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Kent Clinic: A Model for the Future of Community Health Care?

The Kent Community Health Center reveals nothing particularly unusual. The lobby & waiting area are not unlike what you might expect to find in any medical clinic, clean but sterile. Magazines for waiting patients and their families, are as conventional as can be, Women’s Day and the like. The building itself, a one story temporarily sited facility, gives no clue of the unusual nature of what is happening here. There is a sign however, which can be seen as you approach the building. "King County Natural Medicine Clinic at the Kent Community Health Center" it reads, listing participating organizations, Bastyr University, our local naturopathic and natural medicine college, among them. Other participants include Seattle/King County Department of Public Health, the Community Health Centers of King County, and the City of Kent. With federal and state funding, this collaboration has resulted in what is believed to be a first in the entire nation: a publicly funded health clinic integrating conventional (allopathic) and natural medicine. There in lies what is revolutionary about this clinic and what makes it the focus of tremendous attention.

Natural Health Made Available to General Public

Opened in October of 1996, The Natural Medicine Clinic targets low-income people, immigrants and refugees, making natural health care available to many who were not previously able to afford it. Natural health care services offered include naturopathic medicine, acupuncture, massage therapy, chiropractic care, stress management & nutrition counseling. The staff includes medical & naturopathic physicians; nurse practitioners, physician assistants; acupuncturists, and dietitians. Initial funding for the Natural Medicine Clinic was provided by a one year $750,000 federal grant with an additional $500,000 provided by the Washington state legislature for the second year of the two year pilot program.

The Birth of the Idea

In part, the clinic was born of the 1993/94 discussion of health care reform in this country. Many advocates of holistic health took notice that natural and alternative medicine was not a part of that debate. Missing was any discussion of the promise natural and preventive health care could offer to two overwhelming and related aspects of the current health care system: rapidly raising costs and conventional medicine’s lack of success with degenerative disease.

Merrily Manthey, was one who believed natural health care was usually far less expensive than high-tech conventional medicine, and often more effective, especially with long term chronic illness. Manthey was frustrated that the health care debate virtually ignored making changes in the quality and type of health care. The focus was on how to pay for the status quo. "It got me thinking about what would constitute real healthcare reform," Manthey says.

As a member of the board of directors of both Bastyr University and Harborview Hospital, Manthey was uniquely positioned to act. She first approached Harborview with an idea to open an community natural medicine clinic, as one of its more than 50 outpatient clinics. When Harborview didn’t pick up on the idea, Manthey took the idea out, eventually joining efforts with Joe Pizzorno, founding president of Bastyr.

"Dr. Pizzorno has a vision to provide scientific data to support the use of naturopathic and natural medicine," said Jane Guiltinan, Medical Director of Bastyr’s Health Clinic, and Co-director for Natural Medicine at the Kent clinic. In fact, Bastyr University was a recipient of the one of the first National Institute for Health (NIH) grants ever awarded for alternative medicine studies. Bastyr U’s new campus in Bothell has an entire wing devoted to research.

Pizzorno wanted to set-up clinical trials where the results of natural and conventional treatments are directly compared with respect to certain medical conditions. Manthey & Pizzorno found an enthusiastic ally on the King County Council. Kent Pullen, Council Chair, spearheaded the effort on the Council for a publicly supported natural medicine clinic that would include a research component. Pizzorno got his chance to present his ideas to the full Council. Then something revelatory happened. As individual members questioned Pizzorno, their questions revealed that most all of them had availed themselves of natural and holistic practitioners. This was an area of common experience the Council members had not previously shared with one another. These local leaders were going public about their experience with natural health care for the first time. Finding themselves in such good company certainly must have been a moment of delight.

Not surprisingly, the Council’s endorsement for a natural medicine clinic was unanimous. In a time of tight budgets, funding was another matter. To lobby for funding, and otherwise help administrate the creation of the clinic, the Council established a new staff position: Natural Medicine Coordinator to the King County Council.

