Cross-over Clinic: Church and State

Josephine One copy
Cross-Over Clinic/The Richmond Street Center May 1986/Josephine Ensign

Health and Homelessness in Richmond, Virginia in the 1980s: The clinic I worked for at the Richmond Street CenterCross-Over Clinic*—was started by physician Cullen Rivers and his Presbyterian church friend, the Reverend Judson “Buddy” Childress. Buddy had been a life insurance salesman before going to seminary.  His ministry was to business and professional people, as he said: “linking the talents and resources of suburban Richmond to the needs of the inner city poor.” For two years before the Street Center clinic opened, Cullen and Buddy had run a Saturday health clinic out of a downtown Richmond storefront apostolic church.

Balding, with long sideburns as bookends around a serious, intelligent-looking face, Cullen was prone to wearing cardigans. He was practical and caring in a genuine way, one of those people with a quiet personal faith you wouldn’t mind having yourself, even if you were agnostic. Some people have a loud, yelling at you through a megaphone, obnoxious sort of faith. He wasn’t like that, and it was one of the things that attracted me to Cross-Over Clinic. That, and the fact that he and Buddy were trying to provide free basic health care for poor people. Cullen was my main medical back-up, available to me by phone for questions; he exuded an unflappable, competent demeanor, as well as respect for me as a nurse. Buddy convinced the local Sisters of Bon Secours to pay my salary. I was the first employee of Cross-Over Clinic and began my work at the Street Center in May 1986 (photo is of me on the first day of clinic).

Over the nearly four years that I worked at Cross-Over Clinic, I grew as a health care provider and as a person. I was the sole health care provider M-F at the clinic for the first three years, before a Health Care for the Homeless grant (with the Daily Planet as lead agency) allowed Cross-Over Clinic to hire Dan Januzzi as a full-time physician. Cullen and other volunteer physicians and dentists came in on Saturdays to provide care for the more complicated patients.

Nurse-run clinics were rather frowned upon in Virginia (and still are), and less than six months into beginning my work, the Virginia Health Regulatory Board opened an investigation of my ‘too independent’ practice. I’ve written about this experience in a previous blog post, “Not Just Culture” (11-19-11). And, as I’ve written before [see my recent “No Place Like Home(less)” in Pulse: Voices from the Heart of Medicine], even though I was never charged with anything, the stress of the 18-month long investigation into my practice contributed to the loss of my faith, job, family, and home: I spiraled into homelessness.

It didn’t help that when Buddy became the clinic director during my final months there, he admonished me not to refer women for abortions and to council patients with HIV to repent of their sins. When I refused, he put me on a mandatory leave-of-absence to be spent in ‘prayer and reflection to ask for a humble and teachable spirit.’ He also admonished me to return to church and to my husband from whom I was separated. The Cross-Over Clinic lost the Health Care for the Homeless grant funding due to issues of–shall we say–lack of appropriate separation of church and state. The Cross-Over Board also decided to focus its mission on the ‘working poor’ rather than on the homeless population. I did not part from Cross-Over Clinic on the best of terms.

Several years ago I decided to revisit Cross-Over Clinic to see what they’re up to and perhaps to try and heal old wounds. I was scheduled for an interview and site visit with Dan Januzzi, still the Medical Director of the clinic. Dan and I hadn’t parted well, but he was friendly and welcoming on the phone when I talked with him to schedule a visit. He is committed to what he calls poverty medicine, charity care medical practice focused on indigent patients.

I drove down Belvidere Street, past the corner where the Street Center had been, and across the James River. In amongst rundown Pentecostal churches, greasy car repair shops, and towing companies, sits Cross-Over Clinic. The building looks like it might have been a used-car dealership. Printed signs greet you when you enter: “We are sorry if you have to wait to see us. Thank you for your patience,” and, “Cross Over does not receive direct government funding. Our services are possible through funding by the community.”

The waiting room was small and cramped, with fifteen or so patients already seated. I checked in at the front desk and was told to have a seat. At first I was irritated, then amused, sitting there in the waiting room of a clinic where I had once worked–in a clinic that had changed my life so profoundly. A woman seated next to me started cussing loudly at no one in particular about the long wait times. After an hour of waiting I decided I had experienced enough; I left and have not returned.

