Clinic Woes Continue
Last updated 6/3/2020 at 9:49am
Borrego Community Health Foundation (BCHF) doesn’t seem to care about the Borrego Springs community. At least, that’s the consensus of community critiques of the clinic’s service, ranging from a survey completed in 2016, to anger over the recent firings of trusted, full-time professionals. With the unexplained firing of Nurse Practitioner Jan Jones and mental health therapist, Dr. Pamela McEvoy, Borrego Health lost any semblance of kindness, caring, or professionalism.
This week, the clinic lost another full time-professional with the resignation of LVN Charles Collum. In the yet, still unexplained absence of the clinic’s resident doctor, James Huot, the community has the right to ask, “who’s seeing patients? Does anyone at Borrego Health care?”
The clinic is now an empty promise with rotating substitutes from other clinics. Oh yes, there’s treatment by telephone and telehealth. So much for the human touch. The question our community must ask: “Is this OK?” And can anything be done about the increasing loss of service providers, and Borrego Health’s shocking indifference to the needs of the clinic?
It would be nice if BCHF showed more concern, but the truth is, the foundation doesn’t have to care about Borrego Springs. However, the foundation does have to provide the scope of services for which it contracted with the federal and state governments, in order to receive tax-payer-funded patient care. The clinic is a federally qualified health care provider (FQHC), which means the foundation is bound by contract, and paid to treat geographically areas of isolated, economically, or medically vulnerable populations. This means the majority of the $238 million disclosed in the BCHF’s 2018 IRS tax disclosure, comes from patients, the majority funded by tax revenues.
They don’t have to care. Never the less, in return for their non-profit status and receipt of state and federal patient fee subsidies, they do have to meet specific requirements which are to: serve an under served area or population; provide care on a sliding fee scale based on ability to pay; operate under a governing board of directors that includes patients; complete annual reporting requirements; provide holistic health and social services; and have an ongoing quality assurance program
Basically, the clinic can’t turn anyone away. Its income is derived from Medicare, Medicaid, and other state and federal government grants for service, third party private insurance, and cash payments. Arguments that the clinic is losing money – taxpayer’s money – doesn’t hold up. By firing providers that keep and attract loyal patients, and slowly abandoning services through a slow attrition of specialized medical staff, the clinic is bound to lose money.
According to Collum, when there were two key professionals at the clinic, they were handling an average of 16 patients a day. When Dr. Huot disappeared, and Jones had sole responsibility for the client load, she was seeing up to 25 patients a day, plus screening patients with COVID-19 symptoms. He disclosed that Jones was recently asked by the foundation to increase the rate of patient visits to 35 per day. This, not only created an impossible work load, but would require her to cut care and time with each patient.
Collum goes on to say, he “resigned in hopes the clinic would replace me with a much-needed full-time RN.” And because he was mortified by the cruel way Jones was terminated.
“What happened to Jan was reprehensible, inhumane and un-professional. She deserved so much better, given all the time and outside commitments she took on to benefit Borrego Springs,” Collum explained. “I didn’t want to be seen as complicit with the foundation’s practices by continuing to work at the clinic,”
Borrego Health explains the attrition of professional providers by saying it’s too difficult to find full-time professionals, willing to work at the Borrego clinic. That argument doesn’t hold up when three experienced people, two of which live in, and love the community of Borrego, were let go.
The Sun has received numerous complaints and examples of problems created by the absence of key personnel at the clinic. For example, a woman, wishing to remain anonymous, went to the clinic for a refill of an anti-anxiety drug she has taken for five and a half years to help her cope with a past bout with breast cancer. She asked for Jan Jones, who she had been seeing for years and was fully aware of her condition. She was not told by clinic staff that Jones had been terminated. Instead, she was told to go to the pharmacy and the refill would be handled. At the pharmacy, she was told she needed a doctor’s signature.
Back to the clinic she went, only to learn that her doctor was gone – no explanation – but was given the phone number of another provider. Put in touch with a physician’s assistant at another Borrego Health clinic, she encountered queries about addiction, rather than help with a refill.
“I deeply resented being drug-shamed by someone who did not know my history or have my medical file,” stated the woman.
The refill request was denied, and she was referred to a psychiatrist. Running out of time and patience after days of calling and failed responses, a contracting psychiatrist with BCHC eventually filled the prescription. The woman claims she was very fortunate that she had enough medicine to get her through the days and frustrations it took to resolve the issue.
When responding to inquiries by the Borrego Sun, regarding the absence of professionals at the clinic, BCHF blamed financial woes related to the pandemic. OK, but the virus aside, how could they lose money in Borrego where so many, due to income, or age, have no other source for health care, or important services such as prescriptions and referrals to specialists.
If BCHF is losing money, shouldn’t they reduce the inordinately, beneficent salaries going to the “Leadership Team?” The administration includes a redundant number of executives and administrators, claiming to serve at Borrego Health clinics, in addition to running their own separate clinics and private services. When a not-for-profit organization is properly run, it will have staff who earn appropriate salaries for their work. But those salaries should not be as excessively high as BCHF disclosed in the 2018-IRS 990.
