09/08/11 — Commissioners OK $100,000 for WATCH

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Commissioners OK $100,000 for WATCH

By Steve Herring
Published in News on September 8, 2011 1:46 PM

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Tiffany Tyson, lead nurse practitioner, fills out a prescription for Barbara Anderson inside the WATCH. Mobile Unit. Without the WATCH Mobile Unit Ms. Anderson would not have a place to go to receive health care since she is a small business owner and can not afford health insurance.

Wayne County commissioners were unanimous in their agreement that WATCH (Wayne Action Teams for Community Health), which provides health care, mostly to the county's uninsured, plays a valuable role. What they couldn't agree on was whether it was worth another $100,000 in taxpayer dollars.

Commissioners Steve Keen and Andy Anderson questioned the wisdom of appropriating money to offset the loss of WATCH grant money. However, they failed to sway the rest of the board, which voted 6-1 to give the program $100,000 from contingency funds.

Keen voted against the motion. Anderson did not vote, meaning he was counted with the yes votes.

"My concern is when do we stop spending?" Keen said. "As we spend, this is for a good cause, you are doing a good job, but where are we getting the money? If we take it from there is somebody else going to wind up the next day and say, 'We need it?' How far are we going to go?"

County Manager Lee Smith agreed that it opened the door to more requests, but he said spending the money would likely save much more in the long run.

Smith told commissioners that failure to fund WATCH could translate into overloading the Wayne Memorial Hospital emergency department and county Health Department. He estimated it would cost the county almost $500,000 to absorb the WATCH patient load for just six months at the Health Department.

WATCH Executive Director Sissy Lee Elmore told commissioners she was appealing to them and to the hospital for $100,000 each to help offset the loss of a $200,000 Duke Endowment grant. The grant pays the salaries for the family nurse practitioner and support staff in the stationary clinic site at the Family YMCA, Ms. Elmore said.

Without WATCH, the county would need to hire two or three nurse practitioners, two people to order medications and two medical office assistants and clerical assistants to do the office work now done for free by volunteers, she said.

"You are going to have to have specialty physicians that we have free because we have volunteers. You are going to have to pay for the laboratory visits that we get free. A lot of these things we get free because we are a nonprofit organization. If you are a government organization or the hospital, they are not going to give you free laboratory services. The doctors are not going to come in and volunteer for free because they get paid to do that."

Ms. Elmore said it was the first time the foundation had turned her down. She said she could not apply for another grant at the same time she was applying to the Duke Foundation until she found out that she didn't get that grant.

"I am searching for other monies, but we do not have the availability of federal money or state money," she said. "The only money that we can get is private money. Grants, usually they want you to have a new program or a startup and we are not new and we are not a startup. We have been in this county for a long time and have provided almost $10 million in free medications."

Keen asked Smith how much the county had budgeted for WATCH for fiscal year 2011-12. The amount was $120,000, Smith said.

Keen asked Ms. Elmore if she knew why Duke Endowment had not funded the program. Ms. Elmore said she was told the foundation received four times as any requests as it had money to fund.

"Do you see a trend or have you charted who these people are you are treating," Keen said. "Are they city? Are they county? What race? Are they African-American? Are they Hispanic?"

By race, 10 percent are Hispanic, 45 percent African-American and 45 percent white, Ms. Elmore replied.

"We probably see some of your neighbors. We probably see some people who are related to you," she said. "We go all over the county every month so we are seeing people in the whole county, not just in the city."

Keen asked if the program had run out of money. Ms. Elmore said she is required to maintain a reserve to carry the program from three to six months and currently has enough money to get through Dec. 31. She said she would reapply to the Duke Endowment in January and would look for other money as well.

Anderson said he understood the need but said the county always seems to be the place people turn to for money when other sources dry up.

"It would seem to me that a private not-for-profit hospital could fund this rather than come to the county commissioners. Do you know any reasons they couldn't do that?"

Ms. Elmore said the hospital pays her salary and benefits as well as overhead on the program, maintenance on the WATCH truck and provides most of the program's medical supplies.

Smith said that his recommendation up front was to fund the additional $100,000 for several reasons.

"First of all, the hospital is investing right now in the emergency department over $18 million," Smith said. "If we turn loose this number of patients and patient visits on the emergency department or Health Department, we couldn't see them. The ED would be overflowed opening day one.

"They could not do it at this cost. The cost would be higher walking into the ED. The Health Department, I have already calculated it would cost me about $478,000 just for six months to see half of these people. Half. The reason I said half is that I don't have the capacity. It could cost as much as a million dollars (a year) to see additional people because I would have to hire new nurses, have new programs and the transportation issue.

"I looked at this $100,000 versus over $470,000."

Transportation is a huge issue since the patients have to get to the hospital or Health Department, while the WATCH van normally goes to where the patients are, Smith added.

The problem is that the hospital already is paying for a large part of the program, said Commissioner Jack Best, who also sits on the hospital board of trustees.

"The volunteer work that goes into here is probably worth another $150,000," Best said. "The hospital is helping to support it as well as the county."

Anderson said he is concerned about starting a new program. Smith said the program is not new, only that it lost grant money it had been receiving.

It is a matter of looking at return on investment, Smith said.

"You are going to be right back here in the spring unless Sissy Lee can sharpen her pen and get really good to look at other grants because there are additional dollars for the following fiscal year," he added. "It will be a bigger chunk of money in 2013, unless she can come up with more grant money, for the county, the hospital, or whoever."