A tight budget has forced Helena's Cooperative Health Center to cut nearly one-fourth of its staff, reduce services and raise fees.

The CHC is primarily geared toward serving low-income and poor patients, but a change in patient mix has the nonprofit agency facing a $380,000 budget hole. Those with Medicare, Medicaid or private insurance tend to make up for those with no insurance, but those without insurance have steadily climbed to 65 percent of the patient load. That caused the shortfall.

In an emergency meeting Tuesday evening, the CHC Board decided:

- the Parker Medical Center in Lincoln will close April 15 (see related story)

- nine out of 35 CHC employees will lose their jobs

- mental health services will be cut

- minimum medical fees will rise from $7 to $10

- minimum dental fees will increase from $10 per visit to $10 per procedure

- a collections agency might be brought in to handle delinquent accounts

- training and travel will be trimmed for all but doctors, nurse practioners, and physician assistants, who must attend mandatory sessions.

CHC officials said it was ironic that as the center meets its mission -- serving the poor -- they have to make cuts.

"We were too good in our mission, and our mission is to serve the underserved," said CHC Board Chairman Jim Nybo. "We can't serve the community, especially that target audience, and be in the hole."

The national and state trend is that fewer and fewer people have insurance, said CHC Executive Director Kate Wilson. In the Helena area, nearly one-third earn less than twice the poverty level. The poverty level for a family of four is $19,350, according to the U.S. Department of Health and Human Services.

Most of the CHC's operating budget comes from patient fees and the federal government, with Lewis and Clark County and other sources making up the rest. CHC staffers expect to trim about $250,000 from last year's $2.03 million operating budget and dip into reserves. The future is cloudy, though, as the White House's proposed Medicaid cuts could further squeeze CHC services.

Wilson said she'll raise money, asking doctors and individuals for $50,000. The CHC helps private physicians by tackling patients' health problems before they end up at the hospital, she said.

"We keep people out of the emergency room," Wilson said.

The CHC served about 6,000 patients, handling 19,000 visits last year. The one mental health counselor served 250 clients. Those CHC employees in Helena losing their jobs include a front desk helper, administrative assistant, nurse, mental health counselor, and file clerk.

Closure would be 'devastating'

Lincoln resident Teresa Garland was glad she didn't have to drive out of town when her son, Cole, broke his leg during football practice years ago.

She took him to the Parker Medical Center right in town, where physician assistant Roger Barrey set his leg.

"At least we didn't have to go to Helena," she says. "It was convenient."

Lincoln residents like Garland say a decision to close their only medical clinic is "devastating." The clinic served residents in Ovando, Helmville, Canyon Creek and Wolf Creek. But starting April 15, residents needing stitches, a flu shot or a regular checkup will be forced to travel to Helena, Great Falls or Missoula.

The clinic gave everybody an added sense of security, said Rollie Fisher, Lincoln Town Council chairman.

"It would be a crushing blow to the community," he said. "Up here you live here because you want to. It always helps to have someone like Roger around. Lincoln's got enough economic problems, they don't need any more."

Barrey, two nurses and a front desk person were let go, as part of emergency cuts passed by the Helena-based Cooperative Health Center, a nonprofit organization funded primarily by patient fees and federal dollars. The four center staffers will have a shot at other jobs, depending on seniority.

Barrey said he was "blindsided" by the decision, which he was told of Wednesday morning. He might have a job, he said, but in Helena. Barrey added he probably couldn't open the clinic on his own and keep it affordable. Now he'll have to tell his former patients to go see someone else.

The decision to close the clinic was based on dollars and cents. Clinic hours had been cut, but recent budget estimates found more drastic action was necessary.

The clinic has lost money since it opened, according to CHC executive director Kate Wilson, with a deficit of $56,425 so far this year. Helena patients and county money were, in effect, paying to keep the Lincoln clinic open. Lincoln needs the clinic, but there aren't enough people to support it, said CHC Board Chairman Jim Nybo.

While once there were plans to renovate and add dental services to the Parker Medical Center, the doors will close in a month.

"We've kept it open because we really believe Lincoln needs a clinic," Wilson said. "We offset the losses with revenue from the clinic in Helena, but we can't do that anymore."

The decision wasn't totally unexpected. Wilson said she's met with members of the Blackfoot Valley Medical Services Association, which operates the building.

Ann Pryor, a Lincoln resident, CHC board member and chairwoman of the BVMSA, has been involved in the clinic for 25 years. The association holds an art auction to help pay the clinic's bills. The center has had different doctors and has closed in the past. St. Peter's Hospital reopened it, and, as their support waned, the CHC took over.

Pryor said Monday's decision was a tough one, but she, the CHC and others intend to get the clinic back open. She's hopeful another grant will come through.

"It's a very sad situation for us," Pryor said. "Right now, I don't know what is going to happen. The community of Lincoln absolutely relies on it. We just need community support any way they can give it to us."

Lincoln residents might have to rely more on paramedic Bob Fleming and the Lincoln Community Ambulance Service. Fleming said his crews are sometimes called to the Parker Medical Center, if it's serious enough.

"It could certainly have an impact," Fleming said. "It's going to be more inconvenient (for patients) to deal with a doctor in Helena, Missoula and Great Falls."

The clinic might be reopened, but probably not for at least a year, Wilson said. Because the clinic will be closed, it might be eligible for a federal grant to reopen it.

Garland, who works at Garland's Town & Country in Lincoln, said she was sad to hear the news. Kids and seniors were typical users. Some were already travelling elsewhere in case they needed a pharmacy, which the town doesn't have anymore, she said.

"That's never a good thing," Garland says of the closure.. "In a small community like Lincoln, those types of fundamental things...are important to everybody."

Reporter Jason Mohr can be reached at 447-4075 or jason.mohr@helenair.com.