Four weeks ago, a budget proposal submitted by Portland City Manager Jon Jennings recommended the closure of the India Street Public Health Center, a municipally run public health care facility that houses a Positive Health Care program, a Needle Exchange, low-barrier STD screening, and walk-in services for people without health insurance.
Community pushback has been strong. On Wednesday, a petition with over 2100 signatures was delivered to City Hall, demanding that the city find room in its budget to keep the India Street clinic running. Panic around the issue is considerable. With only a six-week window between the initial budget proposal and the May 16 vote by the city council, people are freaking out. And a lot of them are people that require specialized and customized treatment, which for various reasons they feel they won’t get anywhere but through the clinician/patient relationships they’ve established at India Street.
We should believe them. Considering the sort of people this affects most — the uninsured, the addicted, LGBTQ populations, people with HIV-related illness, and other conditions which often have stigmas attached to them — the city’s proposal to shutter India Street borders on discriminatory policy. It might look simple on paper to transfer patients from one facility to another, but some people require increased access, a higher degree of trust, and fewer barriers to the care that they need. The city is making a bet that these people will transfer smoothly while it saves some money in the process, but a chorus of voices claim that the stakes of that bet are too high.
That’s not to disparage the efforts of the Portland Community Health Center, a private nonprofit FQHC (federally qualified health center) 1.5 miles away which the city hopes India Street’s patients will land. PCHC Medical Director Renee Fay–Leblanc told Dispatch that the facility currently sees 49 patients requiring HIV-related care, and that should the city decide to close India Street, it plans to expand their program to accommodate the roughly 275 patients receiving Positive Health Care there. Fay–Leblanc adds that she hopes that many of those hires would be from India Street’s current staff, to make the transition as smooth as possible.
Special to Dispatch, Portland resident Sarah Lazare interviewed Annie Spencer, a volunteer with the Needle Exchange program who has been studying the heroin epidemic in Portland. [Sarah Lazare is a contributor to Alternet and a member of the Southern Maine Workers Center — read her essay, with Dispatch contributor Meaghan LaSala, on the issue here.]
Sarah Lazare: What is your relationship to India Street Clinic?
Annie Spencer: I’m a volunteer in the Needle Exchange Program. I’ve been researching and writing a dissertation for the last several years on the opioid and heroin epidemic in the U.S. and in Maine, focusing on the production of the crisis and examining state and local government responses to it. It’s a topic that’s meaningful to me. I have several loved ones whose lives have been foreshortened and made significantly worse through this epidemic. I sought out volunteering in the Exchange to feel more immediately useful in the face of this crisis and to connect with others who do this work because their hearts compel them. I found an amazing community in the clinicians and fellow volunteers at India Street. Not only the Exchange, but all of the programs housed at the clinic, are staffed by the most fierce, dedicated, principled, skillful and kind people.
Why do you oppose the proposed closure of the clinic?
Firstly, I oppose the closure of India Street because shuttering the clinic (the integrated set of services and practices currently housed at 103 India Street) would be massively destabilizing to our community. The national heroin and opioid epidemic has hit Maine disproportionately. The New York Times, the Washington Post, CBS News, and Vice News have all done national stories on Maine’s heroin crisis, and all their expert reporting led them to India Street, one of the only front-line resources whose Exchange and STD testing and Narcan prescription program are saving lives in the face of disgraceful government inaction at every scale.
In one day last July, 14 people overdosed in our tiny city. Detox facilities have shuttered their doors in the midst of the crisis, citing lack of funding. We need more public dollars for public health care, in general. Everyone keeps saying, “we can’t arrest our way out of this crisis,” and we’ve discursively made a shift to talking about substance use disorder (‘addiction’) as a health (rather than criminal) issue. And yet the wheels of governance keep churning out cash for more cops and cages, while arguing why public investment in public health is outmoded and something the private sector ought to handle.
There’s also the issue of shuttering the Positive Health Care clinic, the largest HIV Primary Care Clinic in the State — with a stellar record. India Street’s viral load suppression rating, meaning the number of positive patients whose virus is undetectable due to precise monitoring and case management, is an unheard-of 95 percent. The national average for other Ryan White (federal grant) funded programs is 80 percent; for other clinics, mostly private, the average is closer to 60 percent.
