Mobile Health Clinics Association

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September            Phoenix
16-19, 2017           Arizona


Sponsor of Bill HB 3139

MHCA conducted an interview with Oregon State Representative Cedric Hayden, a dentist with mobile clinics who ran for office after encountering difficulty getting rural municipalities to allow him to provide free care. This interview was conducted shortly before Governor Kate Brown signed HB 3139, a bill that Rep. Hayden sponsored to increase access for mobile health clinics in Oregon. A copy of the bill text is HERE.

What is HB 3139 about?
It's a really short bill. Close to a page. Only has two sentences other than definitions, basically it says that local government may not prohibit a mobile medical clinic from being located on a private property and staying in one location for 80 days or less.

Background, I grew up on a family that did public oral health. My dad is a dentist who spent most of his life doing dental health around the world. I have 4 brothers and 1 sister and all of them went into health care. Four became dentists, one a physician, and my sister is a dental hygienist. We continued that tradition to give it a more local level in Oregon. As time went on and as resources became available, my wife and I started a charity called caringhandsworldwide.org.

It's a nonprofit health care for oral health that has grown to three international locations. Those locations have surprisingly been easier to get permission for than local counties in Oregon. So when we went to provide oral health to some of the smaller communities, ones without industry, those who can't afford oral health, we were surprised to find the local governments weren't willing to allow that to happen, even though they had a permit process. We went to 3 locations. In 2 of them, even though we appealed, they wouldn't allow us to provide free oral health to their city. It was for different reasons – the clinic wasn't within the scope of permit. I admit it's kind of a new idea. There's room in there for a physician or nurse or whatever type of health care you want to do in here.

They function as a brick and mortar clinic, not on a foundation yet. It's kind of a hybrid between a brick and mortar clinic, and an event-based clinic. We wanted to do something more stable, something that could stay three months in one location and really find people who needed help. It's prohibitive to set up a brick and mortar clinic. This way you could service three to four geographic areas for the cost of one brick and mortar clinic. I ran into two situations that we applied for a clinic. In one I was told no and I wasn't allowed to be in the meeting, another one I was allowed to be in the meeting and it came down to the population we were serving.

What population were you serving?
People who are 150% of poverty level or below and don't have other healthcare insurance (commercial through work or state assistance programs.) If they don't have insurance, we function as a safety net below the state safety net. If there are people below that category, meaning they are uninsurable or don't have insurance.

We spent about five years developing these clinics, and it took about three years for fabrication. It can be put on flatbed trailer. It took a while to get that to function, then we took it to a place in Eugene that builds mobile hospitals mostly for government contracts. They built them to state code. All are built to a specification approved by the state of Oregon but the municipalities don't use the state code, they have their own code. So there are variances they could have used to allow the clinics but what we ran into is they weren't willing to do that.

The solution is to make that happen where local governments are still allowed to go through their permitting process. If it doesn't fit through their codebook, can use variances and go through the process, but what the bill says is they are not allowed to just say, you aren't allowed to come. So they have to have a route for people who want to come in and help.

The bill is past the House and Senate, and it's scheduled to be signed by the Gov. Kate Brown on the 27th.

Well, you"ve already answered my next question about why did you decide to start a mobile clinics, so I guess I"ll ask the next one about why did you decide to run for office?
Those two sentences together is why I ran for office. My wife and I started the work in 2007. We got 501c3 status in 2009, and then we were fabricating during that time, it took about five years and a significant amount of cost (they cost $200,000 to $250,000 a piece to create depending on what you put in them.) We were surprised that municipalities said no, we don't want free dental care. We went to two locations, they said no. the third one said, we already have our own. After this, we did a worldwide search and found the Federated States of Micronesia. So the unit that was scheduled to go to Elaine County is now in Micronesia, we have volunteer dentists, and a pediatric physician going in June. Within a six month period of time, I was able to get a license and put a full clinic in there. So it was kind of like, how come in Oregon I can't drive across the street and do this but I can go internationally and get this done. I figured that there was a disconnect, so I went and talked to a few legislators.

It just so happened that my legislator wasn't running again, and it became apparent that this was a way to fix the problem.

The bill sounds like it will benefit mobile clinics across Oregon. What gets you up and excited in the morning about running a mobile clinic?
Interaction with people who really need that kind of help. Even though I grew up in the family business, it's still rare. It's a brick and mortar clinic and we can't afford to do that in all the locations. I was working in the clinic and a 5 year old boy came in alone and asked "can you help me, I have a toothache?" We said, well, there's HIPAA violations, there's other considerations including why is this kid walking alone by himself? It took us about 3 weeks working with the Department of Human Services and working with this child's parents and getting permission to provide care. It turned out his father was not in the picture and his mom was in jail. He stays with a family member who wasn't there at the time, and we did get him care but it took 3 weeks to figure it out.

One of the things I have learned about working in different communities is the importance of showing up and being there. So how do you develop trust with people and communities?
I had talked about event-based health clinics, like at the state fair. Most municipalities allow those up for 14 days and they"re geared for the short term. People see it via ads in newspaper or on the radio. With mobile clinics, it's a bit different, it takes time to get the word out.

You don't pick up people who are physically there, you need to be there for a longer period of time. They need to trust you to take care of them. We want to go in on a long term basis, three to four months at a time. What makes me excited about it are stories like that, this type of delivery system is able to help them. We have them go through an application process. Those who are eligible for insurance, we treat them, and for ongoing care we help them get on insurance. Usually the issue we"re dealing with is they don't understand the process of state services, such as how to get connected to a caseworker. So we make those connections to them, help them get signed up on what services are available, and if there are no services available and they aren't eligible for services such as undocumented workers, then we continue with restorative care for them.

Is there a last question that I haven't asked that you might want to answer? I know that we have members who serve both urban and rural communities, about evenly divided amongst folks who serve each.
Urban and rural - there's been quite a bit of interest in this once the bill gets signed. What we really could use help with are volunteers and locations who want to sponsor it. Somewhere that says you can come be on private property. What we do now is go for a day, and ask that these locations put together a list of 10 people who could use this care, we contact them and set up the location. Once this bill comes into effect, we can go there and treat them.

Currently we go to faith based organizations and set up for a day because they are exempt from municipal ordinances. Say you are there for three months, once the community trusts you, word of mouth will start to build that these guys are focused on what your healthcare needs are. It will allow us to build in Oregon, not just in rural communities. We are also interested in going to urban communities and helping people there.