How Michigan Stands in the Way of Poor People Getting Medical Care

For Remote Area Medical, licensing laws are a challenge

BRADENTON, Fla. – The true miracle in Lisa Ayala’s life came not when she received a new heart valve, but when her mother spotted a flier for a temporary free medical clinic that would soon arrive in her area.

Since being discharged from the hospital, Ayala’s life had been threatened by a tooth infection that doctors warned could turn into sepsis and kill her if left untreated. While the solution — especially considering the stakes — seems simple, seeing a dentist was anything but easy for Lisa. She doesn’t have dental insurance or the means to pay for dental care out-of-pocket. So she waited and hoped the infection didn’t spread to her vulnerable heart.

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While dropping Ayala’s 17-month-old son off at day care, Lisa’s mother, Donna Souza, saw a flier for a Remote Area Medical (RAM) clinic coming to Bradenton, Florida. The visiting clinic promised free medical, dental and vision treatment for anyone in need — no questions asked and no documentation or insurance required.

The down-and-out mom’s luck was finally turning around.

By 3 a.m. on the first day of the three-day-long event, the pair was in line, waiting for a ticket ensuring Ayala would see a dentist.

The line outside the clinic before the doors opened.

Eight hours later, as her daughter was being treated for the infection, Souza was ecstatic.

“You guys are going to save my daughter’s life,” she said while keeping busy filling a grocery bag with fresh produce offered free to patients. Souza’s day was made even better when she learned that she, like hundreds of others in need, could receive an eye exam and free glasses.

“I’m so thankful,” Souza said. “I had brain surgery a few years ago and I knew it affected my eyesight but I didn’t realize how bad it was. … I feel like a kid at Christmas! I’m so excited about [the new glasses].”

Souza and her daughter weren’t alone. Nearly 1,000 people were served at this clinic, many spending the night or waiting hours outside buildings at the community college that hosted the service, all for a chance at care.

The waiting room.

In 2015, RAM clinics served over 28,000 people — providing more than $9 million worth of services — all without any taxpayer money. They’re made possible by hundreds of volunteers and donors who want to make health care accessible to those most in need.

“People just need a helping hand,” said Jeff Eastman, the CEO of RAM. “This is just neighbors helping neighbors.”

Volunteers — including medical professionals who sometimes close their own practices for weekends at a time — often travel from other states on their own dime to help. At the Bradenton clinic, they arrived well before sunrise and began seeing patients at 6 a.m.

Volunteer dentists working on patients.

The clinics currently operate in a handful of states but RAM’s organizers want to expand its reach to other areas, including Detroit.

Founder Stan Brock said it’s often not a lack of manpower or funds keeping RAM out of new states, but regulatory hurdles.

In many states, including Michigan, it is illegal for people in certain occupations to work without being licensed by the state. If RAM wants to provide free dental, vision and medical services in Detroit, the obstacles are high. Michigan law makes it a felony for unlicensed practitioners to provide care in this state with few exceptions. This is true even if a person is licensed somewhere else and wants to provide the service for free.

Eastman says each event costs about $80,000 to put on, and he’s proud of the strong donor base his organization has built. Eighty-five cents of every dollar donated goes directly to patients and RAM has doctors, dentists and nurses who want to help.

Opticians performed eye exams and gave out free glasses.

Due to regulatory hurdles, RAM currently operates mostly in just a few states, with events planned for Florida, California, Tennessee, West Virginia and New York. While it has a good network of health professionals who want to help, navigating state laws is complex.

“We would love to do a clinic in Detroit,” Eastman said. “But it’s a big struggle.”

Detroit is an area with many needs. The city has one of the lowest insurance rates in the nation and even those who receive care are often limited by what federal insurance allows or where it is accepted.

Other states offer up a model for Michigan.

“The states where it is most successful are the ones where the nonprofit is responsible for checking the licensing,” Eastman said.

Tennessee, for example, passed a law that allows for medical professionals to provide free services as long as they are licensed somewhere. That makes it easy for groups like RAM to hold clinics and get enough volunteers. Even if a dentist who wants to help informs them just a few days ahead of time, the group can check the license through a national database. It’s no surprise that RAM’s clinics are concentrated in just a few states — those in which it is easy, and legal, to operate.

Brock, who founded RAM in the 1980s, said Tennessee changed its law in the 1990s. For the clinics there, more than half of the medical providers are from out of state.

“They pay their own way,” Brock said. “They get nothing from us or the government.”

This would be impossible in Michigan. Detroit borders Canada and is near Ohio but if doctors or dentists wanted to make the short drive to help in the Motor City, state law would prevent it.

RAM clinics cost about $80,000 with most equipment trucked in.

To patients like Jamie Ogline, little of that matters. She is 30 years old, works as a server and can’t afford to purchase insurance for her two children, let alone for herself.

She said that to families like hers that are struggling to get by, whether a doctor comes from Michigan or her home state of Florida doesn’t matter. What matters is that she’s able to get a pair of glasses that enable her to keep her job and that her children can have their teeth cleaned so they can avoid cavities.

“This is saving me and my kids,” Ogline, who had to split her visit to the clinic into two days to accommodate her work schedule, said. “I heard about (the RAM clinic) and I just couldn’t believe it because it’s all free and it doesn’t matter if you have insurance.”

In addition to having their immediate health, dental and vision needs met, patients were offered flu shots and other immunizations, fed, given information on local services and nonprofits in their area, and allowed to fill a grocery bag with fresh produce as they left. RAM also offered a veterinary clinic to provide treatment, vaccines, spay and neutering procedures, nail clippings and other services to dogs and cats whose owners are unable to afford such care.

A pet clinic across the street featured veterinarians doing free services.

In the states which make using outside volunteers illegal, RAM is forced to rely only on local professionals for its mission. But that means fewer people getting service. Eastman said it is often much easier to get someone to travel and help than do so in their own backyard.

Some states allow for the governor or health department to issue a waiver to regulations. Others provide temporary permits or licenses. But too many are like Michigan, with overbearing rules making it all but impossible to easily provide care.

RAM will continue on, doing its best to serve those who need it most. All its people care about is the end result: What is it like for the person getting served? None of the people in Bradenton who went in for care were worried about the bureaucratic hoops the good Samaritans had to jump through — only if a tooth stopped hurting or if they could see with new glasses.

Patients grabbed a bag of donated fruits and vegetables on the way out.

The clinic in Florida began on Nov. 11 — three days after a hotly contested presidential election in the biggest swing state of them all. But nobody talked about politicians or debated how much help the government should be giving.

A few days after the clinic, Souza said her daughter had experienced an unbelievable recovery since having her tooth infection treated and being prescribed antibiotics. For the first time in years, she was able to get on a bicycle and ride around the block. And for the first time in months, she was able to hold her 17-month-old baby.

“This is amazing,” Souza said. “It has been life-changing.”


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