Special to the Express

Kids asking to come back to the dentist’s office? What’s that? That’s the reaction to the Winters Healthcare Foundation’s Dentist for a Day event, which took place on Monday, June 20. Dentist for a Day, which was begun hereby the foundation’s director of dental services, Dr. Ana Maria Antoniu, takes the youngsters out of the patient’s chairandputs them in the dentist’s “driver’s seat,” where they learn about drilling and filling, about cleaning and about making a good impression (of the dental sort, of course.) Antoniu, who was trained in Boston andsaw the Harvard community outreach model in action, began what she hoped would be an ongoing annual event last year. Volunteering their services on the clinic’s usual closure day, she and her staff used toys, props, real tools and equipment to acquaint the participants with the variety of procedures that takeplace in the office daily. Using model teeth that look an awful lot like the “chattering teeth” novelty toys that you might see at Halloween, the children practice cleaning techniques. The older ones even get into the chemistry of dentistry, mixing various filling materials and sealants and applying them to plastic cavities. There are dental Barbies for the youngest visitors, and a whole variety of toys and models to demystify what happens when real people have their real teethworked on. The favorite procedure of all of the kids, whatever age, is learning to do injections using a real syringe and a hot dog, says Antoniu. Another big hit was having the opportunity to take impressions of their thumbs and hands, using that mysterious purple goo that hardens quickly into a perfect model of whatever it touches. There are two purposes behind the day of fun and face paint. One is to introduce children to the variety of career opportunities that are available in dentistry. Thesecondis to make a visit to the dentist a less frightening experience. Antoniu says that children who take part in the programare visibly less anxious and more relaxed whenthey are back in the hear as patients. The WHF dental practice has grown almost sevenfold since it opened three years ago and now has a caseload of nearly 2,000 patients. Some come from as far away as the Bay Area, encouraged by local family members who use the services. The clinic is supported bya mix of private pay, insurance and grants. Not surprisingly, grants are getting harder to come by, says the director. The role of dental health in overall health — especially among children — is much greater than most people understand, so events like Dentist for a Day are true communityhealth outreach programs. Antoniu intends tomake it an annual event and“we hope to make it bigger in years to come.” As for the kids, they “gave it a thumbs up” and want it to happen even more often. That makes perfect sense, because we are all encouraged to see our dentists at least twice ayear. Photo by Debbie Hemenway Hygienist Dan Margarit uses giant teeth to show Julia Antoniu and Paola Martinez the finer points of teeth cleaning. Not pictured are dental team members Vicki Barbosa, Leanne Dodic, Olivia Barbosa and Veronica Barajas who also participated in the event.

Find the full article, at the Winters Express home page, under archives.

Town Rallies To Keep House Calls

Dr. Bill Davis has called it quits, but not from practicing medicine.

The family practitioner left Sutter West Medical Group in June, saying the managed care system didn’t allow him to spend enough time with his patients.

Davis’ neighbors in rural Yolo County apparently approve of his decision. They are raising money for a clinic for the doctor known for making house calls on his son’s bike if his car isn’t available.

The Winters Healthcare Foundation was formed in June by friends and neighbors who told the doctor they didn’t want to see him leave the town, where he has spent his entire 14-year career.

The board, still awaiting nonprofit status, plans to open a 840-square-foot clinic Sept. 1. Much of the office and medical equipment was donated, Davis said.

Davis, 47, one of three doctors in the town of 5,200, about 70 miles northeast of San Francisco, calls himself a “conscientious objector” to the health care system.

“I was tired of seeing patients have to wait for oxygen or wait for pain relief,” he said.

The foundation is trying to raise $500,000 through in-kind donations and community events, said volunteer Theresa Cox. Buckets for donations sit on the counters of many local businesses.

Eventually, the foundation will employ Davis and hire a physician’s assistant, a receptionist and a nurse. But when the doors open, the clinic will be run by volunteers including Davis.

“I don’t anticipate having any income for the rest of the year,” Davis said.

Davis, his wife Wendy and their two sons, will live on Wendy’s income as chief ombudsman with the state Department of Mental Health and the couple’s savings until the clinic can afford to pay Davis.

“There’s a real sense of being someone in the community, everyone has a role here,” said Wendy Davis.

“If that means you go to someone’s home to see them, then you go to someone’s home. If it means looking at an arm at a Little League game, then you look at the arm at the game,” Bill Davis said.

The community is accustomed to Davis’ personalized brand of medicine, from making house calls to standing by at soccer, football and baseball games in case of medical emergencies.

“One time my son crammed Play-doh into my daughter’s ear canal with a Q-tip, really stuffed it in there. I called Dr. Davis and he came right down on a Saturday to take the Play-doh out,” said Debra Ramos, the editor of the weekly Winters Express and a patient of Davis’ since 1986.

A yearly membership fee of $100 per household will cover a checkup with Davis, enrollment in any health courses offered and consultation on how to get the most of a health insurance plan, said Wendy Davis. The foundation is also considering creating a co-op, that would charge an upfront fee and cover all routine health care, she said.

The clinic will take insurance, Medicare “and chickens,” Bill Davis said but it won’t accept HMOs.

There’s no official data on how many doctors leave affiliations with managed care plans, but health care management consultant Albert Lowey-Ball said the numbers are relatively minuscule.

“Of course, there is a great deal of dissatisfaction that physicians have with respect to health plans and larger medical groups related to the level of fee-for-service or capitation rates and over-the-shoulder management,” Lowey-Ball said.

Sutter West President Harris Levin said Davis told him he was leaving because he was frustrated over the increasing amount of red tape and paperwork involved in billing.

