History, January 2023
In 1958 a group of Cassopolis business leaders had a vision of creating a medical practice to serve the community. They garnered community support, raised money, built a medical building at 109 School Street, and recruited doctors to town.
A full-time medical practice was established in 1964 by Drs. Aaron Warren and Lowell Smith, quickly grew into a group practice. Due to the large number of patients covered by Medicare and Medicaid, and poor reimbursement, the practice became certified as a Rural Health Clinic in 1992. A community advisory board was created to guide the direction of the Clinic.
Lakeland Healthcare purchased the Clinic in January 1993. Under Lakeland’s stewardship, the Clinic eventually became a Federally Qualified Health Center Look-Alike in 2005, at which time the advisory board turned into a governing board. Two years later, under President Bush’s initiative to establish a Community Health Center in every high-poverty county in the United States, Cassopolis Family Clinic (CFC) applied for and was granted Community Health Center designation in September 2007. (Note that the terms “Community Health Center” and “Federally Qualified Health Center” are interchangeable). CFC became totally autonomous from Lakeland Healthcare in January 2008.
In 2007 CFC expanded its operation to Niles, providing obstetrical and gynecology services for medically under-served women in Cass and southeast Berrien Counties at a new location at 60 N. St. Joseph Avenue. In 2009 a Maternal Infant Health Program (formerly known as Lakeland’s Family Resource Center) was added at the same site, complementing obstetrical care.
In May 2012 CFC was awarded a $4.4 Million Capital Development Grant from the Health Resources and Services Administration (HRSA) toward the cost of building a new medical facility in Cassopolis. A 30,000-square-foot medical facility located at 261 M62 North, Cassopolis was completed in the fall of 2014 and became the new CFC in November that year. The new CFC expanded medical capacity by 50%, creating access for another 4,000 patients, and included onsite dental and pharmacy services. The 7 Million dollar project was made possible by the $4.4 Million federal grant, $1 Million in local fundraising, investments from the Kresge Foundation and the Delta Dental Foundation, CFCN capital reserves, and financing from the U.S. Department of Agriculture.
In December 2012 CFC received a Capital Development grant from HRSA for $340,925 to build a School-Based Health Center (SBHC) at Ross Beatty Junior/Senior High School in Cassopolis. SBHCs help children access the necessary healthcare they need to be successful in school and life. The former woodshop area of the high school became the Ranger Wellness Center and opened in September 2014. RWC provides medical care in a convenient location for busy students.
CFC was awarded an HRSA New Access Point Grant in October 2013, bringing $650,000 in federal dollars annually to help support primary care to medically underserved patients in southeast Berrien County. Niles Community Health Center opened on February 24, 2014, at 24 N. St. Joseph Avenue, Suite G. The ability to expand medical capacity at NCHC was severely limited by its physical space; however, a third full-time practitioner was added on February 1, 2016.
Now known as the Cassopolis Family Clinic Network (CFCN), the organization continued to develop strategies to expand its medical and dental capacities in Niles to serve more people.
In December 2015, the CFCN Board of Directors moved forward with plans to develop an oral health practice for the Niles community, based on community needs. Lakeland Health collaborated with CFCN, providing a medical facility at 122 Grant Street, across from the Niles Hospital Emergency Department. Extensive renovations were made to the inside and outside of the building, with room for 11 dental operatories. Niles Community Health Center Dental (NCHC Dental) opened in October 2016 and offers oral health care for thousands of people who historically have had no access to dental services. CFCN invested nearly $1.6 million of its reserves in the renovation. At full capacity, nearly 21 new jobs were created.
Beginning in the fall of 2015, CFCN began planning for the construction of a new NCHC facility in order to serve thousands more people in the community. In June 2017 CFCN purchased 10 acres of property at 1951 Oak Street, on the east edge of Niles. The plans for the new 30,000-square-foot facility would double medical capacity, merge primary care, OB/GYN, and add expanded, integrated behavioral health services, along with an onsite pharmacy. 4 additional acres of property were added to the building site in June 2018. A groundbreaking ceremony was held in September 2018. Construction was completed in November 2019.
Behavioral Health services expanded throughout 2018, under the medical direction of Dr. Malik, a local Psychiatrist who worked with CFCN in 2017 and 2018. A Psychiatric Mental Health Nurse Practitioner was added to the medical staff. An integrated model of care allows primary care, psychiatric providers, and behavioral health therapists to work together in managing patients with behavioral health issues. Work began in the fall of 2018 to create a Substance Use Treatment Program (SUT), which includes Medication Assisted Treatment as a treatment option. The SUT program was not launched in 2019, due to operational issues. It was decided that SUT services would be provided at the new NCHC facility in early 2020.
