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Turnover turmoil at Health Center

Call it: A tale of two health centers.

While it would be an exaggeration to describe recent months at the Sonoma Valley Community Health Center under 'best of times, worst of times' scenarios, few close to the 23-year-old community medical clinic would deny it's been a boat sailing on choppy waters.

If the health center took two steps forward last year, it followed with what some are calling a big step back.

It was a year bookended on one side by the exciting opening of a state-of-the-art new facility, and on the other by the eyebrow-raising turnover and management-staff difficulties within the all-important behavioral-health division.

Caught in the crossfire, ostensibly, are the behavior unit's patients – who are at once hopeful for a top notch community health clinic, and yet concerned that staff-and-management infighting could stand in the way of the kind of quality care for which the center has been known.

It was just last July when the future looked brightest – that's when the Health Center moved into its new and improved digs at 19270 Sonoma Highway, after more than two decades at the dinkier, less suitable clinic at 430 West Napa St. The move was an 18,000-square-foot boon to the clinic, which serves nearly 7,000 low-income and uninsured Valley residents, built through $5 million in federal Affordable Care Act grant funds, as well as a large dose of goodwill and financial support from the Sonoma community.

Gone were the days when space was so tight that baby scales were crowded into the hallway, patients were seen in admin offices, and a laundry room served as a computer work station.

Now the 80 or so patients who visit the health center each day have a clinic twice its previous size, with adequate parking.

But the first cracks in the castle walls began to show soon after the grand opening – when irreconcilable differences between Health Center CEO Cheryl Johnson and longstanding behavioral unit doctors Richard Kirk and Jerry Silver led to Johnson's decision last September to not renew the doctors' contracts.

Or, to put it in their terms, they were fired.

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Kirk, a pediatrician and psychiatrist for more than three decades, had been serving part-time at the Health Center for the last 10 years. Silver had served as chairman of the Behavioral Health Department at SVCHC for more than a decade.

The move to loftier climes and the relative luxury of their own Behavioral Health Service Center - with three separate consulting rooms – was a pleasant enough upgrade; yet, Silver and Kirk were disillusioned. They'd locked horns with Johnson in the two years since her hiring – they had deep differences in management philosophy, and the doctors felt their ideas weren't being taken seriously.

Silver describes Johnson's attitude toward their suggestions as 'dismissive of any problems we brought up.'

Earlier in the year, Kirk and Silver called for the formation of a special 'transition team,' which they'd organize, regarding the move into the new facility. They also said the clinic needed to appoint an outside consultant to 'assess and identify the strengths and weaknesses of the SVCHC's organizational functioning.'

Johnson concedes that she and doctors Kirk and Silver 'had fundamental differences about the way the Health Center should be run.' But, as Johnson points out, she was hired to run the center – not them.

Nevertheless, the doctors took their qualms to the Health Center board of directors. They said they lacked faith in Johnson's ability to manage the center, and ultimately called for her dismissal.

The board, however, remained wholly in support of Johnson.

Board President Richard Gantenbein, a pastor at St. Andrew Presbyterian Church, says that beginning in July of 2014, the board became aware of 'performance issues' with Kirk and Silver relating to what he claims was a backlog of untended patients and resistance in the transition to electronic health records – a new system Johnson brought in known as NextGen.

Gantenbein says that strict Affordable Care Act regulations call for detailed electronic medical record bookkeeping, and that Medicare, Medicaid and other federal healthcare funding are in jeopardy if a clinic fails to comply. Kirk and Silver, he says, were failing to comply.

Gantenbein says this was the reason that Kirk, Silver – and a few weeks later family therapist Max Yusim – were let go.

He adds that his biggest complaint about Johnson is that she didn't let them go sooner.

Kirk, Silver, Yusim and another former member of the Behavioral Department's staff, Katie Bandy, paint a far different picture. They charge that Johnson's management style is so autocratic and argumentative that it made working at the health center a tense and unpleasant environment.

'She struggles greatly to connect with and support her staff,' said Bandy, a social worker who quit the SVCHC last year due to what she describes as Johnson's 'authoritarian control.'

Yusim says he was fired 'for the same reasons as Dr. Kirk and Dr. Silver – I was vocal that I thought Cheryl Johnson should be removed from her job.'

