Sisters of St. Joseph catch those who fall through widening cracks in health care system


The free medical clinics that Dr. Ellen Raeker volunteers at three or four times a month were never meant to be permanent, she says. When St. Mary’s Health Clinics began operating in church basements and schools in the Twin Cities metro area in 1992, Bill Clinton was campaigning for president and focusing on a universal health care plan. “[St. Mary’s] was thought to fill the gap until that got off the ground,” Raeker says.

Seventeen years later, a new president is again focusing on national health care reform, and the half-day free clinics that are sprinkled throughout Minneapolis, Saint Paul and the suburbs are “going strong,” Raeker says.

Those clinics, which are run by the Sisters of St. Joseph of Carondelet, St. Paul Province, provide free health care to low-income, uninsured people living in the metro area. There are eight sites and 14 clinic sessions each week, and the group is looking at adding another clinic in January. Some of the clinics operate one afternoon a week; others operate two.

Stories from the volunteers of St. Mary’s Clinics

Here are just some of the stories told by various volunteers who work at the free St. Mary’s Health Clinics in the Twin Cities. These stories were presented to members of Congress and legislators.

A lifelong Minnesotan woman, who worked many years as a housekeeper and cook for a wealthy family in St. Paul, visited me in the out-patient clinic. She had recently been diagnosed with bladder cancer and had her bladder removed. She now needed to wear an ostomy pouch to contain her urine. Unfortunately, she was not of retirement age and did not qualify for Medicare, and she had no health benefits through her employer. She was very distressed about the cost of ostomy supplies and of her life-saving surgery. I was able to arrange for some free products for this woman. This is a glaring example of the type of people who fall through the cracks in our health care system.

A 50-something-year-old Caucasian grandmother, with a low-paying job and no health insurance, came to the St. Mary’s Health Clinic with severe abdominal pain and told of weeks of nausea and vomiting. Her exam revealed an abdominal mass. During a review of her chart it was discovered that she has lost more than 10 pounds in the past two or three months. During the following week she underwent several imaging studies, courtesy of St. Mary’s Health Clinics, and a tumor in her transverse colon was discovered. She was referred to a surgeon who scheduled her for surgery later that week.

But in the next couple of days her bowel became completely obstructed and she returned to the emergency room. Because a diagnosis had already been determined by the doctors treating her through the auspices of St. Mary’s Health Clinics, she was able to proceed to surgery later that day with all of the information needed to complete the surgical procedure successfully. The tumor was removed, and, with St. Mary’s Health Clinics support, she is now undergoing chemotherapy.

Without St. Mary’s Health Clinics she would probably have been forced to go to emergency rooms for each episode, generating multiple visit charges and many expensive tests. If she did not have a firm diagnosis at the time of her arrival in the emergency room, she could easily have died from this disease. 

At St. Mary’s Health Clinics we serve a young pre-teen boy who became our patient after being diagnosed with Type 1 Diabetes Mellitus. His mother works a full-time job without benefits, so she can’t provide health insurance for her son. She also did not qualify for MinnesotaCare or Medical Assistance. Before coming to St. Mary’s Health Clinics, this young boy became sick and spent a week in Children’s Hospital learning about and coping with the new diagnosis of diabetes. When he left the hospital he had to be on two types of insulin to literally keep him alive. Because he was uninsured, he also left the hospital with $30,000 in medical bills.

His mother contacted St. Mary’s Health Clinics because she could not afford to buy the hundreds of dollars of insulin and supplies her son needed every month. She also could not afford to pay for the frequent doctor visits he required. She was desperate for help just to keep her son healthy and keep her from going further into debt from medical bills. St. Mary’s Health Clinics provides her son with his monthly supplies and insulin free of charge as well as provide expert medical care with free physician appointments. This young boy has been able to maintain control of his diabetes and hasn’t needed to be re-hospitalized since his initial diagnosis.

One afternoon at the St. Mary’s Health Clinics Park Avenue site, the patient I was examining had all the signs and symptoms of Type 2 Diabetes. While discussing his situation and the next steps to be taken, I noticed that his very thin teen-aged daughter who was sitting quietly off to the side had a rather bad cough and, in fact, looked emaciated. 

After a brief discussion with the patient, he asked me to examine his daughter. “I’m sorry to tell you this, but your daughter has something serious going on in her lungs,” I told him.  Indeed she did and she was referred to the Minneapolis Public Health Clinics where sputum cultures revealed active tuberculosis and treatment was initiated.

Our patient came back to see us over the ensuing years to maintain control of his diabetes until finally he was able to afford health insurance. Periodically, however, he stopped by to update us on the status of his daughter. Her infection had come under control, she had regained her health, and she had worked her way up the educational ladder until she graduated from the University of Minnesota Medical School in Duluth.

More than 300 volunteers-doctors, nurses, admissions people, interpreters, drivers and miscellaneous helpers-spend time each week hauling exam tables, screens and other medical supplies into the makeshift clinics and giving medical help to those who have nowhere else to go.

Raeker began volunteering with the group 12 years ago, before she retired from her work as a family practitioner in Fridley. A Catholic, she says her voluntarism is part of her faith. “That’s one of the reasons why I work at St. Mary’s,” she says. “To help is what I went to medical school for; it’s why I became a doctor in the first place.”

Those served at the clinics have no private health insurance and are not enrolled in government subsidy programs such as Medicare, Medical Assistance or MinnesotaCare. Many of the clients are temporarily unemployed, between jobs or are working low-paying jobs where they receive no health care benefits or can’t afford the employee portion of the premium.

