In Dr. Kenneth Maier’s day, chickens or eggs worked fine as payment for an office call that never cost more than five bucks.

Paperwork was minimal and third parties such as insurance companies rarely entered the picture.

It was just doctor and patient.

Giving up his free time now, 30 years later, to treat poor people is just as much about recapturing those days, Maier says. He’s not alone in his sentiments.

An impressive cadre of retired doctors, nurses and others geared up this week for the opening of the new Volunteers in Medicine clinic in Bend.

”It’s getting back to what medicine is all about,” said Maier who, at 64, is semi-retired from his Cottage Grove family practice.

”You’re not worrying about the billing, et cetera. You’re just doing what’s in the patient’s best interest,” said Dr. Dan Sullivan, also semi-retired.

”This is sort of the fun part of medicine.”

Three years in the making, the free clinic opens Monday at its spot next door to the St. Charles Medical Center-Bend. Built to serve the county’s uninsured, the Bend project and other similar ones nationwide are a symbol of not only a faulty health-care system but frustration with politicians. Communities are taking matters into their own hands.

Ten thousand Deschutes County residents lack insurance, a number that is expected to jump as much as 4,000 following the failure of Measure 30. Cuts to the Oregon Health Plan are forcing many residents off state rolls.

Those residents join 43 million uninsured Americans nationwide.

Due to lack of coverage 18,000 people die annually, according to a recent Institute of Medicine study – almost equal to the number of people dying from diabetes and strokes.

The Institute of Medicine is part of the National Academies, which gives advice to the federal government on science and technology matters, according to the National Academies Web site.

”The problem with the uninsured is not just a problem of very poor people… It can happen to almost anybody,” said Sullivan, a former emergency room physician who works part time for the Mountain Medical Group in Bend. ”If the doctors of a community don’t address the problem, it won’t be addressed.”

The new Clinic of the Cascades – as the VIM facility next to St. Charles-Bend is called – joins 22 Volunteer in Medicine clinics nationwide. The brainchild of scientist and business executive Jack McConnell, the VIM model was established 10 years ago at Hilton Head Island in South Carolina, when McConnell came up with the idea of using retired doctors to meet a huge community need.

Christine Winters, executive director of Bend’s new clinic, said response from Central Oregon’s large and skilled retirement community has been overwhelming. More than 300 nurses and 75 physicians have stepped forward to volunteer.

”It’s been amazing, the interest,” said Dr. Ronald Carver, the clinic’s medical director. ”We had about 100 people sign up (at the first open house six months ago). The room was packed. It was just electric.”

Carver, an obstetrician and gynecologist who has delivered close to 5,000 of the community’s babies, is himself retired. But instead of hiking, skiing and traveling, the 62-year-old has been spending his retirement logging 30- and sometimes 40-hour weeks turning a dream into reality – for three years running.

The Bend Chamber of Commerce recently honored Carver as a 2004 Citizen of the Year.

”I knew I would do some volunteering, but I never dreamed it would be this much,” he said. ”Sometimes I wonder what I got myself into, but it’s been a fun project.”

The retired volunteers are quick to deflect attention from themselves, saying the opportunity to spend more time with patients, learn new technologies and enjoy the camaraderie of peers make service as rewarding for them as it will be for patients.

”I was hoping not to get any publicity about this,” said Dick Woods, a retired oncologist who plans to volunteer one afternoon a week. ”I just wanted to do it, that’s all.”

The clinic was first proposed by three members of the St. Charles Medical Center board – Jim Petersen, Stan Shephardson and Jim Lussier – after they learned of the Hilton Head facility in the spring of 2001. A task force was formed soon after.

Save for a small handful of administrative positions, the clinic will be staffed entirely by volunteers and funded by community donations. Patients will be charged nothing for services, although they will be given the option of contributing a small donation.

Services will include basic outpatient and preventative care, as well as occasional urgent care. Carver also hopes to establish a network of volunteer specialists who would treat more serious conditions and is working on forming a partnership with St. Charles that would provide limited surgery.

The facility will be one of the few free clinics in the nation to go digital, with client records stored on tablet PCs instead of in paper files. Wireless ports in the ceiling will hook PCs into an information system that automatically backs up files and puts doctors in touch with reference material on drugs, medical conditions and more. Clinic staff say electronic records will increase doctor efficiency and reduce errors.

