How Do We Save the India Street Clinic? Five Ideas for Turning the Tide

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In the last week, public pressure on the Portland City Council has risen to a fever pitch as increasing numbers of local residents have stepped up to demand that the City Council cancel their plan to shut down the municipal health clinic on India Street.

As I detailed last week, many of the reasons that the City has given for the cuts don’t really hold up under scrutiny.  The clinic is not an easily interchangeable, albeit expensive, service that Portland Community Health Center (PCHC) can quickly launch its own programs to replace.

On the contrary, the clinic consists of a number of specialized, high quality programs that operate at little cost to the city.  At best, PCHC’s proposed substitutions, if they were to materialize before the India Street clinic is slated to close, are likely to prove woefully inadequate in comparison.

In a recent revelation last week, one City Councilor announced that, no matter how valuable the clinic may be, it has no choice but to close as their lease is in danger.  When activists looking to protect the clinic emailed the folks who own the building, however, they told us that they’d be happy to renew the lease (see below).

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So, that’s probably not it either.

My guess is that the City Council has been presented with a solidly professional budget proposal from City Manager Jon Jennings and is being told by the leadership of PCHC, who are eager to expand their programming, that they can assure a solid transition.

But where does that leave those of us who vehemently disagree with the vision for the future of our city that Jon Jennings is putting forward and seriously doubt the capacity of PCHC to deliver?

What can we do to ensure that our public comments as community members don’t just plummet from the balcony of Council Chambers, but actually have an impact on the decisions that affect us?

Here are five things I think would help.

1.  Insist that the City increase funding to public health and substance use disorder services.

Last year, 272 people in Portland died of drug overdoses.  In a city of less than 70,000, this number is beyond insane.  Calling it a crisis almost feels like an understatement.

In the long term, we’ve got to do everything we can to get heroin off the streets, transforming both how doctors prescribe pain killers and how police enforce drug laws.  In the immediate future, however, we’ve got to lower the body count.

If PCHC wants to beef up the services that they offer to people with substance use disorder, great, but that really doesn’t let the City off the hook.  Until the crisis is abated, the City has got to continue doing their part.  If they don’t, whatever PCHC does, the blood of next year’s overdose victims will be at least partially on the hands of the Portland City Council.

Similar arguments could be made about the 20,000 Portland residents who lack basic healthcare coverage, and the countless others who are under-insured, those who are able to get routine care, but unable to walk away without a weighty hospital bill.

As I see it, although the Affordable Care Act has made some significant strides toward extending coverage and has done a lot to support the growth of groups like the PCHC, until everybody in Portland has comprehensive healthcare, we will continue to need India Street.  The City is not off the hook.

It would be one thing if the funds the City spends on India Street truly were burdensome.  But, as previously noted, at a thousandth of the City’s annual expenditures, they simply aren’t.

Think about it this way.  The five bedroom house in Oakdale that I own and share with my friends is assessed at around $300,000, so we pay roughly $6,000 a year in real estate taxes to the City.  Like so many young people in Maine, most of our friends are getting by on health insurance that is minimal at best, and all of us in the house have lost at least one person we loved to an overdose.  It’s maddening that the City is trying to avoid spending even six of our $6,000 on addressing the source of so much genuine sadness in our lives.

It’s hard to see any cut that the City makes to public health services in the 2016-2017 budget as anything but a serious abdication of civic responsibility.  Until the federal government actually enacts meaningful, affordable, universal healthcare, which doesn’t seem too likely to happen any time soon, the City of Portland must continue to play an integral role in our local healthcare system.  The need is just too great for them not to.

2.  Demand that the City approach big policy shifts like this with a focus on community participation and democratic decision making.

Right now, when I look at the Portland City Council, I see a group of people, almost none of whom have very much professional experience leading, let alone working at, nonprofits or educational institutions, deciding for themselves how best to operate the public schools and social services that all of us in this city depend on.

If you don’t have very much money, and you and your friends depend on the India Street clinic to remain healthy, you know how big a deal it is for it to be in jeopardy.  If you can afford to get your healthcare somewhere else, and, as far as I know, everybody on Council does, it’s easy to see how it could look more like an accounting calculation.

I’m a big believer in working with big, diverse groups of people to facilitate making collective decisions. I have faith in large sheets of white paper, professional facilitators and magic markers.  I like people sitting in circles.  I like break out groups.  I like “spokescouncils” – horizontal groups comprised of spokespeople from other horizontal groups.  I like community, freedom and listening.  I love actual democracy.

