I was going to start this week’s column with the famed words “Do No Harm” from the physicians’ Hippocratic oath. But when I looked up the actual oath, those words aren’t there.
I’m talking about the medical community’s sacred oath because of the crisis caused by the closing on May 31, of one of Indianapolis’ oldest community health centers.
Citizens Health Center began serving Near Northside neighborhoods from 1650 N. College in 1974.
The clinic was an offshoot of the War on Poverty’s Model Cities program. There was a great need for community health clinics on Indianapolis’ Near Northside and Eastside. The community based Citizens Neighborhood Coalition and Citizens Multi-Service Center helped create Citizens Health Corp. and began to operate a health center.
Citizens began operation three years after the People’s Health Center on the Near Eastside; which was an offshoot of the Near Eastside Multi-Service Center (NESCO). For years Citizens and People’s served the medical needs of the poor, working poor and medically underserved.
But the health care industry is quickly changing. The advent of the Affordable Care Act is quickly transforming how the biggest hospitals to the smallest clinics operate. The big Indy hospitals are cutting expenses, jobs and looking at alliances, partnerships and mergers to stay competitive. So are community health centers.
A couple of years ago, HealthNet acquired NESCO’s People’s Health Center. It retained its East 10th Street facility and maintained Peoples in their name, but they became a part of the HealthNet brand and system.
The story at Citizens Health Center has been somewhat different.
In the last several years, Citizens has been embroiled in a series of problems including a lack of leadership stability. There’s been a revolving door of CEOs. And worse, infighting between the folks who run Citizens Health Center and officials of the Health and Hospital Corp. of Marion County.
The fight stems from the fact that Citizens Health Center is a Federally Qualified Health Center (FQHC).
FQHCs are health care facilities which receive grants under Section 330 of the Public Health Service Act. FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. They must do business in underserved areas and populations, offer fees at a sliding scale based on income, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.
From Citizens point of view, Health & Hospital is the big villain. For several years Health & Hospital was the fiscal agent receiving FQHC grants for Citizens. But that agreement between the two organizations was allowed to expire in February 2012.
Citizens sued Health & Hospital and the Federal government seeking the sole right to receive FHQC monies for the area. In June 2012, Federal Judge Sarah Evans Barker ruled against Citizens’ lawsuit. Citizens appealed and the Seventh Circuit Court of Appeals in Chicago heard the case last month.
Meanwhile, Citizens Health Center wasn’t receiving the Federal FQHC grants. That lack of cash flow imperiled the agency.
I examined the Citizens’ IRS Form 990 tax returns for the three years beginning March 2009 through February 2012. And the last three years with FQHC funding for Citizens. I obtained the public tax records from the Guidestar.org website.
With the federal grants, Citizens wasn’t in bad financial shape.
In their 2012 fiscal year (March 2011–February 2012) Citizens had revenues of $3,653,562 against expenses of $3,381,857; with a “profit” of $271,705.
The previous fiscal year, 2011, Citizens had revenues of $4,460,612, expenses of $4,403,755; a “profit” of $56,857. And in the 2010 fiscal year Citizens reported revenues of $5,074,395, expenses of $5,229,493 and a “deficit” of $155,098.
Examining the three fiscal years I was struck by the sharply declining revenue of Citizens. That wasn’t because of the loss of the federal dollars, but obviously a declining number of patients and customers. The 28 percent loss in revenue over three years is stark.
Now include the shakiness of Citizens’ organization in those years, two CEOs in three years. Their fiscal 2011 tax return was filed over a year late. The fiscal 2010 return was completed by hand, ostensibly by then interim CEO Karen Scrougham. An unusual occurrence for a non-profit then generating over $5 million in revenue.
Also, none of the returns I examined were prepared by an accountant or accounting firm; also somewhat unusual.
Interviewed last week on our WTLC-AM (1310) “Afternoons with Amos,” Citizens’ Board Secretary Margie Oakley revealed that Citizens in recent weeks was trying to reach agreement with HealthNet, the operator of 11 Indianapolis area community health centers. But the Citizens leadership balked at giving up control.
Citizens was like someone playing high trump bid whist with a hand of all five, six and seven cards facing an opponent with kings, queens and aces.
When Citizens suddenly closed down on May 31, there was no warning to patients, the community, staff or other health care providers. In the days to follow, Citizens scrambled to find ways to help their patients get care.
The nearby Raphael Health Center at 34th and Central offered to help. But in an embarrassing exchange on “Afternoons with Amos,” an official of Raphael called in expressing exasperation that they couldn’t get a hold of Citizens Health Center officials. Seems Citizens’ patients were coming to Raphael expecting immediate care and appointments, but Citizens hadn’t forwarded those patients’ records to Raphael – stymieing efforts at care.
After Citizens lost their federal lawsuit in December 2012, and even though they appealed, Citizens still should’ve begun planning for the worst; preparing plans on how to handle their patients and their records in the event of a sudden shutdown.
They didn’t. Instead of thinking of their patients first; they thought of their own self-preservation and survival.
That’s wrong!
You can email comments to Amos Brown at acbrown@aol.com.
