Laurie Udesky |
KHNSunday, January 22, 2017
A large collage decorates a wall of one exam room at the Haight Ashbury Free Medical Clinic in San Francisco, Calif. Dr. David Smith, founder of the clinic, says patients and staff call the mural the Psychedelic Wall of Fame.
Heidi de Marco/Kaiser Health News
Since it opened 50 years ago, the Haight Ashbury Free Medical Clinic has been a refuge — for everyone from flower children to famous rock stars to Vietnam War veterans returning home addicted to heroin.
Strolling through the clinic halls in San Francisco, Dr. David Smith, the medical organization's founder, points to a large collage that decorates a wall of an exam room affectionately referred to as the Psychedelic Wall of Fame. The 1967 relic shows a kaleidoscope of images of Jefferson Airplane and other legendary counterculture bands floating in a dreamscape of creatures, nude goddesses, peace symbols and large loopy letters.
"That was made by a woman who had just taken LSD," Smith says. "She stayed here for a very long time and put all that up. It lasted as long as her LSD trip." He continues on to what was once called the "bad trip" room, where clinic staff would talk clients down during acid trips gone awry.
Fundamentally, Smith and others say, the organization has remained true to its roots in counterculture, still offering free care in a deliberately nonjudgmental atmosphere.
But it is also drastically different: It is now the Haight Ashbury Free Clinics — plural — and part of a multi-million-dollar conglomerate with the decidedly un-hippie name of HealthRIGHT360.
All told, HealthRIGHT 360 serves approximately 40,000 patients each year via a wide range of programs, including reentry services to ease the transition of formerly incarcerated adults and teens into life outside jail, residential and outpatient drug treatment, mental health care and medical and dental care. In 2014, it purchased a 50,000-square-foot building at 1563 Mission Street in San Francisco as additional space, to offer all of these services under one roof. The organization also serves patients in neighboring San Mateo and Santa Clara counties.
It's been a long journey from Smith's early days running a standalone clinic.
When his clinic first opened, it operated 24 hours a day with an army of volunteer physicians from the University of California, San Francisco, and Stanford University. The one paid staffer was a nurse. The first year's budget was her salary: $25,000.
The clinic had what Smith describes as a "guerilla pharmacy." Pharmaceutical representatives, he says, would load up their trunks with medication samples and drop them off at the clinic, where a team of UCSF volunteer pharmacists bottled up the medication and shelved it.
"Our first exam table was my kitchen table," he recalls. Decisions were made by consensus. Even the janitor weighed in, Smith says.
Back then, iconic music promoter Bill Graham organized benefit rock concerts — featuring performances by George Harrison and Janis Joplin — to help keep the clinic afloat financially.
Smith remembers when Joplin overdosed on heroin, and the clinic rushed over an "overdose team" armed with naloxone, a drug that blocks the effects of opiates. "We zipped out there," he says, "and reversed her overdose."
Smith says he saw many Vietnam veterans returning from the war in the early 1970s who were addicted to heroin. They felt ostracized, he says, by what was then called the Veterans Administration, and headed to San Francisco's Haight Ashbury and its clinic, which by then offered comprehensive medical care and a drug detox program.
The influx of veterans led to federal grants to Smith's clinic from the Special Action Office on Drug Abuse Prevention. "That began the government funding era in the 1970s and ensured our survival," Smith says.
In the 1980s, a young woman named Vitka Eisen came to the Haight Ashbury clinic struggling with heroin addiction, and learned firsthand the value of the personal attention the clinic offered.
"I went there for detox at least nine times," she says. "I never felt shamed or judged. They always acted like they were glad to see me."
Her trust in the staff, she says, led her to kick her heroin habit and return to school. She eventually earned a doctorate in education from Harvard University.
Today Eisen is CEO of HealthRIGHT360.
By 2011, like many recession-era nonprofits, the organization Smith helped start in the 1960s was deeply in debt. So it merged with Walden House, a respected San Francisco-based addiction and mental health treatment program, which wanted to offer comprehensive medical care to its patients. The merged nonprofit adopted the name HealthRIGHT360.
By joining forces, Eisen says, Walden House and the Haight Ashbury Free Clinics were able to weather the extraordinary financial expense of shifting their organizations to electronic health records, a requirement of the Affordable Care Act.
With the network in place, she says, it's been easier to train and add new providers as HealthRight360 has expanded. The merger also allowed the Haight Ashbury Free Clinics to erase its debt in a year.
Between 2011 and last July — when the organization merged with Prototypes, a Southern California women's drug treatment center — HealthRIGHT360 acquired five other community clinics in Northern California and now offers treatment at 40 sites up and down the state.
Ben Avey, assistant director of external affairs at the California Primary Care Association, says such mergers aren't new, but they have accelerated under the Affordable Care Act.
At the individual clinics that comprise health systems like HealthRIGHT360, "they speak your language, know your culture, understand the situation you're coming from," Avey adds.
As CEO, Eisen led the consolidation that streamlined HealthRIGHT 360.
"We have one board, one human resources department, one finance department, one payroll department and one executive," she says. The annual revenue is $110 million. Medi-Cal, the city, county, state and federal governments all reimburse HealthRIGHT 360 for providing patient services, as do commercial health insurers.
But ties to the early days remain. The early treatment of concertgoers evolved into San Francisco-based Rock Medicine, which is now part of HealthRight360. Staff members set up medical clinics on-site at rock concerts, circuses and fairs in the San Francisco Bay Area and Los Angeles, providing medical treatment that garners $1,038,000 annually from the venues.
The nonjudgmental attitude of the Haight Ashbury Free Clinics' staff toward patients also continues to this day, according to 61-year-old David Smith, (no relation to the clinic founder), who has been coming to the clinic since the 1980s and says he's always felt welcomed and accepted.
This was true, Smith says, even when he was homeless in the early 2000s.
"It didn't matter if I was dirty," he says. "I didn't have to feel like I couldn't come in here because I wasn't in the proper state of cleanliness — which was, unfortunately, the case for quite a bit of time."
Kaiser Health News, is an editorially independent part of the Henry J. Kaiser Family Foundation and is not affiliated with Kaiser Permanente. Laurie Udesky is an award-winning freelance journalist based in San Francisco. On Twitter: @laurieudesky.
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