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In a city with few health care options, this firehouse answers the call

June 29, 2017 at 6:30 PM EDT
In the city of Hayward, California, options for health care are limited. But officials there came up with an innovative solution: integrating a new fire station with medical services to take advantage of its prime location and other conveniences. Special correspondent Kathleen McCleery reports on how the experiment is working and concerns about the fate of Medicaid.
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JUDY WOODRUFF: Now a health care story about providing help to those who need it most.

Even as the debate over replacing the Affordable Care Act continues, one California city has come up with an innovative solution to an intractable problem.

Special correspondent Kathleen McCleery reports from Alameda County.

KATHLEEN MCCLEERY: On the south edge of the city of Hayward sits a neighborhood with especially high rates of poverty, unemployment and violent crime. People are sicker, too. Many suffer from diabetes, obesity, asthma and other ailments.

Options for care here are limited. There’s just one hospital, and few doctors welcome Medicaid patients. Some call it a health care desert.

ALEX BRISCOE, Former Director, Alameda County Health Care Services: South Hayward is the poster child for lack of access to primary care.

KATHLEEN MCCLEERY: When Alex Briscoe was with Alameda County Health Care Services — he was agency director for six years — he hunted for ways to improve access to care. In 2009, as he coped with the swine flu, or H1N1, epidemic, Briscoe had a light bulb moment.

ALEX BRISCOE: Firefighters joined our public health nurses and many other providers, and we very successfully vaccinated, immunized hundreds of thousands of people.

MAN: Airway aids and tracheal tubes.

KATHLEEN MCCLEERY: Briscoe wondered if firefighters skilled as trained paramedics could help solve another piece of the health care puzzle.

ALEX BRISCOE: This H1N1 experience, combined with our already robust relationship with fire on the EMS system, it’s kind of like peanut butter and chocolate. Do these two ideas go together, and is there a way for us to use this already existing resource and preexisting trust as well?

KATHLEEN MCCLEERY: Trust, because approval ratings for firefighters far exceed other public servants. That got officials here thinking about how to leverage manpower and location.

Kristel Acacio runs special projects for the county agency.

KRISTEL ACACIO, Alameda County Health Care Services Agency: Fire stations, firefighters are strategically located in every community. So we saw this as an existing, but perhaps untapped resource to serve our patient population.

Around the fire station, there is a concentration of low-income residents.

KATHLEEN MCCLEERY: When Acacio examined data about that population, she discovered that the neediest area was just where the county planned to build a new fire station.

KRISTEL ACACIO: And what we can see in this map is that in Hayward, and in particular in South Hayward, that the concentration of avoidable emergency department visits is 1.5 times or greater the county rate.

KATHLEEN MCCLEERY: County health officials seized the chance to collaborate with the city, a community health center and a nonprofit architectural firm to design and build two structures on the same campus. They opened in late 2015.

The clinic is right in front of us, and the fire station is right here.

GARRETT CONTRERAS, Fire Chief, City of Hayward: Yes, the same style. They look integrated, and basically taking advantage of that sort of known trust and location.

KATHLEEN MCCLEERY: Fire chief Garrett Contreras was a supporter from the start.

GARRETT CONTRERAS: Upwards of 70 percent of our 911 calls in the Hayward Fire Department are for medical emergencies. Some of these more routine-type medical problems can be treated at a much lower-cost setting and keep the emergency room beds available for our most critical patients.

KATHLEEN MCCLEERY: Reducing the number of transports to the E.R. is one way to measure success, says David B. Vliet, CEO of the Tiburcio Vasquez Health Center, which runs eight community clinics, including this one.

DAVID B. VLIET, CEO, Tiburcio Vasquez Health Center: Because we have delivered 6,000 urgent care, convenient care visits here, those are visits that didn’t go to the E.R., so right away we know we have kept that volume out of the emergency room.

KATHLEEN MCCLEERY: But not everything went according to plan.

KRISTEL ACACIO: Initially, what we wanted the firefighters to do was that we could possibly dedicate a couple paramedics to actually work in the clinic.

KATHLEEN MCCLEERY: That idea was quickly squelched by the California Nurses Association. Karen Rothblatt has been a nurse for 30 years.

KAREN ROTHBLATT, Registered Nurse: You wouldn’t want me to come and respond to you in that critical first moment. It’s not what my training is about. Same, turn that around, I think you could say that a paramedic hasn’t been trained to do what a nurse has been trained to do, so why would you have them do that? I think it would be putting people at risk.

ALEX BRISCOE: My first thought is the “Family Feud sound. Look, no nurse would say that while a paramedic is trache-ing them or starting an I.V. line Paramedics are extremely highly trained, and highly skilled, and I think that they can do far more than what they’re currently doing, if we remember that the point of our health care delivery system is to serve people, not to protect health care market share.

KAREN ROTHBLATT: Well, I find that insulting, actually. There are jobs out there for nurses. It’s not about that. It’s really, really about making sure that that clinic really functions in a way that is best for the patients that arrive there.

KATHLEEN MCCLEERY: At the clinic, patients are seen by a nurse practitioner or physician’s assistant. No doctor is on staff yet, but they say they are hiring one soon.

Firefighters are close by if the clinic needs lifesaving care for heart attacks, strokes or to get patients to a fully staffed emergency room. And proximity promotes communication, too. Those in the field, like Captain LaShon Earnest, encourage people to use the clinic.

CAPT. LASHON EARNEST, Captain, Hayward Fire Department: We go on a lot of calls where we can make a determination where somebody who doesn’t necessarily need to go to the emergency room, the tax the system. For something — say, for a stubbed toe, this is someone that could probably use the clinic.

Well, did you know the clinic was right next door to the firehouse? Oh, I didn’t know that. OK. Well, maybe I’m fine right now, I don’t need to go to the hospital. I will have my mother drive me tomorrow to the clinic.

KATHLEEN MCCLEERY: Tina Greives lost her insurance after an on-the- job injury as a long-distance trucker. For her, the location, next to the fire station, is convenient.

TINA GREIVES: I don’t have a vehicle, which is unusual for somebody in California. This one is just seriously within walking distance if I’m doing good, or a 15-minute bus ride. So, it’s in a perfect location.

KATHLEEN MCCLEERY: Greives, like most treated in this clinic, qualifies for Medicaid. More than 120,000 people in Alameda County were added to the rolls with the passage of the Affordable Care Act.

The uncertainty over health care in Washington is causing worry here in South Hayward. Cuts to Medicaid could reduce a key funding stream for this clinic, keeping it from being self-sustaining in the coming years. And that’s a concern for providers and patients alike.

TINA GREIVES: I wouldn’t be covered by the new bill. That’s all there is to it, and it’s just like, holy dirty word. So, it’s an uncertainty, and it’s scary.

DAVID B. VLIET: Ultimately, it means that more folks cannot be seen in a health center like this, and would not have a paying source in order to do that.

KATHLEEN MCCLEERY: The partnership of firefighters and health care workers is a first for California.

ALEX BRISCOE: The attempt to bridge the 911 system and the primary care system, I think that’s a unique experiment.

GARRETT CONTRERAS: I do believe it can be a model. I do believe it will be — can be repeated. It’s not easy. Not so easy to do to get multiple governmental agencies to work together, drop the boundaries, drop the egos, drop the who said what, who’s doing what, who’s getting credit for anything, and just do it because it’s the right thing to do and it’ll improve service to the community.

KATHLEEN MCCLEERY: I’m Kathleen McCleery for the PBS NewsHour in Hayward, California.

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