The Council appointed Nancy Weaver as the first Natural Medicine Coordinator, a position unique in the country at any level of government. As a veteran legislative staff member of 26 years, Weaver was not new to county government, but was quite new to natural medicine. "I had been asking council members about holistic and natural health recommendations for my own health issues. I think that is how they knew I might be interested in this position," Weaver explained. At the time, "I was not a firm believer in natural medicine."

Weaver worked with the King County Public Health Department to draw up an RFP (Request for Proposals). The RFP generated approximately two dozen letters of interest from various health professionals and organizations. Eventually a number of these parties collaborated and submitted three final proposals. Ironically, Harborview was a party in one of the final submissions.

A screening panel, selected from around the country, reviewed the submissions. To prevent any behind the scenes lobbying, the identity of the panel members was anonymous. The collaborative team of Bastyr University; King County Community Health Clinics, a private non-profit organization; and CERC, an independent health research organization, submitted the selected proposal.

Although at the time of this writing the clinical trials have not yet begun, CERC will conduct comparative studies around three common conditions: Migraines, Hypertension (high-blood pressure), and Otitis Media (recurrent ear infections). The studies will last about 18 months. There is also a sociological study to track how the integrative medicine aspect of the Kent clinic is affecting the health providers and their patients.

The Natural Medicine Clinic opened as part of the already existing Community Health Clinic in Kent, and has created much change. To begin with the clinic building was relocated, picked up and moved several blocks, to allow for the space for a temporary add-on. The add-on -- a double wide mobile -- houses the natural medicine offices. This is a temporary solution, while an entirely new 20,000 square foot building is being constructed to house the Kent clinic. Scheduled to open in October 1997, the new facility allows much more space for both natural and conventional medicine facilities.

An Integrated Clinic 

The formation of a newly integrated clinic, compelled some conventional health providers to work in conjunction with natural medicine providers. These providers did not necessarily plan to work in an integrated health care environment. None-the-less, the results, according to Trompeter, Associate Director of the Community Health Centers, have been mostly very positive. "The staff has been a really good fit," says Trompeter. "They have worked well together. We are seeing providers consult with each other and refer patients to each other." Despite some initial resistance, and even the departure of one health care provider who did not take to the modifications, Guiltinan essentially concurs, "It is working very well, really exceeding my expectations."

According to Guiltinan, the medical doctors are learning from their natural health counterparts and in some cases modifying the way they practice medicine; while, for the naturopaths, the clinic patients themselves present the greatest need for change. Until very recently natural medicine was generally not covered by insurance, and it was never before subsidized in a community health care system. Thus natural health care has only been available to those who could afford to pay for it entirely out of their own pockets. "I think naturopathic providers are learning about working with poor people & minorities," Guiltinan explained. "How do you ask somebody living on $100 a week to buy $50 worth of nutritional supplements? It is forcing us to go back to our roots, by trying to give medicine through food. Such as having a patient put fresh garlic in food, (rather than buying a garlic supplement) or teaching them to do hydrotherapy (water therapy) at home."

So where is this innovative experiment in community health care headed? What happens when the pilot program ends in June of 1998? According to Trompeter, the King County Community Health Centers has an organizational commitment to provide natural health services at all their clinics. Their participation in the pilot project came along as the first funded opportunity to implement their plans for natural medicine. They have every intention of maintaining the natural health component in Kent, even when the pilot program expires. Weaver feels confidant the King County Council will not only commit dollars to complete the currently under funded program in Kent, but will further its commitment to fully integrated health care. Weaver says, "Things are going terrifically. The clinic is being extremely well received. An integrated system where people are free to choose the kind of health care they use is where we are going."

Yet, the Kent clinic project may have a reach far beyond the community health clinics and King County. It has already garnered tremendous media attention. CNN, Peter Jennings’ World News Tonight, and a French public TV film crew have all visited the clinic. All in all there have been hundreds of local, national & international media spots focused on the clinic. Health care professionals and public officials have certainly taken notice. Manthey says, "I have had inquiries about the clinic from all over the country. I can’t think of a single state I haven’t heard from."

Guiltinan believes, "If this pilot project can demonstrate through the studies that natural medicine can be as, or even more, effective than conventional medicine, while avoiding the side effects, then this can be a model. It can revolutionize the health care in this country."


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