La Familia’s main building on Alto Street, on the west side of Santa Fe, is a cross between a busy medical clinic and a hardhat zone these days. On Thursday, Jessica Mendez held 2-month-old daughter Emily as medical assistant Rosie Bustillos prepared the infant’s first vaccines. A few yards away, construction workers drilled into ceilings of what will be classrooms.

The city’s only comprehensive medical and dental clinic for low-income patients is growing.

A 5,000-square-foot addition to the 20,000-square-foot building will provide more space for the health-education department, which helps diabetic patients manage their disease and guides women through their pregnancies.

Five years after opening, La Familia’s south-side clinic also faces growth pressures . That clinic already has outgrown its space on Caja del Oro Grant Road, turned a storage area into an additional patient room and is considering putting up portable buildings until a permanent addition can be built. A recently awarded $500,000 federal grant will require it to take on 3,000 additional patients in the next three years.

In a state with one of the country’s highest rates of uninsured citizens, La Familia is coping with some staggering numbers: Of its 13,000 patients, 70 percent have no health insurance. During the past five years, the number of uninsured clients has grown by 50 percent.

“We’re not getting reimbursed for these services, but somebody has to provide them,’’ said Paula Devitt, healtheducation director. “We don’t turn anyone away, but we’re swamped.”

At La Familia, no insurance means not even government-funded Medicaid and Medicare. “We’re talking about people who have nothing,” said Richard Taaffe, who recently stepped down as La Familia’s director.

About half the center’s $9 million budget comes from grants and donations while the other half comes from insurance and fees. A larger proportion of uninsured patients means the clinic must scramble to make up those funds.

A typical patient visit costs the clinic $73. The poorest uninsured patients pay only $15. “And some people can’t afford that,” said Katrina Huffaker, the center’s communication’s director.

Uninsured patients tend to be sicker and have little access to surgeries and treatments that La Familia can’t provide.

Administrators say the increase in uninsured patients can partly be explained by the opening, in 2002, of La Familia’s federally funded satellite clinic on Camino Sierra Vista for homeless patients, which saw 1,500 people last year.

But the clinic also sees thousands of patients who aren’t homeless, who work but have no insurance.

“Our gut feeling,” acting director Rick Adesso said, “is that the majority of these people are working in restaurants, hotels, construction, those kinds of jobs.”

Immigrants among uninsured

The increase in the uninsured partly reflects the growth in Santa Fe’s immigrant community . Administrators don’t track patients’ immigration status, but Jean Frank, manager of the south-side clinic, said about 90 percent of patients there speak Spanish.

Last November, after Arizona passed Proposition 200 — which requires people to show proof of citizenship before applying for public benefits — the clinic started seeing pregnant women who said they moved here from Arizona, Frank said.

The Medicaid program, funded with a mix of state and federal money, will reimburse the cost of birth for undocumented immigrant women if they arrive at the hospital in labor. But if the women’s condition requires a scheduled hospital admission — for example, for a Cesarean section — the birth doesn’t qualify as an emergency, and Medicaid won’t pay, said Dr. Gary Giblin, who has delivered hundreds of babies in his nine years at La Familia.

A state fund for high-risk obstetrics-gynecology patients was cut, then restored in a limited form, with a cap of $32,000 a year for the clinic. “You can go through that pretty quickly,” Giblin said.

Giblin said he is also seeing new immigrant patients whose ties to Santa Fe are tenuous. “It used to be that people were here because of family. But now I hear a lot of people are just living with friends. There is not as much of a support system.”

Giblin said the number of prenatal patients has accelerated from about 150 to 180 a year in the mid-1990 s to 600 a year now.

“We’re doing about a third of the deliveries in town,” Giblin said.

“We give priority to pregnant patients because we’re the provider of last resort. But the concern is that instead of a family-practice clinic that does obstetrics, we’ll turn into an obstetrics clinic that does a little bit of family practice.”

Because of a local board decision, undocumented immigrants are not eligible for the county’s health-care-assistance program, formerly called the indigent fund, which draws on a share of gross-receipts-tax collections .

