For the employees of Roxbury Comprehensive Community Health Center, months of anxiety and frustration came to a boil around daybreak last Friday. Payday.
That is when the staff began checking their bank accounts and discovering that their direct deposits had not been made, that the neighborhood clinic had not made its biweekly payroll.
They began texting one another, making sure they weren’t victims of a clerical error. They debated whether to report to work. They reached out to the center’s director, Anita Crawford, concerned that the missed payroll reflected even deeper problems.
In response, Crawford pleaded ignorance. In a series of e-mails, she said that the money to pay them was in the bank, that they might be paid later Friday, that they would be paid on Monday.
They weren’t. They finally got their money Tuesday.
This crisis at the center, commonly known as RoxComp, was not a complete surprise. For at least a year, the center has been mired in financial and medical controversies. State officials had shuttered its HIV/AIDS program and effectively placed its methadone treatment program on probation. On Monday, the center’s doctors refused to see patients, amid concerns that RoxComp’s medical malpractice insurance had lapsed for nonpayment.
Last month, Dr. Lauren Smith, the interim commissioner of the Department of Public Health, demanded an urgent meeting with the center’s board to discuss medical and financial woes plaguing the center. On the same day, the state gave the center 30 days to correct a host of problems in its methadone program or face serious sanctions.
It’s not just state officials who are alarmed. “I am very concerned about the current management and state of affairs at RoxComp,” said Councilor Tito Jackson, who represents Roxbury. He said he had asked for a meeting with RoxComp officials to discuss the missed payday. “We really have to rectify this urgent and growing issue we see at RoxComp,” Jackson said.
Many of those issues center around Crawford, who has run the center for 18 years. Staff members will not discuss her on the record, fearing reprisals. Their fears appear justified: When I was reporting on the center last summer, Crawford threatened to punish employees who spoke to the press.
Crawford offered several head-spinning explanations for why her employees had not been paid on time. At one point she described it as a “blip.” She said that federal grant money that was expected to help cover the payroll had been delayed by a change in federal regulations. She also attributed the cash-flow problem, as she put it, to lower billing, caused by the closing of programs such as the dental program. At no point did she offer anything resembling an apology to her dedicated but beleaguered employees.
“We have had operational challenges, and they cause blips in the cash flow,” Crawford said. “When any department is closed, you are not seeing patients, you are not billing; therefore you are not getting paid.”
But the reason some departments are not seeing patients is because the state has forbidden them to operate. The latest unit shut down was the dental department, which closed for about a month late last year at the insistence of state regulators.
The center’s employees held a meeting Friday to discuss their embattled workplace. It was intended to be a workers-only discussion, but Crawford insisted on attending and took over the meeting, according to people who were there.
Actually, employees are used to such events. A request last summer to meet with board chairman Dr. Keith Crawford — no relation to Anita Crawford — to discuss working conditions has never happened, although he had promised to meet with them by September. Keith Crawford, who some employees see as the chief protector of the director, did not return a phone call Tuesday.
The problems at RoxComp are potentially devastating for the neighborhood, which heavily relies on the services it provides.
At a meeting with Crawford and Crawford on Jan. 25 prompted by her letter, Smith insisted that the center address some compliance issues immediately, including filing long-overdue annual reports with the secretary of state’s office and appointing some new board members. In an interview yesterday, she said she is concerned about the long patterns of problems at the center.
“The fact that they’ve had recurring issues across the health center, over time, makes you wonder what kind of organizational infrastructure there is, that they aren’t able to put changes in place and make them stick,” she said. “The need and the requirement for vulnerable populations to get high-quality care is something I’ve devoted my entire practice to. Yes, I’m concerned.”
Anita Crawford, who grew up a stone’s throw from the health center and says she remembers watching it being constructed, said its future is not in danger. She stressed her commitment to the center and her neighborhood.
“At the end of the day, this is my community. This is where I grew up. This is where my parents brought me home from the hospital. This is where I brought my babies home. As I said to staff, you’d be hard-pressed to believe there is anyone more committed to this health center.”
Commitment is admirable, but it may not be enough. RoxComp’s litany of woes raises obvious questions about Crawford’s future.
Smith said it’s not the state’s job to decide who runs the center. “From our point of view our responsibility is not to a particular individual,” she said. “It’s to the residents of the neighborhood and to make sure that when they go they’re able to access high-quality service.”
Clear enough. Less clear is whether RoxComp management feels responsible for making sure those desperately needed services continue.