Mayor: 'Too many symptoms' of management problems at health department

Boards split overprimary care head

mmeehan1@herald-leader.comFebruary 23, 2011 

  • What aboutthe $11.7 million grant?

    All the turmoil at Lexington's Primary Care Center comes at a time when the health department and the center are scrambling to find land to build a 60,000 square-foot facility and hold on to a $11.7 million federal grant. Both sides say that work continues smoothly.

    That project was announced in October, but last week it became public that one of the partners in the project, the Bluegrass Regional Mental Health-Mental Retardation Board, had pulled out. The mental health board was donating $2.4 million in land.

    Health Department Spokesman Kevin Hall said last week that as the grant moved forward, the federal Health Resources and Services Administration required that Lexington's Primary Care Center change the scope of its care. Essentially the federal authorities wanted the health department — not the mental health board — to provide in-patient mental health services at the center, he said.

    But, according to minutes of the Primary Care Center Governing Council, the problem of the scope of care was raised long before the official announcement of the project was made with great fanfare in October.

    Former Executive Director Rice Leach raised the question in March 2010, the minutes state. In a statement Tuesday, Lexington Mayor Jim Gray said the grant is something "we can't afford to lose."

    Mary Meehan

The head of Lexington's Primary Care Center, part of the city's health department that provides health care to the poor, has been suspended with pay by one board and reinstated by another. And it's not clear who is running the clinic that serves about 18,000 patients a year.

On Tuesday, Mayor Jim Gray expressed concern about the growing turmoil involving the care center and health department.

"We are carefully investigating this situation," Gray said. "I've been in a management role for almost 40 years, and I am concerned that too many symptoms point to management and leadership issues at the Lexington-Fayette County Health Department."

"Especially when health care is at stake, we must act quickly to ensure there is no harmful impact on patients," Gray added.

Dr. Melinda Rowe, commissioner of the Lexington Fayette County Health Department, said she will cooperate with any efforts made by the mayor and is willing to address any staff complaints.

A meeting has been called for 5:30 p.m. Wednesday to hear from staff about the center's executive director, William North.

At two emergency meetings called last week by the board that governs the center, concerns were raised about North's suspension and patient care.

The center is the subject of an investigation by the Kentucky Office of the Inspector General. Employees have alleged there is a Drug Enforcement Administration investigation involving the center's pharmacy, too, but health department officials have denied that. The DEA did not return a call from the Herald-Leader on Tuesday.

Much about the situation at the center remains unclear, including who is in charge.

Bill Rasinen, chairman of the center's governing board, said in a statement Tuesday the board will support its medical director, Dr. Deborah Stanley, in running the operation in the absence of North. But, according to health department spokesman Kevin Hall, Stanley was not scheduled to work Tuesday or Wednesday. She did not return a call from the Herald-Leader to her home on Tuesday.

Hall declined to say why North, who has been on the job about six months and came from Colorado Springs, Colo., was suspended or how long his suspension will continue. Hall said department heads are running the center.

Rasinen declined to comment beyond his statement, but he said the center's board is concerned about the "working conditions at the Primary Care Center" and hopes to resolve the problems as quickly as possible.

Even getting comments from staff on North's situation has caused controversy.

Cindy Derer, a member of the board of health, and John Loventhal, a member of the center's board, have called the Wednesday meeting at the care center's office at 650 Newtown Pike.

The meeting announcement sent to staff Tuesday said the meeting was suggested by the mayor's office and it was to be closed to the public to provide staff a chance to make comments anonymously. Spokeswoman Susan Straub said the mayor's office did not suggest the meeting.

Gray has said the meeting should be open and he would be sending a representative. He has also asked the Kentucky deputy commissioner of public health to attend. Meanwhile, Richard Moloney, Lexington Mayor Jim Gray's chief administrative officer, has been assigned to work on the issues with the Primary Care Governing Council and the Fayette County Board of Health, said Straub.

An eight-member committee, with members of each board, will hear comments at the hour-long meeting. Staff members wanting to speak were asked to e-mail Derer or Loventhal to get on the agenda. They will each be allowed 3 to 5 minutes to speak.

"If there are more speakers than we have time to hear, names will be drawn from a hat for fairness," the announcement states.

Neither Derer nor Loventhal returned calls Tuesday from the Herald-Leader.

The Lexington Fayette County Health Department is the only health department in the state to operate a Primary Care Center. The center, where patients are seen by doctors and dentists, is overseen by both the Board of Health, sometimes called the "big board" by employees, and the Primary Care Governing Council, known as the "little board."

The Primary Care board makes recommendations to the Board of Health, but those recommendations are not binding.

It's unclear how long North has been suspended. However, the Primary Care Governing Board recently held two emergency meetings to hear staff concerns. During the meeting Feb. 20, the board evaluated North and "rated his performance as very high and voted unanimously to retain Mr. North in his position," according to Rasinen's statement.

North did not return phone calls from the Herald-Leader on Tuesday.

Although there has been talk for years that the Primary Care Governing Board should be an independent agency, it remains tied to the health department.

Dr. William Dake, a family practitioner at the center since 1993, said tensions are running high at the center. Comments made at earlier meetings about the poor quality of the care given at the center are not reflective of the overall work provided, he said. But Dake added that doctors are working without sufficient malpractice coverage and that the Board of Health is dragging its feet in providing it.

Hall said that's not true.

"Our providers are currently covered and meet federal guidelines for malpractice insurance. Department providers have requested additional coverage, and we have been working on obtaining it since October 2009," said Hall. "It's a niche product and can be a cumbersome process. It's not as simple as applying for insurance with GEICO."

Reach Mary Meehan at (859) 231-3261 or 1-800-950-6397.

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