Continued operations of the North Country Childrens Clinic have been contingent upon finding an adequate, consistent funding stream since its establishment in 1971.
Tuesdays announcement that the clinic would close Friday, and then Thursdays notice that Samaritan Medical Center would come to the clinics rescue by providing a loan up of to $200,000 to avoid the closure, is hardly a new scenario.
For 42 years, the Childrens Clinic has relied on community organizations and state and federal grants to sustain and expand medical, dental, mental health and other programs and services to children and adults in Jefferson, Lewis, St. Lawrence and Franklin counties. Those years have been marked by turmoil and uncertainty as some funding sources have shifted and others dried up.
Although Executive Director Daniel A. Wasneechak said Thursday the clinic would continue to operate as usual at least through November, while Samaritan serves as temporary operator, Samaritan, the state Department of Health, local elected officials and community agencies will try to come up with a long-term plan to ensure tens of thousands of needy families dont go without health care.
Brian Peck, chief of staff for Assemblyman Kenneth D. Blankenbush, R-Black River, said no help will be available to the clinic in the form of state member items, as those funds mostly dried up about three years ago. The shortage of such funds for the clinic began about 1990, when Janice L. Charles, then executive director and agency cofounder, said then-Gov. Mario M. Cuomo would rather not have member items. At that time, the clinic was slated to lose a $321,000 member item.
Anything we could do would be limited, Mr. Peck said. The big thing is to get payments to happen quicker.
Because state financial support has weakened, clinic officials have relied on promised increased federal insurance reimbursement rates, which they have yet to receive although that was a component of the agency becoming a federally qualified health center last year thanks to a $650,000 grant from the U.S. Department of Health and Human Services. The FQHC status included the addition of adult primary care services and a center in Lewis County. The latter has yet to come to fruition.
The new designation has been accompanied by the same old problems. Payments from federal insurance, particularly Medicaid, often dont come close to the actual charges or cost of services. Federal grant money is sometimes slow to arrive.
In March 1976, the clinic had to borrow $30,000 from the National Bank of Northern New York to pay grocers supplying food under the federal Women, Infants and Children supplemental feeding program because of cash-flow problems created by slow reimbursement from the U.S. Department of Agriculture and the state Department of Health.
Today, the Childrens Clinic is owed $275,000 from a series of federal grants. That money was due to the agency a few weeks ago, and is just one reason it couldnt meet payroll next week without the safety net Samaritan provided. Thirty-nine years ago, the agency feared it wouldnt meet payroll for WIC employees, because $9,000 the clinic requested from the USDA hadnt arrived. A legal agreement at the time with the Community Action Planning Council of Jefferson County prohibited advances from CAPC when the clinics cash flow got tight.
A little bit of faith, and dedicated staff members and volunteers, along with pleas for financial help, have managed to keep the organization alive. Back in 1972, when a mere $5,000 regional medical project grant was to run out, Mrs. Charless husband and agency cofounder, the late Richard E. Charles, said he was confident that after March 1973, the community could continue to support the clinic.
As the agency experienced financial trouble, it also expanded services. In August 1973, it added more community clinics, for a total of 11 at the time, which operated on a $26,000 budget $12,000 of which was Mr. Charless salary. At that time, the clinic also submitted several grant applications to the federal government and private foundations to sustain operations.
The combination of need more money and services was noted in a 16-page paper about how the largest single drawback in developing and operating private, preventive health services has been the chronic problem of finding a stable source of on-going funding that Mrs. Charles presented during a conference in June 1982. Realizing the influx of dollars for health care will be diminished at all levels of government, she said in the paper, from the financial perspective, local expansion is out of the question at this point in time. In human need terms, expansion has never been more essential.
That has consistently been the clinics struggle. One month after that presentation, the clinic began charging minimal fees for the first time.
Since the 1970s, grants have supported the clinics implementation and continuation of programs and services, and covered administrative and other operational costs.
The Northern New York Community Foundation, known as Watertown Foundation in the clinics initial stages, has given a total of $721,000 to the Childrens Clinic throughout the years. Executive Director Rande S. Richardson said the Community Foundation stands firm that no matter what happens to the Childrens Clinic, the foundations investments have been worthwhile since those funds benefited people for whom they were intended.
Looking ahead, however, the foundation board would need reassurance from the clinics board that there would be a sustainable plan for the clinics future if other grants were to be approved.
We dont really know what the issue is, Mr. Richardson said. Whatever funding streams organizations rely on, no one stream can save our communitys problems. All funders are looking for that piece of long-term sustainability. For every nonprofit, the margin is becoming increasingly small. We dont have the luxury anymore of doubling or tripling expenses.
He said that means agencies should focus on maintaining a common mission, not their individual identity.
Organizations of all sizes need to let the mission come first and identity second, Mr. Richardson said. Its just a question of through what vehicle.
Both the Community Foundation and the United Way of Northern New York have, for the past few years in particular, urged nonprofits to streamline internal operations and then, if necessary, consider shared services or even mergers. While some nonprofits have done that on a small scale, most have struggled with the possible loss of identity.
Theyre all in jeopardy, said Robert D. Gorman, United Way chief executive officer.
Clinic Marketing Director Elaine P. Garvey said she, Mr. Wasneechak and other clinic officials were tied up in meetings Friday and unavailable for comment.