History Complied by Jennifer Collins
Independent Studies Project
According to behavioral theories of communication and decision-making, the rational solution to a problem is not always the best answer. Therefore, when controversy inhibits the development of an organization, the organization may be forced to adopt other useful tactics besides ideal rationality. These theories have held true for the development of the Brockton Neighborhood Health Center, an institution formed and molded by controversy, and maintained by the strong will and determination of its supporters.
The arguments of the supporters of the Brockton Neighborhood Health Center were based on concern for the medical needs of Brockton’s diverse population. Statistics were used to strengthen this argument. The political opposition, however, did not lack medical concern for the citizens of Brockton. The dispute, rather, lied in the issue of the proposed effectiveness of the Brockton Neighborhood Health Center, and the concerns of the repercussions of the clinic’s location. Proponents of the Brockton Neighborhood Health Center argued that the downtown area of Brockton is a high “at-risk” area for teenage pregnancy rates and infant mortality rates. It had been found that the high uninsured population of Brockton was a major cause of these medical issues in the community. By using examples of other communities in Massachusetts and New England, Brockton Neighborhood Health Center proponents attempted to persuade the opposition that a community-based health center would target the medical issues that have been recognized in Brockton.
On the other hand, the opponents of the Brockton Neighborhood Health Center were equal in strength. Many of these opponents were members of the Brockton City Council, which ultimately voted on the issue. The area of downtown Brockton is the home to many long-time community businesses including jewelers, restaurants, and clothing stores. This area also contains many political offices; the school department, Brockton City Hall, and the Brockton courthouse. Would the establishment of a free health clinic damage the image of the downtown area? Opponents had many such questions and fears. Would free, general examinations and immunizations draw overwhelming crowds of people? What sort of people? This type of clinic could very well act as a magnet for the medically deprived. According to surveys and research, this medically deprived part of the population of Brockton included poverty-stricken people, pregnant women, STD-infected people, drug addicts, and non-English speaking minorities. Common sense told the opposers that this would not necessarily be a benefit to the community since these types of people would only draw more social and economic problems, which, in turn, lead to more medical problems. The largest problem expected to be enhanced by those seeking free health care was violence. For this reason, many local business owners joined the opposition to the Brockton Neighborhood Health Center. Another argument which was justifiable on the side of the opposition was the idea that the Brockton Neighborhood Health Center would be servicing many people from the surrounding areas. Health Centers established in the Boston area had been receiving patients from the surrounding areas all over the. South Shore in Massachusetts, including Brockton. If Brockton were to be receiving those from other communities, then the Brockton medical problems would not remain the target and the entire concept of the community-based clinic would be impossible to attain. Thus, the strong opponents maintained logical and justifiable arguments along with the proponents. The situation remained a Catch-22. Ironically, although both sides opposed the other, each side argued out of the same concern for the population of Brockton. Therefore, any type of action or progression was - suspended due to controversy.
PART ONE: FACTUAL HISTORY OF THE BROCKTON NEIGHBORHOOD HEALTH CENTER
There was no argument to the idea that health care in Brockton was in need of attention. Statistics made it evident. The Federal Government declared that seven continuous census tracts in Brockton made up a Medically Underserved Area (MUA). This meant that within this area, the medical needs of the population were not being met. This MUA is composed of the downtown area from Oak Street to Nilsson Street. The birth rate of women in the age category of 15-19 in Brockton from 1985-1990 was 66 births for every 1,000 women. This figure was double the statewide rate of 33 births for every 1,000 women at that time. In addition to having a high teen pregnancy rate, the Department of Public Health designated Brockton as one of the three cities in Massachusetts that does not provide adequate prenatal care for teens. In the same age group (15-19), adequate pre-natal care was only administered for 37% of the pregnancies. Statewide, pre-natal care was administered for 53% of the cases. Given these facts, the infant mortality rate in this area may not seem surprising. From 1985-1990, 100 infants died before the age of one in Brockton. Ninety-four of these deaths occurred in the Medically Underserved Area. The overall infant mortality rate in this area was 26.5 deaths for every 1,000 births. This is considerably higher than the state average of 6.9 deaths for every 1,000 births. For all of these reasons, the health of pregnant women and infants was a target issue in Brockton.
