An atmosphere of "fear and intimidation," problems with the "bureaucratic nature" of management and a workplace in "crisis."
That's the way employees of the Lexington-Fayette County Health Department last week described the climate in which they work.
But the problems they talked about at public meetings are not new. When Dr. Melinda Rowe became commissioner in November 2003, similar problems existed at the department, and she promised to resolve them. At the time, the Primary Care Center, a medical facility for the poor that operates under the umbrella of the health department, eventually had to stop taking adult patients because a number of doctors had resigned and there was no one to see new patients.
In mid-2004, a consultant's report said the department was in danger of an "implosion" if matters were not resolved, including making the Primary Care Center more independent from the board of health.
When asked how such problems could continue until now, apparently without being addressed satisfactorily, Susan Straub, spokeswoman for Mayor Jim Gray, said, "That's a very good question.
"The issues first came to our attention last week. By Thursday, there was a public meeting called for by the mayor. The mayor is determined to get to the bottom of these issues and is working with the Board of Health to do so."
Management problems are just one challenge facing the health department. On Friday, health officials confirmed that two primary care employees — the chief operating officer and the head of the pharmacy — were reassigned late last year because of an ongoing investigation by the state Board of Pharmacy and the Cabinet for Health and Family Services' Office of Inspector General.
Health officials also are searching to find land on which to build a medical facility in order to keep an $11.7 million federal grant.
But the management issues seem to be a continuing difficulty. A key recommendation of the 2004 consultant's report by David Bolt, then head of the Lewis County Primary Care Center, was that Lexington's Primary Care Center be given more autonomy.
The issue of independence continues to be a source of conflict between the Lexington health department and its care center.
Dr. Rice Leach, who left as executive director of primary care last March, said the inability to achieve that separation was the reason he resigned after 44 years in public service.
Although there were positive changes at primary care during his tenure, he said, the issues of management and governance were too great to overcome.
"Some would say little has changed" in the seven years since the first consultant's report, he said.
Independence key to grants
The ideal arrangement for Lexington would be a relationship that mirrors what is done in Louisville, said Leach. The Family Health Centers of Louisville have a collaborative relationship with the department of health but are not under the direct supervision of the commissioner of health.
Leach said efforts were made to create a separation between primary care and the health department throughout 2006 and 2007. Representatives of the Board of Health and the Primary Care Governing Council met regularly, and field trips were organized to other primary care centers that had achieved independent status.
A draft of a resolution that would have established a more independent relationship was approved, according to the minutes of a board meeting.
But the joint meetings were suspended from 2008 until January 2009, according to Board of Health minutes. The group began meeting regularly again last summer.
Leach said the issue of independence is key because the federal Health Resources Services Administration, which provides the center with $2 million a year and is administering an $11.7 million grant for a new building, has clear expectations that primary care be independent.
Who's in charge?
Rowe, head of the health department, has had problems at other venues. She served as director of the Jefferson County Health Department from 1995 to 2001. Rowe was fired by Rebecca Jackson, then judge-executive, but refused to leave the job.
At issue was an audit critical of the handling of funding to the Healthy Start program and Rowe's refusal to eliminate 20 health department jobs to trim the budget. Rowe eventually went to head a health department in Savannah, Ga.
The questions of just who is in charge and who reports to whom are at the heart of the recent ouster and subsequent reinstatement of William North, the current executive director of the Primary Care Center.
Rowe suspended North, but the board that oversees primary care said that under its bylaws she had no authority to do so.
Rowe has not said when North's suspension started or why he was suspended. She declined to comment Friday.
A series of emergency public meetings followed North's suspension. In those meetings, employees complained about mismanagement and poor working conditions. North was reinstated Thursday and was greeted with a standing ovation by staff members at a meeting that evening.
Since May, the health department has paid a University of Kentucky professor $6,000 a month to work with management to improve the work environment.