On Monday, local health officials will consider leasing and financing plans that should move along the process of spending an $11.7 million federal grant and expand health clinic services in Lexington.
It is the latest in a long series of incremental steps that have resulted in little tangible action since October 2010, when the grant was announced. Plans have gone from expansive — a new campuslike setting with the donation of $2 million in land — to the familiar — a revamped clinic in the same space it has occupied for 30 years.
With the grant's use-it-or-lose-it deadline looming in September and Monday night meetings at the Lexington-Fayette County Health Department and HealthFirst Bluegrass, here's a Q&A about issues surrounding the grant.
Question: What is the purpose of the grant?
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Answer: The $11.7 million grant was awarded to the Health Department and HealthFirst Bluegrass, operator of the primary care clinic, in October 2010. It was one of 144 awarded to health centers across the country, including three in Kentucky.
The goal of the grant was to expand health care to the under-served of Fayette County. Over the years, health officials have said a new clinic would allow double the number of people to be served and add dozens of jobs. The clinic serves mostly the poor and uninsured, and the number of people using its services is expected to swell under the new national health program.
Q: How are taxpayers affected:
A: Consider these numbers
■ 17,000: People now served by the clinic.
■ 30,000 to 40,000: People who could be served by an expanded clinic, according to health officials.
■ $18 million: annual budget of Lexington-Fayette County Health Department.
■ 200: Health Department employees
■ $10 million: annual budget of HealthFirst Bluegrass, which operates the health clinic.
■ 120: HealthFirst employees.
■ $37 million: Local property tax dollars spent on public health through the Health Department since 2005.
Q: Why is this taking so long?
A: The relationship between the Board of Health (aka The Big Board) and HealthFirst (aka The Little Board) is often cited as at the root of the conflict. (See timeline below)
Control and money seem to be at issue. Dr. Rice Leach, the health commissioner, has publicly advocated changing the "The Big Board/Little Board" dynamic since at least 2006 to allow HealthFirst to control its budget and have a consistent amount of Fayette County tax dollars with which to operate.
In 2011, federal officials said HealthFirst had to become an independent organization with an independent board and have a standard allocation of tax dollars to use the grant. The state auditor made the same recommendation in a special report the same year. William North, executive director of HealthFirst, said the relationship between HealthFirst and the Health Department was unique. Out of 1,200 federally designated health centers in the country, fewer than 100 had a similar structure.
Last June, the Primary Care Center became HealthFirst, an independent non-profit with a fully independent board.
Q: Is the conflict being resolved?
A: Leach and Dr. Gary Wallace, current chairman of the Board of Health, said there has long been tension over money going to public health issues such as emergencies and immunization, which the Board of Health oversees, and the health clinic, where HealthFirst provides day-to-day services.
Both said these tensions could be traced to the tenure of Dr. Melinda Rowe as health commissioner. She retired in March 2011 after employee complaints of mismanagement and low morale.
Former HealthFirst board chairman Bill Rasinen said the Board of Health seems intent on extending its control over the Little Board, and holding on to the purse strings is one way to do it. He said he had hoped the technical separation would strengthen, not weaken, the working relationship between the boards.
"It hasn't worked out that way," he said.
HealthFirst chair William Lester said the different interests of the boards — the Board of Health's focus on prevention and HealthFirst's on day-to-day health — has caused the groups to have different priorities, and those still need to be addressed.
Even after the Board of Health voted April 9 not to let HealthFirst stay in the location where it has been for 30 years, health officials and Mayor Jim Gray said relations between the two boards were improving. But at an April 19 HealthFirst board meeting, member Tom Burich and Leach exchanged several testy remarks.
A joint committee of both boards was to have been Monday, but the meeting was canceled to give both sides a chance to review Leach's proposals on office leases and tax appropriations, said Health Department spokesman Kevin Hall.
North said relations between the boards continue to improve. The tensions that might be evident are a reflection of the passion the volunteer members of both boards have for their missions, the frustration in the grant process and the shifting health care landscape.
"I would rather that they be passionate than not," North said. The grant, he said, "is obviously very important to us and to the community.
Q: Setting an annual tax allocation for the clinic was proposed years ago. Why didn't it happen?
A: Before becoming an independent non-profit last summer, HealthFirst had acted under the umbrella of the Health Department and, as such, the Board of Health treated it as any other department, Wallace said. Tax dollars were distributed where they were needed, he said. The Board of Health is considering a proposal by Leach to set the tax allocation at $1.2 million for the next five years.
Q: The Board of Health voted against allowing HealthFirst to stay at its current location on April 9. Why?
A: The board said it was a "business decision" not to let HealthFirst stay at the Health Department, at 650 Newtown Pike. The board had been working on plans for using that space and other Health Department buildings, Wallace said. HealthFirst had been looking for new clinic space for more than a year.
But 10 days later, Leach presented a plan to HealthFirst to allow it to stay in the building.
Q: Why can't HealthFirst find a place for a new clinic?
A: HealthFirst is essentially a new organization, said North. It has no credit, and despite public pleas for help from the local lending community, it has not been able to secure enough funding to buy a building.
HealthFirst has looked at more than 40 buildings but hasn't found anything suitable for which it can secure funding, North said. Since last spring, the HealthFirst concentrated on obtaining the former Verizon building on Harrodsburg Road. The board stuck with that property for so long because it thought a resolution was closer than it actually was, Lester said, adding the board recently hired a real estate agent to help it obtain a property. North said HealthFirst was looking at other locations at the same time.
Leach has recommended against using the borrowing power of the Board of Health to help secure a lease or contract on a building. The Big Board has agreed, citing problems of liability if something were to go wrong. With the current national health system in upheaval and expected cuts in funding, the Health Department might need that borrowing power itself, Leach said.
Q: Will the grant disappear in September?
A: In recent interviews, Gray, Leach and Wallace said they don't necessarily think that the September deadline means the grant will expire. North has mentioned several deadlines during the grant process. Most recently, he said that the grant expires Sept. 30 but that HealthFirst could file for an extension.