Also, in considering the population that comprises the Medically Underserved Area, 10% of the residents are elderly. Generally, senior citizens have many medical needs to be met. The 2,403 senior citizens residing in the Medically Underserved Area were presumably not receiving the medical attention which they needed.
Another issue prominent in the Medically Underserved Area that presumably could have been inhibiting medical services is the issue of linguistics. Brockton on the whole has an extremely diverse population. Many Brockton residents are recent immigrants from Cape Verde, Haiti, Puerto Rico, etc. Immigration has given rise to a non-Eng1ish speaking portion of the population, as is the case in Brockton. Not only is medical service hindered by inability to communicate. There is also the issue of - comfort with health care. For example, an elderly Puerto Rican woman who is able to speak English sufficiently would probably make more use of the local medical services if the staff could communicate to her in her native language. Instances such as these prove that linguistic and cultural diversity acts as a barrier when the goal of the government is to tend to the medical needs of every person.
Correlating to each of these issues is the fact that 15.535% of the families in the Medically Underserved Area lived in poverty. This shows that there was an economic hindrance that prevented proper medical attention within this area. To get an idea of just how underserved this area of Brockton was, for a population of 26,551 residents, there were only 3 full- time physicians who provided primary and preventive health care. Along with the poverty revel of Brockton, the unemployment rate is also a problem. In fact, nationally, during the 1980s there was an economic decline which resulted.in the loss of jobs in significant numbers. This, in turn, increased the number of uninsured and underinsured individuals and families. This is an example of how nationwide dilemmas can be observed in Brockton. Since the uninsured and underinsured people either do not seek health services, or rely on free clinics and the emergency room, the alarming medical statistics previously discussed have been made possible.
Once the federal government and the Department of Public Health expressed concerns about the medical situation in Brockton by declaring the area Medically Underserved, Mayor Carl Pitaro took action. He called for the formation of a Task Force on Health and Human Services to include various agencies within the community. This Task Force was to investigate the circumstances and the reasons behind the medical statistics and then present a proposal in order to remedy the situation. The Task Force found that other surrounding communities had already found the solution to be a community-based health center. The recommendation for a community- based health center was formally announced in March of 1991. The concept of a community-based/neighborhood health center was originally developed .as a part of the Great Society of Lyndon B. Johnson in 1964. This Great Society focused on national improvements through targeting individual cities and towns. Specifically, the Great Society called for the improvement of education, welfare, and health care of urban areas in need of attention. Nationwide, a portion of the population was being medically isolated and deprived of health care. This portion included the unemployed, uninsured, homeless, and the culturally/ethnically diverse. This portion was growing. Basic health care needed to be extended to include everyone. If primary and preventive health care were an inclusive entity of American life, it was predicted that disease and increasing death rates would be challenged as well. This is the basis of the health care reform that has become one of the largest political platforms in the past decade.
One of the first neighborhood health centers was established in Dorchester, Massachusetts in the late 1960’s at Columbia Point. This clinic provided health care services, such as immunizations, to anyone, regardless of their ability to pay, medical status, or culture/ethnicity. Currently, the mission of the Massachusetts League of Community Health Centers is to .provide accessible, high quality primary health care to an entire community. This mission differentiates a community health center from any hospital that accepts any patients. These health centers pride themselves on quality health care so that the same medical services are offered to the uninsured that are offered to the insured. This quality includes primary care physicians available to the public. When a patient is able to see the same physician for every visit, a relationship develops based on trust and concern for the patient’s medical status. In surveys conducted for the past ten years about health care issues in Massachusetts, residents say that the quality of health care is the biggest factor’ in reviewing Massachusetts medical facilities. It is hypothesized by the Massachusetts Medical Society that “improved quality can reduce costs, particularly costs due to overuse and misuse of services.” Therefore, the purpose of community health centers is to improve the proper usage of basic health care by offering primary and preventive services to all members of the community.
