HAWC in the gap

Andrea Brown started a new job and didn’t yet have health insurance. Because she had served as a board member of Health Access Washoe County in the early 1990s—when a clinic for uninsured patients was still in the idea phase—she knew right where to turn when she ended up in need of a physician’s care.

“I went to see my friends at the HAWC clinic,” Brown says. “When I need to, I still go there. I like the dental clinic a lot.”

Brown, now director of new business development and special projects at Azteca America, is once again on HAWC’s board, representing both the patient and Hispanic communities.

More than ever, she’s come to understand the need for a community health clinic to address patients who fall in an ever-increasing health care gap.

“Without HAWC, we’d be in pretty big trouble,” she says.

The clinic director didn’t always have a spiffy office with a large desk, his awards and degrees hanging from the walls and a business-card holder shaped like the front of a classic car.

Michael Rodolico’s first office as executive director of HAWC was empty except for a phone on the floor. That was eight years ago. HAWC has grown, moved and expanded since then. But some in northern Nevada still don’t know much about the group’s clinics or the services it provides, from family medicine to prescription drugs to dental hygiene to children’s mental-health referrals and counseling.

HAWC was born in the early 1990s when folks from the Washoe County Medical Society worried over a gap in available health care for the working uninsured or underinsured. Given the number of low-paying service positions demanded by Reno’s economy, it’s not surprising that northern Nevada is among areas that have the highest number of working uninsured in the nation.

Rodolico, a combat medic in Vietnam who worked his way through college in an ambulance, came to Reno from New Mexico, where he’d directed a paramedic training academy while earning his Ph.D.

“We started from nothing,” Rodolico says, navigating the maze of HAWC’s clinic space on Wells Avenue. “We’re real proud of what we have.”

Say you’re a single mother with a couple of kids. You make barely liveable wages doing, say, housekeeping at a casino and maybe working at a department store evenings and weekends. You recently lost a job with decent health coverage, so your kids don’t yet qualify for Nevada Check-up, a state program for kids from low-income families who’ve been uninsured for longer than six months.

Neither of your new jobs provides affordable health benefits, and you’re barely able to buy a toothbrush after paying rent, utilities, a car payment and insurance on a vehicle that, despite being generally unreliable, makes you ineligible for Medicaid.

Your lack of money and insurance doesn’t stop your 4-year-old from getting a sore throat that continues to worsen.

How much will it cost to take your preschooler to HAWC’s clinic?

For families with the lowest incomes, a doctor’s visit might start at around $25 (the bottom of HAWC’s sliding fee scale) and go up depending on what kinds of tests have to be done. (For comparison’s sake, an urgent-care visit to Washoe Family Care starts around $130.)

If the child needs medication, HAWC’s pharmacy fills prescriptions at its cost for the drug plus $10. If the physician prescribes a medication manufactured by Pfizer, which has operations in Reno, a low-income patient may qualify to receive the drugs for free through Pfizer’s Share the Care program.

Each year, the HAWC clinic sees about 3,000 kids, newborns through age 5, and another 4,000 or so school-aged children. That’s in addition to about 10,000 adult patients.

Other than some grants from Nevada’s tobacco settlement money, HAWC receives no state funds. Last year, the clinic received about $1.1 million in federal grants, but it’s mostly self-supporting, with $2.6 million coming from patient care.

The clinic has a number of patients (14 percent) with private insurance or on Medicare. About a third of its patients use Medicaid. The remaining 52 percent are the area’s uninsured.

“We’re very true to our mission,” Rodolico says. “If we weren’t here, where would these people be going?”

HAWC’s growing client base could be an indicator that the health-care gap is growing, that access to health care is getting more difficult even for people with jobs “who’re working hard and paying taxes,” says Rodolico.

The folks at HAWC recently added a fourth nurse’s station to the clinic on Wells Avenue. Chairs have multiplied in HAWC’s dental clinic, and an additional dental clinic recently opened in south Reno.

When HAWC, using a federal start-up grant of about $250,000, opened its first clinic in May of 1995, it saw about 25 patients a day. Now, the clinic sees 25 patients an hour.

More than 9,000 patients—mostly children—received dental care through HAWC last year. Its Fourth Street free clinic, geared to the needs of the homeless, has seen about 4,000 visits a year for the past three years.

Still, there’s room for growth in the number of patients HAWC can serve.

Not everyone knows about the services HAWC provides. Stephanie Herrera, a HAWC spokesperson, refers to recent media coverage that implied the uninsured in northern Nevada have “nowhere to go.”

“We’d like to get the word out that there is a place for people to go,” Herrera says, “The awareness is not there.”

Adds Rodolico: “We’d like to get patients here, get them out of emergency rooms, out of episodic health care and into a medical home. … Most non-profits are looking for money. We’re not. We’re definitely looking for patients.”

The clinic on Wells Avenue does accept patients on a drop-in basis. But since the clinic is typically busy, to avoid having to wait a couple hours to see a doctor, calling ahead for an appointment is recommended.

Besides its medical and dental clinics, the HAWC complex includes offices for related health services. At the clinic on Wells, you can find out if your child qualifies for the state’s Nevada Check-Up program. There’s also an office for Medicaid.

At HAWC’s Radiology Department, basic bone and chest x-rays can be done, with patients paying on the sliding fee scale. With the hiring of on-site pediatric mental-health specialist Renee Reveles, Reno became one of only a handful of community clinics across the nation to offer services to uninsured kids at risk for depression or attention-deficit hyperactivity disorder or with other behavioral problems.

Just down the hall from Reveles is the office for the Women’s Health Connection, a breast and cervical cancer early detection program for eligible women aged 40 and over who are underinsured or uninsured.

Stories of women coming through the program frequently don’t have happy endings, says Sharon Houston, case manager. But some do. One woman who called had a history of being a difficult patient. The Women’s Health Connection helped her set up appointments for screenings. When the woman was found to have cancer, Houston walked her through treatment options that the woman found confusing but that finally resulted in a life-saving mastectomy.

“When she recovered, she sent me a pineapple tree,” Houston says. “If we weren’t here for her when no one else was, she’d be dead.”

That theme—providing help for those in need with nowhere else to turn—is one that repeats itself frequently at HAWC.

Rodolico says that his own training in emergency health care instilled a life-long desire to provide care without regard to a patient’s ability to pay.

“If a person dials 911, you go and help them," Rodolico says. "There’s no paperwork regarding income qualifications."