New Orleans Clinic Battles to Keep City's Arts Healthy

(July 19) -- He's performed in New Orleans since college -- everything from AC/DC covers to '70s disco jams. But Paul Pattan, 45, can't believe he's still picking up his guitar and getting behind the mic.

Reflecting on the 2004 motorcycle accident that left him with a fused spine and amputated foot, and the trauma of losing his possessions in Hurricane Katrina only a year later, Pattan swears he's lucky to be getting out of bed.

"Some days I'm convinced I could be 80 years old," he tells AOL News. "I have phantom pains that feel like somebody's sawin' my leg off."

Pattan credits his health -- and, by extension, his ability to stay active in the arts community -- to the New Orleans Musicians' Clinic (NOMC). Since 1998, the clinic has been a bastion of comprehensive medical care for some 2,000 of the bohemian mecca's many artists and performers.

"I would not be getting out there, bringing New Orleans back one note at a time, without their care," says Pattan, who was denied health insurance after his foot amputation. "They are there for me, 100 percent, when nobody else is willing to be."

But NOMC, along with 25 other nonprofit health clinics and organizations in Louisiana that treat the uninsured and working poor, faces an uncertain future after Sept. 30. That's when the federal Primary Care Access and Stabilization Grant, a three-year allotment distributed to bolster medical care after Hurricane Katrina, runs dry.

And despite the best fundraising efforts of NOMC founder Bethany Bultman and her loyal legion of volunteers -- many of them patients -- the clinic is being forced to cut back at a time when it's needed more than ever.

Making Sure the Show Will Go On

The New Orleans Musicians' Clinic is a health care hub like no other.

In a city saturated with centuries of music, dance and celebration, thousands of New Orleanians eke out a living in the arts. But that often means paying their own health insurance -- which many can't afford -- and covering out-of-pocket fees with their savings -- which many don't have.

That's where NOMC comes in. Founded in 1998 by Bultman, a former journalist, and her husband, Johann, the clinic has always had a one-of-a-kind mission statement. Twelve years later, Bultman says, it's still the only facility in the country that caters specifically to artists, most of them musicians, and offers comprehensive care, both traditional and alternative.

"Sometimes, the answer is going to be Feldenkrais or acupuncture," she tells AOL News. "Or it'll be an MRI and physical therapy.

"Whatever gets them back onstage, back earning their keep, is what we're going to do."

And the clinic does a lot of it, five days a week.

At 8:30 a.m, the clinic's on-staff social worker, nurse practitioner and medical assistant open up their small outpost on the eighth floor of a hulking medical compound, in a space donated by the Louisiana State University Health Care Network.

First, they check voice mails and e-mails from patients traveling on tour. Using electronic health records, staffers are able to help keep musicians on the road by offering referrals or prescriptions from a distance.

Then they settle in for a 10-hour day, one filled with scores of patients whose ailments and needs range from soft-tissue damage and the flu to mammograms and massage therapy.

Every patient who comes in spends anywhere from 15 to 45 minutes with Catherine Lasperches, the nurse practitioner. If need be, they can also sit down with the clinic's social worker.

All for a $10 co-pay and services billed on a sliding scale depending on income.

These days, incomes among NOMC patients are more meager than ever. More than three-quarters have been working musicians in New Orleans for more than a decade. But since Katrina, there have been far fewer gigs to go around, and some 80 percent of the city's musicians now survive on less than $15,000 a year.

And for artists whose work is physically rigorous, like dancers, pricey medical treatments can become necessities. In 2007, Pattan's girlfriend, dancer and choreographer El Tahra, needed a $1,500 MRI after a dancing stunt gone awry.

"No way did I have insurance," she says of the accident, which could have left her in a wheelchair. "I couldn't even go to the emergency room for tests."

So, as it often does for horn players with broken teeth or guitarists with carpal tunnel, NOMC arranged for a low-cost procedure. The clinic pays for testing and surgeries, and coordinates "yellow cards" for patients to obtain free care at public hospitals.

After Katrina, a New Fight for Mental Health

Bultman has been overseeing NOMC on a volunteer basis for more than a decade, but in the past five years the job has taken over her life. It's not uncommon for her to spend 80 hours a week coordinating clinic appointments, applying for grants and responding to e-mails.

"I keep thinking the government will recognize the importance of what we're offering and step in and take over," she says. "But they don't -- so I just keep working."

And since Hurricane Katrina, her work, and that of the clinic staff, has taken on a renewed urgency.

"People here are truly on the edge," Bultman says, citing post-traumatic stress, substance abuse and family violence as worrisome trends among patients and their kin.

