The partnership will increase access to specialty care for uninsured residents served by the USF Health student-run program and significantly increase the number of patients seen.

By Saundra Amrhein

Further strengthening ties between the two institutions, Florida Hospital Tampa has committed $1.2 million in donated goods and services to the University of South Florida to help expand community-centered medical care through the USF Health BRIDGE Clinic.

The BRIDGE clinic – a nationally recognized, student-run free community clinic now in its eighth year – provides primary medical care for more than 800 underserved patients a year from the University Community Area one night a week inside the USF Health Morsani Center for Advanced Health Care.

Leadership of USF Health and Florida Hospital Tampa as well as medical faculty and student volunteers pose for a photo on opening night of the BRIDGE Clinic at Florida Hospital.

Now, Florida Hospital Tampa’s donation of goods, services, office space and personnel will help significantly increase the number of uninsured patients seen through the BRIDGE clinic, expand specialty care and procedures, and cut weeks off the appointment waiting times for new and established patients, said Dr. Lucy Guerra, a volunteer co-medical director and one of several attending USF Health physicians at BRIDGE.

The additional resources for the BRIDGE clinic extension at the hospital – set up inside Florida Hospital Tampa’s renowned Pepin Heart Institute, located on Fletcher Avenue across the street from the university – will also help mitigate the plight of working families who cannot afford or qualify for insurance in the new federal health insurance marketplace but who also don’t qualify for Medicaid, Dr. Guerra said.

Officials from both institutions said they are thrilled about the partnership, which adds to their ongoing research and patient care collaborations across the Tampa Bay region.

“We’re incredibly grateful,” said Dr. Charles Lockwood, senior vice president of USF Health and dean of the Morsani College of Medicine. “This is a clear indication that our missions are completely aligned. We are here for the patients.”

Dr. Peter Bath, vice president of mission for Florida Hospital West Florida Region, echoed Dr. Lockwood’s sentiments and said partnering with the hospital’s next-door neighbor to provide health care for struggling families was a continuation of the hospital’s mission.

“This is a natural extension of what our mission is all about, caring for people and giving back to our community,” Dr. Bath said. “We know needs are significant for the underserved and we will continue to look for ways to help the community throughout all of our nine Florida Hospitals in the West Florida Region.”

USF medical student volunteer Jordant Vanzant checks the blood pressure of BRIDGE Clinic patient Sandra Avilez.

The donation and partnership stem from more than a year of meetings spurred by both university medical students seeking more resources for their high-demand clinic, and the encouragement of one of the hospital’s doctors.

Dr. Marian Menezes, a physician on staff at Florida Hospital Tampa, remembers how his wife – Dr. Lynette Menezes, the assistant dean for international affairs at the USF Morsani College of Medicine – convinced him to attend the BRIDGE clinic’s annual fundraising talent show more than a year ago.

“I fell in love with what they were doing,” Dr. Menezes said. He immediately sought out ways to help.

The medical students relayed their concerns about space, patients’ waiting times and the need for more specialty care for patients with serious medical problems. Currently USF doctors waive their fees for BRIDGE patients for certain surgeries and specialty procedures, but there are still facility fees and other types of expenses that add up to thousands of dollars. Dr. Menezes brought the issue to the attention of his colleagues at the hospital.

Expanding services offered by the BRIDGE clinic at Florida Hospital Tampa will significantly cut down patients’ wait times for appointments, which can run from three to four months, said Michelle Blanco, a USF fourth-year medical student and executive student director at the clinic.

“Now being able to tell your patients we can see you in the next few weeks – it’s very exciting,” Blanco said.

The patients will also have increased access to surgeries and specialty tests and procedures in areas like radiology, gynecology, orthopedics and surgery. “Both efficiency and quality of care are going to increase at BRIDGE,” Blanco said.

L to R: Dr. Theron Ebel, a critical care physician at Florida Hospital Tampa, with USF Health Morsani College of Medicine faculty members Dr. Eduardo Gonzalez and Dr. Lucy Guerra, co-medical directors of the BRIDGE Clinic, and USF medical student Kathryn Dean.

