(Lander, WY) They say nothing in life is free, but the lives of uninsured, poverty-level patients who are struggling financially and need access to high-quality medical care are what the volunteer providers at the Lander Free Medical Clinic are all about.
It started with a collaborative vision between Dr. Brian Gee, and Kevin Wilson, M.S.N., R.N.; both of who serves on the Fremont County Search and Rescue team. At one of their S&R meetings, Kevin had asked Dr. Gee what he was doing.
“I’m a commissioner on the Serve Wyoming board,” Kevin said. “It’s something I’m pretty passionate about. I served with AmeriCorps…with the Wyoming Conservation Corps in Laramie.” He is also a Navy veteran, served with the Army National Guard, and is also active in trail building with Team Rubicon, a veteran disaster organization.
“I’m semi-retired from the Lander Medical Clinic,” said Dr. Gee. “I had been thinking about this free clinic idea, which had kind of lived in the back of my head for a bit.”
When an earthquake struck Haiti in August 2021, Kevin went to help in decompressing an emergency room. He noted that, besides critical care, “people started coming in that had acute things going on,” he said. “Broken bones, splinting a bunch of fractures…people just starting coming to us with basic primary care needs like high blood pressure, diabetics with no access to medications. It got me thinking, ‘we have those kinds of folks back in Lander’…you don’t have to travel internationally to find people who don’t have access to good health care.”
When he came back home and was working on his Master of Nursing, he did a community assessment on Lander. “I found at least 400 people that were uninsured, living under 200% of the poverty level,” he said. “These are folks that don’t qualify for Medicaid and can’t afford a health insurance plan on the private market. Most of them are working jobs like in hardware stores, grocery stores, gas stations and can barely pay for their food and housing, much less medical care.”
“I saw these people all the time in the medical clinic and in the emergency room,” said Dr. Gee. “People came in there in crisis; you write them prescriptions and then they can’t afford to fill them.”
Kevin and Dr. Gee worked together on the community assessment and held a public meeting at the Lander Library in November 2021. From there, they were able to form a board of directors.
“They were obviously very formative when we first started,” Dr. Gee said, who is Vice-Chair. “Karen Wendt, Bruce Palmer, Tony Leonard…our other doctor, Garth Reber was super involved and also saw a lot of patients who couldn’t afford care.” Gee and Reber’s original idea was to have a mobile van. “We’re still kicking around the idea again as this eventually grows, as a way we could do outreach in the county,” he said.
They eventually found a program called Volunteers in Medicine under the National Association of Free & Charitable Clinics, and became the 1400th clinic to join the association, and the fourth free clinic to open in Wyoming.
“Finding them was great because it gave us just a massive list of things to do,” said Dr. Gee. “Legally, regulatorily, practically, board of directors, policies and procedures…they gave us a great template to follow. We also got great help from Heart Mountain Clinic in Cody, the Downtown Clinic in Laramie, and the Teton Free Clinic in Jackson. We’ve had tremendous help and practical information from all of their executive directors on how to make this idea a reality.”
From the public meeting in November 2021 and throughout 2022, not only did they work on the clinic’s legal and regulatory structure, but “also just raising the funding that we needed, there were a lot of starts and stops,” Kevin said. “In the end, we had a few big grants come through. Also, just super generous individuals here in Lander…we raised over $30,000 from generous individuals in the Lander community.”
“That was actually a vision because we got a lot of that in Challenge for Charities,” said Dr. Gee. “In the run-up to that main event, there was a giving period of a couple of months. We raised probably one of the biggest amounts of money as first-year participants.”
Challenge for Charities is an annual 4th of July half marathon event that is put on by the Lander Community Foundation.
“We had to do some sweat equity, too,” added Kevin. “We have to volunteer time around the 4th of July, so other organizations like Search & Rescue and others…their members all joined to support that community effort to raise money for the Lander area.”
“I think that’s been the fun thing about this so far,” he continued. “Just seeing a lot of people in the community that are doing really cool things, where to be a part of that, and then how do you connect health care.”
