Vero moves ahead on controversial clinic
City Council kept in dark on details
Vero Beach city employees spent taxpayer money hiring consultants, soliciting bids, selecting a vendor, and picking a location for a health clinic for municipal workers before the City Council ever expressed any interest in such a scheme or had an opportunity to vote on whether development and implementation of this half-million- dollar project actually made any sense.
The idea of a city-run medical clinic was first broached to the Council at a meeting in December, but was tabled when Council members sought more information and asked Human Resources Director Robert Anderson to see if the county and School Board were interested in joining with the city to increase the potential employee user pool and lessen the estimated $579,000 price tag.
Despite any formal expression of interest by either Indian River County or the School Board, city officials on Tuesday assured the Council that both the County and the city of Sebastian were “very anxious to get involved,” and pressed the county for authority to move forward with negotiating a contract with its hand-picked vendor.
Only Council Member Debra Fromang appeared reluctant to proceed, stating several times that she would “not want to go forward without the county’s participation. I don’t think it would be cost effective. I would think that we should wait.”
“I have met with the county regarding this and they are very anxious to join us,” insisted City Manager Jim Gabbard.
But Jason Brown, budget director for the County, said the County Commission last month “requested that we look into other options, such as the University Medical Clinics. At the County, we haven’t decided exactly what direction we will move on this.”
County Commissioner Bob Solari said the city’s presentation to the County Commission a month ago left him more questions than answers. Commissioner Peter O’Bryan said he also was interested in exploring other options.
“The idea of Indian River County partnering with the city of Vero Beach is an intriguing idea,” Solari said. “But a lot more financial analysis needs to be done before we make such a commitment.”
But Anderson, a forceful proponent to the plan, told the City Council on Tuesday “it has always been my recommendation that we proceed whether the county wants to come along or not.”
“I don’t think we will have to go it alone, because Sebastian is very anxious to join us also,” Gabbard quickly added. “We’ve put them on hold because we do not want to jump into a giant program involving three different entities right off. We think we will work with the county and come up with a very good program and then expand north to Sebastian.”
“Well, we don’t know about the county,” Fromang persisted. “I’d hate to go forward without knowing the county will participate.”
Ironically, Fromang – the only one to raise questions about the scheme – was forced to recuse herself from the discussion and voting after a doctor who had once rented office space from her husband attempted to intervene in the Council debate.
After Fromang withdrew, Gabbard said: “We are anxious to move forward with this because of the County’s involvement. We had been hoping to get this online by July but because the county wants to get involved, we’re looking at the first of the fiscal year” in October.
Despite the human resource department’s recommendation, the City Council has never been provided with the Gehring Group’s evaluations so they could compare all the bids and what each vendor would provide to the city. The only paperwork the Council received was a one-page letter from Anderson in the April 7th meeting packet.
The interdepartmental memo dated March 31st from Anderson to Mayor Sabin C. Abell and Council members said the Gehring Group evaluated for providing these services from 12 potential providers, and recommended that “the City award the contract to implement and operate the Health Center to Crown Consulting and Care Here.”
Also omitted from the recommendation was any discussion as to why Care Here was selected, since it had the highest estimated annual cost of the 12 companies which provided bids.
City Attorney Charles Vitunac said he did not know why the evaluations were not given to the City Council, but said it was a public record and available if Council members wanted to review it.
The public, though, has been kept out of the loop on much of the planning for the clinic. No meetings were ever held for public discussion before the matter came up at Tuesday’s meeting.
At the December meeting, the last time the Council discussed the matter, members raised questions about specifics of the health clinic plan and whether it would be viable for a city the size of Vero Beach to undertake such an enterprise.
After those questions were raised, minutes of the meeting show that no vote to proceed was taken except to have Anderson see if Indian River County and the Indian River School Board might be interested in partnering with the City on the venture.
During the December meeting, Anderson outlined costs to the City Council, and said he anticipated the savings to the city would be $267,000 during the first year.
“We also project a reduction of projected costs of approximately $2.4 million over a three-year period,” he said. “We believe that we can reduce future costs even more with a joint city-county venture, which will allow longer clinic hours and shared cost.”
