Ten years ago, a group of friends who worked at Miriam Hospital in Provi-dence, R.I., met for dinner one night and discussed opening a free clinic for uninsured asthma patients. They could have let the idea sit for a while, approach some potential donors and deliberate whether it was feasible, but instead they got busy.

They figured they wouldn't need all that much to make a difference. Asthma isn't complicated or especially expensive to treat—yet treatment greatly improves the patient's quality of life. Along with helping people who couldn't afford a trip to the doctor, they reasoned, the clinic would benefit the hospital, cutting down on unnecessary emergency department visits.

"This was a grassroots idea — a very basic idea," says Richard Karczmar, M.D., the pulmonologist and sleep medicine specialist who led the project. "It never really seemed like an effort. It just seemed like something that should have been done a long time ago."

To get things rolling, Karczmar talked the hospital administration into lending him space in an underused building to house the clinic. He collected donations of unused asthma medication samples from colleagues.

Two respiratory therapists helped with scheduling volunteers and setting up the clinic's tax-deferred status.

"To tell you the truth, we didn't have any money to start with," recalls William Corwin, M.D., Miriam Hospital's chief medical officer.

For many years, the clinic, called Taming Asthma, operated on a little more than $1,000 a year. Recently, Karczmar secured some grants to add a paid part-time administrator and community outreach person. The outreach person, who has strong connections to the Latino community, makes referrals. The clinic also gets the word out at community festivals, on flyers and through ED staff at local hospitals.

Two nights a month, the clinic's pulmonologists see 10 to 20 patients. At first, those patients were mostly adults. "That flipped three or four years ago, and we started to see a lot more kids," Karczmarsays. "In Rhode Island, the funding for children's health care benefits was slashed pretty badly."

In the clinic's early years, doctors often wrote prescriptions for Albuterol, a $4 generic asthma medication. But in 2008, a certain type was pulled from the market because of concerns that its fluorocarbons damaged the ozone layer.

The only option became expensive brand-name drugs. To help cover the cost, Karczmar and his colleagues found grant money to pay for medications and worked out a deal with a local pharmacy to fill prescriptions at a discount. "If we were treating high blood pressure, we could potentially write prescriptions at low costs without having to rely on donations," hesays. "But we're completely relying on donations."

Corwin, who volunteered at the clinic in its early days, calls Karczmar "the kind of guy who takes on projects that need to be done and gets them done. He stays with it." And, "he has a nice way of asking for help."

In addition to his hospital and clinic duties and working with a nonviolence group to establish a health clinic, Karczmar until recently was the president of Miriam's medical staff, an elected post that lasts two years. In July, for his work at both the hospital and the clinic, he was named Miriam Hospital's Physician of the Year.

"He was such an effective leader," Corwin says. "He spent more time and effort on the job than any preceding medical staff president. He did a fantastic job bringing in both community-based and academic physicians, and was able to walk a very fine line between the divergent needs of both groups."

Karczmar is spending a lot of time getting the asthma clinic ready to fold its operations into those of the Rhode Island Free Clinic. His little group can provide better care, he figures, with the help of the Free Clinic's extensive staff and infrastructure, well-established electronic medical records and free-testing arrangement with a local hospital.

"We were just focusing on asthma, but we realized that a lot of our patients have other medical issues," Karczmar says. "It's a more complete approach to patient care than we can provide now."