Rift at longtime St. Paul clinic leads to new home for residency program

On a recent Friday morning, United Family Medicine nurses and technicians in a strip mall storefront rolled up patients' sleeves to administer COVID-19 vaccines.

Gone were the clinic's physicians, who were working at a new facility 4 miles away. To the patients getting shots — many of whom are low-income or uninsured — the drama embroiling their clinic mattered less than the protection they received from people they like.

"Yeah, I love it. I mean it's been great for the services that I have had from the time that I started," said Teretha Glass, 72, drawn to the clinic years ago for its affordable sliding fee. "I thought I missed the chance [for a shot]. But they called me right back and said they could get me in today. I'm staying."

The divorce between UFM and the doctors who once provided its care has led to hurt feelings, divided loyalties and more than a little vitriol. But there may be a winner amid all the angst — the community itself.

Last month, Allina Health launched its United Family Physicians Clinic in St. Paul's West Seventh neighborhood. The new clinic features former UFM doctors and its longtime residency program. The split has given area residents a choice: stay among 15,000 patients at United Family Medicine or follow their doctors to the Allina clinic.

Ann Nyakundi, the new CEO of United Family Medicine, said the split may benefit patients.

"Competition is good," she said, noting that since the physicians and residents from Allina left, UFM has been able to hire its own staff of doctors and expand care. "Allina getting upset and walking away actually helped us."

That sentiment isn't shared by dozens of longtime UFM patients.

John Yust, a longtime UFM patient and architect who has lived in the neighborhood since 1974, said he can't understand why a clinic that worked so well for so many for so long "has fallen apart."

"We really did have the most amazing clinic," he said. "[Nyakundi] has basically destroyed the soul of that clinic. And I have no idea why."

United Family Medicine got its start in 1972 as the Helping Hand Health Center, a collaboration between a handful of doctors, the former St. Luke's Hospital and the West Seventh community during the "free clinic" movement of the time. It was geared to provide health care for people who didn't always have the means to pay for it.

In 1993, the clinic became home to a residency program that has helped train 150 family physicians. It became a federally qualified health center in 2012, now receiving more than 10% of its funding from the federal government.

A federal audit in 2018 flagged several issues, Nyakundi said, namely that for an independent clinic United Family Medicine was "over-reliant" on Allina. It leased all of its doctors from Allina and shared its phone system, laboratories and medical record-keeping. An Allina doctor was the clinic's medical director. Allina doctors sat on its board.

Nyakundi, who became interim CEO in October 2019 and got the job permanently a year later, said she was directed by the clinic's board to become independent of Allina while increasing patient access to high-level care. Despite the 21 residents and the 14 doctors who worked there, each doctor's time in the clinic was limited to 16 hours per week.

She said her intent was to replace most of the Allina doctors with clinic hires, while keeping the residency program.

That plan didn't mesh with Allina's needs, said Dr. Stephanie Rosener, director of the Family Medicine Residency Program. The proposed changes would have kept just three of the 14 doctors at the clinic, not enough to adequately work with residents, she said.

Said Dr. Gerald Montie, a longtime physician in the program: "It did not support the kind of work we've always done."

Rumblings of trouble started last spring. In the fall, Allina notified the clinic that it was terminating the relationship, and later announcing plans to start its own clinic. In October, United Family Medicine told its patients their doctors were leaving.

Allina Health opened United Family Physicians Clinic at 233 Grand Av., next to United and Children's hospitals, in January.

"With the opening of this new clinic, we are deepening our commitment to serve the health care needs of the community," Sara Criger, senior vice president of Allina Health operations and president of United Hospital, said in a statement.

The new clinic will work with uninsured and underinsured patients and plans to develop a sliding fee scale.

Breaking with United Family Medicine, a clinic it helped to grow and flourish, has been painful, Montie said. The community and Allina helped raise nearly $15 million to move into a new facility in 2009.

"We did not leave this building or this practice happily," he said. "It was a huge loss to people to have to move on."

Feelings remain raw.

Lawn signs dotted the neighborhood, asking "Where's My Doctor?" In a November letter, state Sen. Sandy Pappas, DFL-St. Paul, and St. Paul City Council Member Rebecca Noecker urged the clinic to stop the split, saying the planned "forced departure of UFM's physicians and medical residents is a devastating prospect for patients and the entire community."

More than 300 patients and community members signed a petition declaring "no confidence" in Nyakundi and UFM's board.

Stories circulated for months about doctors being shut out of their e-mail accounts and clinic leaders taking over residents' space. The neighborhood newspaper, the Community Reporter, cited patient complaints about losing access to their doctors.

Kerri Allen, a theologian and longtime UFM patient, talked of her frustration just trying to get a prescription refilled and of numerous unreturned e-mails and voice mails over several months last spring. She said clinic officials kept trying to have her talk to a physicians assistant instead of her doctor.

"This idea that they're making things better? The whole thing is odd to me," said Allen, who said she filed a complaint with the Minnesota Attorney General's Office.

Dave Thune, an area resident and former St. Paul City Council member, likened the level of care to going to a Minute Clinic.

"They've totally scaled back to a level you can get at your local pharmacy," he said.

Nyakundi acknowledges leaning on physicians assistants during the clinic's restructuring. But it is now fully staffed, she said, with the equivalent of five full-time physicians and many other advanced practitioners. Patient access to care is better than ever, she said. As proof, she touted results of a recent site visit showing full compliance with federal guidelines.

As dozens of patients received vaccines that morning earlier this month — more than 1,200 got shots over two recent weeks — few were inclined to follow their former doctors to the new clinic.

"You know, it's hard because I've had my doctor for years — and I actually saw her on her last day," said one patient, Yvonne Brazelton. "But I love the clinic. It's warm … and I understand that my doctor's nurse is staying there. So I'm going to stick with it."

James Walsh • 612-673-7428