Dr. Mark D. Jacobs of Coastal Medical, Smithfield, examines Alan Dauray, 50, Lincoln, who lost his health coverage when he was laid off from work.

The Providence Journal / Frieda Squires

SMITHFIELD — Every month, some of Rhode Island’s neediest citizens play a lottery to get health care.

They stand in a parking lot and wait for their number to be pulled from a box. About half win.

The prize: Free exams, tests and prescription drugs, all through the Rhode Island Free Clinic, in South Providence.

Yesterday, Alan Dauray, an out-of-work mechanic, benefited from the agency’s efforts to reach beyond its Broad Street offices. Dr. Mark Jacobs, a veteran physician in Smithfield, agreed to see Dauray for free.

“My leg hurts, I have a back problem, I don’t feel right,” Dauray told Jacobs. Suffering from abdominal cramps, and unable to sleep, Dauray lost his job with a cleaning company last May. At 50, he needed a colonoscopy, but he no longer had a medical plan. “They wanted $1,500,” Dauray said. He took Metamucil instead.

When the pain persisted, the Lincoln man visited the Rhode Island Free Clinic.

Yesterday morning, Jacobs listened to his heart and examined his eyes and ears. Afterward, Jacobs, in practice with Coastal Medical, ordered a series of treatments –– including a colonoscopy.

“He needs a lot of ongoing care. He’s a smoker, he’s a diabetic, he has an eye problem,” said Jacobs. “The country better start addressing this problem. It’s a huge problem and it’s only getting worse.”

About 130,000 Rhode Islanders lack health insurance, according to the Rhode Island Free Clinic. That number is expected to grow as employers and government programs reduce coverage and more people lose their jobs.

With about 2,000 patient visits a year, the free clinic occupies a small but unique niche. It takes no insurance or government money, charges no fees, and relies on volunteers to provide care. It serves only uninsured people –– including those not covered by Medicaid –– with incomes below 150 percent of the federal poverty line.

For a decade, the clinic has treated the poor in Providence. But because of a limited number of doctors, the clinic relies on a lottery to admit new patients. As many as 40 people seek help each month at the agency’s Broad Street clinic. About 25 get help.

“It seems cold, but we have to manage it,” said Julie White, the clinic’s director of development.

To expand its reach, the clinic in October wrote to 1,100 primary-care doctors, asking them to take on 1 to 50 nonpaying patients.

If enough doctors agree to see patients in their offices, the lottery system won’t be needed, White said. “The uninsured aren’t just in Providence. They’re in Chepachet and Westerly, too.”

Under the program, patients carry Free Clinic cards. If they need follow-up care –– such as lab work or x-rays –– the clinic does it through its own network of providers, also willing to give free care.

“It cuts out all the bureaucracy and the red tape” for doctors, said Jacobs.

In Dauray’s case, a doctor at Roger Williams Medical Center will perform the colonoscopy and Lifespan will do the blood work. Both work with the clinic.

So far, about 40 doctors and specialists have agreed to see Free Clinic patients. The clinic hopes to add 10 more by the end of March, but eventually “the goal is to have hundreds,” White said.

“It’s got to be terrifying to be ill and without insurance,” she added. A doctor’s visit can cost $180. A trip to the emergency room can cost $1,300, she said.

In recent weeks, the doctors at Coastal Medical have seen five patients.

“We’re a very busy practice,” said Jacobs, “but we owe this to the community.”

In a new exam room, Jacobs tried to make Dauray comfortable.

“Feeling a little nervous?” he asked as he took Dauray’s blood pressure.

Dauray nodded.

“Understandable,” said Jacobs.

After nearly an hour, Jacobs conferred with Dauray a final time. “Well,” he said, “we’ve got our work cut out for us.”

Dauray should have a colonoscopy first, then blood work and an eye exam, Jacobs said. “I want you to quit smoking, too.” Dauray, Jacobs added, should work with a diabetic expert. “I’ll see you again in six weeks.”

Depressed since his job loss, Dauray felt better after the visit. “I’m very grateful to have Dr. Jacobs.”

pdavis@projo.com