Part Four: Talking with Remote Area Medical Founder, Stan Brock

Welcome back for the fourth and final segment of my interview with Stan Brock, founder of Remote Area Medical. You recently testified before Congress, Stan. What did you tell them?

RAM founder, Stan Brock

The topic last week was about insurance, or the lack thereof, or the insufficiency thereof. And so all I could tell them, really, is that we see large numbers of people who have insurance so it's not just the unemployed or homeless, by any means. We get people who have jobs and they have insurance, something like 40% of them have got insurance but the insurance, either the co-pay is too high and they can't afford to drop $500 or $1000 which is the co-pay in many cases, or their insurance doesn't cover dentistry and vision. I think our figures show that less than 1% of the policies that the patients might hold cover dentistry or vision. Hence, the long lines of people who come for dental and vision care.

Here's a case. At the Centinela Hospital in Inglewood, California, about the 14th of August, one of our volunteers stubbed her finger with a needle while she was sterilizing instruments. We sent her along to the Emergency Room. The bill for that treatment was over $6,000! The bill for 2 cc of gamma globulin, given as a prophylactic, was over $4000. When we researched what the wholesale cost was, it turns out that we were billed 14 times the wholesale value of that 2 cc injection. That is absolutely outrageous. We've told the hospital so,and they said "Pay up."

It sounds like you could use some volunteer lawyers as well. What was the response when you and the others were testifying on Capitol Hill? Did you feel that members of Congress were listening to all of you?

I think so. The chairman of that particular committee, Rep. Stupak from Michigan, seemed to be very engaged, very concerned, as they all were about these horror stories from the patients. But they did seem to be engaged in this issue of doctors crossing state lines. Strangely enough, last Saturday, I was interviewed on C-SPAN at 9:00 in the morning, I think it was, on a program called Washington Journal. For the half hour, the entire subject was doctors crossing state lines. And when they opened up the telephone lines, the calls just cascaded in from people who thought it was outrageous that doctors are not allowed to cross state lines to provide free care. And I gave a talk just this afternoon to a group of prominent businessmen and they too were amazed. The general public doesn't realize that you may be a doctor in one state, but you aint a doctor in another state.

One of our volunteer airplane mechanics here, his license allows him to work on somebody's malfunctioning airplane anywhere in the United States. And, yet, a medical mechanic, so to speak, is not able to work on somebody's malfunctioning body in another state where they don't hold a license.

Well put.

A kidney is a kidney whether it's in California or Tennessee. And a tooth is a tooth whether its in Michigan or Florida. So let them fix it if it's free. Now, I'm not advocating that a doctor who may retire from his or her practice in Buffalo, New York, in the middle of the winter, and go down to Florida and start hanging out a shingle to supplement their retirement income. That's not what I'm talking about here. What I'm talking about is free, absolutely no cost to the patient and the doctor does not get paid. And that's a different horse altogether.

Yes, it is. You sound incredibly organized. What is the size of your support staff and where are your headquarters?

We're in a 37,000 square foot building that was built in 1927. It was an old elementary school that was closed because of being somewhat decrepit and we've occupied it now for 12 years. Before that, we moved from one place to another. The rent is $1 a year. It's tough in here, though. It's very cold in the winter and very hot in the summer. We can't afford to air condition or heat the place. We occupy another 16,000 square foot hangar at a nearby airfield for our donated airplanes, vintage World War II, and that's also $1 a year rent. The overhead for accommodations for our equipment is very, very low. The penalty is that it's very hard to get volunteers to come here and work because of the conditions. So we have a very small staff of five or six people who are on a very modest stipend doing essential things like record keeping and those mundane tasks, bookkeeping and so forth, that are essential. And then we have half a dozen volunteers that are here helping (and I am of course one of those volunteers) that are not paid anything at all. But we've had over 40,000 volunteers in the field, over 300 last weekend alone. When we go out on a mission, we round up a lot of people. But the people that are running the nuts and bolts of the organization on a daily basishere and we're sort of a 24/7 operation are very few and very dedicated. What would we do if they all up and left?

So, if I were your fairy godmother and could wave my magic wand and give you everything on your wish list, what would it look like?

Of course, setting aside the fact that what we need is legislation to allow our volunteers to cross state lines... That would make a huge difference. And protect them against frivolous lawsuits. Let's not forget that. The two questions that a volunteer asks if that hasn't worked here before are: "Is my license good where we're going?" Well, if you're coming to Tennessee, yes. If you're going anywhere else, (unless it's in your own state) no. The second question is always: "Am I protected against malpractice?" And the answer to that is also no. Even though there are federal rules that can make protection possible, they are so onerous.

It's not like we're just recruiting one or two people and you can go through a bunch of the paperwork and get them covered. When you're bringing in people by the hundreds, it's just not practical. So, they need to work that out, they need to protect these people against anything other than egregious malpractice. They need to protect them from frivolous lawsuits and let them cross state lines. That's without a doubt the absolute top of our wish list. Yeah, we'd like to have lots of money so we could buymore tractor trailer units to install more mobile eyeglass labs and carry more dental and vision equipment and that stuff is very expensive. Portable dental chairs are running over $1000 a piece and so there is a lot of expense involved and we have to sort of tackle it piecemeal because we don't have the Bill Gates type of funding.

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