Sunday, June 09, 2013

City Confesses to DSHS Shakedown

Consent agenda item #5 was not pulled by any City Council member for more in depth discussion.  Thus it passed in approving consent items.  City Council's agenda packet described the situation as:

5.  Consideration of adopting a Resolution ratifying the application and contract for, and accepting, if awarded, additional FY2014 Texas Department of State Health Services, Regional Local Services System (RLSS)/Local Public Health Services (LPHS) Grant funds in the amount of $20,000.00, to address public health immunization and disease prevention activities and services (submitted by Health Director Sandra Villarreal)
Page 119 of the City Council packet states under History:

Due to the Department of State Health Services policy changes to the Texas Vaccines for Children in January 2012, the Nursing Division experienced a 50-60% decrease in Revenue in FY12. The decrease in revenue, along with the $78,000 decrease in City General Transfer dollars to FY13, left no choice but to cut three positions plus public services in FY13, to include Immunizations and STD Clinics.

The shakedown, which I called last year, materialized recently

DSHS was compelled to assist because San Angelo is considered a HUB to the surrounding counties of DSHS Health Service Region 9/10 and the only local health department for 112 miles (Midland). Region 9/10, comprised of 36 counties, is serviced by five (5) local health departments: Andrews, City of Midland, City of El Paso, Ector County, and City of San Angelo.  Health Services Director reapplied for a DSHS Immunization Grant for FY14, but was denied and reference was made that there is no funding available for new or prior contractors. The San Angelo-Tom Green County Health Department had been a former recipient, last known to receive funding in 2005-06. 
Financial Impact: The receipt of $20,000.00 will pay the rent and utilities of the Nursing Division for FY14.

If positions haven't been restored and funds allocated for personnel and supplies, how does this grant bring back immunizations or the STD clinic?   It doesn't.  It pays rent and utilities for extremely limited services.  The big shakedown is the 1115 waiver.

Three goals the project strives to achieve: 1) offer a lower cost STD clinic, 2) establishing the STD clinic in a central location, and 3) increase the number of patients seeking primary care and treatment for Chlamydia, Gonorrhea and Syphilis at the Local Health Department, thereby providing the right care, at the right place and at the right time.

I would add a fourth goal, paid for by someone else.  The document stated:

in 2011,the Health Department saw 791 patients for initial STD screens for Chlamydia, Gonorrhea and Syphilis, and 414 follow‐up visits
The City cut $138,000 from the current budget, eliminating the STD clinic.  It asks for $887,500 over a four year period to restore the clinic.  Yet during that period the city projects it won't serve as many people as it did in 2011.

The Health Department anticipates that by Year 4, we will see 700 patients for initial STD screening visits and 300 follow‐up visits.
The City expects the state/feds to furnish a new clinic building, but otherwise tax money will supplant funds traditionally spent by the City of San Angelo.  I see the one year cut of $138,000 as a shakedown given the City set aside an unbudgeted $225,000 for a Downtown Master Developer.  Also, it implemented a new employee holiday, estimated to cost $135,000 the last time the city added a day.

The grant application emphasized:

There is no Sexually Transmitted Disease Clinic at the San Angelo‐Tom Green County Health Department, nor any available space, and therefore, hundreds of patients needs are not being met. Therefore, the Starting Point/Baseline of this project is: there is no STD Clinic and no patients being seen for STDs at the San Angelo‐Tom Green County Health Department as of October 1, 2012.
There was one on September 28, 2012.  It was one of the few remaining health services offered by the City.

San Angelo's Mayor New, City Council and paid staff hatched this sleight of hand.  It'll be interesting if CMS sees through it.

Update 7-13-13:  While the city no longer operates a STD clinic, city staff will help the state conduct a STD clinic on July 17 and 19. 

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