“I can hardly think of a single doctor who isn’t frustrated with the amount of paperwork that exists,” Levin said. Plans are underway to reduce the amount of paperwork by using electronic records, he said.

The medical group, which includes 48 doctors, prides itself on being flexible with physician’s schedules, allowing them to spend as much time as they feel is necessary with patients, Levin said.

Davis, however, said he felt the group wasn’t responsive to his complaints and didn’t fit his view of how medicine should be practiced, especially in a small town.

“I felt I needed to get out of a bad situation,” Davis said.

While the move was frightening for financial reasons, Wendy Davis said she was relieved for her husband.

“The strain of working in a system where you are devalued for doing the right thing is incredible,” she said. “I admire him for saying ‘I’m going to do the right thing.’”

Town Defies HMO, Rallies Around Doctor;

Winters, Population 5,200, Sets Up Its Own Clinic To Keep Physician Who Makes House Calls

Call him old-fashioned, but Dr. Bill Davis likes making house calls.

Carrying his battered black-leather medical bag, he often rides his son’s bike along this rural town’s leafy streets to visit his patients right where they live, spending an hour or so sitting by the bed or at the kitchen table to get to the bottom of what’s ailing them.

But the HMO that employed Davis and the only two other physicians in this Yolo County community didn’t agree with his style of country doctoring. While it might be good medicine, they said, it just wasn’t good business.

Davis says his bosses at Sutter West Medical Group insisted he see more patients, as many as six an hour. Meanwhile, the 47-year-old doctor, who for eight years had run his own practice before joining the HMO in 1994, bristled at the mountain of paperwork required for even simple procedures.

Calling himself a “conscientious objector” to the managed care system, a frustrated Davis finally quit his $ 70,000-a-year job this summer. While reluctant to leave medicine, he considered changing careers to teach high school and feared having to move his wife and four college-age sons away from the town where he had spent his entire 14-year career.

“I got tired of watching patients having to wait for oxygen or pain relief” because of HMO requirements, he said. “I became a thorn in their side because their big-city brand of medicine wasn’t doing justice to people in this town.”

Then the unexpected happened in the tiny farming community of 5,200 residents an hour north of San Francisco—people took a stand against big-business medicine. On the day Davis quit, dozens of his patients lined up outside his old office to cheer him on.

Scores also met at City Hall to try to save this latest in a long tradition of doctors who have made themselves available to townsfolk—from taking late-night calls to doing house calls on holidays.

Their solution was to form a nonprofit health care foundation that would allow Davis to practice medicine as he saw fit. Using volunteer labor, they refurbished an office in the heart of town in what residents proudly refer to as an old-fashioned barn-raising.

HMO Defections Increasing

Davis joined what experts say is a growing number of physicians who have rebelled against what they consider to be the bitter pill of the managed care system.

But rather than quit the profession he loved, this small-town doctor—with the help of his neighbors—created his own alternative brand of grass-roots medicine.

The new Winters Health Care Foundation clinic will mainly treat poor and Medicare patients—charging on a sliding scale based on what they can afford. Among this town’s many Latino farm workers, Davis even takes live chickens, fresh vegetables and tamales as barter.

But there’s one thing he won’t accept: HMO insurance.

Keeping their Sutter coverage for emergencies, 100 people last month saw Davis for their routine care—willing to pay $ 30 instead of the usual $ 10 Sutter co-payment.

“Dr. Davis took a stand against that HMO, and we felt that he did it for us, the people of Winters,” said clinic organizer Esther Brewer. “And we know that if we lose this type of quality care, we’ll never get it back.”

For Davis, the split from Sutter forced a difficult choice between his roles as doctor and family provider: Preserving his medical principals would mean less money.

He would have to forgo a salary for a year while launching the clinic. His family would be forced to live on savings and his wife’s pay as chief ombudsman with the state Department of Mental Health. He would risk losing his home and could no longer help his children pay for college.

But his wife and sons agreed it was worth the gamble.

“We’ll live out of a van if we have to,” said Wendy Davis. “It’s so liberating to do what you believe in. Now Bill’s eyes light up when he talks about his patients. He’s become a real doctor again.”

The HMO breakaway in Winters has brought some small-town tensions. While Davis says his criticisms are not against Sutter but against managed care in general, his two former partners now rarely speak to him. Sutter managers have resisted releasing medical charts for many patients who wish to see Davis instead.

“From Sutter there has been only silence—they figured my only option was to deliver pizzas,” Davis said. “But I thought one of my former colleagues might call to see how I was, at least concerned over whether I could make it or not.”

Sutter West Medical Group spokeswoman Nancy Turner said Davis refused to honor his contract. “Sutter West never said he couldn’t spend time with patients,” she said. “But his contract obligated him to meet its requirements—whether it was filling out paperwork or seeing a certain number of patients in a day.”

While statistics on such defections are scarce, Dr. Marie Kuffner, president of the California Medical Assn., says she encounters HMO dropout doctors all over the state.

“They no longer feel conflicted every day—nobody’s breathing down their necks saying ‘You gotta see the next patient,’ ” said Kuffner, an anesthesiology professor at UCLA Medical Center. “Most don’t care what it costs. They’d rather have their integrity.”

Rex Green, who quit practicing medicine after working 12 years with HMOs in Pasadena, said Davis is lucky to have such local support. “What’s happening in Winters is a rural solution,” said Green, now an administrator at City of Hope Hospital in Duarte.

“Many places so desperately want the kind of country doctoring their parents enjoyed they’ll dream up ways to make good doctors stick around. That’s not going to happen in a big urban area.”

Winters residents agree the new clinic was a revolt against the fast-lane HMO brand of medicine they call “doc-in-the-box.” Said pharmacist Gary Bertagnolli: “It’s this small town’s way of being rabble-rousers. People are tired of what’s being handed to them.”

