By Diane Carman
Dr. Joseph Kay looks people right in the eye when he talks to them and that’s part of his problem.
When the assistant professor of medicine and pediatrics arrived at the University of Colorado School of Medicine in 2004 and realized that he would have to turn away dozens of uninsured patients who needed cardiology care, he knew he had to do something.
“I couldn’t look them in the eye and tell them, ‘I can’t care for you,’” he said. “I couldn’t personally do it.”
He understood the center’s policy that limits indigent care to 10 percent of its overall caseload. “I think it’s a reasonable policy,” he said. “In no way do I think the heart center at University Hospital is failing to do its job.”
The problem isn’t just with University Hospital, he said. It’s much bigger than that. Kay believes the problem is the U.S. health care system.
The United States is “the only developed Westernized country that doesn’t offer at least minimal health care to all of our citizens,” he said. “We should be ashamed of our system and ashamed of our lack of political will to address it.”
So even though he should have been focusing his attention on publishing research articles and doing clinical work in the intensely competitive world of academic medicine, Kay went to his supervisors and requested permission to see uninsured patients voluntarily on weekends and evenings.
They said no.
“They didn’t want to open the gate” to the thousands of uninsured patients in the community who need care, he said.
The policy made perfect sense from an administrative point of view. Still, Kay knew he couldn’t turn so many patients away untreated.
So he met with Dr. Barry Martin of the Metro Community Provider Network and the two physicians hatched a plan.
Martin has a personal interest in treating patients with developmental disabilities. Kay said that a significant percentage of these patients have congenital heart conditions, so providing expanded care for them and other cardiology patients was “a win/win.”
They opened a cardiology clinic at the network’s Potomac Street Clinic using volunteer physicians and nurse practitioners to treat uninsured patients. A federal grant allowed them to buy a used echocardiography machine, and the staff triages patients so they only see those they can help. If patients need catheterization or other sophisticated procedures they can’t do in the limited clinic setting, the doctors refer them to emergency rooms or other service providers.
“We’re seeing patients a half-day a month,” said Kay, who said that means about 14 patients a month receive care. “At any one time, the waiting list is 250 patients, so there’s a real need for this.”
Satisfying as it is to be able to care for more patients, Kay, who is married and has a daughter, still struggles to keep up with the demands of his hectic schedule.
At a recent CU Board of Regents meeting, he was described as “the hardest working man in the division of cardiology” by Professor Lawrence Hergott, M.D., his colleague at the University of Colorado School of Medicine.
Kay was honored with the Chase Faculty Community Service Award for 2011, which gave him personal satisfaction well beyond the $10,000 prize.
“I was told when I was working to create this clinic that I was wasting my time and that it was going to kill my academic career because I was putting so much effort into volunteer activities rather than doing research and writing manuscripts,” he said. “That’s why it was a great honor to have the Board of Regents acknowledge that this was an important thing to do.
“It’s not all about the grants we get and the number of research manuscripts we write, but about setting an example for our trainees and giving something back.”
While Kay is proud of the work done at the Metro Community Provider Network Cardiology Clinic, he’s frustrated with the lack of progress toward a more comprehensive solution to the problem of the medically underserved.
“If I wasn’t a university physician, a state employee, I would be much more heavily involved in politics,” he said. “I have very strong feelings about this issue. I don’t like working in a system that’s unfair. I think of it every hour of every day.”
Kay recalls one patient who made at least three visits to hospital emergency rooms for treatment of recurring arrhythmia, and each time she was discharged and told to follow up with a cardiologist. But she had no health insurance and could not afford care, so she never did.
She finally found her way to the volunteer clinic, where she was examined and given a prescription for a drug to treat her arrhythmia. The drug, which costs $4 a month, has kept her healthy and saved untold thousands of dollars in emergency room care.
“It is cost-effective to do this, to keep people out of the more expensive emergency rooms and to take care of them,” he said.
Kay’s training is in both pediatric and adult cardiology. He was 35 years old before he completed the two tracks in cardiology. He holds a dual appointment at the CU School of Medicine and Children’s Hospital, and is particularly interested in congenital heart conditions and the transition from pediatric care to adult care.
As a result over the years, many of his patients have had a tough time getting health care. Before the Affordable Care Act was passed, they faced rejection by health insurance plans due to the pre-existing conditions they’d had since birth. While Kay said he believes the country still has a long way to go to achieve an equitable health care system, he’s pleased to see changes that protect his patients from categorically being denied coverage.
Preventing those practices by the insurance industry “was a huge step forward,” Kay said.
“Over the years I’ve considered moving from this country, but I’m not going to,” he said. “I’d rather stay and change what’s wrong from within.
“I know my patients at the volunteer clinic are getting a second level of care. We can’t do all the procedures they need there, we can’t offer complete cardiovascular care, but we offer some things.
“I hope someday the clinic will become unnecessary,” the 42-year-old Kay said, “certainly by my retirement … hopefully before then.”