Walking into the Denny Murphy Clinic, one of four community health clinics run by the Community Health Association of Spokane (CHAS), one might feel a little apprehensive. Formerly a Saturn car dealership, the red brick building on the corner of Second Avenue and Monroe Street is surrounded by a locked iron gate. The employee entrance has a palm identifier for enhanced security, and there's bulletproof glass in front of the reception area. This is Spokane's brand-new community clinic, a godsend for anyone who needs medical attention -- insured or not. But despite the high security front, the inside of the clinic is bathed in warm hues. It's quiet, except for the small sounds of a child playing inside a nylon tent in the waiting area. Erase any image of a chaotic, loud and impersonal care you may assume you'd get at a community health clinic. The Denny Murphy Clinic is a brand-new, spacious facility that offers medical care and technology that even private health clinics don't have.
But it wasn't always like this. The CHAS downtown clinic used to be pathetic: two scrappy exam rooms in a storefront in the West Madison Apartments. People waited for hours, and equipment was hard to come by. But that was before Denny Murphy got involved.
"[CHAS was] maybe 13 or 14 months old, and Denny joined when we had no money. You know, the first barrier to [health] care is financial," says Peg Hopkins, executive director for CHAS, which was founded in late 1995.
Denny Murphy, a community activist, had a passion for healthcare. She was a board member for the Sisters of Providence, a board member for the Visiting Nurses Association and on the faculty of the Intercollegiate School for Nursing. When she joined forces with CHAS, things started to happen for the struggling organization.
"The first step was finding a spot for the downtown clinic," Hopkins explains, "and Denny was there every step of the way."
Hopkins says CHAS worked to secure funds through private grants as well as federal and state dollars for a better downtown clinic for the people of Spokane. The effort paid off -- literally.
"When we started, we had $50,000. This year's  operating budget is $13 million." The new clinic, which opened on Aug. 11, has 40 percent more space and 185 employees, all of whom make market wages -- meaning that the doctors, nurses and other staffers don't make any less for working at a community clinic than they normally do. That's good, because the work, if anything, is even more hectic.
"A year ago, our uninsured percentage was 25 percent and now it's 41 percent," says Hopkins. "Every year, [CHAS] will have about 100,000 encounters. Soon we will have about 2,000 people a month coming [into the Denny Murphy Clinic]."
At a community health clinic, clients aren't refused services because of an inability to pay. But Hopkins says that in spite of Medicare and Medicaid coverage, patients do pay, on average, about 40 percent of the cost of their care. This, along with state, federal and grant dollars, has helped CHAS develop into a four-clinic-strong community health organization in Spokane County.
"This clinic is state-of-the-art," says Hopkins, opening one of 15 exam rooms. Each room is equipped with a laptop extending from an "ergotron-arm," which allows the medical professional to access electronic medical records during the exam in real time.
"This is a huge achievement," says Hopkins, about the electronic medical records. "We're one of five [community] clinics in the whole country to have this, and even among private clinics you don't see it."
Electronic medical records take away the time and expense of paperwork, which most healthcare experts agree is a huge part of any clinic's budget. The laptops are an example of how community health clinics are often at the forefront of healthcare technology and efficiency. Out of necessity, these clinics find innovative and productive ways to provide quality healthcare at less cost.
"We can't cost-shift -- every decision has to do with business and efficiency," says Hopkins. "We can't afford to waste any money." Hopkins also says this often means community health clinics provide better care. "We know the quality of care we provide here. We do an expanded scope of services because we have to. There are barriers for the uninsured in the specialty [fields]. People who can't pay [for specialty services] won't be at the front of the list."
In addition to the 15 exam rooms, the Denny Murphy clinic boasts a lab for some blood work and 12 dental operating rooms with televisions built into the ceilings over the dental chairs.
"Sixty to 70 percent of our dental patients are children," Hopkins says, making sure to point out that the clinic didn't include television sets as an indulgence. "For children, TV really is an anesthetic."
Beginning Dec. 1, the electronic medical records system will be expanded so that dentists can also access their patients' records, including X-rays, from a laptop located near the dental chair.
The clinic offers full prenatal care and is working hard to absorb the behavioral health needs, which, Hopkins says, are common.
"The Denny Murphy Clinic is a flagship for depression: 435 registered patients suffer from clinical depression. We have two psychiatric nurse practitioners, one psychologist, one psychiatrist, and two MSWs," Hopkins rattles off, listing them with her fingers. But then she holds up her hands. "The need is just so much greater than the services."
Another innovation in use at the clinic could revolutionize the way we all get our pharmaceuticals. Today, most of us walk into a busy drugstore, stand for 20 minutes at a pharmacy counter, and then have to explain the details of sometimes embarrassing ailments to pharmacists -- in a voice loud enough to hear over the eye-level partition, but quiet enough so the shopper behind you can't hear. If you get care at the Denny Murphy Clinic, or any of the other four CHAS community health centers, you won't have to endure that scenario. The days of the public pharmacy are nearing an end: CHAS patients get their medicine out of a vending machine. Well, almost.
"All our pharmaceuticals we buy bulk and then they get repackaged in generic containers," says Tracy Warren, a pharmacy aid working at the Denny Murphy Clinic. The medications are stored in a "vending machine," of sorts, manned by someone like Warren. When a patient is prescribed medicine, Warren selects the correct medicine in the proper dosage -- ready and waiting from the machine -- and takes the patient into a private room for a real-time tele-conference with a pharmacist at CHAS's Spokane Valley Clinic. The prescription is transferred to the pharmacist electronically. Through the computer, pharmacists can see patients, and vice versa. Patients can then ask questions about when and how to take medications.
"The use for this in rural sites is huge," notes Hopkins, who says small, rural communities often don't have pharmacists, and people have to travel long distances to get their medicine. With the tele-pharmacy program, medicine can be dispensed under the watchful eye of a pharmacist without the patient leaving his or her local clinic.
"It's better for the patient," says Warren, as she demonstrates the tele-conference system by calling the Valley pharmacy over the computer. "They are talking to a camera, not face to face, so they might ask questions they wouldn't normally ask."
In addition to the four tele-pharmacy programs CHAS operates out of their clinics, there is one at the Native Health Clinic on Foothills Drive. Hopkins says it's a great system. Soon many people will be using it.
"We have people come through once a week getting tours [of the tele-pharmacy program," she says. Though the vending machines can't possibly stock every kind of medication in all doses, Warren says they do a good job of anticipating common meds, depending on their patients, the season and studies of prescriptions.
"I worked in a pharmacy for 11 years, and now I work here, and I'd never go back," says Warren. "There is more care because we are here in the clinic. In retail, you don't get the whole picture."
Hopkins shifts much of the praise for all the clinic's advancements to Denny Murphy, who passed away from breast cancer in 2001. There is an enormous portrait of the community leader hung behind the reception desk. But on a tour through the well-kept clinic, watching Hopkins nod to employees, wondering aloud about a misplaced file cabinet and checking thoroughly over each hallway as she breezes through, it's easy for visitors to see who the mother of the clinic really is.
"How could you not believe in a mission like this?" Hopkins asks. "There's hope here, and that's half of getting better."
The Community Health Association of Spokane has four area clinics, two of which offer dental care. To find out more about the medical service, receive care or donate, please visit: The Denny Murphy Clinic at 1001 W. Second Ave. (835-1203); the Valley Medical Clinic, 9227 E. Main Ave. (444-8200); the Northeast Medical Clinic, 4001 N. Cook St. (487-1604); or the Maple Street Medical Clinic, 3919 N. Maple St. (444-7801).