vibinc

Over the past week I’ve written several posts about the contract to provide Family Planning services to individuals in Shelby County. The first post dealt with the political issues involved. The second post took a look at the services to be provided and inconsistencies in scoring based on the quantity of those services. Yesterday I pointed out concerns relating to the ability and/or willingness of one of the potential contractors to fulfill the requirements of the Title X program. Unfortunately, the County didn’t respond to my inquiry about who asked the questions that would lead one to believe they could not fulfill these requirements on the grounds of their “ethical beliefs”.

On Sunday, Wendi Thomas at the Commercial Appeal wrote an article about the issue, and brought up some additional concerns. In that article, she quoted a previous article where the founding physician of CCHC indicated they would not follow the letter of the regulation relating to referrals for pregnancy termination. From her article:

“We really try to provide women with other options and make sure they have those possibilities. And if they at the end still want a pregnancy termination, we know they know where to go,” Rick Donlon told The Commercial Appeal last month. (Source)

There’s one simple truth about receiving public money for a service:

“Play by the rules, or the money goes away.”

For something like Family Planning, the cost of the money going away is huge. The thousands of people served by these funds would be left abandoned without the benefit of these services. If they go away that means a whole lot of women will get pregnant, quite possibly at a time when they aren’t ready. The pressures that unwanted pregnancy will place on them, and the community at large, are huge. Quite honestly, we can’t afford to play games with this money.

I understand there are those in state and local government that have a problem with PPGMR, who has been providing the services for some time in this community. I wish they would acknowledge that those problems have little to do with the actual services that PPGMR renders with this money, and more to do with a service they provide that the money doesn’t touch. Remember, no Federal money can go for providing abortions according to the Hyde Amendment.

That said, Title X funds recipients are bound by the terms of their contract to refer women who ask to a place that does provide abortion. Saying “I think they know where to go” doesn’t fit with the demands the money places on the provider.

There’s another issue that I haven’t touched on, and that’s of staffing. PPGMR already has staff in place to serve people under this program. They’ve been doing it for years, so of course they do. CCHS doesn’t. They explicitly list that they will have to hire 7 people just to execute the contract (you can find this on p. 14-15 of their proposal). That’s a huge problem. How long will it take to get that staff in place and trained? What makes CCHS so much different from the Health Department, who initially refused the money for the very same reasons? Why does CCHS think they can ramp up services quickly enough to be an effective provider?

Another really important question on this same line is why isn’t this weakness in the CCHS proposal reflected in the scores given by the 6 member ad-hoc purchasing panel? The RFP itself expressly states that the personnel must be in place. Here’s the section from page 15 of the RFP:

That this weakness in the CCHS proposal isn’t reflected in the scores, nor addressed in any official statement from the Shelby County Government, raises many questions about the fairness of the process. This is something that all the evaluators need to account for, as it is listed as a requirement, not a goal.

On Wednesday at 9:45 am the Health and Hospitals Committee will take this issue up again. As of right now there’s 1 hour scheduled for the discussion, though I feel certain that it will last much longer than that. I hope that the Commissioners give the issues I’ve raised over the past several posts a serious look. The lives of thousands of people in Shelby County are depending on them to exercise their oversight over the Administration, and get real answers.

Considering the challenges we already have in Shelby County with poverty, infant mortality and teen pregnancy, it hardly seems like a time to politicize a process that will directly impact some of the most at risk individuals in our community.

We’ll see on Wednesday.

Thanks again for reading.

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.