I don’t like testifying in City Hall, speaking with my back to my friends, facing politicians, most of whom don’t like me particularly.  Whenever I offer public comment at one of those things, I always start strong, but the anxiety rises until I’m almost crying mid-speech.  It’s embarrassing.

It doesn’t have to be this way.  But, until we change how we make political decisions in Portland, we’re doomed to keep repeating this Groundhog’s Day of dis-empowerment.  We have a basic human right to participate in every decision that affects us, and we need to demand that the people who run City Hall respect that right.  Right now, for the most part, they just don’t.

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3.  Seriously investigate the dangers of shifts like these and make that information as public as possible.

The plan that the Council is currently considering calls for the lights to be turned off, the doors to be locked and everybody currently working at the India Street clinic to be fired within a matter of months.  The hope is that PCHC will be able to quickly launch their own set of programs from scratch within the next few months that provide similar services, but, by all accounts, that seems highly unlikely to happen.

Is it possible that responsibility for the clinic could eventually transfer over to PCHC? I don’t know.  Probably.  But it’s hard to underestimate the amount of time, planning and resources that it would take to facilitate such a complicated merger in a comprehensive, safe way.

Even if services did “transfer” successfully, you don’t have to look too far to find lots of historical evidence that such transitions have the potential to go horribly awry.

Just in our local area over the last few years, we’ve seen the closures of the old Healthcare for the Homeless clinic in Portland as well as the end of the community clinic in Biddeford.  All the experts who’ve studied the effects of these closures have come to the same conclusion.  They were disasters.  Patients who desperately needed care got lost in the shuffle and ended up suffering profoundly.

If the plan is carried out at the kind of breakneck speed that’s been proposed, it seems likely that something similar will happen here.  If it does, it’s almost certain that a good number of people will get hurt in the process.

We need to bring this information to light and demand that the City make a solid case for why this time will be different.  Should they refuse to, it’s hard to believe that they’re truly acting in good faith.  At the least, decisions like this should be made intelligently, carefully and thoughtfully.  This plan is a far cry from that.

4.  Stand up to the cowards who are calling for the clinic’s closure behind closed doors.

At the public hearing last week, dozens of Portland residents stood up to share heart-wrenching personal stories about the positive experiences that they’ve had at the clinic.  There were zero public comments from people who thought the clinic should close.

Yet, city councilors claim to be receiving a slew of messages from local residents who would like to see the clinic shut down.  To me, this seems cowardly.

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These are David Timm and Mike White, men who were diagnosed as HIV Positive years ago, and, thanks to the highly experienced medical staff at Positive Healthcare, have both been able to live happy, healthy lives for well over a decade.

If you can look one of them in the eye and tell him that you think Positive Healthcare should be shut down, go ahead.  At Positive Health, 95% of patients see their virus suppressed to the point of being practically undetectable. At most clinics, it’s only 60%.

If you wouldn’t have the guts to do that, but you’re sending private messages to city councilors, encouraging them to follow the advice of Jon Jennings, a man whose career has been spent co-owning minor league sports teams and developing real estate, but has never worked in public health, let alone social services, please stop.

And, to the councilors wrestling with this decision.  Please, have the courage to change your mind.  Listen to the experts.  They’re saying closing the clinic like this will hurt people.

5.  We need to get loud.

Our community has invited these city councilors into our municipal home.  We’ve offered them full reign over our shared resources.  They now get to vote on the future of our library, our police, our schools and our health clinic.  And, unless something changes in the next week, it seems likely that they’re about to use that power to shut down our clinic.

It’s not about the lease.  It’s not about the electronic medical records.  It’s not even really about the money.

It’s about a vision for the City of Portland that abdicates the entire responsibility for our health onto the private sector.  It’s about a plan for Portland that recklessly destroys a well-run, highly successful clinic because it simply doesn’t fit into the latest conception of how the municipality should operate.

So far, advocates for the clinic have organized a large protest on May Day that attracted well over 100 people, filled the public hearing on the budget to overflowing and submitted a petition with thousands of names.  None of this has been enough.

We now have one week before the vote.  It’s time to get loud.

Join us at 4:30pm for a rally at City Hall today:
https://www.facebook.com/events/118823368526558/

Take a minute and contact your city councilor directly:
http://saveindiastreet.org/contact-your-councillor/

Rob Korobkin

About Rob Korobkin

Rob is a software engineer, community organizer, teacher and musician. He can often be found at Peloton Labs, staring at his laptop, drafting diatribes and programming software late into the night.