In fact, depression is one of the three most common conditions the clinic staffers treat these days, along with diabetes and hypertension.

That's hardly surprising: A 2007 study by Dr. Lisa Mills, an emergency room director at Louisiana State University at New Orleans, concluded that post-traumatic stress disorder (PTSD) was afflicting 38 percent of her hospital's ER patients. That's "around the same as among Vietnam War vets," Mills tells AOL News.

For musicians, the stress that followed Katrina was exacerbated by a drastic change in lifestyle. Many who once eked out a relatively secure existence apart from the mainstream -- living in an aunt's basement, sharing a group car, eating church suppers -- could no longer make ends meet.

"The creative process already lends itself to emotional challenges," Bultman says. "They pour their soul out every time they walk onstage."

To push sometimes-wary patients to seek help for mental-health issues, NOMC staff opt for unconventional approaches, often appealing to local culture. A drumming circle will draw patients in, but the psychiatrist leading it will elicit a discussion of underlying emotional issues.

"That's where people open up, get to talking, really start to acknowledge and admit what's going on," Bultman says.

With 82 percent of NOMC patients relying entirely on the clinic for medical treatment, Bultman fears looming cutbacks -- the clinic needs a bare minimum of $500,000 by December to stay open -- will leave most without mental and physical health care.

"We want to be there for the long haul, a resource they can trust, they can talk to," she says. "We're trying our best to be comprehensive -- but we can only do so much if the money's not there."

A 'Perfect Storm' of Problems

Given Hurricane Katrina's lingering aftermath, the gulf oil spill, the end of a major federal health care grant and a community warily waiting out hurricane season, it's not a good time for anyone to be sick in New Orleans.

"There's a lot of fear that these services won't continue, and the oil spill has absolutely been an added strain," Maria Ludwick at the Louisiana Public Health Institute, which partnered with the state to distribute the federal grant, tells AOL News. "We've got clinics at the epicenter of the spill -- for them, coping with this is an unexpected, added cost."

If patients didn't have NOMC and other nonprofit clinics to turn to, it's true they could wait in line at a regular hospital (and bear the brunt of the costs). But Bultman says it's unlikely most would even walk through the doors.

"What we see is that they simply do not go," she says. "Until someone cannot perform -- until they lose their voice -- they will not come in about the blood that's been in their urine for three months."

At NOMC, Bultman says, staffers mitigate that problem among patients by "forcing the issue" and following up as much as possible. For Pattan, that means routine appointments to check on his medication dosages and prosthetic device, along with phone calls that operate like clockwork.

"I'm supposed to go in every week," he says. "But I probably go every two weeks. I'm bad. I'm really bad, but they keep me on track as best they can."

Since August, however, NOMC has been able to offer less and less to its patients. An initial cut to NOMC's federal grant money meant slashing $200,000 from mental-health services, eliminating private lab work and trimming clinic hours.

With bills that average $150,000 a month, Bultman's not sure what will be cut come September, when the Primary Care Access and Stabilization Grant runs out. And she knows that with oil spilling into the Gulf of Mexico and storms threatening to ravage Louisiana this summer, government money is stretched thinner than ever.

"What does this mean for us getting a share?" she asks. "I don't know. I don't know if I want to know."

Waiting for Help, Hoping for the Future

Right now, NOMC and two dozen other Louisiana grantees are waiting to find out if the federal government will hand over more funding. While Bultman has tried to apply for other grants, NOMC isn't eligible for most programs if it's still getting a boost from Washington.

"We've been told by three foundations who still have some Katrina-related funding that they won't consider an application from us until we have a letter from the U.S Oversight Committee stating that no federal funds will be forthcoming," she says. "So we're in limbo."

At the Louisiana Public Health Institute, Ludwick and other officials are working with the state on an application to transfer some of Louisiana's Medicaid funds to the clinics, "as a bridge" toward the health reform that will expand Medicaid coverage by 2014.

To be considered for approval, and get the money in time, they need to submit the application in mere weeks. "We'll get it done," Ludwick says of the mad dash. "Because we don't have another choice."

Yet despite the funding issues that threaten to cripple their clinic, patients at NOMC still have one ace up their sleeve: music. They've organized benefit performances, like "A Creole Jazz Tea," and sell a CD, "Get You a Healin'," in a grassroots effort to ease the clinic's budget crunch.

NOMC's bottom line has always been patient health. But Bultman, and NOMC's patients, now recognize its pivotal role in the effort to revitalize the soul of a city that's suffered a devastating five years.

"We can't bring music here back to life 100 percent, but we can keep the heart beating," Bultman says. "It'll still be a big pot of gumbo. Might taste a little different than it did, but this city is gonna keep simmering."