Nationally, this type of center was the perfect remedy to some of the health care issues. Federal and State funds have been set aside for the establishment of community health centers in all neighborhoods that display a need for revisions to medical services. With one of the first community health centers, the branches of these clinics in Massachusetts sprang up quickly. The Uncompensated Care Pool was established in 1985 to provide access to health care for low income, uninsured and underinsured residents of Massachusetts by paying for free care services provided by hospitals and community health centers. It is through this system of financing that community-based health centers are able to offer the quality medical services that they do. In 1996, the Massachusetts Uncompensated Care Pool paid for about I .5 million outpatient visits to clinics. Most of the people who benefit from this Pool are young adults (18-44) with incomes under 133% of the Federal Poverty Guidelines. The extensive use of this Uncompensated Care Pool demonstrates how Massachusetts has acted in response to serious health care problems in recent years.
Through state and federal funding, as extension of community-based health centers in Boston, Massachusetts has reached twenty-six branches in addition to its abundance of hospitals. These clinics are not only located in the state capital, but they have become an integral part of many urban communities in Massachusetts in response to the recognized demand for medical attention. In fact, until the Brockton Neighborhood Health Center was established, Brockton was the only community of its size, in area and in population, without a neighborhood health center.
Thus, with the success of coin munity-based health centers statewide, the proposal of such a clinic in Brockton was developed. However, with the election of Mayor Winthrop Farwell Jr., the center faced definite obstacles. The center was being proposed and supported by a consortium consisting of Cardinal Cushing9 General Hospital of Brockton, Goddard Memorial Hospital in Stoughton, New England Sinai Hospital in Stoughton, the Cranberry Specialty Hospital in Middleboro and Brockton Area Multi- Services. The consortium was one of307 to apply for funding from the Federal Bureau of Primary Care as anew or expanding facility. On September 25, 1992, the federal government awarded a $289,447 per year “start-up” grant for the proposed Brockton Neighborhood Health Center. With this, a Board of Trustees had to be formed to receive the funds and to- , oversee the establishment of the facility. The president of this board was Judith Kubzanski who also worked as chief executive officer at the Cranberry Specialty Hospital in Middleboro. Two weeks later, Mayor Farwell learned that his Human Resources administrator, Robert A. Martin, had written a letter to the Federal Bureaus of Primary Care in May 1992 in support of the neighborhood health center to be located in the downtown area. With this, Mayor Farwell suspended Martin for two days without pay for sending the letter without authorization from the mayor.
Once the health center was granted funding to situate the clinic, opposition to the clinic made their voice stronger. Two key critics of the health center were Councilor at Large Geraldine Creedon and City Councilor Joseph Kelley.
These city officials claimed that the efforts to establish a Brockton Neighborhood Health Center were ultimately a duplication of services, considering that Brockton already had three full-service hospitals in its jurisdiction. “With three hospitals, are we really underserved? I don’t see-a lack of commitment to serving the people we have here,” claimed Creedon. Also, in response to the federal grant, Kelley claimed that the Brockton Neighborhood Health Center “could not satisfy the medically underserved designation” without manipulation of data. “I believe this agency misled the federal government” so that they could qualify for the funding.
In response to the accusations, Judith Kubzanski reminded those city officials who were criticizing the enter that the medical data was not reflecting the status of Brockton on the whole but rather, it reflected the census tracts that showed need. While some city officials stood opposed to the health center, and particularly for its proposed location in downtown Brockton, others supported the idea. Namely, City Councilor Louis Angelo gave adamant support for the health center as well as its location in the downtown area. Angelo stated, “Neighborhood health centers work in every other city. I don’t see why it can’t work in Brockton.” Furthermore, even directors of health centers in Boston questioned the extent of medical services available in Brockton. This curiosity stemmed from the fact that an impressive number of Haitians and Cape Verdeans, Brockton’s two largest immigration groups, had been traveling to either the Mattapan neighborhood Health Center or the Codman Square Neighborhood Health Center in Dorchester for medical care.