The Lander Free Medical Clinic opened its doors on February 6, 2023, at Trinity Episcopal Church, serving patients “18 years of age up to Medicare age,” said Kevin, who is now also the clinic’s Executive Director. “They can’t have Medicare or Medicaid, VA benefits, no IHS benefits, no government-funded insurance. They should be less than 200% of the poverty level as far as income. So if you qualify for that, we can help.”
“We have patients with some other needs, and we’re trying to figure out how to make that work,” said Dr. Gee, mentioning Deanna Trumble, Executive Director of Lander’s First Stop Help Center and a board member of Almost Home. “She and other people in the community do those things, so just trying to tie everybody together has been fun. But right now we’re trying to do outreach to the local medical community, hopefully getting specialists involved…how do we do that with these patients that have these kinds of issues and problems.”
“There’s a movement out to do direct patient care, to get to people’s needs without having to pay extra to insurances, and we’re filling that need,” Kevin said. “You pay your own; you pay your provider to do it…whereas we’re hoping the community will help support us and support doing that for these patients.”
The clinic currently has 24 patients, but there have been more who have expressed interest. Within the first couple of months, they’ve provided over $17,000 worth of healthcare services for a cost to the clinic of about $4000.
“We’ve really done a lot of good,” said Dr. Gee. “We feel we’re providing low-cost, higher-quality care, with hopefully better outcomes for folks than they would be able to access in the current system.”
“A lot of the folks we’re seeing…they’re working for local businesses–make maybe about like $13 an hour–live with a partner or family, pretty much have the sole income for their household,” Kevin said. “It’s extremely hard for them to pay for food, housing, and transportation. Between those, their whole paycheck gets eaten up. Then a health crisis comes up, and they either go to the ER or urgent care. If they go to the ER, they can get hounded with a bill for many thousands of dollars. I have one patient that has $1 million in medical debt, and that’s from different emergency rooms and life flights. That’s happened to them over time. If they’re self-pay at the Lander Medical Clinic, it’s about $150 to see the doctor, plus lab tests and any imaging they might need. It adds up to thousands of dollars by the time they’re done dealing with their health crisis.”
The Value of Community Partnerships and Volunteerism
The clinic is completely volunteer-based, and has eight volunteer medical providers, three medical doctors (M.D.D.O), four nurse practitioners, one physician assistant, three volunteer nurses, and one physical therapist. “That’s all we have right now, but we’ve definitely had others who have expressed interest”, said Dr. Gee.
The clinic has been also able to make deals and form partnerships with several local clinics, providers, and businesses in the community. Safeway and Palace Pharmacies give discounts to the clinic to pay for their patients’ prescriptions. Casper Medical Imaging Outpatient Radiology gives Medicare/Medicaid rates on images.
“Lander Medical Clinic has recognized that they have a lot of self-pay people, so they’re giving us a steep discount in getting our labs, x-rays, heart studies, ultrasounds, etc.” Kevin said. “Fremont Orthopaedics has not only donated a bunch of splints, but is also giving our patients a bunch of visits there so they can see an orthopedic specialist for cases that go beyond what we’re able to provide here. Dr. Teresa Ruehl of Main Street Dental is doing pretty much half-price on dental work, which is a massive help as well. Everything’s connected in your body, and so a lot of times there’s this disconnect between medicine and dental. But if you have a horrible dental infection, that can spread to your heart, to your lungs…it can eventually cause you to go septic if you don’t get it taken care of.”
“Erin Terry is graciously volunteering her time to help our patients out with physical therapy needs,” said Dr. Gee. “There are really great partnerships that we’ve formed, and saving a lot of healthcare dollars for our community. Another cool thing we’re thinking about is…we have rules and regulations we have to follow, but since we’re not tied to insurance or Medicare or Medicaid, we can have naturopathy, health education, and also try to build a robust mental health program. As we continue to grow and try to figure out all of those support networks that we need, we’ll be reaching out further.”
