It should come as no surprise that HealthFirst Bluegrass has experienced significant growing pains.
The clinic, split from its longtime home at the Lexington Fayette County Health Department in 2011, took over delivering primary care to those who can't otherwise afford it, while the health department continued its mission of health education and disease prevention.
A newly created independent board of directors oversaw health clinics serving 17,000 patients and was responsible for a federal grant to build a new clinic.
Now, two years out, the clinic isn't built. HealthFirst has received a stinging report from the state auditor and is running a serious deficit; its chief administrator has been fired; only three board members remain, and last summer the Health Department took back control.
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This series of problems could hardly have come at a more critical time. With Kentucky's Medicaid expansion and the rollout of health insurance exchanges under the Affordable Care Act, an estimated 60,000 Central Kentuckians will, come January, at last be able to seek out a medical home where they can get preventive, non-emergency care.
Monday the Board of Health will consider several measures to get HealthFirst back on track and able to expand service to meet the coming demand.
The most critical will be nominating 12 people to join the three remaining on the HealthFirst board to govern the organization.
The first challenge facing the new board will be to create a structure to assure independent, transparent and knowledgeable governance.
Board of Health member Paula Anderson made two critical recommendations at a special meeting Tuesday evening: that new board members be trained in the duties and responsibilities of managing public funds for public benefit and that training be done by someone from outside the organizations.
Anderson's comments mirror key recommendations by the state auditor's office, which sees the results of board dysfunction all too often. The auditor recommends annual training on their duties and the financial and management structure of the organization.
Some other important auditor recommendations:
■ Create a clear, well-defined mission statement.
■ Set up systems to get information from multiple sources, even anonymous ones, and a process independent of management for analyzing, investigating and resolving concerns.
The complete set of 32 recommendations is available at auditor.ky.gov.
Health Department and HealthFirst leaders are looking for people with a variety of skills and experiences to serve on the new board.
This is a critical moment for community members to step up to do the hard, time-consuming but extremely important work of making HealthFirst an enduring community asset. It's important to get this right.
Finally, despite the problems, HealthFirst professionals have continued to serve patients, even expanding services at two primary care clinics in Lexington and eight clinics at Fayette County Public Schools.
The community should offer a sincere thanks to the health-care professionals who have carried on during these challenging times.