Here is the article that was published online on 7/6/18: www.stltoday.com/news/local/govt-and-politics/st-louis-city-county-join-together-to-tackle-std-problem/article_c8adf797-3b1a-5bd3-a94b-a644ab2b6a5e.html
And below is the entire email that I sent to the reporter the previous day. I am not for one second suggesting that anything was taken out of context, but I do feel it is important in a free society to be able to communicate freely and without being edited by anyone who may have a different agenda.
Some points of clarification:
HAVING CLARIFIED THINGS, I do indeed wish the new consortium well as I stated in my email to the reporter. I have every confidence that, with their greater resources, bigger staff and stronger financial backing, the new contractors will able to absorb the cost of the STI program, better than we ever could.
I am especially grateful to the County residents who are essentially paying for the treatment of STDs in the City. It is this kind of partnership that will bring about much-needed change. The spirit of partnership is far more important than any efforts that some may make to be divisive or to make for a sensational story.
I believe the new physicians who have assumed this contract are good and professional people, and I fully expect them to effect great change, especially with the backing they have. No reporter is going to bait me into saying anything bad about any other physician or clinic in town. We physicians simply don't sink that low - leave that to the politicians.
Here are the two emails, the first from the reporter to me on 7/3/18, and then my response to he on 7/5/18.
Blythe Bernhard Jul 3 (5 days ago)
What are your thoughts on not receiving the latest STD contract from St. Louis city? Why do you think they went in a different direction?
What are your thoughts on the consortium that did receive the contract?
Is there any lingering animosity toward St. Louis County department of health over the handling of the STD problem in the region?
Pam Walker said North City Urgent Care will close without city funding. Is this true? What is the economic impact of losing the contract?
How do you respond to the state saying you were violating the contract and double dipping by charging $30 for STD office visits? Do you think that played a role in the contract decision?
You said not charging the $30 copay would "render the STI contracts illogical." What do you mean by that?
It seems like the payments for STD services were often delayed or otherwise complicated. Do you think the city health department was efficient or competent in its handling of the contract?
Are you working with the St. Charles County health department in any capacity?
Do you intend to bid for any contract again?
St. Louis Post-Dispatch
Blythe Bernhard Jul 3 (5 days ago)
Sorry, I forgot to send this yesterday. Happy Independence Day!
I went through each of your questions and talking points one by one. I hope you'll find my answers comprehensive and detailed. Please feel free to quote me in any way you deem appropriate.
1. My thoughts on not receiving the latest STD contract from St. Louis City, and why I think they went in a different direction:
I think such a contract should be reviewed at least every 3 years, if not annually, as I said when you asked me earlier this year. Thanks to your article in February, I think the City was reminded that it had a duty to the people to 'shop around' for the best possible contractor, not just for STI, but for all such contracts. It's perfectly reasonable to give someone else a chance to demonstrate their skill and efficiency with a task and it was high time that such a contract was awarded to someone else. I had gently mentioned this to the Health Commissioner several times but I don’t know if I articulated my concerns terribly well, at least not well enough to be taken seriously, so I was somewhat relieved that this 'course correction' arrived after some prompting from the media. Frankly, I don't think any organization should hold any contract for more than a year or two, but that's just the way I think.
I truly believe that the government, be it federal, state or local, should be afraid of the people, and not the other way around. Good journalism forces accountability in public officials and, although it may sometimes cause a little pain, it’s necessary in a progressive and civilized society.
2. My thoughts on the consortium that did receive the contract:
My staff and I are truly overjoyed that this consortium received this contract. It was long overdue that such a consortium contract was awarded. The City's new leadership has demonstrated wisdom in this choice. Each of the members of the consortium will have far superior financial backing than we had/have, more staff than we had/have, and vastly more equipment and resources than we had/have. If I was running the Department of Health, I would have awarded this contract to such a consortium years ago. I have no doubt that they will deliver on their promise to finally change Saint Louis' #1 position as STD capital of America for the past 50 years. I think people will applaud the results that I believe we will see very quickly and as a member of this community, I do sincerely wish the new contractors the very best, and so do all my staff.
