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City Councilwoman Dr. Shelley Sekula-Gibbs came into office last year determined to be the authority on all things medical. The only problem was that Houston already had a strong-willed public health director named Dr. Mary Kendrick, who wasn't about to be taken to school by a Clear Lake dermatologist, of all things.
Until the recent budget crunch at City Hall, the doctor duel was pretty much a standoff. As documented previously in the Houston Press (see "Overdose," August 22, 2002), Dr. Shelley drove Dr. Mary to distraction by firing barrages of memos that have been largely ignored, dissed or dismissed by her bureaucratic counterpart.
The councilwoman still rubs plenty of colleagues the wrong way with her doctor shtick, including recently wearing a lab coat to City Council and community meetings. But the balance of power between the two docs is changing. Sekula-Gibbs has found an unlikely ally, Kendrick's boss Mayor Lee Brown. At issue is finding a way to keep city health clinics open despite a lack of municipal funding.
One of Sekula-Gibbs's most persistent campaigns has been to convert some city clinics into Federally Qualified Health Centers (FQHCs). Kendrick previously opposed that change on the grounds it undercuts the city's mission to provide preventive rather than primary health care.
The FQHCs are run by nonprofit private medical agencies and are funded by federal grants. They provide routine treatment for minor illnesses and are touted as a way of taking pressure off public hospitals. More to the point, the federal dollars would also take financial pressure off the cash-strapped city, which faces the permanent closing of at least one of its seven facilities, the Riverside Clinic in the Third Ward.
Although Kendrick chose not to discuss her position, which is at odds with Brown's, a health department source explains it this way: "Her feeling is when you get into the crush of providing health care, what gets left on the table is the preventive side. Given the choice between treating six cases of strep throat or a family planning case or a two-year-old [child's] developmental assessment, the family planning and developmental assessment are going to go out the door."
Riverside has been closed for nearly a year, awaiting extensive structural renovations. When the mayor asked each department for budget cuts, Kendrick initially proposed permanently closing the Riverside and Magnolia clinics and consolidating staff in the remaining clinics to improve services and cut down on appointment backlogs. That was later amended to keep the Magnolia Clinic open but shutter Riverside.
That gave Sekula-Gibbs her opening to pitch the mayor on converting the closed clinic into an FQHC.
"The point is that Riverside is closed and the money is simply not there to reopen it, even though the services are desperately needed," says the councilwoman, who is working with Brown's Chief Administrative Officer Al Haines on options to reopen the clinic. The councilwoman argues that the best choice is for the city to spend $500,000 or so to renovate Riverside and then allow it to be used by an FQHC called South Central Community Health Center.
"The amount and efficiency of care that can be delivered through a private clinic that's got this broad-based leveraged support is tremendous," explains Sekula-Gibbs. "I think we just have to be open-minded and say we just can't ignore any possibility to improve health care in neighborhoods where it's lacking."
The councilwoman compares the available federal funds to "low-hanging fruit," saying that "you need to just take advantage of these dollars."
Brown's chief of staff, Steve Tinnermon, accompanied Sekula-Gibbs last week on visits to community agencies that have applied for federal clinic status.
The mayor made it clear to his staff that he did not want to be caught in the position of having to cut health services for poor constituents. As a way to avoid closing clinics, he's backed the initiative of Sekula-Gibbs, an at-large councilmember.
The Third Ward's representative on council, District D's Ada Edwards, is firmly in Kendrick's camp. She says neither she nor Councilwoman Carol Alvarado, whose District I includes the clinic, was consulted. Likewise, it came as a shock to activists in the neighborhoods served by Riverside.
"We've been telling the community to hang in there 'cause the clinic's going to come back," says Edwards. She's bitter that the budget is being balanced on the backs of children, the sick, the poor and the disabled.
"The easiest way is just to cut it and say, 'We're going to let the feds come in and take over our responsibility,' " Edwards says. "If that happens, it'll happen over my loud voice saying, 'This is betrayal.' The community deserves to have both."
Edwards echoes Kendrick's position that preventive care, including family planning, juvenile diabetes detection and immunizations, will inevitably take a backseat if the clinics are privatized.
"Federal clinics I have no problem with, but they will not provide prevention," insists Edwards. "If we take that away from the community, bad [nutritional and behavioral] habits will go on generation to generation." According to Edwards, the work that has been done in her district to try to educate people to make better choices and take command of their lives "will be marginalized at best and eroded if we're not careful."
Edwards makes it clear who she considers to be the city's top doc.
"Like I told [Sekula-Gibbs], she is not the one I'm holding responsible for public health care in this city, and she is not the one responsible for developing prevention modalities. Dr. Kendrick is, and that's who I go to."
Alvarado says she has not decided whether to support the reopening of Riverside as an FQHC. But she is unhappy about the way Sekula-Gibbs and the mayor handled the matter.
"The first I heard there were serious discussions and action taking place was at the council table, when Haines said they had been working with Shelley. Ada and I looked at each other in amazement." Alvarado says community leaders as well as the district councilmembers should have been consulted in advance.
She shares Edwards's concerns that preventive care will suffer under the FQHC approach. "That clinic and the services it provided -- particularly preventive care -- are crucial. It has to be included and tailored to meet the needs of the Third Ward community."
Sekula-Gibbs counters that both Kendrick and the district councilmembers are wrong in claiming that preventive care can't fit into a federal clinic.
"There is no loss of service," she insists. "Somewhere along the line a misunderstanding about a loss of service came in, and that is certainly not the case. The services will be incredibly expanded."
The councilwoman also notes that a federally supported clinic is required to have a board of directors made up of a majority of members who are patients or clients of the clinic.
"This is an essential way for the community to stay in control," says Sekula-Gibbs. "That's different from a city clinic, where the community can express their opinions but at the end of the day the city runs the clinic."
Brown is not the only ally Sekula-Gibbs has in her corner on the FQHC issue. Montrose Clinic director Katy Caldwell, a former county treasurer with political experience, says her agency is applying for FQHC status. She can't understand why the city wouldn't reach out for federal health care dollars.
"I'm sorry, but I don't get it," Caldwell says after hearing a summary of the opposing position. She notes that under Houston's public health system, preventive care isn't working all that well.
"Why do we have some of the lowest immunization rates in the country?" asks Caldwell. "And why do we have some of the highest rates of communicable diseases in the country?
"Is it better to not have anything than some form of primary and preventative care? If this gets Riverside open, you're going to have both."
The Insider diagnoses the latest top doc dispute as a symptom of a dreaded bureaucratic disease: turfitis. Even councilmembers critical of Sekula-Gibbs concede that Kendrick's opposition is at least partially motivated by her fear of losing control of the clinics.
It may be hard for some folks to swallow, but Dr. Shelley's prescription seems to be the only course of treatment guaranteed to bring the Riverside Clinic back to life.