Practicing Grass-Roots Medicine

Davis raised eyebrows soon after arriving in Winters, fresh from medical school, in 1986. He began volunteering at high school football and soccer games to be on hand in case someone was injured.

“Once a week, while other doctors might be out golfing, he visited rest homes to visit the shut-ins,” said local farmer Joe Martinez. “There was something spiritual in the way he practiced medicine.”

When Esther Brewer’s father became ill with a life-threatening intestinal blockage, Davis visited him several times a day. “He’d sit on the floor next to him and hold his hand,” she said. “He got into bed with my Dad to comfort him and wipe his forehead. That assurance was so much more valuable than just being told to take a pill.”

But tough economic times in the early 1990s made Davis worry over his $ 40,000 annual earnings. “I was struggling,” he said. “I wanted to help my sons go to college, but I was sinking deeper into debt.”

His income rose when he joined Sutter, but the work proved even more stressful. In addition to the pressures of mounting paperwork and patient loads, Davis found that red tape often caused needless and painful delays in treatment.

In some cases, the system would require patients to make time-consuming and emotional changes in their approved medicines, only to be required months later to switch back to the original prescriptions.

He saw patients suffering from back pain and stomach ailments go weeks without physical therapy because of paperwork problems. And one desperate woman suffering from sleep apnea paid for an expensive but much-needed test out of her own pocket because the insurance company refused to cover it because of a technicality, Davis recalled.

“Some bean counter who didn’t know anything about medicine decided rules were rules,” he said. “And so she suffered.”

Davis quit after the pressure began affecting his health, making it impossible to concentrate at work. Months later, he says, the swift community reaction has made him feel well again.

Residents collected $ 50,000 in cash and materials. One woman wrote a $ 100 check, offering to forgo her diabetes medication. Davis refused her money.

They refurbished a vacant office on Main Street with volunteer masons, electricians and contractors. A local attorney offered free legal advice and a bookkeeper volunteered to do the taxes.

As a nonprofit, the clinic can apply for government grants to defer the costs of treating the poorest patients.

“We’re going to try to create comprehensive health care and find a way to pay for it,” Davis said. “That’s the opposite of what insurance-based medicine does. They only do what’s paid for.”

Residents hope to raise $ 500,000 to cover the clinic’s $ 4,000 monthly operating costs and eventually offer Davis a small salary.

“I may be out on a shaky limb, but a lot of hands are reaching out to hold me up,” he said. “I don’t feel alone. And I don’t have to worry about going without food–not in this community.”

Treating Patients Out of the Office

While the clinic was being built, Davis continued seeing his patients anywhere he could. He treated them out of his car and at a local park, and held consultations in restaurants. He carried his cell phone to football and soccer games and took calls there.

“People would come up to me at the grocery store, complaining of a problem, and I’d say ‘Well, lift up your shirt and let me take a look.’ ”

At his small clinic, Davis often answers the phone himself, forwarding calls home when he leaves at night. He shows up many weekends, such as the day he treated the daughter of the local newspaper editor after the girl’s brother stuffed Play-doh into her ear with a Q-Tip.

“Dr. Davis is a holdover from another era–his style of medicine doesn’t exist any more,” said Debra Ramos, editor of the weekly Winters Express. “He has an internal clarity of why he loves his profession–and it’s not to get rich and it’s not to play God.”

When a young baseball pitcher complained of arm pain, Davis left the office, taking the boy out to the diamond to throw some balls before diagnosing a rotator cuff problem.

With a woman who lost her ability to speak in a car accident, he waits patiently while she spells out each word on a letter board. “How, in a rushed 10 minutes in some HMO office, do you allow a patient like that the dignity to express things herself?” he said.

But Davis knows he still risks losing his home to save his medical vision. As Winters residents try to raise enough money to keep their favorite doctor in town, he goes about treating his patients as if it were still 1950.

In the living room of 88-year-old Violet Hughes, he leans in close with his stethoscope. Shaking his head, he worries over how pneumonia has cut her weight to a mere 70 pounds.

After nearly 45 minutes, often holding her hand as she sits bundled under a tartan blanket, he stands to leave, offering to pick up her prescription at the nearby pharmacy.

“What’s your hurry?” the old woman rasps.

As her country doctor heads for the door, she peeks up shyly.

“Are you coming tomorrow?”

The Single-Doctor HMO

A small town dumps its provider for a rebel medic

If you’ve visited a doctor anytime recently, you know the routine. You wait an hour for a 10-minute once-over, and you can’t get an aspirin tablet or a Band-Aid–let alone a referral–without six bean counters and a dozen paper pushers eyeballing your entire medical history.

In the one-traffic-light Northern California town of Winters (pop. 5,300), one doctor has said no to all that. “Why in the world should you have to fill out a referral form and wait for approval when you know the approval is guaranteed?” asks Bill Davis, who got tired of treating patients as they whizzed by on the managed-care assembly line. “There’s no value placed on your relationship with your patients. It’s all on how much money you generate.”

Davis’ ranting is aimed at the entire industry rather than just his ex-employer. But it made him the resident bad boy at Sutter West Medical Group, part of a health-care system with 5,000 physicians in Northern California. There are certain realities no doctor loves, says Sutter spokeswoman Nancy Turner. “But they pretty much live with it and accept it as the state of medicine today.”

Not Davis. He was so fed up by the time he quit Sutter last June, he was prepared to get out of medicine altogether and go teach high school. But the town of Winters, which exists in another time, wouldn’t let him.