With the increasing support of the health center, those in opposition specified their concerns and arguments. Opponents could not deny that the Medically Underserved Area of Brockton was in need of a primary and preventive clinic. However, the issue became branched around the siting of the health center. Abiding by the requirements of the Federal Bureau for Primary Care, the neighborhood health center selected three possible sites within the Medically Underserved Area.
The first of these possible sites for the health center was the former site of Christy’s Market on the corner of Main and West Elm Streets. This location was investigated early in 1992 and when the idea was announced, the supporters of the health center faced overwhelming refusal by city officials and the owners of downtown businesses. Since the consortium at that time lacked the support and specifically political force to fight the refusal, it had to seek out an alternative site. The second site, chosen as an alternative was the former General Electric Building on Warren Avenue, also considerably near the downtown area. The third site was proposed for One North Main Street, which lies outside of downtown Brockton yet within the area designated as Medically Underserved. Ironically, when Mayor Farwell heard about this third site on North Main Street, he shifted his stance concerning the health center. According to an article in the Brockton Enterprise on Friday, November 13, 1992, “Farwell told center supporters that he would approve a site outside the business core of downtown as long as the ward councilor supports it.” For the Board of Trustees for the Brockton Neighborhood Health Center, this was a big step in the success of the clinic because, with the Mayor’s public support, the odds of approval by the City Council were on their side. However, board members particularly wanted the center to be located in the downtown area, more central to the Medically Underserved Area.
END OF PART 1
PART TWO
The opposition claimed that there reasoning for their refusal to allow the health center to be located at the original site (157 Main Street/West Elm Street) was due to concern for the revitalization of the center of Brockton. The site proposals also sparked varying opinions for the local merchants of Brockton. For some business owners, a health center in the neighborhood would not be bothersome, regardless of the types of people it attracts. For others, the opinion was quite different. Mark Travis, the manager of Travis Cycle on North Main Street, commented, “If they want to revitalize Main Street like they’re talking about, that’s not what they should put in. They should put it away from where they want people to shop. Put it somewhere away from the center. They city’s got to make a decision. Do they want businesses or do they want welfare offices?” Many other business owners felt this same concern toward the impact of such a facility on the merchants of Brockton. This concern was to continue until the situation was resolved and, for some businesses, even after that.
Another heated topic of controversy was the interpretation by City Councilors Creedon and Kelley. The two argued that this center would serve as an AIDS clinic instead of a primary and preventive treatment center. The supporters of the health center claimed that this public accusation was not only false, but it also was inhibitory to the progress of the health center because it gave the wrong impression and ultimately drove fear into the minds of many citizens and merchants. It was difficult, however, for these opponents of the health center to face some of the proponents, especially since clergy leaders and members became a strong force in the debate. Rev. Frank Cloherty, pastor of St. Patrick’s church on Main Street claimed that he was relocated to Brockton from Jamaica Plains and he had intended to “lay low. However, he found himself drawn into the controversy of the Brockton Neighborhood Health Center and he became a member of the Board of Trustees to oversee its progress. As an example of the predicted effects of the proposed Neighborhood Health Center, Geraldine Creedon mentioned the impact of the Mainspring House in Brockton. She reminded the proponents of the Health Center that the Mainspring House had similar visions for treating the same “underserved” area and that the business surrounding the site were soon hurt and eventually forced to close doors. This example, in itself is questionable considering that views of the effectiveness of the Mainspring House may shift from person to person. For example, Rev. William McCoy spoke in defense of the Mainspring House claiming that it has been, overall, advantageous for the downtown area of Brockton. Overall, the basis of the arguments thus far in the controversy over the Brockton Neighborhood Health Center can be summed up by assuming that the proponents desired a downtown, central location because that is the particular target area in which there is the most need for primary health care expansion. On the other hand, opponents of the center maintained an argument that the health center would add undesirable elements to the area of Brockton that was already in need of nourishment and instead, the health center should be located on the grounds of one of the three community hospitals in the area.
