Wait time for Amelia Court appointments questioned

ASOs strive to see more clients more quickly but, Parkland patients continue to wait months

Nobles1

Raeline Nobles

DAVID TAFFET  |  Staff Writer
taffet@dallasvoice.com

Over the past year, the wait time to get an appointment at Parkland hospital’s Amelia Court appears to have gotten longer, although the staffing level appears to be about the same now as a year ago.

During that same time, community-based AIDS agencies in Dallas say they have expanded services and decreased wait times.

For new Parkland patients, the time from first contact to seeing a doctor can be as short as two weeks. But new patients trying to access services at the public clinic recently have reported waits of as long as four months.

Candace White, Parkland media spokeswoman, said that the clinic is taking new patient appointments as early as February and through March 1. She said she confirmed that with Sylvia Moreno, the hospital’s director of HIV services.

White attributed the delay to an increase in the number of patients accessing the clinic’s services due to successful HIV testing efforts throughout Dallas County. Some of the longer wait times quoted over the past few weeks may have been due to the holiday, she said.

However, when a Dallas Voice staff member called Amelia Court on Tuesday, Jan. 10, to make an appointment, he was transferred to voicemail to leave a message. As of deadline time on Thursday, Jan. 12, more than two days later, no one from the clinic had returned the call.

Another caller to Amelia Court was told that those February and March appointments White cited are reserved for established patients only. The next available appointment for first intake for new clients who want access to Amelia Court is April 23, the caller was told.

The Ryan White CARE Act, which funds many of the treatment programs for persons with HIV, specifies patients must receive “access to care within three weeks of presenting,” Dr. Gary Sinclair, former medical director of Amelia Court, said.

While he was at Amelia Court, Sinclair said that he and his staff reduced the waiting time to access medical care to two weeks. He left UT Southwestern and Parkland two years ago and is now an independent consultant involved in covering for physicians for Ryan White programs.

For years, all Parkland primary AIDS care was done at Amelia Court, located on Harry Hines Boulevard, a block from the main hospital. However, to relieve overcrowding at Amelia Court, doctors with experience in treating people with the virus have been seeing patients at three of the hospital’s Community Oriented Primary Care facilities in Dallas.

Parkland began opening the COPCs in 1987 to relieve its main emergency room of treating non-emergency cases.

The clinics were designed to provide convenient and affordable healthcare throughout Dallas County.

Parkland

HIGH RISE CLINIC | Amelia Court’s HIV services will move to the new Parkland Hospital under construction across Harry Hines Boulevard from the old facility. (DavidTaffet/Dallas Voice)

Some of the facilities also have specialties. Two clinics — Bluitt-Flowers Health Center in South Dallas and Southeast Dallas Health Center in Pleasant Grove — were designated as HIV treatment sites.

A third — deHaro-Saldivar Health Center in Oak Cliff — previously treated adolescents and young adults with HIV, but that service has been discontinued.

Parkland’s clinic has been staffed at about the same level for the past several years.

But as HIV has changed to a manageable chronic illness, Sinclair said that there has been “a normalization of care.”

That normalization may include longer waiting times for appointments at the public hospital, something that is common in other specializations.

But while Parkland strives to keep the wait time for primary care down, some local agencies that provide clinical service to people with HIV at low or no cost say they have expanded their service and will see new patients quickly.

“On a very human level, it can be quite terrifying to want and need medical care and not be able to find it,” AIDS Arms Executive Director Raeline Nobles said. “AIDS Arms built its second HIV clinic to help with these exact problems in significant and positive ways.”

The agency opened Trinity Health & Wellness Clinic in Oak Cliff this past fall and continues operating Peabody Health Center in South Dallas. Both offer full primary care for people with HIV.

AIDS Arms accepts Medicare and Medicaid as well as private health insurance. And like the county hospital, medical care is free for low-income people without any coverage and is provided on a sliding-scale for others.

Intake takes about a week to complete, Nobles said. Once a person who has an HIV-positive diagnosis is registered as a client, doctors at Trinity Clinic can see a new patient that week.

