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Jacob Klopfenstein,

How a Salt Lake clinic keeps homeless people coming back to get well

By Jacob Klopfenstein, | Posted - May 1, 2019 at 7:30 a.m.

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SALT LAKE CITY — Spencer Gasu is one of the thousands of clients at the Fourth Street Clinic who has been here before.

Gasu, 32, was at the clinic in September 2018 seeking help for a variety of ailments following a diabetes diagnosis and a recent surgery. He had been living with friends and moving from couch to couch.

It was his third visit to the clinic so far. He said he found the clinic helpful and was impressed with his visit.

“It’s a good feeling,” he said. “It’s good to know people care.”

Located just across the street from Pioneer Park in downtown Salt Lake City, the clinic is a community health center that primarily serves Salt Lake’s homeless population. About 90 percent of the clients at Fourth Street are homeless.

The clinic sees between 30 and 40 patients a day, according to James Jarrard, the clinic’s development and communications manager. In 2018, the clinic treated 4,940 patients, but received more than 27,000 visits.

That means most of the patients are repeat customers.

'This place has helped heal me'

Sean Perkins, 52, has been coming to the clinic off and on for 10 years, he said. He is a former heroin addict but has been clean for four years.

A devastating car crash when he was 15 in his native Oregon left him with multiple injuries. He got hooked on opiates during his recovery and that led to heroin use, he said.

He was able to build up a social support system that has helped him stay off heroin for the last four years. After living on the streets for years, he now lives in a small apartment with his son.

Perkins comes to the clinic for medical needs, as well as therapy, which he says has helped him overcome his addiction.

"This place has helped heal me," he said. "That's what helped me ... It made it so much easier to kick."

The clinic offers various wellness classes, including one that provides information on how to eat well and exercise in order to treat diabetes, Michalski said. Other offerings include a behavioral health class, a smoking cessation group, Narcotics Anonymous and a zen meditation group, she said.

Primary care, dental care, behavioral health services and several other specialty health services are available at the clinic. It also has a full-service pharmacy that fills 70,000 prescriptions per year, though it does not distribute prescription narcotics, Jarrard said.

Even though The Road Home shelter downtown is scheduled to close this year, Jarrard said the Fourth Street Clinic will remain open in its current location.

Even with the number of repeat clients, treatment providers try to address everything affecting a client when that person visits the clinic, the clinic's CEO Laura Michalski said. They may never visit the clinic again, as they might be transient and will move on to somewhere else after leaving.

“You want to do everything when you have them sitting in your exam room because you don’t know if they’re going to be back,” Michalski said. “You don’t know if they’re moving on.”

Sean Perkins, 52, gets help from a nurse at the Fourth Street Clinic in Salt Lake City on Thursday, March 28, 2019. He says treatment from the clinic, including therapy, helped him kick a heroin addiction four years ago. (Photo: Jacob Klopfenstein,

'A different target'

The clinic is a federally qualified health center with a special designation to serve a homeless population, according to Michalski. No more than 25 percent of those they treat can be from outside the homeless community according to the guidelines, she said.

“It’s just like any other community health center, but it’s just a different target population,” Michalski told

The definition of homelessness under the federal Health Resources and Services Administration is loose though, she said. It can mean people who live in a shelter, a car, a hotel or a variety of other living situations.

Attitudes prevent people from seeking help

Mitchell Curtis Tootsie, who has been a patient at Fourth Street Clinic for about five years, said he thought he was healthy before he went to the clinic. But he found out a lot he didn't know about his health after visiting.

Many people who live on the streets think they don't need treatment — that if they can't get through living on the streets, they can get through anything, Tootsie said.

"A lot of people, it’s either they feel like they’re owed something or they’re too good for something," said Tootsie, 49. "That’s the mentality that these homeless people are carrying and that’s their downfall."

In March, Tootsie was living at The Inn Between, a center that provides a living space for people who were previously homeless, especially those who are terminally ill, according to the website. He was no longer living there as of Tuesday, according to Inn Between executive director Kim Correa.

Tootsie said he thinks homeless people should be more open-minded when it comes to their medical needs.

"If you enter it with an open mind, you’re being able to speak about what’s going on with your body," he said. "It's not just like a whole bunch of cows going into a pen, they either have horns or they don’t have horns. It’s not separated that way — here they treat you as an individual. That’s good that way."

Mitchell Curtis Tootsie, 49, listens to a doctor at the Fourth Street Clinic in Salt Lake City on Thursday, March 28, 2019. (Photo: Jacob Klopfenstein,

There are lots of misconceptions about homeless people, but the vast majority are trying to improve themselves, Michalski said.

“When you think about the homeless population, people just assume they’re lazy, they’re drug addicted, they don’t want to do different things, but that’s not true,” she said. “We actually have a lot of patients that come and have repeat appointments here. They’re trying to get themselves back on a path of wellness.”


Jacob Klopfenstein

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