”It’s almost like a big Palm Pilot,” said Winters.

The clinic dispensary will offer about 30 free drugs for heart disease and diabetes, as well as antibiotics, anti-inflammatories and anti-depressants. Volunteers will also help clients enroll in prescription assistance programs offered by various drug companies. Such aid has translated into more than $200,000 worth of drugs for patients at the Eugene Volunteers in Medicine clinic.

Established three years ago and serving 5,000 patients, that clinic is thriving, according to Sister Monica Heeran, executive director. A network of almost 300 specialists take referrals from the clinic pro bono, and nearby labs and imaging centers process tests for free. Heeran thinks Bend can expect a similar outpouring of good will.

”For every dollar spent here, close to three dollars of value goes back into the community,” said Heeran, citing the results of a recent clinic survey. ”The clinic just makes people feel good that they’re taking care of their own.”

The free clinics target the ”working poor” – those in jobs without benefits who make too much to qualify for subsidized health plans but too little to buy their own. More than 80 percent of uninsured people 65 and under are members of working families, according to the Institute of Medicine.

The problem isn’t expected to improve anytime soon. The lost productivity associated with uninsured people costs the nation $65 billion to $130 billion yearly, according to the Institute of Medicine.

Uninsured patients are often charged more than their insured counterparts, whose companies can negotiate discounts. The cost to treat pneumonia for fee-for-service plans, for example, ranges from $100 to $3,434. For uninsured patients, it averages $9,812, according to the Institute of Medicine.

Communities are turning increasingly to organized volunteer projects, health experts say. Doctors and clinics provided more than $5 billion worth of charity care in 2001, according to the Institute of Medicine. More than 1,000 free clinics serving 3 million uninsured Americans exist, according to the advocacy group Volunteers in Health. Federally funded health centers, in comparison, serve about 4 million people.

”It’s a model of care that seems to be gaining momentum right now,” said Winters, the mew clinic’s executive director. ”It’s a solution that communities can implement immediately.”

However, debate surrounds volunteerism as a solution to the health-care crisis, according to a recent policy paper by the National Health Policy Forum, a nonprofit grant-funded group in Washington, D.C. While charity care has long been part of doctors’ professional ethos, new tensions have emerged with the rising cost of health care and its evolution into a multibillion dollar industry, the forum said.

While some say volunteerism should be the cornerstone of a safety net for the poor and that new legislation is needed to facilitate efforts, others say volunteer-based solutions are too fragmented to solve the problem, according to the paper. Critics also fear a focus on volunteerism will detract from efforts to increase health-care funding and establish universal health care, the forum said.

Accustomed to a lifetime of serving others, retired medical professionals are a natural pool to turn to. And they’re in large supply – an estimated 160,000 retired doctors and 350,000 retired nurses exist nationwide, according to the Volunteers in Medicine Institute. That number should increase substantially as baby boomers hit retirement.

But the high costs of malpractice insurance and maintaining current licenses make it difficult for retirees to serve. While some progress has been made on the malpractice end – many states, including Oregon, have enacted protections for volunteers – Central Oregon retirees still struggle with the issue of licensing volunteers, Carver said.

The problem is particularly troublesome for retirees who move to the area from other states, he said. While doctors with Oregon licenses can purchase a low-cost license for volunteering, others must take an exam and purchase a new license to provide volunteer care – an undertaking that costs more than $1,000, Carver said. The requirement is a barrier for many local doctors interested in working at the new clinic, he said.

Carver has been lobbying the Legislature to enact a law similar to one South Carolina passed in 1992. Thanks to the legislation, out-of-state licenses of retired doctors wishing to volunteer are now recognized by the state. It’s one of the reasons Hilton Head has such a thriving retired physician community, Carver said.

With the obvious pleasure local retirees receive from volunteering, it’s no wonder Carver works so hard on the issue. Sitting in his office Wednesday, he couldn’t suppress wide smiles as he showed off pictures of beaming clinic volunteers.

”Look at the smile on his face,” Carver said, leaning forward in his chair as he clicked on a doctor’s picture stored on his laptop, tilting the screen toward a visitor. ”And here’s another woman smiling,” he said, ”and she’s cleaning! I mean, they’re all that way… It’s very gratifying.”

Jeanene Harlick can be reached at 541-408-2606 or at jharlick@bendbulletin.com.