By January 1993, the Board of Trustees for the Brockton Neighborhood Health Center had made a key step by hiring a full time executive director. Marti A. Glynn had served as the executive director of the Martha Eliot Health Center of the Children’s Hospital in Boston and she agreed to head the establishment of a similar facility in the Brockton area. When Glynn entered the controversy, the decision was made that the alternative site of 747 North Main Street was no longer under consideration on the basis that is was too far north of the district that displayed medical attention. Although Mayor Farwell publicly opposed the other two sites, Glynn told him that the Board of Trustees would meet and inform him of the final decision following the meeting. By February 1993, the Board had finally decided. The site chosen was located at the corner of Main and West Elm Streets. Glynn commented that “it’s the most affordable and it’s the best location. It’s in the heart of the area we want to serve.” As predicted, this decision angered Mayor Farwell and he promised to fight the controversial location. Glynn knew that she would need a special permit to use this location of former Christy’s Market and Farwell wanted to investigate whether they would need a validation from the Zoning Board of Appeals. Although Farwell was not done fighting the center, Glynn hoped to have the Brockton Neighborhood Health Center open by July 1, 1993. Glynn argued that, contrary to what the opposition envisioned, neighborhood health centers in Boston and Lynn were now considered the focal point of those cities revitalization. She believed the same could be done in Brockton.
Not only was Mayor Farwell furious with the decision of the Main Street sight for the health center, Mr. Alexander Romm Rysman also objected to this location. Rysman was the president of Romm’s Jewelers (directly across the street from the proposed site) and also the chairman of the Downtown Brockton Association which was a group of merchants located in this downtown area. He expressed his concern by stating that the health center would be inappropriate and the downtown area should be strictly for retail as it has been for so many years. He claimed that he did not know of any other merchant in the DBA (Downtown Brockton Association) that did not share this opinion.
Finally, in the beginning of March 1993, both proponents and opponents were able to voice their concerns and opinions at the City Council’s Financial Committee meeting. At this meeting, State Commissioner of Public Health, David H. Mulligan defended the controversial site of the health center. For about two hours, dispute continued and both the proponents and the opponents remained defensive of their visions. The meeting was not meant to produce any decisions. Rather it was used as a forum to begin educating political officials about health - centers and educating health officials about social impacts.
Soon after this City Council meeting came the news from the Building Superintendent, David Tonis, that a city ordinance barred health clinics from establishing in the downtown business zone. The controversy turned from a dispute to a legality. Glynn planned on applying for the permit despite the ordinance and if she was rejected, to take legal action. While awaiting more news from the Zoning Board, Marti Glynn decided to accept the offer of Health Commissioner David Mulligan to tour a facility similar to the one proposed for Brockton. The strong opponents Rysman and Kelley agreed to join the tour to learn more about the proposed health center and to observe what conditions would be like in Brockton if such a clinic came to the downtown area. The tour was scheduled for April 13, 1993.
A few skeptic Brockton area merchants who attended the tour, returned to Brockton with a different view. Seeing the functioning community-based health center in East Boston convinced a few that this would be a positive addition to Brockton. However, Joseph Kelley still remained a strong opponent of the health center.
An ironic twist to the controversy was the fact that, as the Board of Trustees for the health center was awaiting a decision from the Zoning Board, Marti Glynn rented new offices to maintain her work as the executive director. The offices she rented were from Alexander Rysman, of Romm’s Jewelers, who vehemently opposed the idea of this clinic locating across the street from his business. Thus, the Brockton Neighborhood Health Center was receiving office space from one of its strongest critics. The location of these offices was convenient because the planned health center was to be established across the street in the former Christy’s Market building.
Finally, on May 11, 1993, the health center went before the Zoning Board of Appeals. Hundreds of people attended the public hearing to determine the fate of the Brockton Neighborhood Health Center. Despite the support of community members and clergy from the area, the Zoning Board of Appeals rejected the proposal of the community-based health center to be established in the downtown area considering the ordinance acting in the city. The vote of rejection was swayed by the one member, John Cahill, who voted against the center.