Simply put, we did our best (actually for far longer than we should have done) wearing this STI mantle, and it’s high time for someone else (someone stronger, wealthier and better-equipped) to take it on. I have every expectation that they will succeed where we could not, especially as we only treated 16% of the entire St. Louis community. The fact that it is multiple clinics replacing just two clinics also speaks to the City’s realization that more resources and more locations were needed to meet the challenge. The City has demonstrated a rare wisdom in issuing this new contract.
3. Is there any lingering animosity toward St. Louis County department of health over the handling of the STD problem in the region?
I didn't realize there was any animosity toward them in the first place. I have heard some people make the observation that the County has 'dumped' STD patients onto the City, much like the allegation that it has done so with regard to the homeless, but I was not aware of anything that resembled animosity. I am a County resident myself and I believe the County does the best it can do, given its resources, with regard to STDs.
Also, it should be noted that the County is a willing member of the new STI consortium, the County taxpayer should be thanked for helping subsidize the regional problem of STIs. This will be a great step in the right direction toward an inevitable City-County merger, if only at the Health Departments level, which I wholeheartedly support.
4. Is North City Urgent Care (NCUC) closing without the STI Contract?
NCUC might sadly close later this year, but it is open as of now. You may recall that almost a year after we opened North City Urgent Care, the Post ran a story where I stated that the facility might close because of the lack of insured patients, and it also highlighted why no other healthcare organization had been willing to open in that neighborhood. Primarily, although NCUC didn't profit from the STI contract, the arrangement served to make people aware that NCUC existed in the first place, and that kind of intangible marketing effect certainly helped.
STI patients, their relatives and their friends would hear about NCUC, just by word of mouth, and then they would come back and use the facility for a large variety of non-STI problems. Unfortunately, because such an attention-getting situation has now ended, it is likely that NCUC will close by the end of Q3 or Q4 this year, but we are still analyzing the patient numbers and hoping that we can delay or even prevent such a closure.
As you may already know, we started a free urgent care at NCUC on Tuesdays a few months ago, and that has been remarkably popular. We’ve received over 100 applications from people wanting to volunteer there during the free clinic!
If there was a method to the madness of starting a free clinic, it was to raise awareness of the existence of the facility, much like the STI contract did.
If NCUC does see an increase in patient volume in the next few weeks then of course it won't close, but if we can't afford to pay our staff or keep the lights on, then we will have no choice but to close. I am feverishly working on any solutions to keep NCUC solvent and open. We are doing everything we can to prevent the elimination of jobs and worse, a return to the area no longer having a true urgent care center.
NCUC has proven itself to be a very important healthcare resource for people who live in the Northside, where transportation can be a major challenge. We love serving this community and have been working hard for them since 2013, seeing between 15 and 30 patients a day. NCUC is still open and we do hope to keep it that way. We are still glad to see STI patients and will work with them to identify another affordable payment option if they do not wish to go to the free clinics. However the City-funded free STI services ended at NCUC on June 30th.
I am optimistic that the new STI contractors will succeed with free care where we simply couldn’t because, as everyone knows, they have more staff, significantly more money and far more equipment and resources. The new STI contract ,which I personally believe was prompted by the call for public accountability sought by the Post article in February, also serves the St. Louis community by highlighting where people can go to get free care, of any kind, not just STI.
Awarding the STI contract to this consortium will also help the uninsured know where to go for all their other medical needs, and not just STI matters.
It’s not fair or accurate to label the individual members of this new consortium as ‘The STD Clinic’. It’s more accurate to portray them as grant-maintained and heavily subsidized, wonderful facilities that do go out of their way to care for the underinsured and the insured.
Not being a recipient of any grants (governmental or private) or indeed any other kind of subsidy, NCUC depends on patient numbers to keep it solvent, especially those with insurance, Medicare or Medicaid. NCUC has always embraced those on Medicaid (which includes many veterans).
It may be worth noting that perhaps the biggest financial constraint of any clinic operating in an underserved area, such as NCUC does, and their ability to stay open is the State's refusal to expand Medicaid.
As a physician, it is my opinion that a state’s refusal to expand Medicaid is a violation of trust and a dereliction of duty to the citizens of that state, and not just to those below a certain income level but to all of us. If the poorest in society get treated well, then everyone benefits. If the poorest are neglected, then we all suffer. I feel rather strongly about this as you can probably tell.
