The Fayette County Board of Health did the right thing last week in firing HealthFirst director William North and asking the remaining HealthFirst board members to resign.
The day after those demands were made, the remaining members of the HealthFirst board — four of the 11 have resigned — refused to address them.
When the HealthFirst board meets again Thursday, it should reconsider and agree to the Board of Health's demands.
Those are extreme measures, but unfortunately that's what the situation demanded. HealthFirst, the nonprofit entrusted with public monies to provide health care for the disadvantaged in Fayette County, had fumbled the job.
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Much worse, North and the HealthFirst board had insisted they weren't obligated to tell the public what was going on, and they dismissed a damning report by State Auditor Adam Edelen's office.
Auditors said HealthFirst had pre-selected a construction manager for the new clinic, only going through motions of considering other candidates. The report also raised questions about HealthFirst's financial stability.
What's at stake is huge.
HealthFirst currently serves 17,000 patients a year, almost all from Fayette County. But, next year when Medicaid will expand and many Kentuckians gain health insurance, that number could more than double.
Although an $11.7 million federal grant was announced in the fall of 2010 to build a new primary care clinic in Lexington, HealthFirst has yet to begin construction, much less outfit and staff a clinic to serve those who will be looking for a medical home.
It also means that HealthFirst will not be able to capture the revenue that would be available from the insurance that will soon be available to those patients.
It is impossible to tell what combination of individual or collective dysfunction within HealthFirst led to this situation.
The history is certainly complex. The nonprofit HealthFirst was created to operate the Board of Health's Primary Care Clinic. Under federal guidelines, 51 percent of the board must be people who use the clinic's services. So a new board with little experience in the complex field of health care and apparently little training on their responsibilities as board members, took over governance of an existing publicly funded clinic with thousands of patients.
In addition, HealthFirst, like so many other providers in Kentucky, has struggled with delays in Medicaid reimbursements for services provided, a situation that's created cash-flow problems and, no doubt, distracted the board and management.
There's also the point, made by Tom Burich, chairman of the HealthFirst board's building committee until his recent resignation, that getting the new clinic project off the ground may just be more than the board was prepared for.
Last month Burich described "a little board" that was loaded down with "a big new responsibility." At the time Burich proposed a motion, adopted by the board, to abandon the clinic project if other Lexington Fayette Urban County Government and/or others didn't come forward to help with financial issues.
What's clear, though, is that the board simply doesn't understand the public nature of its work and the responsibility to operate transparently.
Board members have complained that Mayor Jim Gray asked the auditor to review operations, even though they receive money from Lexington taxpayers and wanted more. Their response to the audit was so inadequate that Board of Health Chairman Scott White called it "delusional."
We thank the HealthFirst board members for their service under difficult circumstances, and the Board of Health for moving decisively to address this unfortunate situation.
Now, it's time to move on.