinic is better organized than any HMO I've seen," said Dr. Lucy Guerra, co-medical director of the free clinic. She works at H. Lee Moffitt Cancer Center and Research Institute and is an assistant professor in the USF medical school.
"They even had the foresight to include first- and second-year medical students working under the upperclassmen," she said. "So the clinic will continue even after these guys graduate."
- - -
Two hours after the clinic opens, the first two patients are still in exam rooms. In the lobby, a couple is waiting with a 10-year-old girl.
Crane ducks into an alcove where two med students are conferring with a doctor. "Hey guys, what's going on?" he calls. "Is everything okay?"
"We're fine," says a second-year student. "It's just taking longer than we thought."
They check the patients' pulse and reflexes, ask about their family histories, their jobs, their homes. Sleep and smoking, sex and drugs.
Almost three hours after the first patients arrived, the students tell Louis Figueroa he needs blood pressure medication - and give him a Wal-Mart gift card to pay for the prescription.
His friend Benjamin Lebron needs to see a cardiologist. But when the doctor hands him a referral, Lebron gives her a card. "Hillsborough County Health Plan." He has insurance.
Three hours of the students' time, and the man wasn't even eligible for their clinic.
"It was real good though,"Lebron says. "I never had that many doctors take care of me. Or take that much time."
- - -
Four hours after the clinic opens, the students hand the last patient her prescription. They clean out the offices and take out the trash.
They talk about how to improve their forms and process people faster.
Crane folds his lab coat over his arm, turns off the lights.
In the dark lobby, he calls to the janitor: "We won't be this late every week. We're just getting some of the kinks worked out."
The janitor follows Crane to the door, rattling his keys.
"Good night. And thanks," Crane says. "The floors look great."
- - -
In the past month, student doctors have treated 16 patients and referred 12 to other facilities.
Student social workers helped one couple get county health insurance. They showed another woman she qualifies for Medicare. But when they told her she has to go to another clinic with her new card, that she can't come back to see them, she cried.
"Can't I stay with you all? Everyone here is so nice."
Lane DeGregory can be reached at (727) 893-8825 or degregory@sptimes.com.
Fast facts
Opening today
BRIDGE Healthcare Clinic officially opens today. It offers free medical services to uninsured adults and is run by a team of medical students. The clinic, six blocks from the University of South Florida's Tampa campus, is open from 5:30 to 8:30 p.m. on Tuesdays, by appointment only. Medical specialties include diabetes, hypertension and high cholesterol. For information, call (813) 307-8037 or visit www.bridgehealthcareclinic.org.