Because nonprofits have to file special disclosure forms with federal and state officials such as California’s attorney general, disclosing how they take in and spend their money, they are subject to significant oversight and can be prosecuted if they spend taxpayers’ money inappropriately. Another requirement of a federally qualified health center, is to provide public disclosure of their Internal Revenue Service (IRS) 990 form.
The IRS requires all U.S. tax-exempt nonprofits, like BCHF, to make public their three most recent Form 990 annual returns (commonly called “990s”) and all related supporting documents. In submitting their financial statements, nonprofit corporations must include salaries of directors, officers and key employees on the form.
Both the IRS and the nonprofit corporation are required to disclose the information in IRS 990 reports to the public.
If you haven’t seen the latest BCHF 2018-tax filing, or can’t find it, it’s likely not an accident. However, anyone wanting to check out the salaries and number of family affiliates being paid to administer BCHF clinics, can go to websites, like the Economic Research Institute and Pro Publica. Both have free search tools to access BCHF’s most recent IRS 990s. Want to know what Borrego Health cares about? Answers are in the 990s, in black and white for consumers to see for themselves. After Borregans expressed shock and dismay about the recent firings, and absence of a resident doctor, BCHF threw a goodwill crumb to Borrego Springs, offering COVID testing in town. It was only 150 tests. But a relief, no doubt, to those who felt vulnerable and possibly symptomatic.
When the Sun asked about follow-up for the tests, the official response from Dr. Edgar Bulloch, BCHF coronavirus task force leader, was forwarded by Vitor Coral, BCHF spokesperson.
“We are advising patients that results will be back in three to five days. Based off of the county health department statistics which are publicly accessible, there are only two reported cases of COVID-19 in Borrego Springs since the pandemic started.
“As far as positive patients go, any positive patient that is identified is immediately notified and placed in isolation. Specific instructions regarding isolation are given directly to the patient from a medical provider. All positive patients are also given instructions on what symptoms would warrant further evaluation in an emergency room setting. All positive patients are followed via telehealth to track the course of the disease and ensure improvement. Also, patients are directed to inform any contacts that they have tested positive. All positive patients are tracked and released from isolation upon meeting the criteria set forth by the centers for disease control.”
When asked by the Sun if the percentage testing positive with the virus would be made public, there was no response. That’s something the community is entitled to know. Especially since the situation has grown dire in surrounding Imperial County, with Pioneer Hospital so overwhelmed by COVID-19 patients, they’re currently forced to outsource the infected to other medical hospitals.
After weeks of probing of executive management and the BCHF spokesperson about professional replacements for the clinic, the Sun was assured by Vitor Coral that the clinic was going to be staffed daily by medical professionals.
Coral noted, “In June, Dr. Huot will be back full-time and will be the main provider for the Borrego Clinic. Maureen Fleming will cover the clinic on Friday’s. Dr. Figueroa will continue to cover Pediatrics for the foreseeable future.”
Back to caring: Why didn’t the BCHF trustees, especially, those who live in Borrego Springs, sound the alarm, or request an inquiry as Borrego slipped further into oblivion on the foundation’s list of priorities? After all, they have a legal fiduciary responsibility. Trustees review and sign the IRS 990-filings. Why aren’t Borrego Health officials being transparent? Why aren’t they talking to the community; meeting with Borrego’s concerned citizens; and, otherwise, making an effort to work with the community without being pressed by the Sun?
Did BCHF honestly think no one in Borrego would notice or care?
It’s not too late. The crisis isn’t over. Governor Gavin Newsom and national health experts warn about potential new waves of the virus, as well as a flood of sick people impacting providers. The expectations are that people will be seeking help for other medical issues that have grown more severe due to an unwillingness to go see the doctor out of fear of contacting the virus. Mental health experts predict a tsunami of emotional and mental health needs, arising from anxiety about the future, uncertainty, and isolation, combined with economic trauma caused by the pandemic.
The community cares. Borrego has a record of generosity and caring. Borrego has shown and shared its heart with numerous responses to COVID-19, including a community task force organized by volunteers and financed by the Endowment Fund. The Borrego Coronavirus Task Force has been updating and providing the latest news on the virus, filling a void left by BCHF.
Borrego service clubs, like the Soroptimist, are working with community volunteers to make and distribute masks, and raise funds for locals in need of rent and other necessities. Borrego business owners care. People like Anne and Jim Wermers, owners of Borrego’s shopping centers, with the help of volunteers, have been collecting, purchasing and distributing free food in The Mall.
Borrego Springs cares, and has a right to ask: “Is Borrego Community Health Foundation meeting the current needs? Is the foundation prepared for tomorrow, the future? Health care may change drastically as a result of COVID-19. What will those changes mean for Borregans, local businesses and homeowners, as well as seasonal visitors? Is this an opportunity to think about how the Borrego Community can better meet the demand for health care services?