Seven years ago, Nikki Coleman of Altoona was in the Altoona Regional Health System emergency room with complications from diabetes.
She wasn't taking her insulin, having lost her insurance for lack of funds due to underemployment.
At that time, she chronically felt bad, slept too much, had trouble focusing and didn't trust herself to watch her 4-year-old daughter, out of fear that she might lie down and slip into a diabetic coma.
Mirror photo by Gary M. Baranec
Nurse Alexis Dignan takes the blood pressure patient Brandon McHenry of Altoona. A Department of Health grant has allowed Dr. Zane Gates to add staff and deliver primary care to more patients at his clinic.
The emergency room workers took care of her immediate problem, then referred her across the street to Dr. Zane Gates' Partnering for Health Services - which since then has largely taken care of her long-term problems.
On Wednesday when Coleman was at Partnering as a patient, she heard that Lt. Gov. Jim Cawley was coming to see how the clinic has used a $192,000 state Department of Health grant and decided to wait around so she could talk to him.
When he was about ready to leave, Cawley spoke about what Coleman told him, unsolicited: that she'd probably be dead if not for the clinic.
Partnering is a hybrid between a clinic and a health center that functions as a health system for those who earn too much for Medicaid but not enough for regular insurance, according to Gates.
It works because the staff doesn't mess with insurance administration, allowing staffers to focus on care, Gates told Cawley.
A study has shown that primary care doctors spend 14 percent of their time, nurses 50 percent of their time and front office staff 88 percent of their time on insurance administration, Gates said.
Eliminating that focus has enabled Partnering to employ a group of "closing" nurses to ensure that patients know exactly what they need to do when they leave - what medicine to take and when, what foods to eat and avoid, and what exercises to do, according to Gates.
The grant has enabled the clinic to hire a physician's assistant, an emergency room nurse who redirects qualifying patients to the clinic and away from expensive ER treatment when it's unnecessary and a counseling pharmacist.
That pharmacist, Peter Kreckel, has explained for the first time to Coleman why she must take the acid reflux inhibitor she and her daughter need a half hour before eating in the morning.
It turns off the stomach's acid pumps that food would otherwise trigger, Coleman said.
Likewise, Kreckel explained how she should use a peak flow meter to ensure she stays out of her asthma "danger zone."
"I'm not the best patient," Coleman admitted.
But when she knows the rationale for what the doctor orders, she's a better one, she said.
At the clinic, Coleman meets regularly with a dietician, who has taught her how to read food labels for carbohydrates, sugar and sodium - ingredients that diabetics need to manage - and has educated her on serving sizes, while encouraging her to make good choices.
The dietician's job is broader than helping patients with their diets - it's helping them with their lifestyles, Gates told Cawley.
A California study has shown that many patients with insurance nowadays avoid going to the doctor, because they can't afford the deductibles, copays or cost sharing, Gates said.
Those issues don't come up at Partnering, which is subsidized by partner hospital UPMC Altoona, successor to Altoona Regional, to help minimize unnecessary and expensive ER visits by those who can't afford to pay.
There's a hospital-only insurance plan, with different premium levels for those who can afford it - those below a certain income level pay nothing - but policyholders don't have any obstacle-creating deductibles, copays or cost sharing, according to Gates' partner Patrick Reilly.
Getting regular care has helped Coleman get her life together enough to earn two business-related associate degrees from South Hills Business and Technology.
She has interned at the Blair County Chamber of Commerce, has been volunteering at local agencies and is looking for a paying job - preferably at a nonprofit.
"I like helping people," she said.
Gates designed Partnering as if his late mother, Gloria Gates, would be its model patient, he said.
He was entertaining a Republican on Wednesday, but he's "apolitical," he said.
"Not R or D," he said. "P for people."
During the tour, state Sen. John H. Eichelberger Jr., R-Blair, who had invited Cawley and who has been a supporter of Gates for years, said, "This can be a national model."
Mirror Staff Writer William Kibler is at 949-7038.