NEW SALEM, N.D.
- Dr. Tom Kaspari says it's not true that he works at the
medical clinic here for free.
"I usually get jars of plum jelly or some salsa," he says.
It's enough for him now. But it may not be enough to keep the New
Salem Community Clinic in business.
Kaspari, 44, comes to the clinic every Wednesday afternoon and
evening, dressed more like a cowboy than a doctor. He sees up to 21
patients with across-the-board ailments. Thank-yous and occasional jars
of homemade concoctions are his payment.
Wednesday is normally his day off from work at other clinics in the
region and at a Bismarck hospital. He's been coming to the New Salem
clinic for the past two years.
"It wasn't my plan to be here two years, but that's the way it's
ended up," Kaspari said recently as a half-dozen, mostly elderly, people
waited in the clinic's lobby.
Similar clinics close
Brad Gibbens, associate director of the UND Rural Health Center, said
about a dozen similar clinics have been closed in North Dakota in the
past two years by hospitals in Bismarck and Fargo.
The population decline in rural areas made it too expensive for the
hospitals to keep the clinics open, he said.
"Whether it's a hardware store or a hospital, all businesses need
thresholds," Gibbens said.
Bismarck-based Medcenter One Health Systems closed the New Salem
clinic two years ago, along with clinics in Hebron, Elgin, Steele,
Washburn, Underwood and Center, N.D.
Medcenter One officials said at the time that the health-care system
was losing $675,000 per year on the seven satellite clinics because of
low Medicare reimbursements and rising health-care costs.
Some clinics fared better than others. Jacobson Memorial Hospital
Care Center in Elgin took over the clinics in Elgin and Hebron.
New Salem situation
New Salem's clinic closed for a few weeks and has been scraping for
money since, despite a free doctor and volunteer time by its two nurses,
a nurse practitioner and two clerks.
Board member Milton Grube said the clinic is seeking about $25,000
from a city-sales-tax-supported economic development fund. The clinic
also gets donations from area businesses, individuals and groups, but
still needs about $45,000 a year to stay out of the red. And that's
without a salary for Kaspari.
"We need some federal money to keep afloat," Grube said. "I don't
know how much longer we can stay open if we don't have it."
One patient's story
Grube, 89, a patient of Kaspari's who's on the New Salem clinic
board, said his town is more fortunate than others, since its clinic
remains open with a no-cost doctor.
Kaspari reminds him of "old Dr. Gaebe," who served the community a
century ago.
"People used to pay him with a half-dozen chickens or a pig," Grube
said as he waited for a blood-pressure check. "That was back when I went
to high school with his son."
New Salem, about 30 miles west of Bismarck, is the home of Salem Sue,
a huge fiberglass cow statue standing watch off Interstate 94. The
clinic is in a nearly-vacant 1970s-era shopping mall with a gravel
parking lot.
Grube, a retired farm implement dealer, said a big portion of the
town's population of about 800 is elderly, "I suspect like most other
small North Dakota towns."
"The clinic is an asset to our community," Grube said. "We have to
have it to survive."
Doctor's views
Kaspari, a native of Sheldon, in eastern North Dakota, and a graduate
of the UND medical school, said preventive medicine done at clinics not
only saves lives, but also saves taxpayers money in the long run.
"Limiting access to health care is a big concern," Kaspari said.
When Medcenter closed its clinic two years ago in Steele, the town
had another clinic, run by Bismarck's St. Alexius Medical Center. That
shut down in July.
St. Alexius now has no rural clinics in North Dakota, said Nancy
Willis, a spokeswoman for the medical center.
Willis said the hospital's clinic in Steele, N.D., was seeing only
about 150 patients a month, not enough to keep the doors open.
"With rural populations declining - this is a result," Willis said.
"It's a hard thing for everyone to accept."
Hope to keep open
Paul Bakkum, a member of Steele's economic development group, said
residents are looking at keeping the clinic open, perhaps by joining a
health clinic consortium, and are looking for help from federal
agencies.
"We've been told by they want to assist us in every way they can, but
they've all told us that it's going to be a difficult process," Bakkum
said.
Willis said St. Alexius received federal grants of up to $125,000 a
year to keep the clinic in Steele open. She said the grants ran out in
2000, and the hospital continued to fund it for five more years at a
loss.
"I'm not sure a community really understands the investment it takes
to do something like this," Willis said.
Bakkum, a banker, said, "I understand the fiscal part of it." But he
said without a clinic in town, other businesses will likely suffer.
"Clearly, this is the biggest issue facing the city," Bakkum said.
"Anytime you lose a school or a clinic, people will have to go
elsewhere."
UND official's view
Gibbens, of UND, said a few towns recently have joined a network of
community health centers that get some federal money. The clinics share
administration and other costs while getting reimbursement on a
patient's ability to pay.
The New Salem clinic has been working with Beulah, N.D.-based Coal
Country Community Health Centers, which also has clinics in Beulah,
Glenn Ullin and Halliday, N.D.
Coal Country chief executive Tom Nehring said his organization is
seeking more federal funding to add New Salem to its consortium. New
Salem currently pays no administrative costs, he said.
Karen Larson, deputy director of the Community HealthCare Association
of the Dakotas, said the program typically funds up to 25 percent of a
clinic's costs, but federal funding has languished.
"The federal budget has a lot of pressure on it," Larson said. "I'm
not sure when money will become available.
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