Davis, who had his own practice before joining Sutter in 1994, often rode through town on his bicycle to see how patients were getting on with their new crutches or responding to a change in medication. He had driven patients to the hospital and grieved with the families of the dead and dying. “I can’t tell you the number of times he came to my house in the middle of the night because my daughter was sick,” says Debbie Hayes.

And so when he walked out the door of his Sutter office for the last time, townsfolk were there by the dozens to thank him for taking a stand. They also swarmed meetings to figure out how to keep him. “There’s a tradition of people taking care of each other in this town,” says walnut rancher Joe Martinez, 53, who came up with the idea of a nonprofit health-care foundation owned and operated by the residents of Winters. With guess who as resident physician.

Several fund raisers later, they were on their way. Carpenters, electricians and anybody who knew how to do anything pitched in to rehab the abandoned shoe-repair shop on Main Street. On Oct. 1, with $ 50,000 in the kitty, the Winters Health Care Foundation was a bricks-and-mortar reality, accepting all forms of payment, including food, services, IOU’s and cash, but absolutely, positively, no HMO insurance. Right here would be the perfect spot to plug in the happy ending so we could all stand up and cheer. But there is no ending yet, and in some respects this venture is a test of whether a doctor can survive without putting a dollar sign or a clock on a patient’s needs.

Start-up costs have put the clinic in a hole, and getting reimbursement for treatment of low-income patients with medical insurance has been a predictable nightmare. Loyal patients like Debra Ramos are paying cash, even though they have HMO insurance they could use at Sutter West. “But I don’t know how long I can afford that,” says Ramos.

“We are struggling right now, but I think we’re about to turn a corner,” says Martinez, chairman of the foundation, which still gets a trickle of contributions at 23 Main Street, Winters, Calif. 95694 (WBDavis@Davis.com). “Dr. Davis and his wife Wendy [the currently unpaid executive director of the clinic] have put it on the line for us, and we have to all pitch in and fight for them.”

Davis hasn’t yet drawn a salary. But it was a happy doc who made a house call last week to check on chronically ill roommates Ramon Castellanos and Edwin Giezendanner. “I don’t know where all this is going to lead,” Davis says. “But I’m tired of doing the wrong things as a doctor. I want to do the right things for a while and just hope it works out.”

Community rallies to keep a small town doctor

Exasperated, Dr. Bill Davis just said no to HMOs, and his small town rallied round

Modern medicine was making Bill Davis sick. He was an old-fashioned doctor working in a system that put a higher priority on filling out insurance forms and meeting appointment quotas than on opening his office on a Saturday morning to extract Play-Doh from the ear of an 18-month-old, or spending the last night of an AIDS victim’s life at the patient’s bedside.

So at age 47, Bill Davis got ready to give up being a 21st century physician and take up some other line of work. Then a funny thing happened in this one-stoplight town: The patients healed the doctor.

The town of Winters, about 35 miles west of Sacramento, has 5,000 residents, two video stores and three practicing physicians. It’s the kind of town where the local paper, which comes out once a week, still dutifully reports that someone broke into a locked pig feed bin and stole four bags of feed over on Niemann Street.

Like many Valley towns, Winters has evolved concentrically: an outer circle of modern tract homes, a smaller circle of Victorian and mock-Victorian houses, and a core of commercial enterprises and older edifices that mark the heart of the town. People tend to stay put here.

“In Winters,” says Debra Ramos, the local newspaper editor, “if you can remember when you moved here, you’re still a newcomer.”

That would make Bill Davis a newcomer. His clothes are as rumpled as one would expect from a guy who routinely puts in more than 70 hours a week working. He does not wear a doctor’s white coat, nor anything else that would identify him as a physician. He comes across a bit shy, a little wary, maybe a tad grouchy. But his patients swear by him.

“He’s the kind of doctor that makes you surprised when you hear he’s anyone else’s doctor, because he gives you the impression that you are his only patient,” said editor Ramos, who gratefully recalls Davis extracting Play-Doh from her daughter’s ear on a Saturday morning after her son had installed it with a Q-tip .”He’s patient and thorough and he remembers his patients. You’re not just a manila folder full of papers with Dr. Davis.”

In addition to routinely dropping in on patients to see how they are doing, Davis is the unpaid team doctor for virtually all the town’s youth athletics. “Bill had a patient who passed away from AIDS, and he basically spent the last night of the young man’s life at his side,” said Joe Martinez, another Davis fan. “You cannot put a dollar value on what that means to those involved and on the whole community.”

Davis “dropped out of college, got married, had a baby, went to work in a nursing home pushing bed pans, went to work at Atascadero State Hospital, which was a pretty interesting place to work,” he said. “Then it just sort of dawned on me at the age of 23 that maybe medicine could be a blend of science and people. I always was drawn to social service stuff.”

Fresh out of medical school in 1986, Davis moved his family to Winters. He was eager to emulate the ways of Dr. Ernie Young, who had been making house calls, tailoring bills to patients’ abilities to pay, and medically ministering to the needs of Winters residents since 1954, and who took Davis into his practice. But in 1992, Young retired and Davis faced the financially daunting chore of running an independent practice while trying to help provide for a family. So in 1994, he took a job with Sutter West Medical Group, an affiliate of Sutter Health, a network of 29 hospitals and about 5,700 physicians in Northern California.

“The economics of medicine are such that you just get forced into larger systems,” Davis said. “Theoretically, the HMO system could have been very financially rewarding for me.”

By 2000, he was drawing a salary of $70,000 a year, had a retirement plan and could take a day off now and then. But if his wallet was doing OK, his heart wasn’t. “I found that 50 percent of my time was taken up doing administrative work,” he said. “The system somehow created more paperwork just to provide ordinary health care than I had been doing in running my own business.”

