Grand Forks' Valley Health clinic feels the impact of the slumping economy

• Valley Health

Valley Health
• Karen Ryba

Valley Health's Executive Director, Karen Ryba, fears the 37-year-old reproductive health clinic might have to close. Herald photo by John Stennes.

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For 24 years, since she was 18, Kris Nelson has relied on the nonprofit Valley Health clinic in Grand Forks for low-cost birth control, exams and other health care.

“This has been my place,” she said. “Any question, any problem, this is the place I come to for help.”

But Nelson’s clinic soon may be gone, victim of rapidly rising costs for contraceptives and other materials, static or declining government support and the inability of many low-income clients to pay even token fees.

“I would say right now that if conditions stay the same, we have maybe two months left,” said Karen Ryba, who took over as clinic director March 3.

Established in 1972, Valley Health provides confidential reproductive health services, including annual gynecological exams, contraceptives, diagnosis and treatment of such conditions as urinary tract infections, testing for sexually transmitted diseases, HIV screening, and counseling on infertility, family planning and pregnancy.

The clinic had been losing about $8,600 a month until Ryba implemented cuts earlier this year, including a 20 percent salary reduction for all employees, closing the clinic on Fridays, ending extended evening hours on Tuesdays and eliminating one nurse practitioner position.

“Our contraceptive costs have gone up 118 percent in six months,” she said. “There doesn’t seem to be any cap or control on that.”

While costs continue to climb, fee collections are down $1,200 a month, and federal Title X funding allocated through the state — less than a fifth of the annual budget — also is down, as are “donations” by clients whose low incomes exempt them from having to pay any fees. Half of the clinic’s 3,100 clients are at or below federal poverty levels.

“We can’t make them pay,” Ryba said of the lowest-income clients. But if the clinic closes, those people would pay higher fees for services elsewhere or go without.

The clinic charges $15 for a month’s supply of most commonly used contraceptives, which Ryba said pharmacies sell for two, three or even four times that amount.

As rumors have begun to circulate that the clinic is in financial trouble and could close, “I’ve had clients coming in to ask — pleading — that we stay open,” she said. “They say, ‘I can’t afford birth control without you.’ ”

Without the nonprofit clinic and its confidential services, the area could see increases in unwanted pregnancies and sexually transmitted diseases, she said. It likely would lead to more pressure on Altru and other health centers.

‘Filling a gap’

Don Shields, director of the Grand Forks Public Health Department, said that he has met with Valley Health’s board and offered to help with nursing services, 12 hours a month through the summer.

“They provide a very important service to the community, especially for people with little or no insurance,” Shields said. “They fill a gap that isn’t covered by other agencies, and I’m certainly supportive of their being able to continue. We’ll continue to talk with them about finding ways to collaborate.”

The economy in general and rising health care costs specifically are affecting many health agencies and programs. Kathi Di Nicola, a spokeswoman for Minneapolis-based Planned Parenthood of Minnesota, North Dakota and South Dakota, said the agency — which has clinics in Thief River Falls and Moorhead — remains financially sound. But “we are seeing an uptick in women coming in who are uninsured or who have lost jobs,” she said, and who worry about balancing reproductive health services with other expenses.

“We’re seeing more women who are in desperate financial straits or who are worried about losing their (insurance) benefits,” Di Nicola said.

Valley Health has a staff of eight now, working in conjunction with 11 employees at the separately funded WIC (Women, Infants and Children) program. The annual budget for both programs is about $950,000.

“Since I started, a lot of the staff has expressed interest in looking for work elsewhere,” she said. “They ask if they should be looking for a job, and I haven’t been able to tell them no.”

The cuts in staffing, hours and payroll have brought Valley Health’s monthly deficit down, but the clinic continues to lose money, adding to a debt now approaching $120,000. Also, the austerity plan “isn’t working very well,” Ryba said. “We’re down to a skeletal crew (and) we’re expecting more clients because of the economy.”

To make up the difference, she is writing grant proposals and talking with other health agencies, including the Grand Forks Public Health Department, about ways to share personnel and facilities. The clinic’s building, at 1551 28th Ave. S., is well suited for the work, Ryba said, but rent is $3,000 a month.

In any case, grant writing and coalition building “will take time,” she said, and the clinic needs help now.

“Bake sale, bike-a-thon — I’ll try anything,” she said. “Maybe some benefactor will drop out of the sky and give us $1 million. Maybe some physicians in town who will be affected if we close will find a way to help.”

‘No one like us’

Gail Halverson, a nurse practitioner who has been at the clinic seven years, said the crisis is taking a personal toll.

The stress “has affected my health,” she said. “And I worry about our patients. There’s no one else like us.”

But she and other staffers “aren’t jumping ship,” she said. “We’re hanging in here. We don’t want to go anyplace.”

Nelson, the 24-year client who depends on the clinic for birth control and annual exams, said she also turns to “my ladies” at Valley Health for guidance on other health matters.

“There’s an aura of hope, of happiness around here,” she said.

“I’m concerned about what might happen if they go — not so much for me, but what about the younger women? I think a lot of unwanted pregnancies are prevented by the work done here. Where would those people go?”

Reach Haga at (701) 780-1102; (800) 477-6572, ext. 102; or send e-mail to chaga@gfherald.com.

Tags: local news, gf and egf, valley health, reproductive health, health, health care, economy