Physician’s assistant Ray Galley said he sees older immigrants with chronic conditions requiring expensive treatment. Elderly immigrants who have lived and worked in the United States might have had deductions for Medicare taken out of their paychecks for years, but, if they’re undocumented, can’t get the benefit.

Those needing specialty treatments might be eligible for care from Project Access, a program of the Santa Fe County Medical Society in which specialists in different areas of medicine agree to donate a certain number of visits per year.

Workers caught in the middle

The growth in the uninsured population also reflects a national trend toward workers being unable to access insurance through employers or declining coverage because of escalating premiums.

When Wal-Mart , the nation’s largest employer, surveyed its workers, it found half of the company’s employees’ children either had government-funded Medicaid or no insurance, according to a recent report in The New York Times.

Adesso said he understands why so many patients lack insurance, given the difficulties he deals with when shopping for benefits for his own staff.

“We’re constantly facing double-digit increases and having to adjust our benefits,” Adesso said.

“The insurers have employers over the barrel.”

Health-education director Devitt works intensively with diabetic patients to help them avoid complications such as amputations and blindness.

The clinic has a retinalscreening program funded by the Joslin Diabetes Center at Harvard University that allows high-risk patients to monitor for diabetes-related vision changes. But she said one of the hardest challenges her patients face is managing the costs of the illness .

The clinic’s sliding scale is based on federal poverty guidelines, and Devitt said the biggest gap is for able-bodied , nonelderly patients who are working.

Devitt says she sees patents paying up to $500 a month for testing supplies and medication . She feels eligibility for the sliding scale — which covers medications — should take into account the size of a patient’s medical expenses. But because the clinic is federally funded, “we’re restricted as to what we can do.”

Searching for solutions

Some La Familia staff members say the burden of uninsured patients is becoming so great that a new search for solutions is needed.

“It’s getting to the point where we need to have a well-thought-out plan, instead of people expecting that La Familia is going to deal with it,” Giblin said.

Administrators say the center is improving efficiency by restructuring its patient scheduling , allowing more spaces for walk-ins and less waiting time before appointments. More immediate access to care leads to fewer cancellations and noshows , administrators say.

But some staff members said schedules are becoming overloaded and fear burnout will result.

In January, La Familia will launch a new funding drive aimed at getting local employers to make monthly donations to the center. “They know their employees are coming to see us,” said communications director Huffaker.

“If companies wish to do this, it could help cover the costs of all uninsured patients, some of whom are their own employees .”

Hawaii, where Taaffe is moving to accept a job directing a medical clinic, requires employers to offer insurance. The state, which like Santa Fe, has a tourism-based economy, has the second-lowest rate of uninsured residents, 9.8 percent. Taaffe said it’s an idea New Mexico should consider.

“I think that would do more for people than the Living Wage,” he said, referring to minimum-wage increase proposals such as the ordinance adopted by the city of Santa Fe. Meanwhile, Devitt said her department scrambles for donations , some of which come from patients. Her current wish list includes a glucose-monitoring machine for her diabetics. “This community rises up to take care of people,” Devitt said. “The spirit is really generous. But the health-care costs we’re dealing with are just unbelievable .” Contact Barbara Ferry at 995-3817 or bferry@sfnewmexican .com.

BY THE NUMBERS

Number of patients 13,000

Patients lacking health insurance, including Medicaid or Medicare 9,100

Percentage of S.F. residents using clinic 18

Percentage of patients earning less than $8,980 a year 64

Patients in clinic’s diabetes program 1200

Women in clinic’s prenatal program 1000

Babies delivered last year 600

UNINSURED IN NEW MEXICO

New Mexico has the second-highest proportion of uninsured residents in the country — 21.3 percent of working people between the ages of 18 and 64 lack medical coverage — a Kaiser Foundation study says. The only state with a higher percentage is Texas.

LOCATIONS

Main clinic: 1035 Alto St.

South-side clinic: 2145 Caja del Oro Grant Road

Healthcare for the Homeless: 818 Camino Sierra Vista

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