By the spring of 2000, Davis was much more than frustrated. He told his employer he was quitting. “He said he was tired of all the paperwork and all the stuff that comes with being part of a medical group,” said Nancy Turner, a spokeswoman for Sutter West. “Unfortunately, that is the reality of modern medicine.”

Worse, as far as the citizens of Winters were concerned, Davis told people he was thinking of leaving medicine altogether. Maybe he would become a high school teacher. Maybe the Davis family would have to move. “I just knew I had to get out of this situation,” Davis recalled. “Whether there was any other place for me, I didn’t know.”

On the evening of May 22, 2000, the citizens of Winters decided to find a place for their favorite doctor. In a town hall meeting, they voted to form their own health foundation, with Davis as its doctor. The idea had first been broached by Joe Martinez, who became president of the newly formed Winters Healthcare Foundation. Residents began raising money to subsidize the clinic and eventually pay Davis a salary. They also began renovating a storefront on Main Street.

“Opening up the clinic was like a barn raising,” said Wendy Walker-Davis, the doctor’s wife, who is a clinical psychologist with the state Department of Mental Health Services. “Contractors would come after work to do the drywall and the plumbing and the electricity. People donated paint and wiring and things.”

When he wasn’t putting up drywall or painting at the storefront, Davis continued to see patients, often riding one of his four sons’ bikes to make house calls. He drew no salary and went $100,000 into debt. “We had a family conference, and we all decided to go for it,” said Walker-Davis. “The boys (the youngest of whom graduated from high school last month) all said, ‘Don’t worry about us, do it.’ ”

Some of his patients paid cash, some had insurance and some paid in other currency: chickens, turkeys, catfish, peaches, apricots, walnuts, lemons, beets, eggs and tamales. “We didn’t have any money,” Walker-Davis said, “but we ate pretty well.”

And they were compensated in other ways. “The community was there for us,” she said. “We will always be grateful to the community for what it did for us and what it has allowed Bill to do.”

Lately, Davis has been able to start paying off his debts. And small communities in California and around the country interested in following Winters’ example are making inquiries. “I don’t pretend to say this would work everywhere,” he says after a long pause. “I’ll be satisfied if it works here.”

The Best Medicine

Exasperated, Dr. Bill Davis just said no to HMOs, and his small town rallied round

Just over a year ago, Bill Davis, M.D., a country doctor who still made house calls, was ready to quit doctoring to go teach high school science. Simply put, he says, he’d had it with HMOs–the endless paperwork and the constant questioning of his prescribed treatments. He cared about his patients, and he felt right at home in Winters, Calif., the rural Northern California community where he practiced. But he was frustrated as heck and he just couldn’t take it anymore. “It was like holding a weight,” says Davis, 48. “There’s a point at which it just drops.”

Winters’ roughly 5,000 residents, however, weren’t going to let Doc Davis bail without a fight. Mayor Tom Stone called a town meeting and, reluctantly, the reticent physician attended, expecting criticism. What he got instead was a barrage of testimonials. “Dr. Davis visited my dad every day until he died last year,” said farmer Richard Rubio, 49. “When the doctor told me my father wasn’t going to make it, he cried.” After more tributes, Ernie Gaddini, 58, a farmer still in his work clothes, played the Field of Dreams card: “If we build you an office, will you stay?”

They built it and he stayed. With $ 50,000 in cash and materials, supplemented by donated services from contractors and electricians, the townsfolk transformed an 800-sq.-ft. former shoe-repair shop into the Winters Healthcare Foundation. Open since last October, it doesn’t accept HMOs, and fees are low–about $ 30 per visit for those who can afford it. If that’s outside a patient’s budget, Davis, the sole physician, accepts goods in lieu of money, including homemade chicken tamales, deer meat and fresh vegetables. “He’s a modern-day hero,” says Dr. Marie Kuffner, immediate past president of the California Medical Association. “Here’s a doctor who said, ‘My principles mean more to me than being a slave to a system that doesn’t care about patients.’” Adds Yolo County director of health Betty Hinton: “He just got tired of the managed-care system most physicians are required to live with now. He wanted to practice his way.”

That philosophy is reflected in the foundation’s motto: “By and For the People of Winters.” To that end the WHF provides services not traditionally offered by medical insurance, such as volunteer-administered diabetes screenings at churches, transportation for out-of-town hospital visits, looking in on elderly patients–even cleaning patients’ houses and mowing their lawns. “We are empowering the patients to do something about their healthcare,” says Joe Martinez, 53, a walnut rancher who serves as president of the foundation’s board. “You don’t fill out forms in triplicate here.”

If it is short on bureaucracy, the foundation is also low on cash. It barely covers the monthly overhead of about $ 4,000, leaving nothing for Davis, who also racked up $ 95,000 in personal credit-card debt purchasing a computer system for the clinic. “I wouldn’t have done that without some reasonable hope that there was a way of paying it back,” says Davis, a married father of four grown sons who acknowledges that the entire enterprise, though noble, could still fall apart. “I’ve thought about it not working, but I’ve never said it was not a good idea. We’re still in the process of getting there.”

Until then, Davis relies on wife Wendy’s annual salary as chief of ombudsman services for the department of mental health in Sacramento. The couple live on a tight budget. “It’s scary,” says Davis’s mother, Dorothy, 77, a homemaker wed 53 years to William B. Davis, Sr., 76, a turf specialist at the University of California. “But we’re certainly proud of him.”

