Friday, February 19, 2010


They arrived early at the Connecticut Convention Center as they had before in Little Rock and Kansas City. The line formed long before the doors opened. As a primary care doctor, I had come to help the National Association of Free Clinics run a one-day medical clinic in Hartford, CT to provide care for anyone without health insurance. This was the third time I was volunteering for a one day free clinic

Volunteers, health professionals came from around the country to participate.

I came from Boston where I have practiced primary care medicine for thirty-three years. I was asked to triage the registration line for anyone needing urgent care. As the line grew, I made my way through the crowd.

Most were working. Others had been laid off. None had health insurance. Half had not seen a doctor since 2000. A third did not go anywhere. They did not have insurance. They did not have cash. Those who had been to the doctor could not afford to fill their prescriptions.

A man, with a below knee amputation, rested in his wheel chair.

His medical insurance had denied his prosthesis. He hoped the clinic could assist him in obtaining a prosthetic leg so he could return to work and care for his family.

A woman, grimacing in pain, had cancer treatment two years ago, but without insurance she was unable to continue treatment. No insurance, no physician, no medication.

Another woman wore a trench coat to cover her emaciated frame. She had had three seizures in the past two weeks. A local emergency room told her that the level of her seizure medications was “OK” and discharged her. No follow up was arranged. During her seizures she had bitten the inside of her mouth that she now could barely open. I could not see an intact tooth in her smile. She could not eat. No Insurance, no doctor, no care.

A young man with labored breathing and sweaty brow was given a wheelchair. His weak voice told me five days ago he was in the intensive care unit of a local hospital for leg swelling. He did not understand why his legs had swelled then nor why the swelling had recurred. For a month, he experienced chest pains walking across his living-room. He needed three pillows to avoid awakening from sleep breathless. At discharge, he was handed a list of unaffordable medications that he did not understand. Continuing care was not arranged.

HHe had an unstable heart condition. I wheeled him to the front of the line. An ambulance was called. He was taken back to the emergency room with a possible heart attack. Why was this man’s leg swelling and chest pains not completely evaluated before discharge? Was it because he did not have health insurance? Had there been no free clinic, and his daughter not insisted that he come, he may have died. No insurance, no physician, no continuity.

A young man tried to avoid eye contact. His slouched posture told me he did not want to talk, but had something to say. Later, I learned the suicidal plans of three young people had been averted. Surely he was one. Would they have completed their plans were it not for the free clinic? No insurance, no access, no help.

A woman was leaning against the wall breathless. She was taken out of the line and seen immediately and then transported to the closest emergency room for acute congestive heart failure. No insurance, no doctor, no care.

Diabetes was her problem said a middle aged woman who had not seen a physician for three years. I asked her who was helping her control her diabetes. “Oh, I do” she said. “But where do you get the medicine” I asked. Staring me straight into my eyes she replied unabashedly “I get it from my brother who gets it from his doctor”. No insurance, no doctor, no medication.

Over one thousand patients were seen at each of these one day clinics. More were turned away. From the south through the mid west and into the northeast, all the patients, as if rehearsed, said the same thing: “No insurance, no doctor, no care”.

The day was overwhelming. In each city, I felt I was in a undeveloped country. I had seen patients with this burden of illness, but that was 40 years ago in medical school.

The American Medical Association claims to support health reform, but they were not in Little Rock, Kansas City, or Hartford. Absent was the American Association of Medical Schools planning the education of tomorrow’s physicians remote from the health crisis of today. My profession shames me.

Despite multiple invitations, absent were the politicians, bragging with self-righteousness, that they cannot support a ‘public option’ all giving a multitude of reasons filled with hypocrisies and fictions.

The cost of reform is not the question. We already incur the expense with the loss of manpower and the extraordinary cost emergency, and end of life care. The question is how much it costs not to reform. The question is how much we value our neighbor and fellow citizens. The question is how long our nation will allow the million citizens without health insurance to remain unseen. The question is of how we see ourselves.

No self-respecting, informed person could honestly believe without a public option private insurance companies will write policies to alleviate the suffering I witnessed in Little Rock ARK;, Kansas City,MO: and Hartford,CT. The opportunity was theirs for more than fifty years. They did nothing. It is time for reform.

Ralph B Freidin, MD

Boston, MA

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