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Kaleida Health says it will close busy health clinics in three city schools unless someone else comes up with funds to help keep the money-losing operations open.

Officials of the big hospital system expressed regret over the decision but said Kaleida Health, like other hospitals, faces tremendous financial pressure to cut costs.

The clinics, located in some of the poorest city neighborhoods, would be sorely missed in a district in which already only a handful of schools provide full-time health services to students.

"We've got kids with serious physical disabilities and medical problems," said Bernard Youra, principal of Stanley Makowski Early Childhood Center, one of the three schools. "It's with the clinic's help that they're able to be a normal part of the school."

Kaleida also operates clinics at Herman Badillo Bilingual Academy and Westminster Community School.

The clinics are staffed by advanced-degree nurse practitioners who can diagnose and treat health problems, administer medications, perform physicals, provide first-aid and monitor pupils with such chronic illnesses as diabetes and asthma.

They also care for more complex health problems, including students with catheters and feeding tubes in their abdomens. This coincides with an increase nationwide in children attending school with more complex medical, physical and emotional problems, according to the National Association of School Nurses.

The clinics were opened in the mid-1990s by Millard Fillmore Health System and Children's Hospitals, both of which later merged with Buffalo General Hospital and DeGraff Memorial Hospital to form Kaleida Health.

With more than 2,220 students combined at the three schools, they don't suffer from lack of use.

At the Makowski school, for instance, roughly 100 pupils used the health clinic on one day earlier this week, said Kathleen Guarino, Kaleida's director of ambulatory services. They included several-dozen students who receive medication daily,
a responsibility that would fall to the principal or teachers if the clinic closed, Youra said.

Elsewhere in the district, Geneva B. Scruggs Community Health Care Center operates clinics in eight schools and the Catholic Health System's Sisters Hospital is in one school. The rest of the schools rely on part-time nurses from the Erie County Health Department.

"The services the clinics offer are desperately needed," said Denise Rivers, director of the Scruggs School Health Project. "It's a safety net."

Kaleida said the hospital system has lost $1 million over the past five years at the three clinics, which cost about $400,000 a year to operate.

Kaleida receives grants from the New York State Health Department and Buffalo Public Schools for the clinics. It also bills Medicaid, the government health insurance program for the poor, for performing patient histories and physicals.

But it has not been enough, according to the hospital system, which recently notified the schools that the clinics would close at the end of June unless alternative funding was found.

"We are far from making a final decision and are actively pursuing money," Guarino said. "But we just can't afford to do this anymore."

"Our intentions were good, but it's now time for someone else to step in," said Andres Garcia, the hospital system's vice president of West Side Community Health Services.

Assemblyman Sam Hoyt, D-Buffalo, whose district includes the Herman Badillo school, said he was "cautiously optimistic" about identifying additional state funds to keep the clinics open.

District officials also expressed hope .

"Losing those clinics would be extremely unfortunate. They opened as an attempt to meet the needs of some of the poorest sections of the city," said Andy Madigan, district spokesman. "We're trying to find a resolution."

Nationwide, the number of school-based health centers increased rapidly in the last decade, from 200 in 1990 to 1,157 in 1998 in an attempt to help low-income children and to respond to emerging health issues for students, according to the National Assembly on School-Based Health Care.

The organization said the growth has been fueled by increasing investments by states and, in some instances, local governments, as well as by rising Medicaid payments.

Based on number of visits, the biggest services nationwide at such clinics are mental health, 25 percent; health supervision, 20 percent; respiratory problems, 10 percent; and ear, nose and throat problems, 7 percent, according to a survey by the National Assembly.

New York had the largest number of such health centers, 158 as of 1998, most of them in elementary schools and most sponsored by hospitals or community health centers.

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