End of an era in Haight-Ashbury: Original free clinic closes its doors

San Francisco Chronicle, August 3, 2019

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San Francisco, CA -- Dr. David E. Smith remembers the day he opened the Haight Ashbury Free Clinic during the Summer of Love in 1967.

"It was not one word of advertising, and it was like 300 people showed up," said Smith, then a young physician running the alcohol and drug abuse screening unit at San Francisco General Hospital. He created the small, second-story medical clinic at 558 Clayton St. to fill a need he saw being ignored by city health officials: free, nonjudgmental, 24-hour medical treatment for drug use and addiction. In its first days, Smith said, "my kitchen table was the exam table."

"A lot of it was talking about a bad acid trip and dealing with the medical problems," he said, recalling the clinic's early patients. "Kids were flocking to the Haight thinking it was sunny and got pneumonia, got sexually transmitted diseases, cut their feet dancing. ... We were known as the hippie clinic. That's what they called us."

Now, after years of losing money, the site of the original clinic, which became a model for free health care and substance use treatment nationally, has closed its doors. Its July closure marks an end, at least temporarily, to a 52-year run that began at the height of the city's counterculture movement but grew financially unfeasible as the neighborhood and the economics of operating a medical clinic changed.

Medical services will continue to be provided at the clinic's second, larger and newer location near Mission Street and South Van Ness Avenue, which offers primary care, dental care, addiction treatment and assistance finding housing and employment. Administrators say they hope the Haight clinic will reopen as early as year's end, potentially staffed by volunteer medical, nursing and dental students.

For now, the site will retain its lease and medical license, said Lauren Kahn, managing director of policy and communications of HealthRight360, the umbrella organization of statewide health clinics and social services providers that includes the Haight Ashbury Free Clinic. It will continue to provide the space free of charge to the nonprofit Homeless Youth Alliance three times a week for needle exchange and other services, she said.

At its height, the clinic served about 2,000 patients each year, but that has since dwindled to 1,000.

Years of providing free medical care for patients, many of whom did not have insurance and could not pay for services, took its toll on the clinic's finances. And while the Affordable Care Act greatly expanded the number of people who qualify for Medicaid health insurance for the poor - the clinic's primary patient population and source of revenue - the clinic has struggled to hire and retain doctors, nurses and other staff to keep up with the demand. The clinic has seen a 20% staff turnover rate the past couple of years, said HealthRight360 CEO Vitka Eisen.

"It's very difficult for community health centers like Haight Ashbury Free Clinic and HealthRight360 to compete with Kaiser and UC and the VA and the Department of Public Health," Eisen said. "It's difficult for us to compete on salary and benefits, try as we might. The clinic loses money, and it's hard to keep increasing salaries because you have to get the patients back to be seen in order to cover the cost."

HealthRight360's four primary care clinics in San Francisco - Haight Ashbury Free Clinic's two sites, Tenderloin Health Services and Lyon-Martin Health Services - have been incurring collective losses of more than $1 million annually since 2017, Eisen said. The Tenderloin clinic is also scheduled to be closed in October and relocate to the Mission District center. Closing both the Haight and Tenderloin clinics is expected to halt the losses, Kahn said.

The Tenderloin location needs to treat 4,000 patients a year to stay open, but sees only about 1,500. In recent years, patients have been lost to other health clinics that opened in the area because of high demand for care.

Sabra Matovsky of the SF Community Clinic Consortium, which includes 11 community health centers including HealthRight360, said many of its members are similarly struggling to recruit and retain medical professionals, in part because the Bay Area has higher-paying jobs in the field at nearby universities.

"We haven't had one that's closed, but we do have ones that are definitely experiencing challenges on multiple fronts," she said. "A couple have had chief medical officer positions vacant, and it's been hard to recruit."

Haight Ashbury Free Clinic has struggled financially before. In 2008, the clinic's former chief financial officer, Carl Gill, was sentenced to seven years in state prison for defrauding the organization out of $773,000. In 2011, after seeing funding from the city drop by half over the previous three years, the clinic merged with the larger Walden House, a San Francisco substance abuse program, to stay afloat. The newly combined organization became known as HealthRight360, which runs clinics and recovery services across California.

The historic Haight-Ashbury site also had quirks that were tolerable in the past but began posing challenges more recently. The clinic is small and up a flight of stairs in a building with no working elevator, making it hard for older patients and people with disabilities to access. And the neighborhood has gentrified.

"You have a lot of people living in the neighborhood who don't really need a free clinic anymore," said Steve Heilig, associate executive director of public health and education at the San Francisco Marin Medical Society, who has worked closely with Smith for decades co-editing medical journals on addiction medicine and other public health issues. "Some people say if you can afford the rent, you don't need this anymore."

Next month, HealthRight360 plans to open a new mobile medical clinic in a small bus to provide some of the lost medical services in the Haight. It will also stop at medically underserved parts of the city, Eisen said.

The shuttering of the Haight-Ashbury site marks the end of an era. But its impact on the medical community lives on, Heilig said.

"It spurred a movement of free clinics around the country," he said. "The other thing that came out of it was the mainstreaming of addiction medicine as a specialty. That was really frowned upon and even illegal in the 1960s when they started this. Smith said at the time he was committing multiple felonies a day by treating them and not turning them into the cops. Within that came a movement within the medical profession to develop scientifically based treatment for addiction of all kinds, and that is still going. That can be traced back to the clinic."

In 52 years, Smith said, he saw it all: "Bad LSD trips and speed freaks and heroin overdoses. ... It was so wild, you couldn't figure out what was weird. Everything was weird."

He more than once dispatched a team to treat rock star Janis Joplin, who had overdosed on heroin. Another time, Charles Manson and some of his followers came by the clinic, two years before their infamous murder spree.

"Of course, no one knew at the time what was going to happen," Smith said. "They were just another weird character in this counterculture stream."

Smith, who teaches at UCSF Medical School, retired as the clinic's medical director eight years ago but remains involved informally, bringing his students there each quarter.

"I put 52 years of my life into the place, so it's sad," he said. "As my son said, 'Dad, you haven't changed. The city's changed.' I have to adapt to it and keep the free clinic spirit open."

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