In the he-said, she-said back and forth that can occur when jobs are being lost, questions about the situation abound:

Is Johnson's management style too top down – or is a firm hand necessary to accomplish the ambitious goals of the Health Center? Was the doctors' unwillingness to adapt to new federally mandated record-keeping policies a legitimate reason for dismissal – or did their squeaky wheel approach lead to an impromptu exit?

One thing is clear: management and the former doctors of the behavioral unit could not get along. And when that happens at a safety-net medical facility, more is at stake than bruised egos and grips on control.

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Charlene Peele-Carty had been a Health Center patient of Dr. Silver for more then three years. The retired sixth grade school teacher has been seeing Silver for depression and what she describes as 'life issues.'

'He changed my life,' she says.

Peele-Carty gets by on retirement income and Medicare. She'd recently been referred to Dr. Kirk, who she says wrote up the prescriptions to help with her depression. She says the quality of care she's received over the years through the Health Center has been 'excellent.'

But Peele-Carty says everything changed dramatically last September when the doctors were let go.

'Nobody from the health center told me my doctors were fired,' says Peele-Carty. 'There was nobody to replace them who could renew my prescriptions.'

Another woman, who requested her name be withheld for this story, says her husband had been seeing Dr. Kirk for substance abuse issues – but when Kirk left the Health Center it was never made clear who would take up her husband's care. In the meantime, she says, he's fallen off the wagon.

Kirk, meanwhile, says he's received calls from patients confused about their status at the Health Center since his leaving.

On Dec. 18, San Francisco litigation firm Hassard Bonnington sent a letter on behalf of Kirk to Health Center board member Susan Drake, requesting information about how Kirk's and Silver's former patients were being informed about, and transitioned to, new caregivers – formally spelling out the clinic's legal obligation to do so.

Kirk insists his pressing the matter more than three months later has nothing to do with his dismissal – rather, it's out of concern for patient care.

If one were to ask the United States Department of Health and Human Services, however, fears about quality of care might be calmed. On Dec. 16, HHS Secretary Sylvia Burwell announced that the Health Center was the recipient of more than $46,000 in Affordable Care Act grant funds, rewarded for quality and improvement in care in the 2012-13 year.

Health and Human Services named the Health Center among the top 10 health centers in California for 'quality' – noting that it exceeded national clinical benchmarks for chronic-disease management, preventative care and pre- and post-natal care. The Health Center was also named among the nation's biggest 'improvers' in patient health.

In a statement accompanying the Affordable Care Act grant announcement, Secretary Burwell said, 'This funding rewards health centers that have a proven track record in clinical quality improvement, which translates to better patient care.'

On the other hand, the Health Center received zero out of a possible $15,000 awarded to clinics that use electronic health records to report data on all of their patients – an issue which no doubt led Johnson to institute the NextGen system.

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The Sonoma Valley Community Health Center was founded in 1992 by Cynthia Solomon and Heidi Stovall, with a mission to provide health care for the Valley's uninsured and underserved residents – many are agricultural workers and their families, non-English speakers, and low-income residents including the homeless.

Its importance to those it serves would be difficult to overstate. According to svchc.org, Sonoma Valley is a federally designated Medically Underserved Population and a Health Professional Shortage Area.

When Cynthia Solomon died last May 29, just a few months shy of seeing the Health Center's grand reopening, she passed away having left behind a vital service in a community that sorely needs quality, affordable medical care.

Community clinics and health centers largely began in mid 1960s as a product of President Lyndon Johnson's 'Great Society' programs to deliver medical care to the poor. Today there are more then 1,200 community healthcare clinics across the United States – with more than 9,200 serving sites – providing care for an estimated 22 million people.

At the inauguration of Medicare on July 30, 1965, Johnson spoke about how so many Americans will no longer 'be denied the healing miracles of modern medicine.'

'This program is not just a blessing,' said Johnson. 'It is a test for all Americans – a test of our willingness to work together.'

For the sake of the thousands of Valley residents who depend on it, let's hope the Sonoma Valley Community Health Center can pass that test.

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(Editor's note: Currently listed as serving in the behavioral division on the Health Center's website, svhc.org, are Joseph Cutler, licensed clinical social worker; Luis Janssen, psychologist; and Robin Grimm, who works one day a week as a registered addiction specialist.)

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