Dr. Neil See retired from office practice at the end of 2018, having cared for generations of families. He dedicated 44 years of his life to caring for patients in our community. Throughout 2019 he continued to see patients at the Cass County Medical Care Facility, fully retiring at the end of 2019. Dr. Andre Smyth assumed the role of Medical Director for the Medical Care Facility on January 1, 2020.
The new NCHC facility opened for business on November 19, 2019. The first ambulance call from primary care on the first day of operation was for a patient needing a psychiatric evaluation for suicide ideation. In January 2020, NCHC Behavioral Health opened, and NCHC Pharmacy opened in February. Spectrum Health/Lakeland operates an onsite phlebotomy service available to all patients. The new facility is 30,000 square feet and cost $9.2 Million to complete. It has 24 exam rooms and 2 procedure rooms in medical; 9 exam rooms, 1 procedure room, 1 non-stress test room, and 1 ultrasound room in OB/GYN; 9 medical exam rooms in behavioral health along with 4 therapy rooms and 1 group therapy room; pharmacy; 6 administrative offices, and a large meeting space that can serve as 1 large room or 3 smaller meeting areas. The new NCHC is dedicated to Robert Feldman, Board President, who served for 27 years on the CFCN Board of Directors, and Dr. Neil See, who spent 44 years caring for people throughout Cass and Berrien Counties.
The integrated model of primary care and behavioral health has proven effective in increasing access to mental health services for persons living with mild to moderate behavioral health issues. Becky Brueck, Psychiatric Mental Health Nurse Practitioner, shares her time between CFC and NCHC. A second PMHNP will be added full-time at NCHC by summer 2021. Currently, there are 2 full-time therapists at CFC and 5 at NCHC. Additional social workers will be added in 2021 to meet the ever-increasing demand for behavioral health services.
On August 11, 2020, NCHC officially opened its Substance Use Treatment program. The program was dedicated to Cass County Chief Judge Susan Dobrich, who has been a driving force for more access to medication-assisted treatment (MAT) for substance abuse. Under the medical guidance of Dr. Matthew Pazderka and LuAnn Tracey, FNP, the program grew to more than 75 patients receiving MAT. We anticipate the demand for behavioral health and addiction treatment services to soon outgrow the space of NCHC’s behavioral health department.
Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by the coronavirus. The first known case was discovered in Wuhan, China in December 2019. By March 2020, most of the United States went into lockdown to mitigate the spread of the virus. Coronavirus (Covid-19) changed the world, and it quickly changed the way medical care was delivered. In-person visits changed to telemedicine visits, by phone and video. To keep people safe and socially distanced, CFCN facilities set up screening stations at guest and employee entrances to screen out people who may be sick with the virus. CFC Dental was closed, with all dentists assigned to work at NCHC Dental. Dental support staff was laid off from April to July, as only urgent and emergent dental services could be provided. Medical, behavioral health, and pharmacy continued to operate in both Cass and Niles taking all the necessary safety and infection control precautions recommended by MIOSHA and the CDC. Our goal was to keep people well and out of hospitals and emergency departments, allowing hospitals to handle the influx of people seriously ill with COVID-19. Slowly, as restrictions eased, a mix of in-person and telehealth visits in medical resumed. CFC Dental reopened in January 2021.
Ranger Wellness Center closed in March 2020 when schools were shut down due to COVID-19, and children attended school remotely for the rest of the school year. Due to the ongoing pandemic, and the fact that half of the students were subsequently moved to a different building, keeping RWC open was financially unsustainable. It was closed permanently in October and removed from our health center Scope of Project.
Throughout 2021 CFCN worked closely with Van Buren/Cass and Berrien County Health Departments, as well as the Michigan Primary Care Association and HRSA to secure the COVID-19 vaccine to immunize staff, volunteer Board of Directors, patients, and the general public starting in January 2021. Most staff members willingly were vaccinated. Some declined. Pfizer was the first 2-dose vaccine approved for emergency use by the FDA. Moderna was second. Johnson & Johnson also received approval for a 1-dose injection. First to be vaccinated were healthcare workers and the elderly, then all essential workers. Later in the year, it was recommended that a 3rd dose be provided to immunocompromised people, followed by a recommendation for a booster shot for healthcare workers and people over 65. Boosters were soon recommended for ages 18+. In late summer the Pfizer vaccine was recommended for kids 12-18, and shortly thereafter for kids 6-11. Vaccines for kids under age 5 are expected in early 2022.
Stan Ruder, PMHNP joined the NCHC behavioral health staff in the summer of 2021. Becky Brueck returned to CFC full-time.
Throughout the entire 2021 calendar year, the Covid-19 pandemic marched on in waves throughout the country. The initial virus suspected from China mutated into the Delta variant from India. Toward winter the highly contagious Omicron variant appeared, coming from South Africa, and is overtaking the United States by storm. Fully vaccinated people are susceptible to breakthrough infections from Omicron. Medicines have been developed to treat Covid-19 and are saving lives. Healthcare workers at every level are tired and stressed, with many quitting healthcare. At the end of 2021, the reported death toll from Covid-19 in the U.S. is 826,000.
