Ryan Nena Medical Center in the East Village. Photo by Simon McCormack

Ryan-Nena Community Health Center in the East Village. Photo by Simon McCormack

Maria Nazario said she’s counted on the Ryan-NENA Community Health Center in Alphabet City for more than 40 years.

The senior citizen said her doctors have helped her deal with her chronic asthma and diabetes ever since she moved to Alphabet City. She said her doctor keeps pushing her to make sure she takes care of herself.

“I can’t pay the prices of other clinics,” Nazario said. “If I couldn’t come here, I’d have to go to the hospital, and you die waiting in a hospital. Here I get individual attention, which I need.”

As Nazario turned to walk home, a Ryan-NENA doctor burst out the door and jogged down Third Street toward Avenue C.

“Raul!” the doctor shouted. “Raul, wait a second.”

A portly, unshaven man with a large gap between his two front teeth turned around, and the doctor handed him a sheet of paper with his prescription written on it. Raul thanked the doctor, first in Spanish, then in English, before heading on his way.

Amidst the fierce debate over what works when it comes to health care, for many patients, Ryan-NENA serves as a model for success.

Many of the patients who go to Ryan-NENA are on Medicaid. In 2009, in order to qualify for benefits, a family of two had to earn less than $19, 378 a year. Without government assistance or the clinic’s sliding pay scale, some patients questioned whether they could afford health care.

Elaine Lugo, a senior citizen and Medicaid recipient, said she appreciates that her doctor at Ryan-NENA listens to her feedback before deciding how to treat her.

“They take good care of me,” Lugo said. “They know what they’re doing.”

Elaine Lugo audio
Elaine Lugo on whether health care is a privilege or a right.

But Mia Jones had less than flattering things to say about the center. The mother of three said the care her children receive is fine, but the women’s health unit is another story. She said her doctors keep leaving, and it’s difficult to develop a rapport with a particular physician.

“It seems like there’s always some new doctor,” Jones said. “It’s very frustrating. I need to find myself another clinic.”

Jones said when the doctor she’s been seeing leaves, she has to wait a month before she can get an appointment with another physician. If she comes in during walk-in hours, Jones said the wait can be four or five hours.

“I wish they’d get their act together at women’s health,” she said.

mia jones audio
Mia Jones on the center’s women’s health unit.

Victoria Gonzalez, the center’s community relations coordinator, said Ryan-NENA can’t afford to pay doctors as much as other health-care providers who charge more for their services.

That means some doctors could be lured away by a bigger paycheck elsewhere. Even so, Gonzalez contends the turnover rate of doctors isn’t especially high at Ryan-NENA.

The center’s medical director, Dr. Matthew Weissman, said most doctors stay at Ryan-NENA for at least four years. The center was founded in 1968. The non-profit organization is part of the Ryan Network, which also includes the Ryan Center on the Upper West Side and the Ryan/Chelsea-Clinton Community Health Center in Midtown. Ryan-NENA provides a broad swath of services including mental and geriatric health, dental care and optometry.

According to Gonzalez, in 2008, 51 percent of the patients who came through the center’s doors were on Medicaid. In that same year, 37 percent were uninsured. Gonzalez said more than half of Ryan-NENA patients speak English and Spanish, and that’s true of the center’s staff as well.

Depending on their family size and income, patients without insurance pay between $32 and $93 a visit.

“We work with the person as much as possible to make sure they can afford care,” Gonzalez said. “Community health centers never turn anyone away.”

To pay for the services patients can’t afford, Ryan-NENA gets funding from the city, state and federal government. With budgets being slashed at the city and state level, Gonzalez said, the center has had to eliminate “anything that’s not going to improve patient care or access.”

Gerard McGovern audio
Ryan-NENA patient Gerard McGovern explains why he won’t go anywhere else for health care.

Upper-management at Ryan-NENA took small pay cuts this year. Caring for people without a lot of cash affects how doctors at Ryan-NENA approach treatment plans for their patients.

When deciding what medicine to prescribe, for example, Weissman said doctors must make sure they select a drug their patients can afford.

“It’s an exciting challenge,” Weisman said. “It’s not just take this pill and call me in two weeks. You get to know more about your patients.”

Doctors at Ryan-NENA must become familiar with the pressures facing each person they treat, Weissman said. If the patient is a diabetic living in a homeless shelter, for instance, Weissman said they might not be able to check their blood sugar because they aren’t allowed to carry needles.

“The doctors get involved not only in the medical care, but the social aspects of their patients’ lives,” Weissman said. Ryan-NENA and many of the people at the center serves are on tight budgets. But Weissman said his center provides care that’s just as good, if not better than its for-profit counterparts.

Weissman explains Ryan-NENA is under greater scrutiny than health care organizations that don’t rely on government funding or private grants. The center must prove to its funders that it is using its cash wisely.

“All the granters who are giving us money are constantly checking up on us,” Weissman said. “They do surveys, they check our charts, and they make sure we’re providing the quality care they expect.”

Lugo said she hopes the center continues to be a resource for the community. “If something happens and it closes for some reason, I’ll go to another clinic,” Lugo said. “But I don’t have any reason to leave now. I’m happy there.”