The expanded BRIDGE clinic, like the current one, will continue to pair medical students with supervising physicians. In addition to the USF Health doctors who volunteer at the Morsani site, the new site will bring in volunteering physicians from Florida Hospital Tampa. As the numbers of participating hospital physicians grow, the clinic at the hospital may increase its capacity from one Thursday night each month to opening as many as four nights monthly.

Dr. Krishna Tewari, a hospitalist physician at Florida Hospital Tampa, will be among the first. He said he plans to volunteer at least two nights a month.

“I’m excited to see the work here,” Dr. Tewari said.

The expansion also creates more volunteer opportunities for USF students from the colleges and schools of pharmacy, physical therapy, public health and social work – as well as student interpreters. They currently rotate through the current BRIDGE clinic and its 13 exam rooms at the Morsani Center.

Ali Antar, 22, nearing the end of his second year of medical school at USF, said with the expansion of BRIDGE, he would love to volunteer even more time at both sites. After a year at the original BRIDGE clinic location, the experience has deepened his understanding of the practice of medicine beyond what he’s learning in the classroom.

“When you’re a lower classman, any real clinical experience changes your perspective,” Antar said.

Meanwhile, patients are grateful for faster access to needed care.

“I went to get this appointment in October,” said Sandra Avilez, 51, sitting in one of the four BRIDGE clinic exam rooms inside the Pepin Heart Institute at Florida Hospital Tampa on the night of the expansion’s opening.

Avilez, formerly a customer service representative, lost her health insurance coverage with her job when her company moved her department and positions to another state. She hoped to get a check-up with a doctor at BRIDGE, because she was recently experiencing hot flashes. While waiting for an appointment these last few months, she did her best to keep herself informed about her health condition by reading articles and taking vitamins.

She was relieved to see the new BRIDGE clinic office space open at Florida Hospital Tampa in late February. It enabled the staff to bump up an appointment for both Avilez and her 77-year-old father.

“We were luck they could move up our appointment,” Avilez said. “Our date was for the end of March.”

Sandra Avilez, who lost her health insurance coverage with her job when her company moved her department to another state, was relieved to get an appointment sooner than expected at the BRIDGE Clinic.

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Photos by Eric Younghans, USF Health Communications and Marketing

By Saundra Amrhein

The fourth annual BANDaids for BRIDGE talent show and fundraiser for the USF BRIDGE Healthcare Clinic will be held on Friday, Jan. 9, from 6:30 p.m. to 10:30 p.m. at T. Pepin’s Hospitality Centre, 4121 N. 50^th St. in Tampa.

All profits will go to the student-run clinic, which provides free health care to residents of the University Area Community. The 18 talent acts by USF Health students, staff and faculty include a standup comic, a Bollywood dance troupe, the USF Health Orchestra & Choir, an a cappella group, solo singers and other performers. Tickets are $20 for USF students and $45 for faculty, staff and guests. Tickets can be purchased at http://www.usf.edu/ua/md/BRIDGE.

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Since its inception, the talent show and fundraiser – begun by fourth-year medical student Madeline Snyder – has raised more than $30,000 for the clinic. While science, biochemistry and physics were Snyder’s principal loves as she grew up, the multi-talented medical student had also starred in plays and musical productions all through elementary and high school.

As it has been for Snyder, the BANDaids for Bridge talent show is a great way for the doctors, students and faculty to bring together their professional calling with a companion passion for music, dance and entertainment, says current talent show director and second-year medical student Michael Carr.

Carr, a piano player since the age of 3 and a volunteer at the BRIDGE clinic, says he almost majored in music before deciding to keep it as a beloved hobby and devote his career to medicine. The talent show allows him to combine the two while helping the clinic – something to which he felt a strong connection, as a Tampa native. The clinic, he says, plays a crucial role in helping provide health care for struggling families in the community while also giving medical students like him a unique chance to practice skills they’re learning in the classroom.

“It’s a huge learning opportunity for us,” Carr says. “These are real patients with real problems.”

Michael Carr, talent show director and second-year medical student

Tampa, FL – It is a Tuesday evening, shortly before 6 p.m., and as patients start to trickle in, Jennifer Lee calls about a dozen students – clad in short, white jackets – to their feet.

