Health workers’ fate still pending

August 19, 2008 - 11:54PM
Despite the fact that Medical Director Dr. Kathleen Shapley-Quinn and Nurse Practitioner Karen Saxer won't face charges for their roles in the writing of alias work notes for Hispanic clients at the Alamance County Health Department, the two remain on paid administrative leave and their employment status is in limbo, at least for several more weeks.

On Tuesday, Health Department Director Barry Bass said he will decide by Sept. 8 whether to reinstate Shapley-Quinn and Saxer.

Bass' revelation to the county board of health came only after board member Charlie Wilson pressed him for information, and after a good bit of legal wrangling between Chairman Keith Whited, Wilson and other board members over whether to discuss the personnel issue behind closed doors or as part of its public meeting.

The board ultimately voted down Wilson's motion to hold the discussion.

Dennis Harrington, the assistant director of the state Division of Public Health, attended Tuesday's meeting. Harrington said the health department must provide services regardless of residency status.

Controversy over the issue has been swirling since June, when the board voted to strengthen its oversight of the department and require staffers to release all patient names on the work excuse notes.

Two months ago, County Manager David Smith suspended Saxer and Shapley-Quinn with pay pending the completion of an SBI investigation into possible fraud arising from the notes. The suspensions came after health board Chairman Keith Whited brought forward concerns about the practice.

Whited said staffers should end the practice of filing false names apart from patient medical files. Including such names in excuse notes could result in clients committing identity theft, he said.

Board member and county Commissioner Bill Lashley shared those worries and asked Smith to call in the State Bureau of Investigation. At Smith's request, Sheriff Terry Johnson got the Bureau to investigate.

BURNS SAID THAT over the past three months, the total visits to the department's family planning and maternity clinics had increased.
The department has "downsized a little bit" with services since the suspension but has "managed to keep things running."

Initial family planning visits have gone from waits of two or three day to about 4 to 6 weeks. "But that's expected when you have staff that you are unable to use."

Plans will go into place to "stack that clinic and be able see more patients" to make up the backlog, once the department is back at full staff, Burns added.

Dr. Isa Cheren works part time at the health department and has filled in during the suspensions. "We cut other clinics at the expense of keeping maternity (services)," Cheren said.

Cheren said the health department had a "big backlog" of patients that staffers were able to "work down" efficiently because of "open access" when she first started working there.

Now, she said, the department is, "in many ways, creating huge barriers" to access especially when it comes to "young people."
While the department is "kind of holding our own," it is "deficient, at minimum, for the quality of care that we can normally provide."

BURNS ASKED BOARD members to review a draft policy covering the use of alias names in work excuse notes. Among other things, the draft recommends a client that requests the use of an alias fill out a "Personal Data Continuation Sheet" that will allow the use of one alias name. The alternate name also is listed on the patient registration screen and included on the "outside of the medical record" and any other forms in the record.

The board agreed by consensus to review the draft before voting on it.

Having a policy on work notes will help, Bass said. "We're going to heal some wounds ... We're going to have a really good dialogue among ourselves and staff about where we are and how we want to move forward, and commit to each other that we will agree to disagree in a very professional way."

Lashley said despite the conclusions of investigators and prosecutors, he thinks the county is spending local money for Medicaid services that should be paid for with federal Medicaid dollars. "Something is going on. That is just not logical to be spending more money than Orange County and Guilford County on that process."

An SBI agent told him, Lashley said, that confiscated health department e-mails between doctors and nurses referred to the spending of local funds on Medicaid. "They can cover it up if they want to, but that is illegal if these people that work for the health department is doing that."

The board "needs to be aware that there's more to this than what you all are saying," Lashley added.

"Well, who has the information?" Wilson asked.

"Well, it's been covered up," Lashley responded.

Whited and others asked Lashley to bring forward the information; the commissioner promised to get to the bottom of it.

Bass said, as far as he knew his employees "are operating in a lawful manner."

The agency and the board has been damaged, and certainly Dr. Shapley-Quinn has been through hell ... It should been an administrative matter."

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