September 26, 2001 11:00 pm

By Alice Perry Linker

Observer Staff Writer

In a report that is mostly favorable to Union Countys public health agency, a Marion County health official urged the countys public and private health care providers to work through their differences and cooperate more fully.

Jeffrey Davis, director of the Marion County Health Department, analyzed the performance of the Center For Human Development at the request of the Union County commissioners. Davis spent several days in August observing CHD and interviewing about 47 people, including health care providers, physicians and commissioners.

I did not find in my review that the service system is bad, Davis wrote in a letter to the commissioners. I did not find that any services harmed residents of Union County. I did find relationship issues among providers and perceptions generated by CHD missteps early in their transition to a non-profit agency. I found interest and energy on the part of the community and CHD staff to make things even better.

CHD is the private, non-profit corporation that provides public and mental health services for county residents. The corporation is also the public and mental health authority.

Commissioner Steve McClure presented Daviss report to the commissioners during Wednesdays meeting.

The countys Health and Human Services Advisory Committee will review the report in a public meeting Oct. 15 and discuss recommendations. Copies of the report are available to the public at the county commissioners office in the Joseph Annex on K Avenue.

In the report, Davis chastised the countys health care providers, including CHD, for lack of cooperation.

The poor relations among providers contribute to the problem of addressing health care needs, including rural health needs, he wrote. The poor relationships prevent the health community from coming together and planning for what can and cant be done.

Davis recommended that health care providers hire a facilitator to develop a coordinating group that looks at relationships and system needs and works together to achieve a better system.

Davis praised the level of rural services, writing, It is surprising the amount of rural services being provided. The focus is on what is not being provided rather than what is.

Davis is recommending that CHD:

Include a public health nurse supervisor on the executive team.

Develop a plan and establish protocols for responding to communicable disease outbreaks

after hours and on weekends and holidays.

It is essential to be prepared by having a plan in place. Given the recent events in New York, such a plan becomes imperative, Davis wrote.

Improve its communications with primary care physicians, including sharing mental health information and establishing a standard to return phone calls from private physicians.

The adult mental health program is not as responsive as (it) could be in getting information to primary care physicians, Davis wrote. Phone calls are not returned promptly.

In addition to providing health care, CHD is the countys contracted public and mental health authority. Davis has recommended that before any contract is approved, CHDs executive officer present the county with a review of spending for services. The county could adjust any funding plan.

Davis also recommended that the county and CHD develop a performance-based contracting system for CHD and all subcontractors beginning with July 1, 2003.

As the mental and public health authority, all of CHDs functions, budgets, etc., are open for public scrutiny, Davis wrote. CHDs budgets and board minutes have not been available for public scrutiny.

Davis suggested that the corporations role as the county mental and public health authority be more clearly defined, with the executive director allocating about 10 percent of his time

as mental and public health authority.

It is necessary to separate the authority role, so that CHD can operate more cleanly as a provider for the county, he wrote.

Davis praised the CHDs use of self-directed teams.

The problem is that CHD has not found a way of connecting with the community without using this model. People outside the agency are not sure where the buck stops or who to talk to about issues, he wrote.

The county commissioners have hired Bob Armstrong of the Oster Group to direct an independent financial audit of the corporation.