“Team four!” says Lee, a second-year medical student at the USF Health Morsani College of Medicine, working her way down a dry erase board that outlines assignments for five teams of medical students and doctors. “Alex, you’re going to be with Dr. Slone. You know the drill.”

One night a week for the last seven years, medical students have been paired with physicians from USF Health at the student-run USF BRIDGE Healthcare Clinic. Together with students from colleges and schools of pharmacy, physical therapy, public health and social work – as well as student interpreters – they donate their time as volunteers to provide free medical care and services to University Area Community residents.

“This is really a collaborative effort,” Lee says as the students make their way to assignments through the corridors of the clinic on the fourth floor of the Morsani Center.

Now for the fourth year in a row, USF Health doctors, students and faculty will tap another set of skills to help keep the clinic running smoothly. At the annual BANDaids for Bridge talent show and fundraiser on Jan. 9, doctors and students will dispense with white coats or jackets and stethoscopes to don dancing shoes, stilettos, ties and sequins – all to ensure that this beacon of care stays lit for struggling families.

“I think in medical school, there is a tendency to get tunnel vision,” second-year medical student Ajay Koti, a student operations coordinator at the clinic, says over paperwork before a large computer screen, showing the ropes to two first-year med students.

“But here you are part of a bigger process, something bigger than yourself,” Koti adds. “We’re talking about patients who without a free clinic would have no health care.”

* * *

Jose Martinez waits patiently in a chair as Dr. Fred Slone, sitting across from him on a round, wheeled stool, pulls bottles and packets of his medications out of a large envelope.

“Oh, good, you’ve got the Omega 3,” says Dr. Slone, a faculty medical advisor to BRIDGE, as well as an assistant medical professor of medicine and medical director of the USF Health Center for Advanced Clinical Learning.

“Thank you for bringing in the medicines. That’s a big help.”

Over the next hour, Dr. Slone will carefully go over the half-dozen medications that Martinez takes as well as life-style changes and stressors as he charts the best treatment path – and affordable prescriptions – for Martinez, whose conditions include diabetes, high cholesterol and high blood pressure.

The sheer amount of time and comprehensive care provided to each patient is both a welcome relief to community residents and a teaching tool on clinical care. Not only do patients visit with doctors and medical students, but when needed, a student social worker will help refer them to area services. Some are also seen by physical therapy students.

“I’m very happy here, how they attend to me,” Martinez says after medical students have finished recording his vital signs and Dr. Slone steps momentarily out of the examination room.

Martinez, a 47-year-old construction worker, says he tried to get private health care insurance for himself, wife and their three children. But even on the new federal Health Insurance Marketplace, he couldn’t afford it.

“It’s so much,” he says, listing off his expenses for his household, including food, rent, clothes and utilities. He’s just trying to survive, he adds.

Back in the examination room, Dr. Slone gently chides him about some changes since his last recent visit.

“I put on some weight?” Martinez asks sheepishly in English, while a student interpreter is sitting at his side to help the native Spanish-speaker when needed. “That’s not good.”

“That’s not good,” Dr. Slone agrees in a friendly but concerned tone about the 10-pound weight gain. “That’s going to make the diabetes harder to control.”

The vital signs and laboratory results aid Dr. Slone’s decisions and guidance, which include adding baby Aspirin to the regimen. He also explains how and when Martinez should check his blood sugar levels at home and call in the results to help Dr. Slone adjust his insulin treatments.

But it’s the time Dr. Slone takes to talk with Martinez that illustrates a big point students say they glean from their experience at the clinic: with personal clinical care, the aspiring doctors obtain more information from patients about how their socioeconomic circumstances interact with their health.

In their conversation, Martinez reveals he has developed a voracious appetite and he doesn’t know why. Also, his hours have been cut back at work.

Dr. Slone, using his own health conditions as examples throughout the appointment to empathize, prods Martinez to exercise more.

“Can you give me about 15 minutes a day walking?” Dr. Slone asks. “If you can promise me 15 minutes, I’ll do 15 minutes.”

Martinez smiles and nods. “I can promise,” he says.