From this point, the controversy was expected to go to court and Attorney George N. Asack agreed to represent the health center assuming that his clients would probably want to sue the city of Brockton. He was correct. In late June, the Brockton Neighborhood Health Center filed a lawsuit against the Zoning Board in response to the rejection on May 11. Asack not only represented the health center, but also James Mihos, who owned the building of potential location and was in the process of finalizing a lease when the Zoning Board ruled. Despite the denial by the Zoning Board, the health center continued to receive federal funds to establish a health center after Marti Glynn met with officials from the Federal Public Health Service and explained to them the commitment to the health center. Next, Glynn wanted to seek a change in the ordinance that refused the establishment of the health center. For an ordinance to be changed, eight or nine votes of the eleven-member City Council was required. Glynn believed this was within reach. Six of the City Council members had already publicly supported the health center.
Then, in July of 1993, Louis Angelo announced that he would not seek ree1ection in the fall so that he may care for his ill father. As Ward 7 City Councilor, Angelo was an influential proponent of the Brockton Neighborhood Health Center and he promised that during his last six months of service to the city would involve efforts for the health center. More unfortunately for the health center, by the end of October 1993, three top officials that had given considerable support and structure to the health center, resigned from their positions during a crucial period of the clinic’s development. These three officials were the Executive Director Marti A. Glynn, the president of the board of trustees for the center, Judith S. Kubzansky, and the center’s chief financial officer, Pam St. Germain. At this time, Joanne Hoops, also a member of the board of trustees and Executive Director of the Brockton Boys and Girls Club was named as the temporary president of the board while the search was underway for replacement positions for the executive director and board of trustees president.
While the health center was going through a transitional phase, as so many referred to the time period of resignations, it also had some aspects working. for its benefit. The City Council election for the fall of 1993 was a decisive one for the future progress of the health center. City Councilor-At-Large Geraldine Creedon won her re-election despite the fact that she was an adamant opponent of the health center. However, the other force within the City Council that was inhibiting the progress of the Brockton Neighborhood Health Center was Joseph Kelley. In the election, Kelley was defeated by the Ward 6 candidate Donna Dailey, who had previously expressed her support for the downtown health center. Thus, the Brockton Neighborhood Health Center began 1994 on a good note since there was more political support in the City Council.
In January of 1994, the health center hired a new executive director to replace Marti Glynn. The selection process yielded the former vice president of human resources and nursing and finance at Community Hospital in Cranston, Rhode Island. When the hospital closed in 1993, Susan Joss found a new position in Brockton. The former executive director, Glynn, had left her position for a higher-paying job at Boston University.
One month after Joss became the new executive director, she announced that the Brockton Neighborhood health center would resubmit the ordinance amendment to the City Council after it had been tabled already by the Council. At this point, the health center staff was still leasing office space from Romm & Co. Jewelers, directly across the street from the predicted site for the center. By mid-February, Joss decided to move the downtown administrative offices to the basement of St. Patrick’s Church at 335 Main Street. The purpose of this move was so that the health center could offer its first medical services while awaiting zoning approval from the City Council. . Offering basic medical services to the insured and uninsured was the primary mission of the Brockton Neighborhood Health Center and Joss decided that too much time had passed with no action because of the political controversy of zoning.
So the health center leased a mobile medical van from Goddard Occupational Health Services. The staff of the van included doctors and nurses contracted by The Good Samaritan Medical Center. Every Monday, Wednesday and Friday, the van was in service, and offered free care to senior citizens of Brockton. This health care included cholesterol and blood pressure screenings. The van also offered flu shots and basic lab work. Preventive and nutritional information and counseling was also available. While the health clinic was busy at work in the parking lot of St. Patrick’s church, the community activism was also spreading into the church itself. Two priests of the parish, Rev. Francis Cloherty and Rev. John Doyle (pictured above), were also influential advocates of the Brockton Neighborhood Health Center. The two spread the idea of community involvement, specifically toward the health center to the parishioners. In fact, during the time period when the medical service van was functioning, the weekly trend was for seniors in the parish to visit the van following Sunday Mass. This shows how the mission of the health center, which was M. Creedon alerted local media and took photographs of the sign to show at the council meeting as evidence of the community’s views of the proposed health center. Also in reaction to the prank, Susan Joss defended the Brockton Neighborhood Health Center by saying that the clinic had no connections with any type of methadone clinic.