5. $30 for STD Office Visits:
The $30 ‘donation request’ was initiated reluctantly by us at the repeated insistence of Commissioner Melba Moore, who said to me that "the patients need to have a stake in their care and take some personal responsibility for their own actions".
Commissioner Moore suggested this $30 voluntary donation amount because we (being NCUC and DUC) complained that the contract awarded by the City did not cover the costs of testing and treatment and that we were losing money at both North City Urgent Care and Downtown Urgent Care as a result of the STI contract being honored at those two facilities.
Simply put, the DOH Commissioner was the one who directed us to request the $30 donation from every patient that presented with an STI. However, as I’ve said before, the patients were always aware that this $30 donation was entirely voluntary and we didn't even collect very much because most patients did not donate it.
As I said before, no patient was ever turned away and the vast majority of patients didn’t make this suggested donation to the clinic.
Even today, anyone is welcome to make a voluntary donation to our clinics, especially to NCUC, which is in difficulty. When a facility doesn’t turn people away, such as the poor on Medicaid or veterans on Medicaid, it does the right thing, but it also means that it’s always thirsty for financial assistance.
From when we first opened Downtown Urgent Care in 2009, we were determined to always put patients before profits, even if it meant we always just break-even. That is why we have always accepted patients on Medicaid and we always will, even if it costs us to do so. We know that some other companies won’t ever accept Medicaid, but we prefer to be able to sleep at night.
If you’re saying that someone from the state said that we were 'violating the contract' and 'double-dipping', then that someone is obviously unaware of the truth of situation and is probably just speculating or guessing for reasons unknown to me. Nobody from the state ever made any such ‘violation’ comment to me or to my staff, so I’m not sure this is actually a state position or just one person’s comments that may have been misunderstood or received out of context. Indeed, during the entire period that we held the STI contract, I don’t recall ever having been contacted anyone from the state about it.
It is also an unfortunate mischaracterization to use the word 'charging' with regard to the $30, when it was only ever merely a 'suggested voluntary donation' as directed by the Health Department Commissioner. The vast majority of patients did not even make this donation and they were always tested and treated appropriately regardless, and they were routinely told that not making a donation would not prevent us from providing testing or treatment. I am not sure why or how this entire $30 suggested donation thing has been taken out of context or mischaracterized as some of kind of crazy mandatory charge, which it never was. Meh, I just put it down to things being lost in translation I guess.
The City has always been aware of the truth of the $30 suggested donation, since they are the ones who asked us to put it in place, and so I do not believe such rumors played any role in the contract decision, although I suspect there may have been some attempt to placate the critics who misunderstood what was going on.
Ironically however, I do believe that the City will no longer repeat the suggestion that any contractor request voluntary donations of any kind from patients, and to be fair, I think the new STI contractors can more easily afford to absorb the losses they may experience during this contract, so it won’t be an issue.
6. Payments for STD Services:
The City Health Department has been nothing but super-efficient and competent in its handling of the contract with us, and they always met their contractual obligations. They were never late unless we issued our invoices late, so I have no complaints at all with regard to working with the City. Indeed, under the direction of the Commissioner Melba Moore, the contract was handled well from our perspective. She was always receptive to any concerns we had and, as I stated above, even when we had concerns about the financial viability of the STI contract, Commissioner Moore was quick to make suggestions and recommendations and to come up with solutions that would work.
7. St. Charles County:
No we have had no contact with St. Charles County Health Department and we are not working with them in any capacity. Our three facilities are not located in St. Charles County so I don't think they would have any interest in working with us either.
8. Future Contracts:
We will always be ready and willing to bid for any City contracts in the future if we feel we can handle them. As I stated earlier, it is a good and wise practice for local government to 'shop around' and reassess a contract every 1 to 3 years, under any capacity and in every department. The Post-Dispatch article that you wrote did a great job reminding us of the need for such a practice and I do believe such a policy will improve outcomes.
I do feel that good journalism promotes both public accountability and that citizens are kept well-informed. I think your piece earlier this year did exactly that.
Many thanks for giving me the opportunity to clarify some of the confusion that seemed to dominate the situation earlier this year.