Closing its doors



WESTERLO — As St. Peter’s Hospital announced last Thursday that it will close the Perkins Center in February, residents speculate about their future health care.

Six percent of those who responded to a recent questionnaire said they use the facility, and 80 percent of those surveyed in Berne, East Berne, and Westerlo did not feel the clinic was necessary, according to St. Peter’s. Patient visits have decreased in recent years and the clinic is losing money, said Elmer Streeter, spokesman for the hospital.

The clinic has lost $160,000 in recent years, according to St. Peter’s.
"What we are hoping for...is that St. Peter’s doesn’t close so quickly," said Leonard Laub on Tuesday; he is a patient of the center and a member of Friends of the Perkins Clinic. "I’m hoping that St. Peter’s...can be persuaded to stick around for at least another six months, preferably a year."

The Friends group of 20 to 30 residents formed one month ago, after St. Peter’s mailed the questionnaire. The group wants to attract a new doctor with the patient pool intact. It wants St. Peter’s to run the clinic longer so that the center’s patients are not dispersed throughout the area to other doctors.

The Perkins Center has been run by St. Peter’s Hospital since shortly after Dr. Anna Perkins died in 1993. The building is owned by the Helderberg Medical Building Association, Inc., a not-for-profit corporation that Perkins signed her clinic over to in 1986.
"We have no intentions of selling it at this time," said Bob Dietz, president of the Helderberg Medical Building Association, Inc. Dietz said the association will try to get a doctor to use the facility. There are no other doctors practicing in rural Westerlo or in the nearby towns of Rensselaerville or Knox.
"That’s what it was intended for, and we will still abide by [Perkins’s] wishes," Dietz said of the clinic. The association owns two buildings, and rents space to a tenant, he said.

St. Peter’s will be sending letters to patients, informing them about other doctors who are accepting patients as well as instructions about how to have their medical records transferred.
"This was not a decision that was made easily," said Streeter.
"The numbers of patients had diminished, but the number of patients who were poor and elderly was also diminishing," he said.

All three of the hospital’s charity clinics — in Westerlo, South Albany, and Rensselaer — lose money, said Streeter. Patient visits at the Perkins Center had declined from 4,401 in 2005 to 3,456 in 2006, and this year the center had had 2,341 visits as of the end of September, Streeter said.
Over the next few months, Streeter said, "It will kind of be a wait and see."
If the clinic’s patients transfer to other physicians, Streeter said, "We may not need to have as many hours."
"We really need somebody over there," said Dr. Margery Smith of Berne. Like Dr. Perkins, Smith, now retired, was a rural physician and lives in a house where she also saw patients.

Smith, 81, said this week she is no longer licensed to practice medicine, but that she would help run the office or help in any other way she can. Smith had spoken with a female doctor who lives locally this week, and asked her if she would be interested in practicing in Westerlo. She isn’t.
"Now, kids have thousands of dollars of debt and need a salary," said Smith of recent medical-school graduates.

Members of the Friends of the Perkins Clinic asked town council members Tuesday for a public meeting and for the town to invite St. Peter’s representatives.
"People are interested to have some dialogue, and St. Peter’s could make an effort to come down and talk to the people," said Councilman Ed Rash. "They’ve already published that they’re closing it, prior to its approval. I don’t think it would hurt to make the effort to have them come down."

A public meeting is scheduled to be held at Modern Woodman’s Hall on Route 412 in Westerlo on Tuesday, Dec. 11, at 6:30 p.m.

The town’s supervisor, Richard Rapp, is one of the seven members of the Helderberg Medical Building Association, Inc. A representative from St. Peter’s medical board and several members of the association will attend the Tuesday meeting, Dietz said yesterday.

"Not just a Westerlo problem"
The Friends of the Perkins Clinic has discussed measures to keep the Anna Perkins Center open, other locations for a clinic, and finding a physician. Members of the group want "an open dialogue" with St. Peter’s, and they want the hospital to wait six months to one year before closing the facility.

Cathy Rudzinski, a patient at the clinic and spokesperson for the group, asked the town board Tuesday to invite officials from surrounding towns to a public meeting to be held next week.
"It’s not just a Westerlo problem. It affects everybody in the Hilltowns," said a member of the group at its Tuesday meeting.