Although this prank seemed to influence both sides of the argument in the last few days before the final decision was made, on Monday, June 27, 1994, the Brockton Neighborhood Health Center finally received the necessary zoning permission. The decisive vote was ultimately 10-1 in favor of the health center. The surprising turn-around came from the Council President Thomas Plouffe, who had voted against the proposal the month prior but changed his vote at the last minute. The only vote against the proposal this time came predictably from Geraldine Creedon who had never swayed from her opposition to the health center. The next day, June 28, Mayor Farwell signed the ordinance to allow the clinic zoning at 157 Main Street. Now that this major obstacle had been overcome in the development of the Brockton Neighborhood Health Center, the officials of the center had to shift gears immediately to the task of establishing the clinic as planned.
END OF PART 2
PART THREE
By September that same year, the health center planned on opening its doors by the end of October while there were only five people on the payroll: Executive Director, Susan Joss, Chief Financial Officer David L. Hanson, Nurse Practitioner Christive Bonanno, Office Manager Kristin Bausemer and medical director, Dr, Elsie Varughese. The staff wanted to hire at least five more members including a pediatrician, a nurse, a nutritionist and a maintenance worker. The health center was able to do so because the federal grant extended its funding for another three years so that the clinic could finally get on its feet. Considering the population of the Medically Underserved Area that the clinic would be established in, the job offerings favored those that were fluent in another language besides English. In explaining the type of services that would be offered, Susan Joss said that it would be much like a typical family practice doctor’s office, offering prenatal care, checkups, screenings, immunizations, physicals, and treatment of minor illnesses and chronic diseases. Those patients with significant problems would be referred to specialists. Joss also addressed the lasting accusation that the clinic would be an AIDS clinic. She said, “AIDS patients will be treated the way a family practitioner would first threat them and then they would be referred to a specialist somewhere else. We are not specializing in the treatment of AIDS.”
While the health center was under development, the coalition that comprised the Brockton Neighborhood Health Center continued to act in support of its mission to spread health care to everyone in the community. On October 8, 1994, volunteers from the health center and from Boston’s Hope for Kids ran a free immunization clinic primarily targeting children between the ages of 6 mo. - 5 yrs who were un-vaccinated. The efforts of these volunteers demonstrated how committed the coalition was to the mission of the health center. Within the next few weeks of this event, the Brockton Neighborhood Health Center finally opened its doors to the public at the end of October, 1994.
Only a few months later, one of the leading political supporters of the health center from its origins, Lou Angelo, was in the middle of a battle with liver and pancreatic cancer. His situation triggered the concern of city official and especially members of the Brockton Neighborhood Health Center. On June 11, 1995, the State Representative lost that battle. Angelo died at the age of 42, but not before he had left his mark in the community. Angelo lived to see the ultimate success of the Brockton Neighborhood Health Center that he had fought so hard to defend. Still, today, he has not been forgotten, and on August 16, 1995, an examination room in the clinic was dedicated in his memory.
After so much protest from the opponents in the community, the health center could finally report its progress and prove that the accusations were wrong. By August, 1995, the clinic was seeing more than 450 patients a month with an expected increase. It was also questionable as to what types of patients would be drawn to such a clinic and opinions spread that it would attract those who were poor, drug addicted, or diseased. However, the majority of the patients were those who were maintaining a job, but the jobs did not provide health insurance. The services that the center was offering were seemingly effective; including the pre-natal program, screenings for diabetes and blood pressure and nutritional counseling.
Because of the success of the clinic thus far, funds were adding up. In November, 1995, the clinic raised over $8,000 through the Donor Club with the help of supporters such as Jack Yunits, George Papas, and Gerry Studds.
Proposed site: 1992 Health Center: 1995
Then, in early 1996, the Good Samaritan Medical Center donated $25,000 to the center to help establish obstetric and gynecological care at the center.
