MEDICINE: Rural health-care struggles: One doc paid with jars of jelly

NEW SALEM, N.D. - Dr. Tom Kaspari says it's not true that he works at the medical clinic here for free.

"I usually get jars of plum jelly or some salsa," he says.

It's enough for him now. But it may not be enough to keep the New Salem Community Clinic in business.

Kaspari, 44, comes to the clinic every Wednesday afternoon and evening, dressed more like a cowboy than a doctor. He sees up to 21 patients with across-the-board ailments. Thank-yous and occasional jars of homemade concoctions are his payment.

Wednesday is normally his day off from work at other clinics in the region and at a Bismarck hospital. He's been coming to the New Salem clinic for the past two years.

"It wasn't my plan to be here two years, but that's the way it's ended up," Kaspari said recently as a half-dozen, mostly elderly, people waited in the clinic's lobby.

Similar clinics close

Brad Gibbens, associate director of the UND Rural Health Center, said about a dozen similar clinics have been closed in North Dakota in the past two years by hospitals in Bismarck and Fargo.

The population decline in rural areas made it too expensive for the hospitals to keep the clinics open, he said.

"Whether it's a hardware store or a hospital, all businesses need thresholds," Gibbens said.

Bismarck-based Medcenter One Health Systems closed the New Salem clinic two years ago, along with clinics in Hebron, Elgin, Steele, Washburn, Underwood and Center, N.D.

Medcenter One officials said at the time that the health-care system was losing $675,000 per year on the seven satellite clinics because of low Medicare reimbursements and rising health-care costs.

Some clinics fared better than others. Jacobson Memorial Hospital Care Center in Elgin took over the clinics in Elgin and Hebron.

New Salem situation

New Salem's clinic closed for a few weeks and has been scraping for money since, despite a free doctor and volunteer time by its two nurses, a nurse practitioner and two clerks.

Board member Milton Grube said the clinic is seeking about $25,000 from a city-sales-tax-supported economic development fund. The clinic also gets donations from area businesses, individuals and groups, but still needs about $45,000 a year to stay out of the red. And that's without a salary for Kaspari.

"We need some federal money to keep afloat," Grube said. "I don't know how much longer we can stay open if we don't have it."

One patient's story

Grube, 89, a patient of Kaspari's who's on the New Salem clinic board, said his town is more fortunate than others, since its clinic remains open with a no-cost doctor.

Kaspari reminds him of "old Dr. Gaebe," who served the community a century ago.

"People used to pay him with a half-dozen chickens or a pig," Grube said as he waited for a blood-pressure check. "That was back when I went to high school with his son."

New Salem, about 30 miles west of Bismarck, is the home of Salem Sue, a huge fiberglass cow statue standing watch off Interstate 94. The clinic is in a nearly-vacant 1970s-era shopping mall with a gravel parking lot.

Grube, a retired farm implement dealer, said a big portion of the town's population of about 800 is elderly, "I suspect like most other small North Dakota towns."

"The clinic is an asset to our community," Grube said. "We have to have it to survive."

Doctor's views

Kaspari, a native of Sheldon, in eastern North Dakota, and a graduate of the UND medical school, said preventive medicine done at clinics not only saves lives, but also saves taxpayers money in the long run.

"Limiting access to health care is a big concern," Kaspari said.

When Medcenter closed its clinic two years ago in Steele, the town had another clinic, run by Bismarck's St. Alexius Medical Center. That shut down in July.

St. Alexius now has no rural clinics in North Dakota, said Nancy Willis, a spokeswoman for the medical center.

Willis said the hospital's clinic in Steele, N.D., was seeing only about 150 patients a month, not enough to keep the doors open.

"With rural populations declining - this is a result," Willis said. "It's a hard thing for everyone to accept."

Hope to keep open

Paul Bakkum, a member of Steele's economic development group, said residents are looking at keeping the clinic open, perhaps by joining a health clinic consortium, and are looking for help from federal agencies.

"We've been told by they want to assist us in every way they can, but they've all told us that it's going to be a difficult process," Bakkum said.

Willis said St. Alexius received federal grants of up to $125,000 a year to keep the clinic in Steele open. She said the grants ran out in 2000, and the hospital continued to fund it for five more years at a loss.

"I'm not sure a community really understands the investment it takes to do something like this," Willis said.

Bakkum, a banker, said, "I understand the fiscal part of it." But he said without a clinic in town, other businesses will likely suffer.

"Clearly, this is the biggest issue facing the city," Bakkum said. "Anytime you lose a school or a clinic, people will have to go elsewhere."

UND official's view

Gibbens, of UND, said a few towns recently have joined a network of community health centers that get some federal money. The clinics share administration and other costs while getting reimbursement on a patient's ability to pay.

The New Salem clinic has been working with Beulah, N.D.-based Coal Country Community Health Centers, which also has clinics in Beulah, Glenn Ullin and Halliday, N.D.

Coal Country chief executive Tom Nehring said his organization is seeking more federal funding to add New Salem to its consortium. New Salem currently pays no administrative costs, he said.

Karen Larson, deputy director of the Community HealthCare Association of the Dakotas, said the program typically funds up to 25 percent of a clinic's costs, but federal funding has languished.

"The federal budget has a lot of pressure on it," Larson said. "I'm not sure when money will become available.

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