Growing up in Davis, Calif., with his parents and sister Pam, 51, Bill was curious and methodical. “You’d ask him to clean his room, thinking it would take 20 minutes, and it might take 2 days,” says Dorothy. “If he’s going to do something, he’s going to do it right.” Three decades ago her son accepted the invitation of 16-year-old Davis Senior High School classmate Wendy Walker to help out at a summer camp. “He had pretty brown eyes and blond hair and great legs,” recalls Wendy, now 47. Smitten, they threw themselves into political causes, protesting the Vietnam war and supporting Cesar Chavez’s farmworkers movement. Says Wendy: “We got together over wanting to serve the world.”

A year after Davis graduated from high school, the couple married. He earned his degree from UC Davis School of Medicine in 1983. When Davis first visited Winters in 1986, he was taken with its quaint charm and, rejecting more lucrative offers, set up a practice, often riding a bicycle to visit patients at home. “He’s like that special best friend from high school you go to when the chips are down,” says Martinez. Ask Victoria Garibay, 63, a recent heart attack victim who suffers from diabetes and hypertension. After treating her in his office, Davis stopped by her home to explain her condition and prognosis to her husband, children and grandchildren. She paid for his services with a promise that her husband will trim the doctor’s ivy. Davis knows it will be hard to keep the WHF up and running, but he also knows that this kind of doctoring has special rewards. “It feels better to do something for somebody who is not able to find first-class medicine,” Davis says, “than dealing with people who can afford to pay anything.”

Winters welcomes back farmers market

Winters sits at the heart of the slow-food movement, its organic fruits and vegetables prized by residents of the Bay Area and Sacramento.

Many area farmers are committed to locally grown food that is good for the community and good for the environment.

But when Ana Kormos, a nutrition educator at Winters Healthcare Foundation, began teaching low-income residents to cook fresh local vegetables, she found her students had little opportunity to buy the food grown in rich abundance on surrounding farms.

Local groceries were more likely to sell peppers from Mexico, for instance, than those grown on the town’s doorstep.

“People were loving it. They loved bok choy. They loved eggplant. They loved chard,” said Kormos.

“They loved it, but they had a hard time getting it.”

Kormos set out to change that, and on Sunday the Winters Farmers Market – the first the town has seen in many years – got off to a rollicking start.

Hundreds of locals turned out despite the threat of rain.

As bands played and children gorged on juicy strawberries, vendors sold just-picked carrots, local almonds, and wine and olive oil produced within a few miles of the community of 7,000 in western Yolo County.

Fresh-cut flowers, baked goods, coffee and eats from local restaurants rounded out the offerings at Rotary Park, a green space with a white gazebo at the center of town.

Brody Johnson and his wife, Tiffany, both 25, arrived with a group of neighbors – some of whom would drive 20 minutes to buy Winters produce at the Davis Farmers Market.

“We’re super excited,” Johnson said. “We were able to walk from our house. Our whole street came together.”

They had gathered up a case of strawberries, bottles of olive oil, and tomato, basil, cilantro and pepper seedlings for their gardens.

Kormos, a former worker and manager on an organic farm, has lived in Winters more than a decade. She’s been planning the market for 18 months, helping to secure thousands of dollars in grants to make the local produce more accessible.

The city, the chamber of commerce and others joined in the effort.

Kormos said the challenge now is to make the market fare affordable to those who live on laborers’ wages. Many have been hit hard by the recession and are out of work.

A fundraiser Saturday will help provide monthly vouchers of $25 to low-wage workers who couldn’t otherwise buy at the market.

Organizers also are trying to make fresh fruits and vegetables available at prices that families can afford, Kormos said.

They are working to bring in farmers who can sell to locals at lower prices.

Another challenge is keeping the market going in a town as small as Winters. Sunday’s turnout raised hopes of success.

Rafael Chavez Jr., whose family grows organic vegetables on 18 acres near Esparto, had nearly sold out of carrots, snap peas and chiles by 11 a.m.

He had picked it all just hours before.

Chavez’s parents worked beside him at the market as his daughter Marissa, 3, ate strawberries.

Chavez said he enjoyed selling directly to his Yolo County neighbors.

“It just feels good giving back,” he said. “All the hard work you put into it.”

City manager John Donlevy said other markets had started in Winters over the years but couldn’t maintain momentum. He thinks this one is different because of the organizers’ commitment.

“Everyone is certain this thing is going to sustain itself,” Donlevy said.

___________________________________________________ Hudson Sangree

Community health centers are vital to health care reform

With the current economic downturn, many community members have lost not only their jobs and homes but also their health insurance. Accordingly, CommuniCare Health Centers and Winters Healthcare Foundation have stepped in as the safety-net providers of primary care and preventive services for hundreds of newly uninsured families.

President Obama and legislative leaders have now put the issue of health care front and center, and we have a tremendous opportunity to fix and rebuild our broken health care delivery system. Over the next few months, Congress will be discussing and debating health care reform. In doing so, lawmakers should recognize and support parts of the current system that work — namely community health centers. Lawmakers must seize this opportunity to expand coverage to families that are currently uninsured.

Our community health centers provide families with the convenience and added value of being a “one-stop” for their health care needs by having medical, perinatal and dental services on-site, along with lab services and a dispensary. Community health centers like ours provide a medical home — a place where you develop a trusting relationship with your medical provider, where you can go when you are ill or in pain, but even more importantly, a place to find the support of a health care team to help you remain healthy.

By providing a medical home, community health centers offer health care services that are comprehensive and provide a continuum of care. For instance, if you are diagnosed with diabetes, having a medical home enables you to develop a treatment plan with your provider (doctor, nurse practitioner, physician assistant, or midwife), talk to a nutritionist about your diet, and work with a health coach to set realistic exercise goals. If you are in pain from a cavity in your tooth, having a medical home enables you to get a filling. If you are an expectant mother, having a medical home enables you to get pre- and postnatal care, attend birthing classes and get the caring support you need to help deliver a healthy baby. If you need a lab test or medication, having a medical home enables you to receive it at a low cost.