By March of 1996, the health center reported that the expected number of patient visits, which ‘as originally 350 per month, was expected to be tripled within the next few months 1000 visits. With a $165,000 grant from the federal government, the health center planned to renovate the building to include at least ten new examination rooms on the first floor. By this point, Joss explained that the problem with health care in Brockton was the lack of primary services being offered to the population. The clinic was seeing children who had never received immunization shots and adults with dangerously high cholesterol and blood pressure risks. If these patients had been receiving primary health care, the screenings and immunizations would have been done before. Another service that the health center was focusing on was teenage health. In October, 1995, a teen clinic was opened on Monday evenings for those who did not want pediatric care or adult care. This is an example of how the health center was giving the community options about the health care services, and overall, improving the standards of health care in Brockton.
In early April of 1997, the first floor was finally opened for services after renovations and the second floor then went under renovations so that a total of 14 examination rooms on the two floors could be in operation. By this point, the staff had expanded to include several languages, including Cape Verdean Creole, Portuguese, Spanish, French and Haitian Creole. As predicted, less than three years after the clinic opened its doors in November 1994, it was seeing about 1,100 patients per month. Also, the clinic’s budget grew from $250,000 to over $2 million since November, 1994. One statistic that proved the impact of the health center was infant mortality in 1993 was 15 deaths and in 1995, after the center opened, there were 3 deaths in the city of Brockton.
To add to the success of the Brockton Neighborhood Health Center, in May 1997, Harvard Pilgrim Health Care foundation awarded a $25,000 grant to the health center to address domestic violence and HIV prevention issues. This grant allowed the expansion of the health center’s services even more. Another sign that the mission of the Brockton Neighborhood Health Center was spreading was the fact that Dr. Gerald Jensen, pediatrician of Bristol, Conn., decided to donate his medical supplies to the clinic when he retired in July of 1997. Jensen had the option of selling his pediatric equipment for his own profit but the decision was made based on the cause that the health center was sewing.
The services at the health center also improved as medical breakthroughs were made. In 1995, the U.S. Food and Drug Administration approved the vaccine called Varivax for chicken pox. By August of 1997, the Brockton Neighborhood Health Center was administering the vaccination on a regular basis. On Saturday, October 25, 1997, the health center held an auction to benefit the pediatric services offered at the clinic and also to pay for vision correction of patients.
Another positive impact that the Brockton Neighborhood Health Center brought to the downtown area of Brockton was the opening of the Plaza Pharmacy in the building of the former Romm’s Jewelers Company. For this reason, the health center was bringing about economic development in downtown Brockton instead of inhibiting it as some politicians predicted. On April 20, 1998, the pharmacy opened its doors with support from Mayor Jack Yunits and U.S. Senator Edward Kennedy. Brockton had not had a pharmacy downtown since 1989 and pharmacies that were developing in other parts of Brockton, such as CVS, Walgreens and Osco Drug, had avoided the downtown area.
The funding still had not subsided. In March of 1998, the health center received a $20,000 grant from the Executive Office of Health and Human Services. This grant was to help expand the MassHealth and Children’s Medical Security programs. An extraordinary bit of information came from a 1998 report form the U.S. Public Health Service. This report said that the Brockton Neighborhood Health Center was the second fastest growing federally funded urban health center in the nation. The average rate of patient-visit increase was 5.4% from 1994-1995 while the increase at the Brockton clinic was 195%. It was also the fastest growing clinic in the state of Massachusetts.
Five years after the Brockton Neighborhood Health Center opened its doors in 1994, it has become an integral part of the community of Brockton. Through an overall improvement of the primary and preventive health care standards in Brockton, the health center has been able to pull the community closer together. The perseverance of those adamant supporters who took an active role in the center’s establishment and who did not submit to the opposition during the times of intense controversy with strong political figures allowed the success of the clinic. These supporters were finally able to prove to the community that such a clinic was the logical solution to the - medical situation which was addressed many years prior. The time and effort spent debating the issue of the health center proves that, although a logical solution to a problem may be proposed, concerns may inhibit the immediate action and cause those who support the proposal to resort to other political and communication tactics so that the problem may be resolved.
END OF PART 3