On the afternoon of Friday, Feb. 8, the County Health Department notified the Indian River Hospital District that after 15 years, it was pulling its caregivers out of the Gifford Health Center effective March 1, despite a lease and funding agreement with the Hospital District that extends through September.

But less than two tense weeks later, the Health Department did a 180:  Instead of pulling out of Gifford and consolidating services at its main clinic three miles away, it agreed to consolidate adult and pediatric primary care at the Gifford center, for at least the next three months.

The off-and-on-again decisions by the Health Department were the latest tense chapter in a longtime relationship that recently has seemed to be increasingly in jeopardy.

District trustees appeared dumbfounded and deeply disappointed by the Health Department’s decision to pull out of Gifford when they met at the district chairman’s meeting last Wednesday, which was their first chance to speak together about the matter due to Sunshine laws.

During the meeting, Health Department director Miranda Hawker sat grim-faced and silent, her raised hand ignored, while board Chairwoman Marybeth Cunningham allowed trustees to vent.

Trustees Karen Deigl and Michael Weiss called the department’s planned pullout from Gifford a breach of the lease and wanted to pursue legal remedy.

Trustee Allen Jones, who has spearheaded efforts to expand the care available at the Gifford clinic, questioned future collaboration with the Health Department, saying it depended on “whether the Health Department feels it can make any kind of commitment that they can honor.” Currently, the Hospital District reimburses the Health Department for close to $1 million in indigent care delivered at Gifford Health Center and elsewhere.

Then the Hospital District’s attorney, Jennifer Peshke, proposed an interim solution: Instead of consolidating services at the main Health Department clinic at the county government center, as the email outlined, couldn’t adult and pediatric primary care be consolidated at the Gifford center instead?,

When Hawker was finally asked to speak at the meeting last week, she told trustees, “I do believe there is opportunity to look at consolidation at the Gifford site.”

For nearly a year, district trustees have shown deep concern for the Gifford community where life expectancy is a decade shorter than in white neighborhoods a few miles away. Several have personally attended Gifford Health Council meetings, taken tours of pockets of poverty and spoken at length with leaders of various healthcare agencies about how to remedy the dearth of services and reach out to more patients in need.

That personal investment of time by the volunteer District Board may have triggered some of the ire over Hawker’s pullout. Consolidating at the Health Department’s main clinic would mean moving care three miles away from Gifford Health Center. The impediment to care created by that distance was exactly what the Hospital District intended to eliminate in 2003 when it spent $2.6 million in taxpayer money to build a health center in the heart of Gifford.

Last year, the Hospital District sought proposals from healthcare organizations to run an expanded Gifford Health Center offering more services and types of care. The Health Department, which has run the clinic since 2004, and Treasure Coast Community Health Care both submitted proposals for the job but seemed to base their proposals on widely differing patient volumes.

The Hospital District then sought a more formal second round of proposals, pushing back the date when expanded services will start until next fall.

This time around, the Health Department is not bidding on the job due to financial concerns, despite having strong support in the Gifford Community.

While Gifford leaders were notably absent from the district meeting, NAACP president Tony Brown seemed unsurprised by Hawker’s move, saying it was to be expected “when you put the Health Department in a predicament where they have no other options.

“This was a cause and effect from Day One, when the district stepped in and started to initiate what it thought was the best thing for Gifford,” he said. “It should have been the Health Department all along. Just give them what they needed and bring [the center] back to what it used to be.”

In November, Brown took the podium in a televised district meeting with much the same message, lambasting the Hospital District board for putting the management of the Gifford center out for bid.

“Our community has been deeply troubled,” he said. “We did not ask for a divorce. We are very much comfortable with the Health Department.”

Attorney Peshke made clear Wednesday that the talk of legal action against the Health Department didn’t mean the Hospital District was wavering in its commitment to Gifford.

 “Nothing has changed on the end of the district with regard to our funding commitment,” she told the board.

“Over these last few months, our actions more than show as a board that we are committed as a board to work to ensure that these services continue not only for the current funding cycle but into the future and the long-term plan for a full-service health clinic.”

In the current proposal round, Treasure Coast Community Health is expected to again submit a proposal, and there is a possibility of a second proposal from Whole Family Health Centers. Treasure Coast operates as a federally qualified health center, or FQHC; as such, it receives federal grants. Whole Family is an FQHC Lookalike, meaning while it doesn’t receive federal grants, it does have the same access as Treasure Coast to discounted drugs to sell at its pharmacies, along with enhanced Medicaid and Medicare reimbursement rates. Both agencies can also accept philanthropic dollars.

State Departments of Health receive none of that, even as cuts in Medicaid, their main source of revenue, continue; as a result, Hawker said, many counties were cutting primary care altogether.