Research demonstrates that investment made in patient-centered medical homes reduces overall cost of care, improves health, and reduces health disparities. Low-income populations are the greatest users of expensive emergency room care for minor health care issues and the most likely to be hospitalized for preventable conditions. Our hospitals bear the brunt of these unnecessary costs. However, every $1 spent in preventive and primary care saves $3 to $5 in health care costs.

Medi-Cal patients seen at community health centers are 19 percent less likely to use the emergency room for avoidable conditions, 2 percent less likely to be hospitalized and, when hospitalized, are sent home sooner. People who have a medical home have better health outcomes.

Both Republicans and Democrats in Washington have recognized community health centers as a cornerstone of a more efficient and equitable health system. Funding under the Bush Administration enabled health centers to almost double in size. Funding from the Obama Administration’s Recovery Act has provided additional funding for health center infrastructure. However, given the collapse of state finances and the ever-increasing number of uninsured families, our supply simply cannot keep up with the demand for services.

This year, National Health Center Week is being celebrated Aug. 9 through Aug. 15, with the theme of “Where Access and Quality Care Begin.” The theme highlights the record of community health centers in providing affordable, high quality, cost-effective health care for all people, regardless of ability to pay.

___________________________________________________ Robin Affrime and Christopher Kelsch

Robin Affrime is the chief executive officer of CommuniCare and Kelsch is executive director of the Winters Healthcare Foundation. CommuniCare Health Centers and Winters Healthcare Clinic are a part of Redwood Community Health Coalition, a network of 16 community health centers in Napa, Sonoma, and Marin and Yolo counties. In Yolo County, CommuniCare and Winters Healthcare Foundation provide a medical home for more than 25,000 people and care for over 20 percent of Yolo County’s children.

February 17, 2010

In rural regions, health facilities fight to survive

As the debate over national health care plays out in Washington, D.C., many smaller, cash-strapped medical facilities in rural communities say they face a series of challenges that could force some to close.

“It is really hard for small hospitals. We struggle every day here and we need every type of funding we can get,” said Wanda Grove, administrator for Surprise Valley Community Hospital in Cedarville. “Our employees are working a 36-hour week right now because we are trying to save money. Our people are all underpaid compared to other hospitals.”

Surprise Valley serves a community of about 1,500 people and sees between 350-400 patients each month. Grove said her medical facility is the smallest hospital in California and has the capacity of only four acute-care beds and 22 long-term care beds, and staffs one full-time physician and one part-time physician.

A hospital’s lack of operating funds directly affects a patient’s access to physicians and services and/or special procedures. Although Surprise Valley offers interim obstetrics services, Grove said, the facility does not deliver babies except for emergencies, because it does not employ a full-time anesthesiologist.

“A lot of little hospitals don’t deliver babies anymore, which is very sad. So our ladies have to go to Lakeview, Ore.; Klamath Falls, Ore.; or to Fall River Mills in California, between here and Redding,” she said.

Following the national health care debate carefully, Grove said she believes overhauling the entire system would be a mistake.

“We don’t want them to revamp the whole system all at once; we would prefer it if they would go through it slowly and step by step,” Grove said. “I also don’t want them to take funds away from Medicare or Medi-Cal, because then we would have more patients with no insurance. It would make it even harder than it already is.”

As at many other rural facilities, most patients are low-income and are either on Medicare, Medi-Cal or are uninsured, though some patients have private insurance.

According to the California HealthCare Association, hospitals are absorbing more than $11.3 billion in uncompensated care to provide services to the uninsured and underinsured in California.

Jan Emerson, vice president of external affairs for the California Hospital Association, said in 2009 California hospitals lost $4.2 billion in Medi-Cal funding and another $3.5 billion from Medicare. Of the 69 hospitals in California designated as rural, 75 percent operate in the red and of all hospitals statewide, 50 percent do, she said.

Whether a hospital is urban or rural, another impact to the quality and access that patients have to health care is the lack of funding in the California state budget. California Farm Bureau Federation Rural Health and Safety Chair Joe Valente, who manages a diversified farming operation in San Joaquin County, said a lack of state funding could be devastating for county hospitals that depend on that money to survive.

“In San Joaquin County, we have a general hospital and they were estimating to be $11 million over budget and now it looks like they are going to be $20 million over budget,” Valente said. “If the county was forced to close this hospital, this would place an even bigger burden on the other hospitals in the area and become a greater problem as more people become unemployed.”

In Winters, the Winters Healthcare Foundation Inc., a non-profit community health care center, serves a local population of about 7,000, including farm employees and their families. Founded in 2000, the facility offers a variety of medical services and a dental clinic.

Due to the slumping economy, more patients seen at the medical clinic in recent months are uninsured, said Christopher Kelsch, the foundation’s executive director.

“Although we see a mix of insurance types, our uninsured rate has grown over the last two years from 20 percent to about 33 percent,” Kelsch said. “It is not just folks who have never had insurance; it is folks that had insurance and have either been laid off or their insurance has been cut off.”

Foundation president and founder Joe Martinez, who also serves as president of the Solano County Farm Bureau, said that it is important for people to receive medical care. As an employer in the community, he said, he wants healthy employees.

“A happy, healthy employee is more productive and a better all-round employee at the ranch. There are fewer chances that they are going to be in an accident or get injured,” he said.

Through federal grants and local and matching grants, the foundation uses a sliding fee schedule for patients, “so if they cannot pay the cost of the visit, then it is prorated, which is especially effective,” Martinez said.

