Sitting in Dr. Ovidio Peñalver’s kitchen, I employ one of my favorite tricks of the trade.
I pose a simple question to the longtime pediatrician, who unexpectedly closed his Puyallup practice last month after a nearly four-decade run.
“If you were me, what would you write about you?” I ask Peñalver, a one-time revolutionary who decided to flee Cuba — and more specifically Fidel Castro — at the age of 21, shortly after the Bay of Pigs in 1961.
Originally drawn to the seminary, after a stint in New York as a Franciscan friar, Peñalver found his calling in medicine, and, eventually found his way to Puyallup.
“I would write nothing,” Peñalver, now 77, answers matter-of-factly, with only with the slightest chuckle. “There’s nothing interesting to write about.”
“Just keep that in mind,” he continues. “There’s nothing to write about.”
With all due respect to Puyallup’s humble doctor, Peñalver was wrong.
There’s plenty to write about.
And plenty of places to start.
But for the sake of getting to the point, let’s begin with the unfortunate truth that brought me to Peñalver’s home in Puyallup, where he’s lived with his wife, Meg, since the 1980s.
In March, Peñalver made the painful decision to close his longtime pediatric practice. Or, more accurately, according to his telling, it was a decision forced on him by an unavoidable economic reality.
I’m fairly depressed about how it turned out. I didn’t expect my practice to turn out like this.”
Dr. Ovidio Peñalver
Over the years, more and more of the young patients Peñalver served were covered under state health insurance — or Medicaid. Though reimbursement rates can vary, generally Medicaid reimbursement rates are lower than those of private insurers. It’s the reason many small medical offices, such as Peñalver’s, limit the number of Medicaid patients they see, or don’t see them at all.
Among other things, it’s one symptom in a larger system that increasingly views medicine as a strictly moneymaking endeavor. And as giant offices slowly replace small practices in the quest for profit, it’s a trend that’s claimed another victim in Peñalver.
Bottom-line, dollars-and-cents thinking, however, has never been part of Peñalver’s DNA. By the end, he estimates, “about 75 percent” of his patients were on state insurance, many of them Hispanic.
“For me, to limit the people that could come because of financial issues, it was preposterous. And it was not the reason why I became a physician,” Peñalver explains. “In my practice, I always decided that no matter who came, and their financial situation, they’d be welcome.”
“I’m fairly depressed about how it turned out. I didn’t expect my practice to turn out like this,” Peñalver continues.
“But it did.”
In Puyallup, Peñalver became nothing short of an institution. He remembers opening his practice, 37 years ago, with one patient on the first day. It was a little girl, getting a recheck on an ear infection, he recalls.
Growing alongside the city he calls home, Peñalver’s practice blossomed into one with some 3,000 patients on the rolls, seeing an average of 30 patients a day, sometimes more, and employing two nurse practitioners.
“I’ve seen third-generation kids,” Peñalver says of his time practicing medicine in Puyallup.
In speaking with Peñalver — who told me that, near the end, he was forced to dip into his family’s savings to cover the cost of payroll — it’s clear he’s pained by the decision to close his practice. He misses the interactions. He misses the work.
Most of all, he misses his patients.
“I care about all of my patients,” he tells me. “They’re like my own kids.”
Even in forced retirement, though, Peñalver is trying to keep busy. He’s working for another doctor in town a few days a week, though he says it isn’t the same.
“I don’t know how to do anything else,” he says, looking forlorn when he admits that much of his time is now spent in the garden or taking care of his fish.
On the table, Meg Peñalver points to a letter from the mother of one of her husband’s many longtime patients, one with a serious medical condition. Against her husband’s wishes, she left it for me to read.
I ask Dr. Peñalver what it says.
“I don’t know,” he insists, defiant in his humility.
Again, he’s wrong. He knows exactly what the letter says.
It’s because of doctors like you that I’ve been able to care for (my son). ... You will never know just how much you’ve done.”
Handwritten letter from one of Dr. Peñalver’s longtime patients
“It’s because of doctors like you that I’ve been able to care for (my son),” the handwritten letter reads in part.
“You will never know just how much you’ve done.”
Before leaving, I employ another trick of the trade, sometimes useful in stories like these.
Seeing how things turned out, I ask Peñalver if he has any regrets.
“I would do it the same way again. And lose again,” he tells me.
“I think medicine is not a business. Medicine is a right. People have to be healthy,” he continues, still a revolutionary in a country where the for-profit health care model increasingly trends in the other direction.
“It’s not like going to buy cigarettes at the store. I think people have a right to have health care.”
In this, Dr. Peñalver is exactly right.