AURORA, Colo. — An Aurora doctor who has dedicated his practice to serving refugees and asylees is running into a roadblock trying to protect them from COVID-19.
Dr. P. J. Parmar has operated the Ardas Family Clinic at Mango House for nearly 10 years.
As vaccines became available, he decided to open up a vaccine clinic at Mango House, a business center and shared space for refugees and asylees at E. Colfax Avenue and Galena Street.
"I think there are 800 sites in the state where they're doing shots right now," Parmar said. "I don't know of any others that are walk-in, with no appointment."
Parmar said the reason they don't require an appointment is because of a desire to cut out barriers to care.
"That's the whole idea of health equity — where you're giving them a little bit of a hand up to people who can't make appointments, who don't have computers, and who don't have the transportation to get to places on time," he said.
Parmar said they started trying to follow state guidelines, which require clinics be open to anyone eligible.
He said most people showing up were those who have their own computers, phones and transportation.
"The ones who are richer," he explained. "They quickly flooded our clinic and what we were doing, wasn't 'underserved' medicine, it was 'overserved' medicine."
That's when Parmar decided to make a change.
He posted a flyer on the Mango House Facebook page targeting residents in the 80010 zip code.
"We're going to stick to our refugees and to our 80010 zip code — the underserved part of the city, the poorest part of the city, which has been disproportionately hit by coronavirus," he said.
Initially, the flyer said, "Only for Residents with Proof of 80010 Zip Code."
That flyer drew swift reaction from the state.
Rick Palacio, a strategic consultant to Gov. Jared Polis, wrote to Parmar saying, "We share your commitment to the residents of 80010, but it is not allowable for you to offer vaccines exclusively to the residents of a single zip code. If you amend your efforts to target residents of a certain area, but don't restrict access to others, that is an acceptable practice. ... Additionally, it is not permissible for your clinic to require that an ID or proof of residency be presented in order to receive a vaccine. Identification and proof of residency are barriers to access to many Coloradans, and disproportionately affect those in our immigrant communities and Coloradans without a home."
He said the goal, as outlined in a Colorado Department of Public Health and Environment update to providers, is to remove barriers to distribution.
Parmar said he'd like to have a conversation with people in the Governor's Office about equity.
"A lot of folks from richer parts of town are getting on the phone and calling endlessly at clinics like ours, and they're asking to be put on waiting lists, and they have the time of day to do this," the doctor said. "They go to work, maybe social distance in their own room, where we have people in this community who are living six people in one bedroom and share the same car, and they've been doing that for the last year. And they've had a family member who died from it. I think there can be a little bit different prioritization put on these folks, but nobody at the state has been willing to talk to me about these challenges."
Parmar said his office is trying to navigate the fine line of being open to everybody, as the state requires, yet still giving a hand up to others.
"The state is requiring vaccine equality which is different from vaccine equity," he said. "It almost feels as they're saying, 'You guys are the runts of the litter, but we're not going to help you out. We're going to just put out the milk there and let you fend for yourself.'"
He removed the line requiring proof of residency in zip code 80010 from the Facebook flyer.
When asked if he worries about repercussions, he said yes.
"By sticking my neck out there and trying to deal with this issue of vaccine equity — absolutely," he said. "The state might come in and take away the vaccine supply, in which case that would be very sad for this community."
He said he receives about 500 doses a week and has vaccinated about 2,000 people so far.
"I got my vaccine here," said one patient, who was translating for a group of refugees from Nepal. "The doctor definitely makes whoever comes here more comfortable than other clinics and hospitals."
Parmar said he has a plan to follow guidelines and still focus on the underserved.
"If somebody calls, we're going to tell them that we'll make them an appointment and we have a wait list for that, which again is the same thing that most of the locations in the state are doing," he said. "If someone is from our local community, they don't need that appointment. They can come on in. That's our extra hand up for this community."