A clinic specializing in care to uninsured LGBT patients is the latest in SF to face closure
When word got out that the Lyon-Martin Health Services clinic faced imminent closure, Luette Chavez's cell phone started ringing off the hook. Her friends were going into panic mode.
"It's shocking to think that something that's so important to so many people could just be lost so easily," Chavez told us. The clinic serves nearly 2,500 patients, regardless of their ability to pay for health care. It offers specialized services for queer women and transgender people, providing everything from primary care to mental health services to hormone treatment. A Hurricane Katrina survivor, medical school student, and part-time sex worker, Chavez volunteers at the clinic and relies on it for health care. Her dream is to someday start a free clinic in New Orleans that is cast in the mold of Lyon-Martin. But for now, all of her energy is consumed with the widespread effort to raise enough money to keep the clinic afloat. To survive, Lyon-Martin must pay off a $250,000 debt immediately.
As one volunteer among many, Chavez has adopted the mindset that failure is not an option. "I have absolutely every confidence that we will be able to save it ourselves because we're running ourselves into the ground doing it," she said.
Lyon-Martin's board of directors initially voted to shut down the clinic at the close of business Jan. 27, citing insurmountable financial problems. That decision was rescinded, however, following an emergency meeting held at the LGBT Center shortly after news of its pending closure went viral. By Jan. 28, an emergency fund drive had netted close to $100,000 in pledges and cash donations. A fundraiser held Jan. 30 at El Rio drew nearly 700 supporters and roped in another $28,000.
Despite the outpouring of support, the long-term future of the 30-year-old clinic remains uncertain. Lyon-Martin can restructure and avoid shutdown if it manages to clear the $250,000 urgently owed, but it must find $500,000 to continue operating in the same capacity as it has. It has stopped accepting new patients, but will likely be able to serve current patients until at least the end of February.
"Without Lyon-Martin, a community that is historically marginalized won't have anywhere to turn," stated an open letter to supporters from Board Chair Lauren Winter, who was unavailable for comment.
A combination of state funding cuts, increased demand, and poor financial management created a perfect storm for Lyon-Martin. A key source of the trouble was that the clinic had not been keeping up with its billing, and after a certain amount of time, it could no longer claim reimbursements from Medi-Cal. Yet external factors such as state and local budget cuts contributed to the problem, too, and Lyon-Martin is not alone in that respect.
All across San Francisco, community clinics that serve low-income and uninsured people are struggling to do more with less. Jim Illig, president of the San Francisco Health Commission, told us that he knows of several other clinics in dire financial straits.
"There are a lot of clinics on the edge because they have dedicated their mission to serving the uninsured," he said. "Any nonprofit clinic that you see — they're struggling." The Haight Ashbury Free Clinics, another nonprofit healthcare organization serving the uninsured, recently announced a merger with Walden House, a substance-abuse treatment center. The merger allowed the venerable health-care nonprofit to continue offering services after its budget was slashed by 50 percent due to reduced support from the city's General Fund. Even as the cuts took effect, demand for the free clinic's services rose 10 percent from 2009 to 2010.
"Every time I look into the waiting room, it's full," said Jeff Schindler, chief development officer.
If Lyon-Martin closes, its patients will have to be transferred to other clinics, but there's high demand everywhere. Such an outcome might evoke a sense of dèjá vu for some. Last fall, when an LGBT-focused clinic called New Leaf shut down due to crippling financial problems, many of its clients were transferred to Lyon-Martin.
The front office manager at Lyon-Martin, who wished to be identified only as Braz, said she'd had no warning that closure was imminent. "Just closing down like that seemed impossible. We couldn't ethically do that," she said. "Our patients are freaking out right now."
Once people became aware that the clinic was on the brink of closure, some aired the criticism that the board should have been more forthright about financial troubles. The Bay Area Reporter, a San Francisco publication covering LGBT issues, published an editorial calling for the resignation of the six-member board, and several sources told the Guardian they expected the board members to step down.
Meanwhile, health officials and elected representatives have stepped into the mix, but no promises of governmental financial assistance had been secured by the time the Guardian went to press.
Department of Public Health Director Barbara Garcia was unavailable for comment, but released a prepared statement: "The Department of Public Health has been in close discussions with Lyon-Martin and the pressing need to make immediate changes to the way they conduct their financial affairs. We value the important health care services they deliver and will continue to work with them to find the best long-term outcome for the clinic and the patients."
Sup. Scott Wiener told the Guardian that he'd been in discussions about Lyon-Martin with Garcia and Sup. David Campos. Sups. Ross Mirkarimi and Jane Kim also attended the emergency meeting, and California Sen. Mark Leno was said to be attempting to secure some state funding for the clinic. As the push to save the clinic continues, a parallel effort is moving forward to craft a contingency plan for how Lyon-Martin's nearly 2,500 patients can access care in the event that it doesn't survive.
Lyon-Martin patients and others familiar with its services stressed that the women's clinic is a critical resource for lesbians and the transgender population, because medical staff are trained in that specialized area of care.
"The service there is incredible," noted Cheryl Simas, who has been a patient there for three years. "They explain everything to you, you're listened to, and you're treated with care and respect." Simas said it was a dramatic difference from an experience she'd had in the mid-1990s, when her healthcare provider was barely comfortable pronouncing the word "lesbian."
Lyon-Martin medical staffers receive training on transgender patient care, and it even offers training in that realm for medical professionals from cities throughout the United States. "They are internationally renowned as a model for what it means to offer transgender care," noted labor organizer Gabriel Haaland, who said he was once denied health care due to his transgender identity. "The healthcare system is a fairly traumatic experience for most transgender people," he added.
If Lyon-Martin closed, "it'd be pretty tragic," noted Carlina Hansen, executive director of the Women's Community Clinic, which works closely with Lyon-Martin. When it comes to health care, "We live in an unusual city, in that there is a lot of need among low-income people, due in part to a high cost of living. "Every clinic in San Francisco provides an integral part of that network," and each clinic fills a specific need, Hansen noted. "The diversity of the clinics matches the diversity of our community."