Kelsch said the foundation will continue doing what it can to maintain and expand services, but added that costs increase each year and a shortage of physicians further complicates the situation.

“In California alone, we are going to be thousands of primary care doctors short. In rural areas, we will be inordinately affected in the next 10 years,” he said.

Throughout the health care debate, In communications with Congress Farm Bureau has stressed big picture issues such as determining how large of a role the federal government should have in health care decisions, to a narrower focus that answers what will the legislation do to the delivery of health care in rural areas, and what mandates will be placed on farmers and ranchers as employers.

“There is a lot riding on what Congress decides. We recognize the need to improve our health care system, but we favor a more incremental approach,” said Jack King, CFBF National Affairs Division manager. “Whatever happens, we want to boost rural services, not witness its further decline. There’s already an inequity in Medicare re-imbursement rates to rural health care providers, so how can we close that gap and also create incentives for health care professionals to serve in rural areas?”

In communications with Congress, Farm Bureau has encouraged investments in wellness programs, opportunities for individuals to exercise greater control over their health care expenditures, discourage defensive medicine by reining-in malpractice lawsuits, while opposing a public health care option, King said.

The national health care debate came to a halt in January with the election of Republican Scott Brown to the U.S. Senate seat in Massachusetts left vacant by the death of Sen. Edward Kennedy, a Democrat. As a result, Brown swept away the Democrats’ filibuster-proof, 60-vote majority, adding uncertainty to the debate.

“This has stopped everything in its tracks for the foreseeable future,” said Bryan Little, CFBF director of labor affairs. “I don’t see them being willing to risk the wrath of the public. The Brown election seems to mean that the public is so upset with them that they need to be really careful about everything that they do.”

President Obama and the Democrats are reaching out to Republicans, offering to work together to find common ground on the health care issue.

“At this point, I think the federal bill is probably dead, except for some lowest-common-denominator things they can all vote for, like forbidding insurance companies from denying insurance to people with pre-existing conditions,” Little said.

___________________________________________________ Christine Souza

Winters doctors dispense prescriptions for exercise and diet

The folks at Winters Healthcare say they have an Rx for well-being.

In the past year, doctors at the clinic in the Yolo County town of 7,000 have been handing out prescriptions for exercise and nutrition classes to patients suffering from diabetes, high blood pressure, depression and other ailments.

It’s a new use for the venerable Rx pad, long a symbol of a physician’s authority to prescribe medications. Clinic staff members say the written instructions carry more weight than merely telling patients they ought to eat better and exercise more.

“It’s a different situation when a doctor hands you a prescription and says, ‘You need to do this,’ ” said Ana Kormos, the clinic’s outreach and education coordinator, who came up with the idea and proposed it to doctors.

“I asked them to write a prescription and put it in their hands, just the way they would with a drug,” she said.

Kormos had been frustrated that patients weren’t following through on diet and exercise plans.

Now, doctors are writing a handful of prescriptions for classes every week, and the number of people signing up has doubled, Kormos said.

Both the cooking and exercise classes – each offered twice a week for free or at a very low cost – are taught in Spanish.

On Thursday at a downtown Winters dance studio, a dozen men and women took part in an exercise class, doing leg lifts and situps to music.

Victoria Garibay, 71, said she lost 75 pounds through a combination of nutrition and exercise classes. At home she rides her stationary bike and walks up and down her stairs, she said.

Garibay was severely diabetic, but said she no longer has to take medication for diabetes or high blood pressure.

Cecilia Morales saw a doctor for weight gain and depression and received a prescription to the exercise and nutrition classes. In the few months she’s been attending, her health and mood have improved, she said.

She cut out sugary sodas and sweet bread and is eating more fruits and vegetables. Morales said she feels motivated again and has more energy.

Children, too, benefit from the classes, said pediatrician Andrea Trader.

Trader said she sees lots of cases of childhood obesity and writes out prescriptions for parents to go to the cooking and nutrition classes.

“You have to change the family’s eating habits,” she said.

Kormos, who oversees the classes, has made it her mission to improve the health of folks in Winters through eating well.

She founded the Winters Farmers Market last year, with the goal of making it easy for residents to buy fresh seasonal produce.

Now she’s trying to start a community-supported agriculture program for low-income residents. CSA programs allow families to buy boxes of local produce each week directly from area farmers.

Meanwhile, planting will soon commence in dozens of garden plots on acreage donated by the city, Kormos said. Many residents have signed up and are eager to have their own gardens, she said.

Making fresh fruits and vegetables available is one challenge, Kormos said.

Getting parents and children to switch from diets high in starches, fats and sugars – and to embrace cooking with fresh produce – is another.

That’s why the prescriptions for cooking classes are useful, Kormos said. They encourage people to come and learn to cook vegetables grown on nearby farms.

On Thursday, Kormos gathered with a half-dozen women in the Winters Community Center’s kitchen to prepare a meal of roasted butternut squash and kale-and-lentil salad.

Such ingredients can be unfamiliar to some, but Kormos said she tries to make the dishes more familiar by using the flavors of chilies, limes and cilantro.

Dora Bermudez, 52, and her daughter Maria Correa, 33, have been attending the nutrition classes together.

Bermudez said her diet used to be heavy on beef, rice, potatoes and tortillas. Now, she said, she eats kale, bok choy and spinach along with tilapia, salmon and tuna.

Correa said her husband once ate only steak and pasta. But she made him a salad of salmon and quinoa, a South American grain, and “he loved it,” she said.

“You learn to cook things that you never thought you would eat,” Correa said.

She said she used to see beets in the supermarket and wonder how a person could eat them.

Now, she said, she knows.

“It’s a different situation when a doctor hands you a prescription and says, ‘You need to do this.’ “