Once able to make appointments for breast and cervical cancer screenings at HealthFirst Bluegrass, women are now having to line up outside the clinic at 7:30 a.m. to be seen and still might not be screened that day.
Hundreds have had to seek screenings elsewhere, and some are being asked to pay $25 for what is supposed to be a free service, said Vicki Blevins, founder of Pink Connection, a Lexington-based nonprofit focused on breast cancer.
The process involves "too many hoops," Blevins said, and she fears many women will just go without the screenings, which are critical to early detection of cancer and the potential for successful treatment.
Because HealthFirst is taking women on a first-come, first-served basis and performs a limited number of procedures a day, Blevins said, "We have women go and line up and get to the door and be turned away."
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There has been a dramatic change in this service since HealthFirst took over the program for the Lexington-Fayette County Health Department in July 2012, she said. Beginning in 2008, when Pink Connection was founded, Blevins worked with the health department to get poor women free breast and cervical cancer screenings through a state-funded program.
When the program was offered by the health department, appointments could be made over the phone, and the health department would follow up with patients with results and, if needed, referrals for care.
"We were so fortunate for so long," Blevins said.
Funding appears to be part of the problem.
The health department received state and federal funding for the screenings and allocated an additional $650,000 annually for cervical and breast care screenings in the two years before HealthFirst took over the screenings, said Dr. Rich Leach, health commissioner.
Significant state and federal funding cuts forced the health department to stop managing the screenings and cut back the additional allocation to focus on the department's core responsibilities as mandated by the state, Leach said. Those include public health issues such as infectious disease control and restaurant inspections.
Currently, HealthFirst has $185,000 allocated for the screenings through a contact with the health department, said Royana Rice, public health official at the Lexington-Fayette County Public Health Department.
HealthFirst's executive director, William North, said the clinic has done the best it can with the money available. And, he said, the state has approved HealthFirst to provide the service during the 2014 fiscal year.
Women needing cancer screening appointments are not singled out to wait on the clinic sidewalk before the doors open, North added.
"Patients waiting in the morning at 7:30 a.m. may have nothing to do with that program," he said, adding he has noticed people gathering on the sidewalk before the clinic opens and has asked his staff to address it.
Same-day appointments are HealthFirst's policy for some patients, he added.
Leach has heard some general complaints about patients not being able to get appointments at HealthFirst, he said, and he referred those to North. He said he was unaware of the scope of the problems Blevins has raised.
As HealthFirst assumed responsibility for the screenings from the health department, glitches were expected, Blevins said. But things have gotten steadily worse for her clients. She had a meeting May 28 with HealthFirst officials, including those immediately in charge of the program, and at the time HealthFirst employees seemed eager to help. But nothing changed, she said.
Blevins said she finds it difficult to track what HealthFirst requires to see patients.
"Their protocol for getting people in has changed a lot," Blevins said. "It is changing constantly."
Intent on getting women the screenings they need, Blevins sought grant money to create an alternative. She received grants from the Lexington office of Susan G. Komen for the Cure and St. Joseph Hospital Foundation for a total of about $50,000.
That money has allowed Pink Connection to refer women needing mammograms to any St. Joseph facility where they can make an appointment. About 275 women have been served since May, she said.
She has not found an option for women needing cervical cancer screenings, so they must either stand in line or, more likely, not get the screening, she said.
The women receiving mammograms from St. Joseph via HealthFirst face another hurdle. Blevins' clients qualify to receive screenings under the state program aimed at the poor and uninsured that HealthFirst offers. They must receive diagnosis and treatment by a certified agency, such as HealthFirst, or pay for any needed cancer treatment themselves, Blevins said.
Now, if a woman's mammogram shows any potential problem, the screening at St. Joseph must stop, and the woman must return to HealthFirst to continue with the mammogram and any other tests necessary to meet the requirements of the state program.
Imagine, she said, sitting in a doctor's office, being told there is the potential you have cancer, only to be told you will have to go through the mammogram process again, later, across town. "It's horrible," Blevins said.
Three women have had to do this since May, Blevins said. One of them was ultimately diagnosed with breast cancer.
The current arrangement is not ideal and was intended as a temporary fix, she said, adding that the grants will provide screenings for about a year.
"It's a back-up plan until somebody can figure out something better," she said. "If they can ever figure out something better.
"We just want to make sure these women can get screenings in a timely manner."