2021 in review is simply a year of survival in many aspects; personally, professionally, emotionally, and physically. At the December Board meeting, we announced a health center mandate for all staff to be fully vaccinated by February 2022.
Planning for an expansion of NCHC started in the summer of 2021. A 6300 square foot, $2.4M wing will be built onto primary care to provide more room for substance use treatment. The Substance Use Treatment team will move from the behavioral health wing to primary care. Construction is expected to start in the spring of 2022. A maintenance building was constructed at NCHC in the fall of 2021.
The purchase of the 201 M-62 Cass County building, formerly used by the Health Department and later, the Department of Corrections was negotiated with the county for $300,000. The purchase was completed in January 2022. It will be used to house care management staff. Land improvements were made in the summer of 2022. Interior and exterior renovations will be required prior to using the building. Since the costs will be covered by an HRSA grant for minor additions/renovations, the project must come in under $500,000. We are working with Hooker DeJong Architects and Frederick Construction.
In the spring of 2022, Niles Community Health Center broke ground on a 6,332-square-foot addition to primary care. The project will cost approximately $3,000,000 and be funded in part by an HRSA grant, and from CFCN reserves. The project will add space for 4 practitioners, 12 exam rooms, 2 additional treatment rooms, and office space to accommodate the substance use treatment team. The project is expected to be completed in March of 2023.
On March 18, 2022, we learned of the sudden and unexpected death of Dr. Karen Zienert, one of Lakeland’s OB/GYNs who has worked with us for many years. She died peacefully in her sleep. Dr. Zienert will be remembered for her dedication to providing the best medical care to patients and her sense of fashion. She will be missed.
Our staff has grown over the years. The medical staff as of September 2022 is 16 providers, and overall staff numbers hover between 120-130 employees.
Throughout the Covid pandemic, it has been very difficult to hire staff. Many people have left healthcare, either retiring or choosing another profession. Many people are choosing to work from home, refusing onsite work, and many still refuse to be vaccinated for Covid. The Centers for Medicare and Medicaid Services (CMS) mandate issued in November of 2021, required healthcare workers to be vaccinated, to mitigate the spread of Covid in healthcare facilities and residential settings such as nursing homes. This mandate caused non-vaccinators to leave healthcare and further limited new applicants from accepting positions.
In July of 2022, the Cass dental site was closed and Dr. Dang moved to the Niles practice. He resigned at the end of the summer and moved east. Dr. Patel resigned in mid-September, leaving just 1 FTE dentist, Dr. Madison Mick. In September we partnered with the University of Michigan School of Dentistry to train dental interns. We are actively recruiting 2 new dentists. Due to COVID-19, many dentists retired or quit dentistry. Recruiting dental assistants is also very difficult.
Significant staff changes included Kyleigh Kramb, Controller for CFCN, being promoted to Chief Financial Officer, a third full-time pharmacist added, a second Psychiatric Mental Health Nurse Practitioner was added full-time in Niles, and two young Physician Assistants joined the medical staff. Dr. Andre Smyth left the practice at the end of 2022, thus ending a 55-year relationship in which CFCN provided medical care and a Medical Director for the Cass County Medical Care Facility.
At the end of 2022, the population in Southwest Michigan fully vaccinated for COVID-19 was around 54%, with 62% having at least one dose. Misinformation spread on social media about the science of the Covid vaccine, its efficacy, and safety has created great controversy in society about being “mandated” to be vaccinated. Now with more known about the disease, and medications available for treatment, people can recover from COVID-19. Those unvaccinated are still more likely to be hospitalized and be sicker than those vaccinated.
The east wing of NCHC opened in May 2023. The Substance Use Treatment team moved into the wing, along with Dr. Pazderka, Dr. Zakhary, and Melissa Burpee, FNP who are all providing medication-assisted treatment for people living with addiction. As of October 179, patients are receiving MAT. Dr. Sabrina Cole, who joined the Cass medical staff in August, is offering MAT at Cassopolis Family Clinic. Dr. Peter Cho joined NCHC Dental as a full-time dentist in June. Becky Brueck, PMHNP left the organization in August.
The health center continues to grow and serve more people. As of October 2023, the health center is on track to serve more than 14,000 patients. Pharmacy is very successful at both the Cass and Niles sites, providing exceptional customer service. Patients are able to be seen and pick up their prescriptions as they leave the health center.
Even with the personal and professional stress of working in healthcare, staff shortages and now learning to live with COVID-19 from pandemic to endemic, our staff continues to not only care for our patients but to care about them. The focus on our mission provides stability: “To provide compassionate healthcare to people in our communities.”