“The clinic is full of these stories,” Raeker says. “It’s heartwarming to [volunteer]. I just wish I didn’t have to do it. It’s heart breaking sometimes. A poor lady lost her job. She’s 63, can’t get Medicare yet. Young people trying to establish themselves. It makes you go home and ask why does this have to be?

“We do a lot with a little, but we can’t provide everything,” Raeker says.

Barbara Dickie, executive director of the clinics, says St. Mary’s is a temporary source of health care. “We want to meet their immediate needs, stabilize and move them into MinnesotaCare and Medical Assistance. Sometimes they are between jobs, waiting.”

Moving those patients from no insurance to a government program has recently become a little more difficult. In May, Gov. Tim Pawlenty vetoed funding for General Assistance Medical Care (GAMC). The program, which provides coverage for single, childless adults with annual incomes of less than $7,800, will end March 1, 2010, leaving 33,000 of Minnesota’s poorest adults without health care. Pawlenty also cut the budget for MinnesotaCare, eliminating eligibility for adults without children-about 55,000 Minnesotans-by 2010. Eligibility for adults with children-about 29,000 Minnesotans-will end by 2011.

How will this affect St. Mary’s? “We’ll stretch and do what we can,” Dickie says. “[National] health care reform is finally on the docket. We are happy for that. The Sisters of St. Joseph are very social justice focused, and we are very involved in bringing stories of our patients to those who need to hear it.” In an effort to tell those stories, St. Mary’s compiled pages of what they call “Call to Action” stories and delivered them to legislators and members of Congress. (See sidebar for some of these stories about patients who have benefitted by St. Mary’s Health Clinics.)

St. Mary’s does not operate drop-in clinics. All patients must make an appointment before visiting. When they call the St. Mary’s number they are screened to make sure they are financially and medically eligible. Last year, there were 6,200 visits at the clinics. Dickie says patients average two visits a year.

“We get about 26,000 calls annually,” she says. “We ask them how they hear about us and the number one way is word of mouth. Most don’t have access to the internet and many can’t read. Usually it’s word of mouth, though it could be referral from the county, emergency room or a doctor’s office.”

The clinics deliver primary care, Dickie says. “Well baby, sports physicals, pap smears, and episodic things like rashes, bladder infections, bumps and bruises that could be more serious.” She says another third of the care usually deals with asthma, diabetes and hypertension.

“We see a little of everything. We provide medications at no cost either at the clinic or we give vouchers for Cub Pharmacy. We have a network of 1,200 specialists we have contracts with who have agreed to see our patients in their offices at no charge.” They even have a contract with a local eye glass merchant to enable patients to get new glasses free of charge.

“Minnesota is a very benevolent place,” Dickie says. “The health systems are stepping up to the plate. This is wise because they are needing to see these patients anyway because they may show up in the ER. It makes financial sense for everyone.”

St. Mary’s is staffed by about 15 full- and part-time employees who oversee operations. It costs about $1 million a year to operate the clinics.

“St. Mary’s probably can’t go on forever,” Dr. Raeker says. “Funds are limited. It wouldn’t work without volunteers.”

Raeker says she plans to continue volunteering at the free clinics, “unless we get universal health care and there’s not a need for a free clinic.”

Her view of health care in America: “Right now most people I know that aren’t going to the doctor, it’s because they lost insurance, lost their jobs. That’s our clinic patients: they lost their jobs and they can’t afford COBRA. They are working part time and have no health insurance or can’t afford it.

“I think we should have universal access to health care,” she says. “There are different ways you can do that. There are many models. What fits our society may be different than what fits Canada, Germany or Sweden. There has to be some universal access so everyone can have access. Who is okay to leave out? That’s the question. My feeling is nobody.”


Where to find free or low-cost healthcare in the metro area

If you are in need of free or low-cost health care, here’s a list of some clinics in the Twin Cities metro area that offer free care or care on a sliding-fee scale.

Free clinics

St. Mary’s Health Clinics are held in multiple locations throughout the metro area each week. St. Mary’s provides care to uninsured people who are not eligible for government subsidy programs and whose income levels fall within specific guidelines. To make an appointment call 651-690-7029.

Al-Shifa Clinic is sponsored by the Islamic Center of Minnesota. It’s held every Sunday from 11 a.m. to 2 p.m. in Anoka County. The clinic provides free consultation and prescription services but is not equipped for urgent care or emergencies. Call 763-567-9605 to schedule an appointment.

Low-Cost Clinics

The following clinics provide services on a sliding fee scale:

Community-University Health Care Center (CUHCC), 2001 Bloomington Ave. S., Minneapolis  612-638-0700 • CUHCC provides medical, dental, mental health and social services and has an on-site pro bono legal clinic.

Fremont Community Clinics include Central Avenue Clinic, 2620  Central Ave. N.E.; Fremont Clinic, 3300 Fremont Ave. N.; and Sheridan Clinic, 342 13th Ave. N.E.  612-588-9411

Native American Community Clinic, 1213 E. Franklin Ave., Minneapolis 612-872-8086

Native American Community Clinic Counseling Services, 1113 E. Franklin Ave., Suite 104
Minneapolis 612-238-0747

Neighborhood Involvement Program Community Clinic, 2431 Hennepin Ave. S., Minneapolis 612-374-4089 • This clinic offers medical and dental services.

New Americans Community Health Center, 1821 University Ave. W., Suite S-130, St. Paul  651-287-5223 • Services are focused on the needs of the African immigrant and refugee community.

People’s Center Medical Clinic, 425 20th Ave. S., #1, Minneapolis 612-332-4973