Before they finish, Dr. Slone writes a referral for him to get an upper endoscopy through the USF’s GI Program – procedures made possible for BRIDGE patients by grant money from the Colon Cancer Alliance. The funds also help BRIDGE patients gain access to another greatly needed area of care: colonoscopies to screen for colon cancer.

The patients who qualify for care at the BRIDGE clinic are uninsured residents from the University Area Community who earn up to 200 percent of the poverty line, says Michelle Rosario, a fourth-year medical student and a student director at the BRIDGE clinic.

When applying to medical school, Rosario sought out USF in part because of the BRIDGE free clinic.

“I knew I wanted to participate in that,” says Rosario, who started volunteering here first as an interpreter before working her way up through other positions like patient coordinator and finally to student director. “I just love helping others,” she adds. “It’s an amazing experience providing services to those who otherwise might not get the care they need.”

* * *

In addition to receiving care and service referrals, eligible BRIDGE patients can obtain counseling and assistance to help shop for health care insurance on the federal Marketplace through the USF Navigator program. The assistance comes as part of a $5.38 million second-year Navigator grant – the largest in the country – that USF won this fall to help enroll eligible Floridians and small employers into the Marketplace.

The BRIDGE clinic is no stranger to broader university and health issues. For instance, graduate students throughout USF, including from the College of Arts and Sciences, have in the past anchored research projects at the clinic. Also, students in the College of Public Health work in conjunction with the Hillsborough County Health Department to provide free and confidential HIV testing and counseling at the clinic.

“As an undergraduate, it’s almost impossible to get any hands-on experience,” Lauren Aziz, studying for her bachelor’s degree in public health, says in a clinic corridor between patient visits.

Working alongside her is Melina Santos, a public health graduate student and the student supervisor of the public health HIV program in the clinic. She agrees – not only did the clinic give her real-world experience early in her academic career, but it also helped lead to her current job at Tampa’s DACCO – the Drug Abuse Comprehensive Coordinating Office.

“I absolutely loved that I had that patient interaction,” Santos says, adding how much it means to her to provide HIV education to underserved populations, particularly Spanish-speakers.

“One of the most important things for me is that they feel comfortable talking about it,” Santos says.

* * *

Down the corridor and around the corner, a treatment plan is unfolding. Third-year medical student Jared Gopman consults with attending physician Dr. Phuong D. Nguyen about a patient, while first-year medical student Seth Vanzant hovers nearby, observing. The tiered system is part of the clinic’s “conveyor belt” method of progressively increasing responsibilities for students under professional guidance. (The medical students wear short white jackets while Dr. Nguyen and the other physicians wear the doctor’s signature long, white coats.)

Gopman has already done an initial check-up and assessment of the patient in question – a man suffering from several ailments, including cancer. Now Dr. Nguyen is going to follow through to make the final call on his medications and determine his needed follow-up care. The man is eligible for disability insurance, but it hasn’t started yet, and he remains without insurance in the interim.

The three slip inside the examination room, and Dr. Nguyen takes the lead.

“How long have you been on this regimen?” she asks, regarding his medications. A few moments later she tells him about another medication they would like him to try to help him with his chronic obstructive pulmonary disease.

“I may have an ulcer, too, and I don’t know it,” the man says. Gopman takes the man’s chart from Dr. Nguyen and makes notes about setting up a GI endoscopy and also a colonoscopy.

“Trying to keep my costs down, stretching my money as much as I can to pay my bills,” the man says.

They discuss his jaw pain and some other needed tests and exams – with Gopman speaking loudly and sitting on a rolling stool close to the man, who is hard of hearing. Gopman writes everything down for him. All the while, he and Dr. Nguyen try to align care the man needs with the services he can get at the BRIDGE clinic or other low-cost area providers as well as reasonably priced medication.

“Hopefully this will help you before disability kicks in, because we know you can’t afford all these medicines,” Gopman tells him.

At the end of the day, says Koti, the second-year operations coordinator, though members of the community receive free medical attention, the students are just as grateful to the patients for the education they get in return.

“That’s an incredible social gift,” Koti says. “It tremendously outweighs whatever we’re doing for them.”

Photos by Eric Younghans, USF Health Communications