“With fast access to medical appointments at our Trinity and Peabody clinics and five licensed providers, we are a partner in the solution to very large and disturbing access to care problems in our community,” Nobles said.

The agency is seeking to expand the services it offers its patients and is currently looking for specialists in ophthalmology, cardiology and renal care to supplement its care.

In addition, AIDS Arms is involved in drug research trials, something Amelia Court no longer does.

Sinclair said he believed that was part of a shift in federal research dollars away from “’How do we treat people?’ to ‘How do we eliminate the epidemic?’”

In addition, AIDS Arms is offering several new services to its patients at its Trinity clinic.

Legal Hospice of Texas will soon begin providing on-site legal assistance for disability, social security and HIV-related discrimination issues. Bryan’s House will be providing free childcare for patients visiting the clinic on Thursday and Fridays beginning next week. And once a week, onsite psychotherapy services will be offered.

Resource Center Dallas offers a variety of specialized medical services at its Nelson-Tebedo Community Clinic on Cedar Springs Road. Dental care is the most frequently accessed and something not provided by other agencies or Parkland.

With a recent expansion of facilities at the clinic, RCD Communications and Advocacy Manager Rafael McDonnell said the wait time for an appointment is three weeks or less. He said the clinic is able to treat emergencies even more quickly.

This article appeared in the Dallas Voice print edition January 13, 2012.

—  Kevin Thomas

Big changes ahead for ASOs

AIDS agencies have to look for ways to branch out if they want to survive and thrive under health care reform

Tammye Nash  |  Senior Editor
nash@dallasvoice.com

An estimated 1.2 million people in the United States are living with HIV infection, and 20 percent of them are not even aware of it, according to the Centers for Disease Control. And a CDC report released in early August suggests that there are about 50,000 new HIV infections each year.

And yet, federal funding for HIV/AIDS services have remained flat for the last five years — from funding for medical services to research dollars to money for support services — according to Raeline Nobles, executive director of AIDS Arms Inc.

And that means, Nobles and Resource Center Dallas Executive Director and CEO Cece Cox agreed this week, that the nonprofit, community-based organizations that have been the backbone have to look ahead and keep their options open to remain viable.

Changes in the way that federal funds through the Ryan White CARE Act are distributed — requiring that 75 cents of every Ryan White dollar be used for core medical services — give an edge to nonprofits that operate clinics. And that means that AIDS Arms, which just opened its second clinic last month — is “more competitive at the national, state and local levels,” Nobles said. “With the number of people who are uninsured and living at poverty levels, access to any kind of medical care is a priority. So if you are providing those kinds of services, it does give you an edge.”

Agencies that don’t provide those kinds of services, she added, can get in on that competitive edge by collaborating with those that do.

“There’s really no new money to sustain new agencies,” Nobles said. “AIDS is definitely off the docket in terms of diseases people seem to be concerned about. In fact, any HIV provider across the country who is not considering all their options is in a great deal of denial, and that may well come back to bite them rather severely.”

There’s also health care reform to consider, with several parts of the law passed in late 2010 still to be implemented. That reform, said Cox, is changing the face of community health clinics, like RCD’s Nelson-Tebedo Clinic, and HIV/AIDS service programs.

“Our nutrition program is a good example,” Cox said. “It has really been hammered in terms of federal funds, so we have focused on supporting the program through the community, foundations and corporations. … It is an amazing puzzle we have pieced together, even with cuts in traditional funding streams. But we have managed. We have done the things we felt we had to do.”

And there are more changes coming. Nobles said that if the Ryan White funds survive beyond 2013 when more health care reform measures go into effect, “it likely won’t include any money for outpatient services like we offer” at the Peabody Clinic and the new Trinity Clinic.

“So we have to take a look at what we do best, and we can use our model and globalize it into different areas. We have to become even more sustainable. Diversification of business is key to survival,” Nobles said. “It can’t just be about HIV and AIDS any more.”

Nobles said “serious discussion has been going on at AIDS Arms for at least two years, at the board and staff levels” about how the agency can expand its focus beyond HIV/AIDS and remain viable.