From public records, I discovered that Cross-Over Clinic has an annual budget of $2.5 million, and receives an additional $2 million of in-kind donations: doctors, nurses, dentists and pharmacists volunteer for Saturday clinics—they call these “mission trips that you don’t have to leave the country for.” A local private hospital does $800,000 of clinic lab work per year free of charge and the hospital uses it as a tax write-off. VCU/MCV Medical Center (one of my alma maters) sends nursing, pharmacy, and medical students to assist with clinic. Cross-Over sees about the same number of patients per year as the Daily Planet clinic, although they include outreach screenings in churches by lay volunteers in their patient numbers.

Virginia has the second highest number of free clinics in the country. North Carolina has the most, and Georgia is close to Virginia’s number. Most free clinics, like Cross-Over, are faith-based, and since George W. Bush’s Faith-Based Initiative, are legally able to discriminate in provision of services and in hiring (and firing) practices. George W. extended his father’s campaign to blur the separation of church and state.

I find it ironic that the principle of the separation of church and state had its founding in the U.S. in 1786 less than a mile from the Richmond Street Center, at the Virginia General Assembly, when they voted in favor of Thomas Jefferson’s Virginia Statute for Religious Freedom. This statute was the forerunner of our country’s first amendment protections in religious freedom. Part of Jefferson’s statute stipulated that no person could be compelled to attend any church or to support it with taxation.

President Obama promised to reverse the erosion of basic civil rights (and the erosion of separation of church and state) from the Faith-Based Initiative, but so far, he has not done so. U.S. Congressman Bobby Scott from the 3rd District in Virginia, which includes Richmond, is trying to address this issue. He is the first African-American congressman from Virginia since Reconstruction, and he has an excellent ‘Faith-Based Initiative’ information page along with an explanation of how it allows discrimination based on race, gender (and, I would add–sexual orientation), as well as on religion.

While I don’t agree with how I was treated as an employee of Cross-Over Clinic, and neither do I agree with their principles of ‘poverty medicine,’ I know that many Richmonders view Cross-Over clinic as an essential part of their health care safety net. Which is probably true given the fact that Virginia has an extremely ‘hol(e)y’ health care safety net [see previous post: “Got Medicaid (Expansion) Virginia?” from 6-20-14).

* The clinic was called/spelled ‘Cross-Over Clinic’ when I worked for them. Since then, they have variously called themselves ‘Cross Over Clinic’ and ‘CrossOver Clinic.’

5 thoughts on “Cross-over Clinic: Church and State

  1. oh my…we have so far yet to go and in many ways not different from 1986. Free clinics correlated with lack of medicaid expansion and faith based clinics correlated with the same. This tale is beyond cautionary.

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  2. Not sure if you were aware Josephine but Cross Over is not a “Free Clinic”. They claim, “To increase patient revenue, we transitioned to asking for a set fee rather than asking patients if they would like to make a donation. ” If you notice in their annual reports for the past 4 years, 11% or more of their total revenue comes from Patient Donations. They’ve become quite the revenue generating practice.

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    1. Thanks for this update and that change is not surprising to me. That is a conversation/debate the leaders of the clinic had back in the 1980s soon after the clinic opened. My sense is that most all ‘free clinics’ are no longer free all across the country.

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      1. In Richmond, this is only exclusive to Cross Over. My issue is they “advertise” to the public on their website, donors, grant applications and other collateral material, “CrossOver Healthcare Ministry is Virginia’s largest free health care clinic” which is misleading and deceptive.

        Cross Over is “Free” but only to a small number of patients whose services are paid for 100% by another program/grant/fund such as the OB or HIV clients. They will waive the fee if a patient disputes the policy but the chances of this occurring is rare considering the fact the majority of their patient population are undocumented immigrants who would not want to risk deportation and the legal residents fear their services would be compromised or discontinued.

        Sheryl Garland, VP for Health Policy and Community Relations for the VCU Health System and who is also a Board Member at Cross Over, states the Virginia Coordinated Care Program (VCC) at VCU is VA’s largest safety net provider and in 2015 they had 17,000 people enrolled.

        I am not opposed to patients/clients being asked make a contribution IF they are able but the criteria for being eligible to receive services is that you must be 200% below the FPL. That is the true definition of poverty so I feel as though it should be left up to the discretion of the patient AND the provider should fully disclose their policies and requirements in advance to ALL parties impacted financially, especially those receiving services directly so they can make an informed decision.

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