http://www.azcentral.com/health/news/articles/0506STDs0506.html

County's STD clinic short on staffing

Kerry Fehr-Snyder The Arizona Republic May. 6, 2006 12:00 AM

The only public clinic in Maricopa County for treating sexually transmitted diseases is turning away hundreds of clients each month, citing a shortage of staff.

The backlog comes amid new state health data showing rising numbers of the most common venereal diseases: chlamydia and gonorrhea.

The county Department of Public Health's STD clinic, which treats everyone from laborers to students, doesn't have enough nurses to test and treat clients, increasing the risk of infections being spread to their sex partners.

In recent months, the clinic near 16th and Roosevelt streets has turned away clients an average 600 times a month, said Dr. Bob England, interim director of the health department since February. In April, people were turned away 680 times.

"It is a core responsibility to control communicable diseases when we have the tools to do so," England said. He has asked for $751,000 from the county to hire 14 more workers at the STD clinic.

Even if the positions are filled, the demand for services will likely outstrip the supply, England said.

The walk-in clinic is the Valley's main treatment and testing center for venereal disease. It charges $20 for a screen of four STD tests. That compares with $225 at Planned Parenthood, for example.

Even clients with health insurance seek out the clinic, not wanting their personal doctors or employers to know they may have an STD.

People seeking testing routinely line up at 6:30 a.m. in the parking lot. The clinic doesn't take appointments in advance. Instead, at about 7:15 a.m., a receptionist gives numbers to those waiting in line.

Typically, by 9 a.m., the clinic's 30 to 40 appointments for that day are gone. The number of appointments varies depending on the number of nurses available.

Usually, dozens of clients leave each day without getting tested or treated. The county counts these but doesn't record their names. Many likely return a day or two or weeks later, but others do not.

One resident, a married man from Phoenix who has a small daughter, waited with a friend in the clinic's parking lot Friday morning. He declined to give his name, saying he didn't want to his wife to know he was getting tested for chlamydia.

Standing with a friend, he said, "I swear I'll never fool around again."

The man said he has been trying to get tested for the past three weeks.

Because he often works out of town, he has been unable to return the day after being turned away. He said he had $100 in cash on him for an emergency room co-pay if he was turned away again. He wasn't. He has medical insurance but said he didn't want to disclose his condition to his doctor because the information could get back to his wife.

England said a variety of people visit the clinic concerned that they might have an STD.

"We have people come to our STD clinic in business suits," he said. "We have college students."

On Friday, clients ranged from young women to older married men, from laborers to professionals.

The backlog of clients has been driven by turnover and staffing shortages in the county's health department.

"We're having the same problems with shortages of nurses, nurse practitioners, physician assistants and other health care workers that other health care facilities are having," England said.

He said he became aware of the backlog when he arrived in January as the medical director. He became the department's interim director after its new director, Jacquelynn Meeks, was placed on administrative leave and later fired.

England said the county needs various short- and long-term strategies to address the problem.

Among the 14 clinic hires he is proposing are two nurses and six communicable-disease investigators, who would contact partners of those testing positive for an STD to advise them they also should be tested.

He also wants to persuade other medical providers, including community health centers, to accept referrals from the county STD clinic. The referred clients could have private insurance, state Medicaid coverage, or could possibly be reimbursed by the county.

In the long term, England said the county needs more STD clinics to treat its growing, spread-out population.

"We need to have multiple sites where people can be treated rather than one overcrowded downtown site," he said.

Health officials cited various reasons for the increase in venereal disease cases.

Over the past five years, the number of chlamydia cases in Arizona rose by 58 percent to nearly 22,000, according to the Arizona Department of Health Services. Gonorrhea cases rose by 16 percent to more than 5,200.

Chlamydia also has been rising nationally, but gonorrhea has fallen.

The increase is due in part to a step-up in screening, especially among women at correctional facilities and family-planning clinics, said David Engelthaler, state epidemiologist. Also, more cases are being identified in rural counties, where growth has picked up, and among ethnic minorities, whose quality of health care is lower.

England said infections may be increasing because of "the waning effect of the fear factor of HIV since the epidemic is so old and people have grown up with it."

In terms of treatment and testing, some people standing outside the STD clinic on Friday said more clinics are definitely needed.

"It's ridiculous. They need more than one clinic," said a college nursing student in her 20s who lives in Mesa and was trying to get an STD test before her 9 a.m. final exam.

After waiting more than an hour, she left without being seen, saying the wait was too long.

She said she has a new boyfriend and wanted to be sure she was free of an STD before having sex with him.

Reach the reporter at kerry.fehr-snyder@arizonarepublic.com or (602) 444-8975.