Oct 10 2011

The Battle for Title X – Part 3

Posted by Steve Ross in Shelby County, State Politics

When we last left off, I had just finished taking a look at the proposed services to be provided by both PPGMR and CCHC. In addition, we took a look at the individual scores from the six evaluators. I raised some questions about their choices and noted that we’d talk about that more here. Well here we go.

As a part of just about every RFP I’ve ever seen, there is a question period where potential providers get to ask questions, and hopefully get them answered.

This RFP process was no different. Prospective contractors submitted 18 questions and, for the most part, got some answers. From the questions, I’m pretty sure at least one of the potential providers wasn’t too happy about the answers.

Let’s make this easy and start with the first question.

Q: In providing information about pregnancy termination, is it sufficient to have the referral information in writing?

A: No

The rest of the answer goes on to say that patients need to be counseled, not handed a card and sent on their way.

The next question follows the same theme:

Q: If the information about pregnancy termination is provided, is the contractor allowed to indicate in wiriting (NOT coerce) – on a referral sheet or in the office- that
a. it does not provide that service because of its beliefs.
b. or, is the contractor never allowed to indicate its position or why it does not offer the service.

A: (to both questions) No, followed by a long paragraph about the importance of face to face counseling and how the “beliefs of the contractor about pregnancy termination should not be part of a process.”

Whoever asked this question wants to say they don’t believe in abortion to their patients and thinks that will somehow not be coercive? When did medicine become about beliefs? Last time I checked abortion was a medically approved and legal procedure. If a contractor doesn’t feel comfortable referring out, then maybe they shouldn’t be considered. In any case, it seems pretty clear from the way these first two questions were asked that they came from the same prospective contractor.

The next interesting question is number 13.

P.12, paragraph 5: If a contraceptive method is not provided on site by a provider because of the provider’s ethical beliefs, can the provider refer the client to another Title X provider who offers this method? If so, does the referring provider have to pay for the service?

Wait, wait, wait… Contraceptive method? A contraceptive method is against the providers ethical beliefs? Why would they want to engage in this line of work if a medically accepted form of contraception is against their “ethical beliefs”?

To be honest, these three questions left me flabbergasted. Certainly individuals and associations of people are allowed to hold their own beliefs. Certainly, different physicians and networks of physicians have different preferred treatment plans. There’s plenty of room for this diversity out there in the private sector. However, when you choose to enter the public sector by seeking a contract for public dollars, you are bound by the requirements those public dollars place on you. If those requirements are unpalatable to you, then perhaps you shouldn’t seek them.

The questioners aren’t identified so I asked the woman with the Shelby County Government who received the questions if she could identify the questioners for me. Unfortunately, I never received a response to my request. In fact, I never even got a response saying a response couldn’t be provided.

Since I didn’t get an answer from the County on this issue, I decided to take a look at the mission statements of the contractors. Maybe that holds the key to making an educated guess about who asked these questions. Here’s the first one.

Christ Community Health Services will provide high-quality health care to the underserved in the context of distinctively Christian service. We recognize that Jesus Christ is the true healer of individuals and their communities and the source of our ability to serve. (Source)

What’s interesting is neither of the other two potential contractors have anything about “belief” in their mission statements. Here’s Memphis Health Center, and PPGMR.

Now look, I don’t think an organizations beliefs excludes them from serving. They may choose, based on those beliefs, that they don’t want to perform the service or receive the funds. However, I don’t think that being a religious organization is an automatic exclusion. From a practical standpoint, it can’t be. That said, the three questions listed above leave some serious doubt that whoever asked them can provide the services required by Title X.

Nowhere in the RFP is it noted that questions are confidential, or whether or not they will be considered in the evaluation process, so it’s interesting that the County hasn’t responded to my request. The questions are, no doubt, subject to public disclosure. In the interest of full disclosure and the public interest the Administration should list which prospective contractors asked which questions, and whether or not those questions were considered in the evaluations of the proposals.

Of course, had the questions been considered in the evaluation process, it still might not have changed the outcome. The way the score sheets are structured there are 52 points up for grabs in very subjective categories, and no listed benchmarks to be met. That leaves a lot of wiggle room to let your “beliefs” guide you.

As we saw in the previous post, there was a great deal of variation in the scoring, particularly from political appointees. Because specific benchmarks for the scoring of these 52 points are not explicitly laid out in the RFP its hard to know what metrics were used, or explain this variation in any way other than personal preference. Further, because there is such variation in the number of services to be provided, one is left to conclude again that personal preference played a greater role in the process than we’ve been led to believe.

Because of the way the proposals are structured, there’s no way for the evaluations to be “blind”. This, of course, means that anyone with a predisposition against one of the prospective providers would be free to exercise that perspective. Further, because the questions submitted during the Q & A period were apparently not included in the evaluations, the evaluators may not have been aware of the depths of “belief” or ethical conflicts that exist with, what is most likely only one of the prospective contractors. This seems like a huge oversight and opens many potential problems for the County and the people who receive these Title X services.

Tomorrow morning I’ll wrap up my coverage of this issue, with a recap of what we’ve seen thus far, and some additional information that has come my way in the past few days.

Thanks for reading.