Bent over and barely able to walk, Dale Gowan turned to Deaconess Medical Center’s emergency room for relief from the pain shooting down from his lower back and into his legs.

“We’re not in the pain management business,” Dale said the ER doctor told him before writing a prescription.

With his long hair and thin frame, Dale’s appearance apparently fit the profile of a drug user looking for a fix. At least, that’s the way Dale believes the doctor treated him - not as a man with a chronic back injury in need of attention.

A spokeswoman for Deaconess denies this was the case, which makes it the word of a health care professional against that of someone on Medicaid. But it would not be the first time Dale, 38, who came to Spokane in search of work with his wife, Rebecca, and their three children, has suffered the indignity of poverty. The family lived in an old school bus before entering a homeless shelter in January.

In March, soon after moving into the Salvation Army’s reduced- rent transitional housing apartments, Dale lost his job as a drywall hanger. His employer had read about Dale’s back problems in The Spokesman-Review.

More than 20 years of drywalling have damaged the vertebrae in Dale’s back, making it dangerous for him to continue the only work he knows.

In health care matters, the United States is still pretty much a country where you get what you pay for. By that standard, the Gowans are fortunate to have the care they are receiving at the Community Health Association of Spokane’s Maple Clinic.

CHAS, a nonprofit system of federally qualified community clinics, provides medical and dental care to patients regardless of insurance status. In 2003, the clinics treated more than 24,000 people, 18 percent of whom were homeless.

Nearly five months after his first visit to the Maple Clinic, Dale, who was diagnosed a year ago in Boise with a bulging vertebra, has yet to see a neurosurgeon or even get an MRI. Though primary care is available to the poor at clinics such as those run by CHAS, specialized care is still hard to come by for an estimated 45 million uninsured and an untold number of underinsured Americans.

Spokane is no exception.

“We haven’t as a community gone to the next step of getting people who have extreme needs that special attention,” said Becky Swanson, vice president for marketing and communications at Empire Health Services, which runs Deaconess.