Serving the underserved in Idaho: How one retired DO changed a community

When Sarah Jessup, DO, retired in 1999 and moved to McCall, Idaho, a small resort town, she quickly learned that many low-income individuals in the seemingly affluent community lacked access to health care.

With a population of nearly 3,000 that swells to 10,000 during the summer and ski season, McCall attracts wealthy people who have multiple homes and affluent vacationers. “But we also have a bunch of people who serve those folks, people who work as maids and waitresses and so forth,” Dr. Jessup says.

Now that she had free time as well as a desire to help the less fortunate, Dr. Jessup served on DOCARE International medical missions in Guatemala and Peru. She found these one- to two-week trips interesting but also frustrating, as she was unable to provide ongoing care to patients in those countries.

Back at home in McCall, Dr. Jessup thought about the unmet health care needs in her own town. She realized that she had an opportunity to make an impact that could last years, not weeks.

Dr. Jessup started working on opening a free clinic for the uninsured. Today, it is an integral part of the health system in McCall.

“Sarah Jessup retired at an age when she could still enjoy such pursuits as kayaking and skiing but soon recognized that medicine has no finish line—there is always a need to be met,” says Felix J. Rogers, DO, who practiced cardiology with Dr. Jessup in Trenton, Mich., for 17 years. “It didn’t take her long to realize that the people in McCall didn’t have adequate health care resources. So she said, ‘I can do something about this.’ And she did.”

Glaring gap

In Idaho, the working poor often lack employer-provided health insurance and don’t meet the state eligibility requirements for Medicaid. “In order to qualify for Medicaid in Idaho, you basically have to be a single parent with an income less than 30% of the federal poverty level,” Dr. Jessup says. “It’s an astoundingly difficult classification to get. A young unmarried mother who has delivered a baby will qualify for Medicaid for a while if she has no job and no money. But a 50-year-old diabetic with heart disease and hypertension and lung disease will not.”

Dr. Jessup talked to the administrator of McCall’s 15-bed hospital, practicing physicians and other area health professionals about starting a free clinic. “I thought this was something we could do quickly to help address the gap in health care,” she says. “The free clinic, as I envisioned it, would be a bridge to something that would be a more sustainable health care solution for the poor, such as a federally qualified health center [FQHC].”

But she made minimal progress at first. “I went to innumerable meetings, which accomplished very little,” Dr. Jessup remembers. “It seemed like there were always barriers to getting going. And some of the local doctors were even anxious that a free clinic would be some kind of competition, which amazed me. Competition for what? It wasn’t dollars, that’s for sure.”

Meanwhile, she talked to a number of free clinic directors around the country for ideas and visited several such clinics in other parts of Idaho. “Years are going by with this effort,” Dr. Jessup says. “Intermittently, I would give up. And intermittently, I would get energized and try again. But I was not getting where I needed to be.”

The turning point for Dr. Jessup came in 2005 after Hurricane Katrina struck. She flew to Vidalia, La., to help with medical relief efforts. Several nurses had started a free clinic there to treat Katrina evacuees.

“I was so impressed that these nurses could get together a free clinic in this town in virtually no time,” Dr. Jessup says. “In contrast, I was spending years spinning my wheels, trying to go through all the right channels in my town without getting anything done. I thought, ‘If these women can do it with limited resources, I can too.’ I decided I would no longer take no for an answer.”

Dr. Rogers wasn’t surprised by Dr. Jessup’s persistence, having witnessed it while she was in practice. “If there is one word that describes Dr. Jessup, it is tenacity,” he says. “She is the kind of doctor you want when you have a problem. She won’t let up until it is resolved.”

In 2007, Dr. Jessup opened McCall’s free health care clinic by using space in a public health department office and recruiting volunteers, including physicians, nurses and a physician’s assistant. From the beginning, Community Care Clinic has been open for patients every Thursday evening and is now also open every other Friday afternoon.

Word of mouth

Community Care Clinic’s patient roster and reputation began to grow steadily through word of mouth and referrals from the town’s hospital, the local food bank and other organizations that help those in need.

“On the first day of opening, we had just one patient, a man with complex medical problems,” recalls Dr. Jessup, who serves as the clinic’s medical director. “The next week, we had two patients and the following week, four. We were seeing patients on a first-come, first-served basis, whoever would show up. But soon we got to the point where we’d go to the clinic and there would be 20 people in line and most of them had complicated conditions.

“We knew we weren’t going to be able to see them all, that we’d be there until midnight. So we switched to a same-day, phone-call appointment system and now usually see 10 to 12 people when we’re open.”

Because children from poor families have other sources of care in McCall and elderly patients are Medicare-eligible, the clinic serves adults between the ages of 18 and 64 years. Patients must document that they make less than 200% of the federal poverty level.

Most of Community Care Clinic’s patients have chronic diseases rather than minor ailments such as sore throats and colds, Dr. Jessup says. “We’ve seen diabetics who haven’t had medication for a year or two,” she says. “We’ve seen hypertensives who haven’t seen a doctor for 20 years.

“This means that we may spend a half hour to an hour per patient sometimes. It’s a nice luxury because we don’t have to worry about productivity. But it does decrease the number of people we can see.”

Since the clinic opened, the area’s economic boom went bust, and a new ski resort nearby slid into bankruptcy. So patient demographics have fluctuated. The mostly Latino construction workers who came to build the ski resort have left town; they were replaced by the rising number of jobless adults who have moved in with relatives.

The need for the clinic has only grown, according to Dr. Jessup, as has the support she gets from the community. A local pharmacist provides the clinic with medications at cost. The clinic’s volunteers, most of whom are retired health professionals, have given more and more of their time over the years. Retired internist Margaret A. Rosenthal, DO, is especially committed to the endeavor. And Linda Klind, a retired nursing administrator from the local hospital, has become an increasingly dedicated volunteer and now serves on the clinic’s governing board.

“Adults without insurance and without a lot of income—the people who fall between the cracks—are very prevalent in our community,” says Klind, who has spent her entire adult life in Idaho. “Dr. Jessup was wise and insightful to recognize the needs of this population.”

Patients sometimes need surgical procedures and specialty care the clinic cannot provide. “We joined the Volunteer Physicians Network, which was started by some doctors in Boise,” Dr. Jessup says. “We can send patients to the variety of specialists in this network, who are each willing to see one or two patients for free each month.”

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Dr. Jessup may be tireless in her efforts to provide or find the best care for her patients, but her demeanor is understated. “She is a no-nonsense person, but she is extremely humble,” Klind says. “And she has probably the biggest heart of anyone I’ve ever known.”

Steadfast determination

While running the Community Care Clinic, Dr. Jessup has held fast to her ultimate goal of establishing a federally qualified health center in or near McCall. “This would provide a much more full-time medical environment for those in need,” she says.

She is buoyed by the Affordable Care Act, which calls for funding additional FQHCs around the country. However, the congressional budget crunch has forestalled full financing of this initiative.

Still, Dr. Jessup remains hopeful of starting an FQHC, and her friends in McCall marvel at her determination.

“Dr. Jessup won’t give up,” Klind says. “She has never stopped attending multiple levels of meetings to pursue the possibility of bringing an FQHC to this area. She is one of the real credible heroes in our community.”