City council member Kevin Sawnick said ahead of the April 7 Council meeting he thought the clinic proposal had been rejected months ago.
“I recall some discussion at a City Council meeting about an employee health clinic, but the costs were prohibitive for the city to undertake,” he said. Sawnick added he was surprised that a department of the city would take it upon itself to pay consultants, ask for bids, decide on a vendor and then place the item on the City Council agenda for approval.
The idea for a city-run health clinic first came up about 18 months ago when the city’s Risk Manager, Barbara Morey, attended an open house for a clinic in Port St. Lucie and met the Gehring Group consultants who operate similar clinics throughout the state.
“Barbara brought the idea to me and I followed-up on it,” Anderson said. The follow-up came in the form of a presentation he gave to the City Council last December extolling the cost savings the clinic was projected to earn. However start-up costs were estimated to be over $579,000.
Part of that $579,000 is $179,676 the Gehring Group will be paid to hire the medical group and to administer the clinic. Interestingly, the human resources department recommended that Vero Beach use the same medical group that Port St. Lucie initially contracted with — Crown Consulting and Care Here.
While Anderson told the Council that Port St. Lucis was “very happy” with Crown, records show that Port St. Lucie has yet to renew its contract with the firm.
Many other questions on the project remain. For instance, the December presentation estimated the clinic would be open just 20 hours a week, and stipulated employees may continue to see their own doctors as part of the city health benefits package. This leaves open the question of the extent to which employees will actually use the clinic.
At Tuesday’s meeting, Anderson said the clinic would be open 24 hours a week. He also told the Council orally that the cost of the project would be $503,000, down more than 10 percent from the estimate contained in his memo dated March 31st.
Anderson’s December presentation also made comparisons between Vero Beach and Port St. Lucie, including his statement that he was told by Port St. Lucie officials their city was saving money by running its own clinic.
However, Vero Beach 32963 reported at that time that Sharon Park, the Assistant Human Resources Director for Port St. Lucie, said the only area she knew where money was being saved was in dispensing generic prescriptions. It was also pointed out in December by council member Fromang that Vero Beach has 507 employees compared to over 1,250 in Port St. Lucie.
Anderson’s presentation in December also assumed the city employees and their families would need to make 4,072 visits to the clinic each year, or about eight clinic visits a year per family, to achieve the projected savings. “In Port St. Lucie, I would estimate only about 20 percent of all of our employees actually use our clinic,” said Park. “I can’t say that it makes money except perhaps on the 20 percent of our employees who utilize it.”
At the county commission meeting, Solari noted commissioners had not been presented any meaningful financial information and requested that the Gehring Group give a complete financial analysis for the proposed city-county health clinic and bring it back to the county for discussion.
After the meeting, Solari said his two main concerns were quality of care and cost of care. “In order to be fair to county employees, we need to insure that the quality of care is what it needs to be and in order to fulfill our fiduciary duty to the taxpayers we need the numbers to show that the costs are as low as they can be, consistent with quality care.”
Anderson insists that the health clinic, to be housed at the County Recreation Administration Building, will be a money-saver for the city.
“The main idea is that the doctor is paid an hourly rate as opposed to a salary,” he said. “That is a savings. He will advise patients on overall wellness and things like diet and exercise to prevent our employees from becoming ill. The clinic will buy drugs in bulk and that is where prescriptions can become a savings.”
Although the clinic is only scheduled to be open 24 hours per week, Anderson said he had already spoken to some physicians in the area willing to work there. He did not identify them.
Anderson also said the clinic will have an X-ray machine, but was unsure who would be reading the X-rays. Primary care physicians are not trained radiologists.
There is also the issue of privacy.
“We have thought about matters of privacy,” Anderson said. “Employees don’t have to come to the clinic. It is voluntary. We would try to not have any other employees there at the same time.”
One city staff member, who requested anonymity, said she would never go to a city-run medical clinic for her health care.
“My health is my own business. I’ve had my own doctor for twenty years. I’m not going to change.”