Values Proposition: Suzanne Lagarde ’14 on Giving Back

My core value is a commitment to help people who have less than I do. I’m the CEO of Fair Haven Community Health Care, a federally qualified health center with 18,000 patients in 14 locations around New Haven. After many years as a gastroenterologist, I returned to school to attend Yale SOM’s executive MBA. When people ask me why, I say, “It’s very simple: what medicine desperately needs is efficiency and that’s what business is all about.”

I grew up fairly poor in a very Catholic family in Fall River, Massachusetts. My father ran a gas station. My mother worked with him because that was how they could make ends meet. Even then, giving back was a high priority.

I remember vividly wanting to go into medicine. The sense of healing and caring for others was always a very big drive. But I certainly didn’t have any role models around me that said I would be able to do it. The expectation was, “You’ll go and be a teacher.”

I graduated from an all-girls Catholic high school. From our class of 23, three of us went to four-year colleges. My father and mother were both one of five siblings. Of that entire extended family, I was the first to complete college. I got an undergraduate degree in math so that I could become a math teacher.

I also completed the minimum requirements for applying to medical school. I got in and attended Cornell. I came to Yale for my internship. For years, I worked in private practice and at Yale New Haven Hospital. I always wanted to work with underserved populations. But I got married. I had kids. Life got very busy.

In 2007, I went with a church group to Mississippi to help in post-Katrina restoration. I was taken aback by the poverty. We worked on rebuilding a house on the Gulf Coast. My skills with a hammer or sheet rock are minimal, so I knocked on the door of the executive director of Coastal Family Health, a federally qualified health center. The trailer we were staying in was in their parking lot. I asked if I could help.

After a crisis, states allow clinical providers from outside to help on an emergency basis. Two years on, that had lapsed. When I realized I wanted to keep going back, I applied for a Mississippi medical license. It was an extensive process, but in October of 2008 I was able to start seeing patients for Coastal Family Health.

I spent a week there every quarter for almost five years. One of the first patients I saw was a young man who had been experiencing rectal bleeding for six months. Examining him, I found a huge mass. There was no question; he had rectal cancer. He didn’t have insurance. It was pre-Obamacare. The number of uninsured patients was well over 50%.

The only academic medical center, where someone without insurance had a shot of being seen, was in Jackson, 180 miles away. I called to get him an appointment. They offered one in eight months and put him on a waiting list with 200 people ahead of him.

Eight months for someone with cancer? I called locally. No one would see him because he had no insurance. It took about five weeks of working on it, but we got him treated by the surgeons in Jackson.

We were so limited in our resources at Coastal Family Health that I really had to draw on every ounce of my diagnostic skills. You don’t want to tell somebody whose monthly salary is $700 to figure out how to get $2,000 for a colonoscopy if, in your heart of hearts, you think their rectal bleeding is hemorrhoids. It was always walking a fine line. When do you say, “I really think you’re okay”? When do you say, “Pull together the money”? It was so difficult and challenging and rewarding; I made over 20 trips.

The experience with wait times in Mississippi led me to do a study to see how long it took for Medicaid or uninsured patients to get specialty care in New Haven. It was often a three-to-six-month wait. For some specialties, like orthopedics, there were instances of patients being given appointments more than a year down the road.

So, in 2009 I worked with some other physicians to start a nonprofit called Project Access-New Haven. It’s modeled on a similar organization in Asheville, North Carolina. We get uninsured patients the care they need by recruiting doctors to see a limited number of patients—even one a year is fine—for free. And we get hospitals to pay for imaging and lab tests—it keeps uninsured patients from using the emergency room as a last resort. Project Access is still running today; it’s doing incredibly well.

During that period, I was going to Mississippi, volunteering at Fair Haven Community Health Care in New Haven, and doing my job as a gastroenterologist.

I was also getting increasingly annoyed with the health system. It was inefficient. It made no sense. I wanted to see if I could effect change. It sounds a bit pretentious, but I wanted to be leading an organization the way I thought it should be led.

I wanted it to be a local nonprofit. I’ve been in this community for a very long time. Having tons of connections in the medical world has been a humungous asset.

I wasn’t getting any younger, so I said to my husband, “I’m going to give up my lucrative GI practice. I’m going to go to Yale’s executive MBA program that costs a ton of money, and when I’m done, I want to go work for a nonprofit.” I have a great husband who said to go for it.

The program was outstanding. It was an eye-opener, an entirely different way of thinking. As much work as it was, I loved those weekends in class because they were just so stimulating.

Six months into the program, Fair Haven Community Health Care started looking for a new director. Initially, I wasn’t going to apply. I thought I needed to finish the program and get more experience. But I did apply and got the job.

When I took over in 2013, the organization was struggling financially. We had two days’ cash on hand and $3 million in short-term debt. Six years on, we have 60 days’ cash on hand and no short-term debt.

We care for 18,000 primarily low-income individuals. We’ve grown our patient population by one third. We’ve opened new sites. We’ve added services—vision, dental, and substance use treatment. I have the satisfaction of knowing I’ve been able to steer this organization to a much better place.

It’s a different kind of satisfaction than diagnosing and treating a patient, then seeing that individual get better. It’s totally different. I still see patients one day a month. I miss doing it more often, but I did that for many years.

I want to help those who need the most, who can benefit most from what I have to offer. Part of what I have to offer, as a physician and as the head of a federally qualified health center, is a bully pulpit. It’s not huge, but it’s helpful.

So much of what we do is dependent on what happens in Washington and Hartford. When they make major changes in how Medicaid is reimbursed or they make changes in the Affordable Care Act or the state is in a budget crunch and suddenly the $700,000 we were receiving to take care of uninsured patients is gone, it changes what we can do. I spend a fair amount of my time advocating for the patients we are currently seeing as well as the ones we could be seeing.