“We have to diversify our business plan. The situation has been serious for awhile and it is becoming even more serious for our board,” Nobles said. “We hope to have, by early 2012, a final business plan in place to move into the future.

“Health care reform is a great thing for a lot of people, but it poses real challenges for the nonprofit sector. You have to stay ahead of the curve, or health care reform will run right over you. We definitely want to stay ahead of that curve,” she continued. “The HIV nonprofit community has the best model of care and support the U.S. has ever seen. That model can be globalized to include care for other disease — heart disease, cancer, diabetes.”

Cox said that staff and board members at Resource Center Dallas also began planning for the changing future some time ago, and its current capital campaign to build a new facility is part of the plan.

“Nobody seems to have all the answers right now. The feds won’t say what they will and what they won’t fund. So savvy business people are already thinking, ‘If this funding goes away, what can we do instead?’” Cox said.

“Everybody feels like the challenge working in the nonprofit sector is that you are always aware there is so much more that needs to be done,” she added. “But doing more requires more space, more staff, more resources. And to have that, you have to build the business in a way that is sustainable. And you have to remember, nobody can do everything.”

Both Cox and Nobles are quick to remind that even though their agencies are “nonprofits,” they are businesses nonetheless, and have to be operated with an eye toward success.

“There has been, and probably still is, the mindset about nonprofits. People expect the nonprofits to be there to provide all these services without caring about costs,” Cox said. “But the fact is, nonprofit or not, these agencies have to be run like a business. You have to anticipate, plan ahead. You have to put the structures in place and you have to invest. We make large investments in our staff and in technology. For-profit business sell stock and they answer to their stockholders. We get our money from our donors, and we have an obligation to let our donors know what we do with their money and to let them know we use it responsibly.”

This article appeared in the Dallas Voice print edition November 11, 2011.

—  Kevin Thomas

Razzle Dazzle needs 100 volunteers

STREET FAIR | John Coop-Lara and Jimmy Bartlett at Cedar Springs Arts Festival promoting Razzle Dazzle Dallas.

Return of annual event an opportunity for groups to participate

DAVID TAFFET | Staff Writer
taffet@dallasvoice.com

The Razzle Dazzle Dallas committee needs 100 volunteers, organizers said this week.

“Planning and hosting [the] five-day festival for 35,000 people will take nearly 100 volunteers,” said John Cooper-Lara, co-chair for Razzle Dazzle Dallas.

The event — returning this year after an absence of several years — will be held June 1–5, beginning with a Wednesday evening wine walk on Cedar Springs Road. Thursday the event goes off the street with a party bus pub-crawl to clubs located off Cedar Springs Road.

Metro Ball at S4 on Friday night will raise money for AIDS agencies in North Texas.

Saturday’s events begin with a sidewalk sale and street fair on Cedar Springs Road. The evening is when the most volunteers will be needed. Three blocks will be fenced for a large street party.

Gate attendants, runners, stagehands, information booth workers and food service assistants are needed.

Volunteer co-coordinator Henry Ramirez said volunteers are also needed to help set up and tear down tents.

“They’ll be making sure people have ice where it’s needed, watching the entrances and making sure people aren’t walking out with alcohol,” Ramirez said. “Runners are needed from beer booths to the main booth.”

Ramirez said food will be catered for volunteers and he is scheduling extra people so there will be time for volunteers to take breaks and enjoy the event.

Setting up and tearing down the fence has been contracted out, as has trash clean up and garbage removal, he said. But volunteers will be needed for set-up and tear down of booths, stage and other equipment and displays along the street.

Ramirez said working at Razzle Dazzle that night would be a fun project for groups or organizations.

The beneficiaries of Razzle Dazzle Dallas are AIDS Arms, AIDS Interfaith Network, Cedar Springs Merchants Association Beautification Fund, Legacy Counseling Center and Founders Cottage, Legal Hospice of Texas, Lone Star Ride, Resource Center Dallas and Youth First Texas.

To volunteer, sign up on the RazzleDazzleDallas.org website or email co-volunteer coordinators Ramirez or Travis Gasper at hramirez@rcdallas.org or tgasper@aidsinterfaithnetwork.org.

—  John Wright