Portland Community Health Center doesn’t presently do any HIV-related specialty care, to my knowledge. The word “transition” is not an accurate one according to the pittance of a “plan” the City Manager put forward and that the finance committee approved two weeks ago. The plan is to abolish the Positive Healthcare program (which pays for itself with the Ryan White grant), to lay off the two CDC-certified HIV-specialty practitioners who staff Positive Health Care — experts in their field at the national scale — and simply suggest that Positive Health Care patients get their medical care from PCHC (and other private-sector providers, like off-site/non-integrated labs for regular — sometimes weekly — blood work).
Which populations are served by the clinic? Do you feel these services are easily replaceable or “transferred”?
Lots of different kinds of people get health care services at India Street. I think in the community there’s a misperception that it’s “the free clinic.” It’s true that a free clinic is housed at India Street and is part of the integrated services that make the place work so well, but it’s only a portion of the work, and it itself is a nonprofit that funds its own overhead and has an all-volunteer doctor and nursing staff.
India Street is the only walk-in, low-barrier STD clinic in the state of Maine. People can qualify for free testing (funded through a per-test-reimbursement from a State CDC grant) if they are high-risk and can’t afford a test.
Lots of kinds of people get their testing done at India Street. It’s discrete, well-regarded, and the staff have expertise in LGBTQ+ healthcare and disease prevention. Many members of my queer family have a special place in their hearts for the staff at India Street, having had importantly affirming, supportive, and expert care there — which contrasts nearly every other story ever about queers in the doctor’s office. These are the sort of concerns that don’t make a City Hall balance sheet or a calculation about what can and can’t be dismantled and “transferred.” There’s a culture of care at India Street. The ethos of harm reduction, compassion, and acceptance is steeped in the institution, and it’s a very real reason why the clinic is such a success. India Street has earned trust in this community among populations with every reason not to trust the health care system or the four walls of any public institution. Portland resident Mike Sylvester said in his [May 2] testimony at City Hall that India Street is a model that should be studied and exported statewide and beyond. I think he’s exactly right.
City officials who back the closure have repeatedly argued that the “transfer” makes sense because it is in keeping with national trends, in which public control over health services is declining and the health sector is privatizing. Do you agree with this argument? Do you see this national trend as a good thing?
Firstly, I think it’s worth noting here that the city buy-in for India Street represents only 15 to 20 percent of India Street’s budget. The amount needed to fully fund India Street for FY 2016 is $292,000. Basically the city pays the fringe for employees whose salaries are covered by grants (that they them selves consistently write and win). Without getting into the weeds, there’s a boring but important issue regarding a one-time investment for infrastructure (a type of secure internet system) required by federal legislation associated with the Affordable Care Act, for which there are many grants available, that India Street would be an excellent and likely candidate to win, but no one has pursued this issue yet. I’ve raised it to several city councilors. It has just been made known to me that the city had a contract for this work already in place with Athena Health, but curiously the contract was canceled in October, well before the rushed, unplanned six-week timeline that has occurred under the public eye.
But the point is that the city’s case that India Street should be abolished — despite its success, despite the challenges of the present-day heroin epidemic, and despite its major cost-effectiveness to the city — because “municipalities aren’t in the business of direct care” is weak. That national trend is a part of the story of how the present-day heroin epidemic came to be. To use a data point about the abysmal state of public divestment in public health as a case for further divestment is the worst kind of debunked Reaganomics logic I can imagine.
In the same budget that would shutter India Street for a lack of $300,000 in city allocations, the city manager proposes the city increase the amount of money it spends on the municipal golf course and adjacent, paradoxically city-owned club restaurant and bar, to a total of nearly $1.3 million dollars. My understanding is that the city took over direct control of the restaurant a few years back after complaints of lackluster performance from the previous contractors. Talk about government intervention! [City officials have stated that the golf course restaurant “comes very close to paying for itself,” costing $392,500 to operate and generating $361,000 in revenue in fiscal year 2017]. How does this cohere with the city manager’s insistence that India Street must be closed because the city needs to get back to more appropriate “core-functions” of municipal government? The golf course, incidentally, has fewer members than the Save India Street Facebook page has supporters, and far fewer than the number of people who signed the Save India Street petition in the span of 24 hours.
The contradictions speak for themselves. In response to an email from a constituent fearful for the proposed closure’s impact on his personal health and life outcomes, Councilor Belinda Ray actually stated that one of the great things about the city’s interventionist plan for the subsidized golf club was the intention to use more locally sourced ingredients! I saw her after the hearing last night on the street and told her that her remark was straight out of a Portlandia episode. People’s lives are on the line. People will die without India Street.