From Its Counterculture Roots, Haight Ashbury Free Clinic Morphs Into Health Care Conglomerate

SAN FRANCISCO — Since it opened 50 years ago, the Haight Ashbury Free Medical Clinic has been a refuge for everyone from flower children to famous rock stars to Vietnam War veterans returning home addicted to heroin.

Strolling through the clinic, one of the first of its kind in the nation, founder Dr. David Smith points to a large collage that decorates a wall of an exam room affectionately referred to as the Psychedelic Wall of Fame. The 1967 relic shows a kaleidoscope of images of Jefferson Airplane and other legendary counterculture bands, floating in a dreamscape of creatures, nude goddesses, peace symbols and large loopy letters.

“That was made by a woman who had just taken LSD. She stayed here for a very long time and put all that up. It lasted as long as her LSD trip,” Smith said moving on to what was once called the “bad trip” room, where clinic staff would talk down clients during acid trips gone awry.

Fundamentally, Smith and others say, the organization has remained true to its counterculture roots, still offering free care in a deliberately nonjudgmental atmosphere.

But it is also drastically different: It is now the Haight Ashbury Free Clinics — plural — and part of a multi-million dollar conglomerate with a decidedly un-hippie name: HealthRIGHT360.

All told, HealthRIGHT360 serves approximately 40,000 patients each year in a wide range of programs, including “reentry” services to formerly incarcerated adults and teens, residential and outpatient drug treatment, mental health care and medical and dental care. In 2014, it purchased a 50,000 square foot building at 1563 Mission Street in San Francisco as additional space to offer all of these services under one roof. The organization also serves patients in San Mateo and Santa Clara counties.

It’s been a long journey from Smith’s early days running a standalone clinic.

When the clinic first opened, it operated 24 hours a day with an army of volunteer physicians from the University of California-San Francisco and Stanford. The one paid staffer was a nurse. The first year’s budget was her salary: $25,000.

It had a “guerilla” pharmacy, Smith said. Pharmaceutical representatives would load up their trunks with medication samples and drop them off at the clinic, where a team of UCSF volunteer pharmacists bottled up the medication and shelved it, according to Smith, who noted wryly that the illegal activity long ago reached its “statute of limitations.”

“Our first exam table was my kitchen table,” he recalls. Decisions were made by consensus, and even the janitor weighed in, Smith said.

Benefit rock concerts organized by the iconic music promoter Bill Graham, featuring performances by George Harrison and Janis Joplin, helped the clinic stay afloat financially.

Smith remembers when Joplin overdosed on heroin, and the clinic rushed over an “overdose team” armed with the anti-opioid medication naloxone: “We zipped out there and reversed her overdose,” recalls Smith.

As Smith tells it, many Vietnam veterans returned from the war in the early 1970s addicted to heroin. They felt ostracized by what was then called the Veterans Administration and headed to Haight Ashbury and its clinic, which by then offered comprehensive medical cares and a drug detox program.

The influx of veterans led to federal grants from Special Action Office on Drug Abuse Prevention. “That began the government funding era in the 1970s and ensured our survival,” said Smith.

In the 1980s, a young woman named Vitka Eisen learned firsthand the value of the personal attention the clinic offered. She came to the Haight Ashbury clinic struggling with heroin addiction. “I went there for detox at least nine times,” she said. “I never felt shamed or judged. They always acted like they were glad to see me.”

Her trust in the staff led her to kick her heroin habit and return to school, where she eventually earned a doctorate in education from Harvard.

Eisen took the helm as CEO of HealthRIGHT360 in 2010.

The clinics’ business model began to change dramatically in 2007, when it added another site at 1735 Mission Street in San Francisco.

But by 2011, like many recession-era nonprofits, the clinics were deeply in debt, Smith said. So they merged with the renowned San Francisco-based addiction and mental health treatment program, Walden House, which wanted to offer comprehensive medical care to its patients. The two nonprofits merged, and adopted the name HealthRIGHT360.

By joining forces in 2011, Walden House and the Haight Ashbury Free Clinics were able to weather the extraordinary financial expense of shifting their organizations to electronic health records, a requirement of the Affordable Care Act, said Eisen.

With the system in place, she said, it’s easy enough to train and add on new providers as HealthRight360 has expanded. The merger also allowed the Haight Ashbury Free Clinics to erase its debt in a single year.

Between then and its latest merger in July with Prototypes, a Southern California women’s drug treatment center, HealthRIGHT360 has acquired five other community clinics in Northern California and offers treatment at 40 sites up and down the state, according to its former Vice President of Development Michelle Hudson.

Ben Avey, assistant director for external affairs at the California Primary Care Association, said such mergers aren’t new, but they have accelerated under the now-imperiled ACA.

At the individual clinics that comprise health systems like HealthRIGHT360, “they speak your language, know your culture, understand the situation you’re coming from,” Avey added.

As CEO, Eisen led the consolidation that streamlined HealthRIGHT 360. “We have one board, one human resources department, one finance department, one payroll department and one executive.” The annual revenue, said Eisen, is $110 million. Medi-Cal, the city, county, state and federal governments reimburse HealthRIGHT 360 for providing patient services, as do commercial health insurers.

But ties to the early days remain. The early treatment of concertgoers evolved into San Francisco-based Rock Medicine, which is now part of HealthRight360, and sets up on site at rock concerts, circuses and fairs in the San Francisco Bay Area and Los Angeles, garnering $1,038,000 annually from the venues.

And the nonjudgmental reception by the Haight Ashbury Free Clinics’ staff continues to this day, according to 61-year-old David Smith, (no relation to the clinic founder) who has been coming to the clinic since the 1980s and has always felt welcomed and accepted.

This was true even when Smith was homeless in the early 2000s.

“It didn’t matter if I was dirty,” he says. “I didn’t have to feel like I couldn’t come in here because I wasn’t in the proper state of cleanliness, which was unfortunately the case for a quite bit of the time.”