Medical assistant Claire Rase disenfects some lab equipment. For an uncertain length of time, Lyon Martin is still seeing patients.

“Well,” says Dawn Harbatkin, medical director of Lyon Martin Health Services, “we’re a community clinic. I’ve never known a community clinic that didn’t operate on the edge. Health care for adults isn’t sexy. It’s not like puppies. People give to puppies.”

Still, when Lyon-Martin’s board decided this weekend to shut down the clinic entirely, the news that Lyon-Martin had slipped over that edge came as a shock even to those associated with it. Like Harbatkin.

“It came as a complete surprise,” says Harbatkin, with an air of almost preternatural calm. “Most clinics, when they close, take two or three months to do so.” She sighs. “We can’t afford that. But we also can’t afford to close in two or three days.”

Lyon-Martin began in the ’70s as a research project by a UCSF student who noticed that lesbians were coming into the emergency room with dire health problems that were clearly caused by lack of access to primary care. She realized that many were avoiding doctors entirely.

The clinic was a way of figuring out what lesbians’ health issues actually were — what were their STD risks? What were their odds of having an abnormal pap smear? The medical files were in the basement of her apartment. The phone was in the living room. Office hours were held in the homes of volunteers.

In 1979, it was founded as a clinic and named after the lesbian activists Phyllis Lyon and Del Martin.

And then, says Harbatkin, “we added one marginalized population after another.” Today the clinic’s patients are about 50 percent queer and transgendered people, and 50 percent low-income women. Some 17 percent are homeless.

Like many of the Bay Area’s community clinics, Lyon-Martin has been struggling with the effects of the recession: more patients, less money from donors, less money from patients and this summer’s devastating freeze on MediCal payments.

Added to that was an attempt to integrate mental and physical care — a psychiatrist, two social workers and two assistants were hired to help with situations like patients who confessed to being beaten by their partner, or who couldn’t manage to stay on a diet that would keep their diabetes under control. The program was a success in every way except financially, Harbatkin says.

And then there was the billing. In late summer, Lyon-Martin realized that it had spiraled out of the control of the one-person billing department. The situation was so dire that the San Francisco Community Clinic consortium temporarily gifted them a consultant who took complete control of back-billing. The consultant managed to get the outstanding bills down to about $100,000.

When asked if the person formerly in charge of the billing felt bad about the situation that had developed, Harbatkin replied, “I don’t know. She doesn’t work for us any more.”

Lyon-Martin laid off staff. Management took a pay cut. They negotiated for lower rent and cut back on lab and medical supplies.

Then, this weekend, Lyon-Martin’s board took a look at the clinic’s finances and decided that, despite these measures, there was no comeback in sight.

“We have a volunteer board” says Harbatkin. “They have good hearts, but they don’t have the skills to run a clinic. They are working on rescinding their decision.”

There are signs that things might be turning around. When Harbatkin came in this morning, she found that the clinic’s PayPal donation page had completely shut down. In it was $9,000 that hadn’t been there earlier — money that had collected before the volume of donations overwhelmed the system. Things are changing with the board, as well. “We had a meeting last night,” says Harbatkin. “The lack of communication between us and the board has stopped. The board is a good-hearted group that just didn’t have the right information.”

Still, it’s a tough road ahead. “We need to raise $500,000 — $250,000 in the next few weeks. We’re trying to set up a meeting with the city. A board member rustled up $55,000 from friends and family. There’s an event at El Rio this weekend.” She pauses. “I would love it if the thing that saves us was 100,000 people each giving $5. It’s going to be some of that, but realistically, it’s going to be mostly a handful of people giving us $50,000 or $100,000.”

Since the announcement yesterday, Lyon-Martin has proceeded on parallel tracks — trying to save the clinic on one hand, and preparing for its closure on the other. Primarily this has involved trying to transition its patients to other clinics. “It’s hard to think of where they’ll go,” says Harbatkin. “Everyone is so strapped. Like BAART [Community Healthcare] — they’re expanding primary care. But their primary population is heroin-addicted men. How many of our female patients are going to feel comfortable there?”

Meanwhile, in the lab, medical assistant Claire Rase pulls on a plastic smock, blue plastic dish gloves and a face mask, and sets to washing a sink full of unpleasantly pointy-looking examination equipment. “We’re hoping,” Rase says. “There are definitely a lot of patients that I’ve seen who have avoided seeking health care until they came here. If you’re a trans guy, walking into a clinic with a beard and saying, ‘I’m here for my pelvic exam’ — you’d like to think differently, but not many people are ready for that.”

For now, says Rouse, the only option is to keep on believing. “We just sent out a tuberculosis test today whose results won’t come through until Friday. We’re waiting.”


Those interested in answering Lyon-Martin’s appeal for emergency funding can take one of the following steps:

– Donate online.

– Send a donation via check to 1748 Market Street, Suite 201, San Francisco, CA 94102.

– Make a donation over the phone by calling 415-901-7131.

– Attend Lyon-Martin’s fundraising event this Sunday, January 30, from 7 to 10 p.m. at El Rio (3158 Mission at Precita).

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Heather Smith covers a beat that spans health, food, and the environment, as well as shootings, stabbings, various small fires, and shouting matches at public meetings. She is a 2007 Middlebury Fellow in Environmental Journalism and a contributor to the book Infinite City.

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    1. Kate – It’s very true that bookkeeping and volunteers usually don’t mix well. In this case, the bookkeeper was a paid employee that just couldn’t keep on top of the billing process.

  1. wait, so who was giving the board wrong info? Read that public health said the executive director had not provided proper financial oversight. Should a volunteer board be held accountable for the malfeasance of the clinic’s management? Seems Harbatkin is trying to distance herself from her fair share of blame.