Streeter said Dr. Edwin Windle, who has worked at the Perkins Center since 1996, will be offered a job with St. Peter’s, and the center’s nurse can transfer to the St. Peter’s facility in Slingerlands.

Westerlo resident Peg Duncan said earlier that the center has fewer patients because it has reduced its hours of operation.
Asked if the center’s hours have been reduced over the past few years, Streeter said, "They were reduced more recently...but the decline in patients was occurring well before that ever happened."

St. Peter’s filed a plan of closure with the state’s Department of Health, said Streeter Tuesday.

When closing a clinic, a hospital is required to notify the Department of Health and provide it with a plan of closure, said Jeffrey Hammond, spokesman for the department. The health department either approves or disapproves the closure plan or suggests amendments to the plan, he said.
"We take each clinic on a case-by-case basis," said Hammond.

Patients who have visited the center in the last six months will receive a letter with the name of a doctor in Greenville, Delmar, Bethlehem, or Slingerlands who is willing to see them, said Streeter.

Those who visited between six months and two years ago will also be sent a letter telling them of the closure with information about how they can have their medical records forwarded to another doctor, he said.
"We have been talking with doctors who would be willing to take those patients," he said.

Streeter said he expects St. Peter’s will also run notices in The Altamont Enterprise and The Greenville Press to inform patients who haven’t been to the clinic in the last two years how they can have their medical records transferred.
"All of the pediatric patients from that facility," Streeter said, "we will offer to take at our Slingerlands pediatric facility."
Area wealth"

Streeter said fewer and fewer poor and elderly patients were using the facility, taking the Perkin’s clinic farther from its mission, and it was also losing money.

Based on visits this year through the end of September, there are 800 active patients at the clinic, said Streeter. Of the 800 patients, fewer than 5 percent are charity patients, fewer than 5 percent are Medicaid patients, and 25 percent are Medicare patients.

At the hospital’s clinic on South Pearl Street in Albany, 85 percent of the patients receive Medicare, Medicaid, or charity care, said Streeter.

St. Peter’s clinic in Rensselaer provides both medical and dental care, Streeter said. Over 60-percent of Rensselaer patients receive Medicare, Medicaid, or charity care, and 100 percent of its dental patients receive Medicaid, he said.

According to Steven Schrade, Berne-Knox-Westerlo’s superintendent, of approximately 1,100 students at BKW, 270 — or about 25 percent — are eligible for free or reduced lunch. Only 143 — or 13 percent — applied for the program.
"This is a little less than last year," said Schrade.

The school’s food service supervisor said that the decrease in the amount of applicants is not due to the community doing better financially, Schrade said. Because the income for eligibility is higher this year, he said, BKW has had to reject a number of applications.

Dr. Margery Smith was for decades a rural physician in the town of Berne.
She said this week, "Yes, I had poor patients. I used to discount them...I took a lower fee, which was fine. At least the costs of the office were met."

She estimated that each year she didn’t collect between $10,000 and $15,000 by discounting or not charging patients.

Smith cited instances when she didn’t charge patients. Once, a woman called her and said Smith hadn’t charged her for a visit to her home. The woman said she wanted Smith to bill her so that she would know that, in the future, she would receive services.
Smith said the woman’s house was on her way back to her office, that the visit only took 10 minutes, and that part of the visit she was "just chatting with her." She said she told the woman, "I would have come whether you paid me or not."

Smith said that, while Dr. Perkins was ill, she saw Perkins’s patients. During Perkins’s illness, if patients of Perkins asked to become her patients, Smith said, she refused to take them as her own.

Survey
Twenty-one percent, or 429, of the 2,000 questionnaires mailed out by St. Peter’s were returned, said Streeter, which he termed "a very good, high response."

The questionnaire was sent to residents of Berne, East Berne, and Westerlo to gauge their use of the Westerlo facility.

Members of the Friends of the Perkins Clinic have questioned the validity of the questionnaire.
Asked, of the 2,000 questionnaires sent out, how many went to Berne, East Berne, and Westerlo, Streeter said, "I don’t have an absolute breakdown of how many went to each town." The number of questionnaires returned due to incorrect addresses, Streeter said, was less than 2 percent.

Originally, he said, St. Peter’s was only going to send the questionnaire to Westerlo residents.
"I felt that wasn’t a wide enough survey, that certainly people came from a wider area," said Streeter.