Jose got his asthma checked out and received some advice about losing weight. It was just a routine check-up — but an extraordinary visit to the doctor.
Jose (at right in photo) is a client at Crossroads, a residential drug treatment facility in West Hills. Two months ago, a Crossroads patient like Jose would have had to trek across town to see a doctor. Now, thanks to a partnership with New Haven’s Hill Health Center, a medical professional came to see him. That’s what made his doctor visit so extraordinary.
The new clinic at Crossroads opened in March in a small building next to the main center. It’s staffed three afternoons a week by Gerald Kayingo (at left in photo), a physician’s assistant (PA), and Gloria Soto, a bilingual nurse. For now, the clinic is open only to Crossroads’ 125 residential clients. But Hill Health Center, a 40-year old community health center network, is looking into opening it up to the wider West Hills community in the future.
The clinic was established with money from a State Department of Social Services grant intended to reduce the burden on emergency rooms. In the past, Crossroads patients had gone to the emergency room for everything from sore throats to minor cuts, Kayingo said.
“Over the years, people have turned the ER into primary care,” said the Ugandan-born PA.
There’s been a 75 percent decrease in ER visits by Crossroads patients since the on-site clinic opened, Kayingo said.
“That’s a tremendous impact,” said Dr. Miguel Caldera, director of Crossroads.
The new clinic is the brainchild of Dr. Caldera, who approached Hill Health Center with the idea after he noticed that client trips to the emergency room were getting in the way of people’s recovery. The trips were also a source of increased expense, using staff time and resources to coordinate transportation to the hospital and back.
The new clinic represents an opportunity for “transdisciplinary collaboration” between Hill Health Center’s medical professionals and Crossroads’ counselors and therapists, Caldera said. Such collaboration will ideally result in more efficient and holistic care for Crossroads clients.
In addition to cutting down on trips to the ER, the Crossroads clinic also provides preventative care to Crossroads patients, many of whom may not have seen a doctor in years.
“They really don’t focus a lot on their health,” Caldera said, referring to the client population at Crossroads. “Their medical issues have been placed on hold because of the problems with mental health and substance abuse.”
Piranha Pounds
Jose was one of several back-to-back appointments Kayingo had on Monday. Jose, who’s 39, came in for a routine follow-up after his Crossroads intake examination on March 24. He said that he was at Crossroads under a court order, to deal with “anger management.”
Jose got an unpleasant surprise when Nurse Gloria Soto had him step onto the scale. “I’ve gained an obscene amount of pounds,” he lamented. He attributed the gain to all the good food that Crossroads has been feeding him. “I tear up food like a piranha,” he said.
With a stethoscope, Kayingo checked on Jose’s asthma, noting that the right side of his lungs had “a little bit of mud as you breathe in.”
Kayingo examined Jose’s feet. Like a lot of people who have been incarcerated, Plaza was dealing with some toenail fungus.
Finishing up the exam, Kayingo re-upped Jose’s inhaler prescription and urged him to try to lose some weight. Kayingo also ordered some bloodwork, tests which Jose said he had not had in five or six years.
On his way out, Jose voiced his satisfaction with the visit with Kayingo. “He takes care of me,” he said.
The new clinic is able to give vaccinations, screen for tuberculosis and sexually transmitted infections, and test for diseases like HIV and hepatitis. Kayingo (pictured) said that he has also been able to address health problems that are particularly prevalent at Crossroads, like insomnia and chronic pain.
A lack of medical history is common for Crossroads patients, Kayingo said between patients on Monday. Last week, he saw a middle-aged man that said he had had open-heart surgery at age 19, over 30 years ago. After his teenage surgery, he was prescribed Coumadin, a blood thinner, and told that he had to take it for the rest of his life.
“Because of life issues, he got lost from Coumadin,” said Kayingo. When the patient came in last week, he told Kayingo, “If I don’t use Coumadin, I will die. How do I go back on Coumadin?”
For a patient like that, with no medical history, “you start it all from scratch,” Kayingo said. The PA did some tests and made an appropriate prescription for the patient.
Kayingo said that he was gratified to be able to help the patient, who he said would not have been able to get medical help elsewhere. “No private practice out there would open his doors to him,” Kayingo said. “This is it for him.”
In another example of care for a patient who had gotten off track, Kayingo mentioned the case of a Crossroads patient with HIV. He had started a course of medication in Hartford, Kayingo said, then he was sent to jail and his medical care was “cut off.” Medication for HIV can be complicated, requiring many pills, and it demands a 95 percent adherence rate, Kayingo said, “but the guy completely got lost.”
Kayingo said that he was able to restart the proper medication regime for the man. “He’s now back on track.”
Expansion?
Robert Kilpatrick, director of development at Hill Health Center, said the Crossroads clinic may be opened up to the surrounding neighborhood in the future. “The question is whether there’ll be enough utilization of the site,” he said. “We have to make sure we have a stable operation” before expanding hours and outreach.
The Crossroads clinic was established with what was supposed to be a two-year grant from State Department of Social Services. However, due to processing delays, “we didn’t get the money and the contract until the first year had elapsed,” Kilpatrick said.
The grant money runs out after July 1, Kilpatrick said, but the clinic will continue to operate. The clinic will be sustained by “patient revenue,” mostly in the form of Medicaid reimbursement and payments from the state health insurance programs SAGA and HUSKY. For uninsured patients, there is a sliding scale.
Kilpatrick compared the Crossroads clinic to a similar operation that Hill Health runs at Columbus House, a city homeless services center. He said that Hill Health Center is looking into other partnerships like the Crossroads clinic, working with behavioral health service agencies in Branford, Milford, and Ansonia.