The antique examination tables at the Queen Street Clinic for the uninsured accent the shiny black and white checkerboard floor fittingly, evoking a squeaky clean scene from a 1950s movie. The medical equipment, donated to the clinic at its inception, is no doubt unique. But more unique is the healthcare model employed by sole owner and operator Ann Boston Parish.
Queen Street Clinic is not free, nor does the city or state government subsidize it. Its a family practice where patients can pay a nominal fee for medical service, the only qualification being a lack of health insurance. But lately, Parish has been confounded by a tapering patient flow from a city with 8.3 percent of the population below the poverty line, according to the 2004 US Census.
Theres not a week that I dont get a thank you from patients, Parish said. But I cant count on volume any longer.
In the clinics first years, Parish received local and regional acclaim for her project, which she says represents a middle tier of healthcare for the poor, in between free clinics where patients often endure months-long waits to be seen, and emergency rooms, which often serve the indigent population while costing patients and taxpayers a hefty sum.
It costs $60 for an office visit at Queen Street, and $350 for an MRI, an expense that can run a patient $3,000 elsewhere. But despite discounted rates for low-income residents, the rabbit-eared television in the lobby remains unwatched, with patients trickling in only every so often.
What I saw when I saw this building was a haven for sick people, Parish said, pointing out photographs of the gutted building prior to its renovation. I saw a clinic that would be in the city so the inner-city population would have access to healthcare.
And they do. Parish has gained the trust of her patients and the community she serves. Boxes of thank you letters are scattered around her office. But its not easy on her back or her wallet; she mortgaged her house to start Queen Street, funding it almost entirely by herself, with small donations from churches every once in a while. She rarely takes a day off and her only vacation came when she was seriously ill and unable to work.
So where are the patients?
Many go the Emergency Room at Alexandria Inova Hospital, a service not intended for chronic ailments. While some uninsured patients can fill out an application and get fees waved or subsidized, its main function is still emergency care, so its not surprising that parish was frustrated when a patient, referred to her by the ER, said she is $1,200 in debt for a pap smear that was erroneously analyzed. According to Parish, the doctors missed precancerous signs in the patient, which she found after administering a test that cost Parish $220.
Its not negligence on the hospitals part, Parish said. The ER is an inappropriate venue for a pap smear. 90 percent of diagnosis is history taking, which is what I can offer at a family practice.
Parish says she turns no patients down, but referrals are tough to get from area clinics like the Arlandria Health Center or clinics run by the citys Department of Health, that offer free and reduced-priced medical service to many but cannot guarantee instant appointments.
We try to provide as much information as we possibly can [to patients] if we cannot treat them, said Veronica Abere, director of nursing at the Alexandria Health Department. We would definitely consider sending patients to Queen Street Clinic if its not an emergency. Abere said that she could not be certain if patients have been referred there in the past, adding that paperwork proving Alexandria residency is necessary for treatment, meaning a longer wait time potential patients.
59 percent of Parishs patients are from Alexandria, meaning the inner-city customer base she originally intended is only partially benefits from the discounted service. In fact, most of her referrals come form Fairfax County. She does not marginalize what other area clinics do for the community, but Parish wants the city and other clinics to stop ignoring I exist, hoping for recognition of what shes accomplished not for her, but for her healthcare and business model so that more of the at-risk population can be seen promptly and at a reasonable cost.
I just need someone to recognize who I am and what Ive done, Parish said. And take the idea and either run with it or implement it as a selection [in the healthcare system]. I listen to these candidates talk [about universal healthcare]. They dont understand you cannot safely, with safe medical guidelines, provide the healthcare that they are talking about. And I am.
Queen Street Clinic is a business that pays for itself, deriving no profit, yet Parish maintains that the model is not predicated on selflessness, and can be replicated across the country if a financial backer is willing and able at the projects inception. But Parish would never do it again alone because of the emotional and financial toll of remodeling and developing the clinic, which initially cost her approximately $100,000.
She talks about this model in her book, Confronting Americas Health Care Crisis. Focusing on sustainable ways to bring dignified medical treatment to the poor, Parish wants to see wealthy people in other communities funding clinics through their own pocketbooks, then turning them over to the nurses and doctors who operate it once a profit is achieved. But you need somebody with name recognition to acknowledge what youre doing, the nurse practitioner said.
Parish has received letters of praise from Mayor Bill Euille, for instance, but she says its just not enough to get the word out. Hes only one person, Parish said. I know Im doing a good job, but everyone needs to feel like what theyre doing has some value.
Meanwhile, Parish will leave her doors open.