Dr. Gee mentioned a study done on ER care in New York, which has one of the highest ER patient rates. “They took the top two percent of the patients out and put them into a system like this…where you had social work, a nurse care manager, that sort of thing,” he said. “They found that it not only improved their health care outcomes, but also saved the hospitals a tremendous amount of money because these people were getting their diabetic care, their hypertensive care, or heart care. I think in general, primary care should be that. But unfortunately, it’s not always that way, especially for these patients, because there is just no way to access consistent care.”
“Standard of care, unfortunately, in a lot of places…is like, if you’re a diabetic, you just get handed your kit, a real quick lesson on how to inject yourself, they discharge you, and that’s it,” Kevin said, referring to his experiences as an R.N. “We find that if you just give that patient a call about a week later…see how they’re doing, ask them if they have any questions, ask them where their blood sugars have been…just doing that little extra work makes such a difference. We have hypertensive patients, so we’re giving them at-home blood pressure monitors, and checking in on them. So then we can adjust their blood pressure meds to what they’ve been finding at home. We’ve been able to get a few patients’ blood pressure down substantially from just trying to do more closer monitoring.”
Lander Free Medical Clinic is currently located at Trinity Episcopal Church. Walt and Janet Seeley, now retired Rectors, along with Deacon Linda Hudson, were instrumental in the genesis of the clinic, providing two rooms inside the church. The church also gave the clinic a loan of $7000, and The Foundation for the Episcopal Church in Wyoming donated $25,000.
“They have been extremely generous and supportive,” Kevin said. “This wouldn’t be here without them…we might have found another way, but they just made it so that it took that one worry off of our plate as to where we were going to be.”
“We’ve raised a little over $90K so far for everything we’re doing up until now, but we’ll probably need about twice that in the ensuing years to make this sustainable annually,” added Dr. Gee. “This can be a really nice safety net to bring patients in, and if they do qualify for benefits, hopefully, we’d be able to get them on to Medicaid or disability. That would be another vision…if they’re better served elsewhere, and where they can get more stuff done for their care.”
Fundraisers such as Challenge for Charities, donors, partnerships, and volunteer providers are also beneficial to the clinic’s future success. “if they want to donate time, or if they have a skill set that would be beneficial, like grant writing or health care…they can reach out to us,” Dr. Gee continued. “I think if businesses are interested financially, that would be fantastic. If they’re health care related, they can talk to us about how we can utilize their services at reasonable rates and think about the future for us.”
Opening a stand-alone clinic is also a part of their plans for the future. “If we could ideally double the funding we have right now, then we’d be able to pay rent on a place somewhere of our own,” Kevin said. “What’s great about this space (and a big reason behind it) is that churches in general reach out to their parishioners, so if you or a church leader knows someone that takes care of someone as a family member, or knows someone that might need help and might qualify…reach out to us; we can see how we can help them.”
The goal is sustainability. “This is a real community-based solution to take care of our neighbors in need, and we haven’t had to take a dime of money from the federal government, or the state government,” Kevin continued. “This is just a community seeing the problem and coming up with a solution to take care of the vast majority of hard-working people trying to make a living and can’t make ends meet. I’ve seen some skepticism as we’ve gone along, and I think a lot of it has melted away, now that we’re open and taking care of people. I think a lot of the results are speaking for themselves, so I encourage people to come down here and see what we’re doing and see that this is us, working in partnership with private foundations, individual private philanthropy, and the faith community to deliver really awesome results. These are our neighbors.”
“No matter what your creed,” added Dr. Gee. “You might see these folks at the checkout counter, or stocking the shelves at your favorite store around town. These are people who are keeping our economy moving, and to keep it moving, we need to live and have a dignified, fulfilled life.”
For more information about the Lander Free Medical Clinic, visit their website at landerfreeclinic.org. Click here to listen to Vince Tropea’s Coffee Time interview with Kevin Wilson.