Kentucky surgeons save Sundays for charity care

Like his father before him, Paul Kearney, MD, has a heart for the poor. It's a trait he acquired as a boy watching his dad devote one day a week at his pediatric practice in Newark, N.J., to treat patients whose families couldn't afford to pay.

"He always thought it was an obligation he had to the community," said Dr. Kearney, now a surgeon in Lexington, Ky.

Dr. Kearney shares that sentiment but thought giving vaccinations and tending to aches and pains at a free clinic wasn't the best use of his surgical skills. Then he heard about Surgery on Sunday, a Lexington program that offers surgical care the third Sunday of each month to poor and uninsured Kentuckians. It was the right fit.

Since joining the program, he has done hernia and gallbladder surgeries and plans to take his residents there to teach them the importance of caring for the uninsured. "You're fully trained to provide this care and these people need to have these operations done," said Dr. Kearney, professor of surgery and chief of trauma and critical care at the University of Kentucky Chandler Medical Center.

Across the nation, charity clinics provide primary care to the poor, while some physicians give free care to uninsured patients in their offices. But a program that provides free surgeries is rare.

Operation Access in San Francisco and Fresh Start Surgical Gifts in Carlsbad, Calif., are among few programs that regularly offer free surgical care to the uninsured, physician leaders said. In September, Surgery on Sunday marked its first anniversary of operating in a donated surgical center -- a model that might spawn other charity surgical clinics.

"These programs represent a paradigm shift in providing surgical care for the uninsured. By coordinating with the free clinic system, and integrating the critical hospital component, they've created a very viable solution," said Kathleen Casey, MD, director of Operation Giving Back, an American College of Surgeons program that is a resource for surgical volunteers.

Serving on Sunday

Lexington plastic surgeon Andy Moore II, MD, who founded Surgery on Sunday, is happy to be a trendsetter. For years he watched too many uninsured patients slip through the health care system without getting surgical care. He rounded up local doctors and got Birmingham, Ala-based outpatient services giant HealthSouth to donate a surgery center in Lexington for use one Sunday each month.

Catholic Health Initiatives contributed $145,000 in startup funds through a two-year grant, and HealthSouth provides surgical instruments and most of the supplies.

"We do anything we can do as an outpatient clinic," said Dr. Moore, whose Sunday surgeries have included reconstructive procedures for cancer patients. "Most people are in medicine to help other people, and this kind of rekindles your fire."

Patients are referred by area agencies and clinics, then meet at their volunteer surgeon's office before their operation. When the third Sunday arrives, surgeons, nurses, clerks and other volunteers gather in the early morning at the clinic. The group uses three operating rooms and one suite for colonoscopies and other procedures. A Baptist church group serves lunch.

One recent Sunday, Edward Cook had an operation on his right knee. He tore cartilage in the knee while doing concrete work on a construction job but had no insurance. "And I just don't have $2,000 sitting around in the bank," said Cook, of Bowling Green, Ky., a three-hour drive from the clinic.

A relative told him about the program, which agreed to take his case. On the day of his procedure, Cook arrived at 7 a.m., went into surgery at 8 and was done at 9:30 a.m. He was back to work two weeks later.

Without Surgery on Sunday, "I'd still be laid up, buddy," Cook said. "For people who don't have insurance, it's a great thing. I feel blessed."

About 300 volunteers, including 80 physicians, take part in the nonprofit program. Some physicians had liability concerns before signing on, but medical leaders said the doctors have medical liability protection under the Federal Tort Claims Act. Lexington gastroenterologist Jerry Yon, MD, is among the volunteers, and he does five to eight procedures on surgery Sunday, usually colonoscopies. "It's very satisfying just to be able to take care of a patient, give them the care that they need and not have to worry about the other stuff," such as insurance, he said.

Orthopedic surgeon Ron Burgess, MD, gives up time with his family on Sunday to spend a few hours on reconstructive surgery, nerve release procedures and removal of hand tumors.

"Obviously the [uninsured] problem is bigger than a bunch of surgeons and one surgery center, but it's a start," the Lexington surgeon said.

Surgery on Sunday has caught the attention of WellPoint-owned Anthem Blue Cross and Blue Shield in Kentucky. After reading a newspaper article about the effort, Anthem officials got interested in launching a similar program in Louisville, Ky.

Louisville medical leaders are scheduled to meet Oct. 6 to discuss the idea. Anthem would turn the program over to the medical community once it starts, said Michael Lorch, vice president of health services for Anthem in Kentucky.

Richard Lane, MD, Anthem's medical director in Kentucky, visited the Lexington clinic on a dreary, rainy Sunday in August and found an upbeat and uplifting atmosphere -- a climate he and others hope to duplicate to aid the uninsured.

"The doctors were happy to be there. One rode his motorcycle in the rain to get there," Dr. Lane said. "It just brings a smile to your face."