Roxbury Comprehensive Community Health Center has been a neighborhood fixture since 1968, dispensing readily available care to a needy community from its Warren Street headquarters.
Unfortunately, its own health is dire and worsening by the day, as its management confronts a near-mutiny from frustrated staff and pressure from state regulators to improve its standard of care.
Alarmed state Department of Public Health officials forced the center to close its laboratory in late June, citing a list of shortcomings that runs nearly 30 pages long. The problems included mislabeled lab samples, use of expired medical supplies, and failing to comply with various Medicaid and Medicare regulations. Despite the lab closure, the center itself remains open to deliver daily care, at least for now.
The state was willing to give the center a short period of time to correct the problems, but health center officials opted to close the lab instead. They admit they had little choice.
“We looked at it and we know the work involved and we said, ‘That’s not happening,’ ” Anita Crawford, RoxComp’s chief executive, said in an interview Friday. “If you don’t cure the deficiencies you get fined, and you get fined daily. We took control of the situation and acknowledged that we can’t meet the timeline.”
This was not the only issue between the center and the public health department. Tensions came to light through a series of unsigned letters written by center staff to the board of directors, and distributed to DPH, the Massachusetts League of Community Health Centers, and the Globe over the past several weeks.
After a series of Freedom of Information requests from the Globe, the state confirmed that it had essentially forced the lab to close. In addition, in recent months, it has also canceled a $241,500 grant for HIV/AIDS testing and raised serious questions about the center’s methadone treatment program. That onsite program, which is licensed by the state, is operating on a six-month license while it tries to correct a number of issues. Such licenses are normally renewed for two years. Essentially, the program is on probation.
The state doesn’t like to disclose actions it has taken again against community health centers — partly because it doesn’t want to undermine public confidence in a center, and partly because at some point many of them run afoul of regulations, to varying degrees. But officials acknowledged that the scope of actions taken against RoxComp is extraordinary.
“The Massachusetts Department of Public Health has actively provided technical assistance and training opportunities to Roxbury Comprehensive Community Health Center and will continue to do so,” DPH spokesman David Kibbe said in a statement. “DPH is working with Roxbury Comprehensive Community Health Center to address significant issues that have been raised surrounding performance at the health center’s laboratory. We remain committed to working with the health center to provide the highest quality of care to the residents of Roxbury, Dorchester, and Mattapan.”
Crawford, who has led the center for 17 years, blamed many of the problems on her staff. Both the lab and the methadone center fell victim to staff members who weren’t doing their jobs, she said. (The state says they were run by people — hired by Crawford — who were unqualified.) She noted that the lab received a relatively positive review from the state in 2010 but has since fallen into disarray.
The laboratory services previously performed onsite, such as blood tests, have been turned over to an outside lab, with much of the cost picked up, as it was previously, by Mass Health. For economic reasons, many community health centers get by without a lab on the premises, state officials confirmed — but it is usually by choice, not because an onsite lab was found deficient.
“I would call this rare,” said one state official involved in the decision.
Equally rare was the the decision to shut down the center’s HIV/AIDS program, which had been funded for at least 20 years and served a community with one of the state’s highest highest rates of HIV. While the issues in that program were also wide-ranging, state officials said one deciding factor to pull the grant was an odd statistic: only 23 percent of the patients who underwent testing at the center returned to find out the results.
Think about that. Who would go to the trouble of getting tested for HIV but wouldn’t come back a few days later to find out if they were ill? Statewide, 94 percent of the patients who are tested in health centers come back to receive results and counseling, if they need it.
“It defies explanation,” one DPH official said when asked to explain.
Crawford didn’t argue the point. “I’m not going to speak to a statistic I really don’t know,” she said. “I don’t know what would account for it.”
Crawford is also chairwoman of the board of Roxbury Community College, another beleaguered institution. She said her parking space at the center had been defaced during the controversy over ousting Terrence Gomes as the head of RCC, and she hinted that disgruntled health center employees who believe Crawford might be vulnerable because of her ties to RCC were attempting to damage the health center and force her out. She suggested those employees might face retribution.
In fact, she said Friday, the five-person staff at the lab is going to be fired — though she hadn’t told them yet. “The board of directors had to vote to close the lab first,” she said. “I haven’t had a chance to tell them that they're losing their jobs.”
Now they know. Nice.
Crawford, an engaging, 30-year health care professional, repeatedly made the point that there is a nexus between the RCC controversy and the attacks on the health center.
Here’s the thing, though: the Department of Public Health isn’t made up of disgruntled Crawford employees. And as far as I know, they couldn’t care less about Roxbury Community College. But they see a deeply troubled medical facility, and seem prepared to shut it down if necessary, one unit at a time. Another Roxbury institution is fighting for its life, and only the people it serves will suffer.
Adrian Walker is a Globe columnist. He can be reached at firstname.lastname@example.org. Follow him on Twitter @Adrian_Walker.