Oct 05 2011

The Battle for Title X – Part 2

Posted by Steve Ross in Shelby County, State Politics

As noted in my last post, there has been a great deal of politicization of this issue, not just at the state and local level, but nationally. What gets lost in this political tug of war are the people who stand to benefit most from the family planning services that would be provided. This issue is more than just about unplanned pregnancies and STD’s, its also about arming people with the information that will help them reach their fullest potential educationally and professionally.

Study after study has shown that women who have children before they complete their education are far less likely to do so. This negatively impacts their income potential, and in the long run, many more things.

From this frame, the importance of family planning takes on a different character. Family planning is not just about stopping unwanted pregnancy or slowing the rate of STD infection, but it also is a workforce development strategy. The fewer unintended pregnancies that occur in women at an early age, the more likely they are to finish High School, College, and perhaps more.

With all this in mind, the numbers matter, and that’s what we’re going to look at today.

Going by the numbers

The RFP’s presented by Planned Parenthood and Christ Community Health Center (ed note: CCHC also has this program work plan that wasn’t included in my copy) detail the services each group plans to provide and the means by which they intend to proved them.

While both plans deal with many of the same things the quantities are different. The following table is a breakdown of the services that both organizations offer, and the quantities.

Services Planned Parenthood Christ Community
Health Center
Proposed number of Clients to be served over the 9 month period of the contract 3500

Reference – p. 19

2000

Reference – p.1 CCHC work plan

Provide Preventative health care services (includes testing for breast cancer, cervical cancer, STD, and HIV) 2000 HIV tests
6000 Gonorreah tests
30 Gardasil vaccinations
2500 Clinical Breast Exams
2500 Pap tests
95 colposcopy
10 cryotherapy

Reference p. 18,19

No number given
Contraception 130+ Long Acting Reversible Contraception
650 Emergency Contraception
130 IUD
30 Implanton
20 IUD
20 Implanton

No other mention of contraception in the work plan

Pregnancy Testing 5000 pregnancy tests None listed
Other Services listed 3000 3 month supplies of 400 mcg folic acid

It should be noted that in the actual RFP, Christ Community lists that some 3375 individuals will be served over the 9 month period of the contract, however, their work plan lists 2000. This inconsistency should have caused a good deal of confusion with the individuals scoring the proposals. However, the score sheets show no markdown for this inconsistency.

Another thing of concern in the CCHC proposal is the absence of current Family Planning staff. Both the narrative and the work plan list that staff will be hired upon receiving the contract. This should have raised serious questions by the evaluators, yet this, again, is not evidenced by the score sheets.

So what of those score sheets? You can see them here, and that’s where we take back up the political angle of this story.

Confronting the Judges

From looking at the information provided above, it appears that there might have been a mistake, to put it mildly, but it was noted in the County Commission meeting on September 21st that Planned Parenthood had lodged a complaint and that complaint was found to be without merit. One of the Commissioners characterized this as a contractor that was just complaining because they didn’t win, but it seems like there’s a little more to it than that.

In order to really get at the judging, you need to know who the judges were. Here’s the list:

Yvonne Madlock – Director of the Shelby County Health Department
Harvey Kennedy – Shelby County CAO
Bill Powell – Shelby County Criminal Justice Coordinator
Kim Hackney – Shelby County Director of Legislative Affairs/Sr. Policy Advisor
Dr. Kenneth Robinson – Shelby County Public Health Policy Advisor
Dr. Helen Morrow – Acting Shelby County Health Officer

First and foremost, I don’t want to besmirch the names of these individuals. They are all serving the public in their official capacities and I’m sure they’re good people. Some have medical or public health training, others do not. Some are appointees from the current administration, others are holdovers. I’m not interested in attacking anyone, but I do think there is a good deal of cause to question the choices made by some of these evaluators. So, rather than make a claim I’ll try to either ask a question or point out an interesting pattern.

Below is a spreadsheet with all the evaluators scores for both PPGMR and CCHC. Each organization’s scores are on their own sheet.

What is, perhaps, most interesting about these scores is that the three top political appointees for the administration on this evaluation team scored Planned Parenthood in the 80’s, despite far more bang for the buck in terms of service delivery. The primary determinant is the “Clinical Services” section listed on page 29 of the RFP. While the CCHC scores show little variation, the PPGMR scores vary wildly with a 10 point range. That’s some serious disagreement.

So what does “Clinical Services” refer to? Let’s take a look:

Now, it could be argued that because CCHC has six locations, they should have been scored higher. I would agree with you if they had staff currently in place, but as I noted before, they do not. Six locations, with no staff to serve these individuals is about like having zero locations or six “potential” locations. Why on earth would anyone rate that unfulfilled potential between 5 and 10 points higher than a provider that has one location that is, you know, actually functioning.

“Project Approach” is the other area of variation. The section is too lengthy to quote or screen cap, but you can find it on page 26 of the RFP.

This seems to be directly related to the services that the prospective contractors will provide. As I showed above, PPGMR proposes to provide a good deal more to more people than CCHC, so one has to wonder why PPGMR was rated below CCHC?

I’m not going to lob any charges at anyone. I don’t know these people. But I am going to say that it might be a good idea for them to start thinking about how they’re going to explain these scores if the process was truly unbiased, as asserted in the Committee meeting on September 21. It doesn’t seem very likely that some of the highest ranking people in the current administration would miss these huge discrepancies in services, and rank the vendor that proposes to provide less higher, but either they did, or they went in with a purpose in mind. In either case, this certainly doesn’t instill much faith in the process.

This has been a long post, and of course, there’s more to it that what I’ve presented so far. That said, in the area of pure levels of service, PPGMR has proposed to do much more than CCHC. On that account alone there are some serious questions to be raised about the scoring process. At the end of the day the big goal should be the number of people served. That’s the thing that will combat teen pregnancy, infant mortality, and an increase in the incidence of STD’s. Based on the information I’ve reviewed, I’m not seeing that CCHC is providing more of anything.

What’s worse, there are more questions about CCHC, like just how committed they are to following through will delivering all the accepted methods of family planning.

That’s coming up in my next post.