Guy Burwell
From bellyaches to ringworm to pelvic pain, Dr. George Waldmann treats Multnomah County residents for conditions he says are common to the poor. For the past four years, he has volunteered at NeighborCARE, a so-called safety-net clinic in outer Northeast Portland serving 10,000 uninsured or underinsured people annually. But next month, in spite of voiced concerns by politicians and the threat that thousands in Portland will be left without healthcare services, this clinic will close.

"Unemployment rates are up, and there are more people without insurance," says Waldmann. "We have safety net clinics closing at a time when they should be expanding."

Safety net clinics are state and federally funded community clinics that serve both people without insurance and those on the Oregon Health Plan. (In Oregon, one in seven people do not have health insurance.) In spite of the Bush administration's promise to double access to community clinics in the next five years, the future for NeighborCARE--and the 72 other safety nets statewide--is dire because of a lack of county, state, and federal funding.

In February, Neighborhood Health Clinics, the non-profit operating NeighborCARE, went out of business. At that time, the County Health Department and CareOregon, a Medicaid managed care organization, stepped in to take temporary control and to keep the clinics doors open. But, even though the clinic operated beyond its capacity and turned away up to 30 people daily, the county decided to close NeighborCARE this July.

According to County Health Department Director Lillian Shirley, with a strapped budget, there is little more the county can do. By holding immunization clinics and supplying health care in jails and public schools, Shirley explains that the county pitches in where it can.

"We've done a lot to support safety nets throughout the state," she said. "The hard part is no matter what we do, there is still a need. We try to partner with other organizations, because no group can meet this need alone."

The letter informing NeighborCARE clients about the closure didn't give a reason. Instead, the letter simply directed them to visit nearby emergency rooms or call the Multnomah County referral line if they have a "hard time in the future finding medical care."

While Multnomah County insists its hands are financially tied, officials at the City of Portland explains that this issue is not the responsibility of the city, but of the county. Even so, with a pending crisis, and local politicians passing the buck, an unlikely hero has stepped forward: The mayor of the well-to-do suburban city of Beaverton.

Mayor Rob Drake says although it may be counterintuitive that residents of upscale Beaverton would depend on community clinics for health care, he is spearheading a project to open a safety net clinic to serve poor communities in Washington County. Traditionally, health care isn't a city issue, but Drake says that serving on a Blue Ribbon Task Force--a state panel looking for creative ways to increase affordable health care--has lit a fire under him.

"[The city of Beaverton is] not in the health care business, but we could combine resources to get somebody set up to run [a clinic]," Drake says. Besides allocating $250,000 to health care agencies annually, Drake has applied for a $250,000 federal grant. He also is trying to donate city-owned land to build a clinic for poor communities of Washington County.

"A lot of my citizens enjoy everyday access to health care. At any point I want, I can go to the emergency clinic or call my doctor of 25 years and Ralph will say, 'C'mon over,'" Drake said. "But there are well over 100,000 in the county that can't do that, and it's just basically not right."