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That a dying man would be so thankful for treatment that was simply humane disturbs Rottnek -- but not as much as how in the midst of a system designed to help the poor, dramatic shades of life and death could still get so easily lost in a bureaucratic gray.
"If he hadn't come to the clinic that evening, he would have died at Harbor Light, probably very much alone and in a great deal of pain," says Rottnek.
He shakes his head and adds this pensive lament: "It just shouldn't be that hard."
But as he learned in the six months before he closed the clinic, hard that shouldn't be can always get harder.
With his long hair and preference for blue jeans and boots instead of lab coats or scrubs, Rottnek looks like a cleaned-up version of his patients. Most of those he sees have a healthy distrust of doctors.
But they know this doc is different. After an examination and a couple of kind pats on the back, they know the reason why. They may forget his name, but they always remember the "nice doc with the ponytail."
For the 37-year-old physician, providing health care to the poor is a spiritual mission etched into the core of who he is.
"I think health care is a basic human right," he says. "I think it is something people are entitled to because they are people. I am not someone who always wanted to be a doctor. I don't necessarily love medicine. I just love what I can do with medicine."
Rottnek manages to do a lot with very limited funds. Armed with a black duffel bag stuffed with medical instruments, bandages and athlete's-foot cream purchased from the local Kmart and a milk crate filled with medications snagged from pharmaceutical reps, Rottnek can see 50 patients on a given night at the shelter.
Two or three medical student volunteers help him tote the load. Rottnek calls his work "seat-of-the-pants health care."
"The key is to provide quality health care with a minimum number of roadblocks," he says.
And for four years, through fits and starts, he and his volunteers did just that, until March of last year. That's when Rottnek ran into roadblocks of a different kind -- barriers of paper and politics as solid as stone.
The first hard hit came in a letter from Villie Appoo, associate executive director of Grace Hill Neighborhood Health Centers Inc., informing him that their pharmacy would no longer fill his prescriptions -- something they had done readily in the past.
Rottnek was shocked. He shouldn't have been.
Appoo's letter followed Rottnek's abrupt resignation as president of one of Grace Hill's advisory boards. The missive had all the hallmarks of a retaliatory slap, delivered in the aftermath of a boardroom brawl. It was a paper symbol of the widening rift between the doctor with a passion for the homeless and Grace Hill, the golden, century-old charitable organization agency that last year reported serving 10,499 homeless. This powerhouse organization has an $11 million annual budget, including $1.4 million for homeless health care.
Appoo pleads legalities instead of politics. She says Grace Hill stopped filling Rottnek's prescriptions because he refused to sign on as an official Grace Hill volunteer. In the absence of that act, the agency decided, prescriptions and lab work ordered by Rottnek would have to be co-signed by one of their physicians.
"Our pharmacy is not a commercial pharmacy," Appoo says. "If we fill prescriptions for anyone who is not one of our physicians, we will be in violation and lose our funding. Dr. Rottnek was trying to establish a foothold at Harbor Light and made it clear that it was his program. We wanted to be cooperative and wanted to rise above the backstabbing. Our relationship is with our patients."
Maybe so, but Grace Hill's decision meant the homeless would have to navigate another layer of bureaucracy to get the medicine and doctoring they needed. Instead of the one-stop medical shopping offered by Rottnek -- during evening hours, right at the shelter -- his patients had to take off from work and find transportation to a Grace Hill clinic.
"For years, I used to be able to write scripts using Grace Hill's pharmacy for these guys, and the nurses would bring the medications back to the shelter," Rottnek says. "If I make a diagnosis of blood-pressure problems and can get medication delivered to them, that is a whole lot easier than writing a referral for them to get evaluated for hypertension, having them go to a Grace Hill clinic to be evaluated by a Grace Hill doctor and then have a script written for them."
It was a clear duplication of services and an indication that the doctor and agency who had once been on the same pathway, sharing the same vision of easily accessible health care for the homeless, were suddenly moving in very different directions.
The quiet middle child of Fred and Marie Rottnek always seemed out of step with his peers, preferring books over sports and spiritual discussions over a buzzing social scene. His working-class roots separated him from his classmates at Chaminade College Preparatory School, a prestigious Catholic school known for its strong academic environment.