County Health Department tolerates ‘bad behavior’ without consequences, report says

In stinging reports released Friday, outside consultants and internal investigators found widespread problems in Mecklenburg County’s Health Department and harshly criticized top management, including outgoing Health Director Marcus Plescia.

Reports from two consulting firms and the county’s Internal Audit office portray two publicly run health clinics beset with issues that include workers failing to put accurate information in patients’ files, long waits for appointments, outdated technology and internal strife.

Perhaps the strongest criticism is aimed at the agency’s management, which one report says failed to hold employees accountable and sent the message that “ ‘bad behavior’ is tolerated and there are no consequences for their actions.”

Mecklenburg leaders ordered reviews of the Health Department after acknowledging in February that the two health clinics did not notify at least 185 women about abnormal Pap smears.

The lapses helped lead to the resignation of Plescia and four other employees.

Plescia and some other county officials have defended the agency’s performance for months, and gave assurances that the Pap smear failures did not reflect the overall quality of patient care.

But county Commissioner Jim Puckett said Friday that the reports provide evidence of mismanagement and incompetence within the department.

“It was clear to me that what was happening was clearly far greater issues than poor performance of one or two employees,” Puckett said.

Puckett said he is irked that some officials were initially reluctant to hire outside consultants and now believes officials did not want the full extent of the agency’s problems exposed.

“When we are talking about the Health Department and the lives of our citizens it is inconceivable to me that this culture and level of incompetence would not only be allowed but shielded via supportive emails and public endorsements,” he said.

Commissioner Bill James said the county must make major changes, including considering outsourcing some of the department’s services.

“We’re going to have to make substantive changes that are going to cost taxpayers a lot of money,” James said.

A spokesman said county administrators would not comment on findings until Tuesday when commissioners meet to discuss the reports.

County Manager Dena Diorio has recently acknowledged that major reforms are required to address problems within the agency.

She said she is open to all ideas, including privatization of services.

‘Not held accountable’

Mecklenburg’s Health Department is the community’s first line of defense against threats such as sexually-transmitted diseases, highly contagious diseases and food-borne illnesses.

The agency, which has roughly 800 employees, has a wide range of duties – including regulating restaurants, child care centers and swimming pools.

Clinics on Billingsley Road in southeast Charlotte and Beatties Ford Road in west Charlotte – which serve primarily low-income patients – have come under public scrutiny since the Observer first reported in February that they did not notify a number of patients about their risks for cervical cancer following Pap smears.

Health Department employees have peppered county commissioners with emails and calls for months.

They allege that patients who depend on the two clinics endure unacceptably long waits for appointments and sometimes receive inaccurate test results for pregnancies and STDs, as well as other poor care.

Consultant firms Navigant and Praxis and the county Internal Audit office investigators interviewed department employees, observed operations and analyzed data to compile their reports.

Among the findings:

▪ Employees repeatedly failed to put information about patients into the agency’s electronic medical records system – information that included immunizations and mammogram results.

Staff does not always check the identities of patients at check-in, one report says.

Another problem is numerous “demographic/registration errors.” In one case, a registered nurse was unable to prescribe a medication for a patient because there was an extra digit in the ZIP code of the patient’s address, the report says.

▪ Patients sometimes wait as long as 50 minutes to check in for appointments.

Appointments for Pap smears typically have taken between two to four hours. The amount of time doubled or tripled if an interpreter was needed.

“Clinical and quality performance standards and metrics minimally exist or are not used to gauge clinical performance,” the report says. “The lack of an organized and robust infrastructure has limited MCHD success resulting in patient dissatisfaction, staff and provider dissatisfaction.”

▪ One report suggests that Plescia did not do enough to help managers hold employees accountable.

The health director wanted to be involved in strategic planning instead of the “hands on” work needed to improve the clinics, consultants found.

“Staff are not held accountable for their inappropriate behavior or actions by leadership,” the report says. “This inaction provides staff with a negative feedback loop that ‘bad behavior’ is tolerated and there are no consequences for their actions.

“Some managers do not exhibit/model appropriate behaviors for their staff. Staff, also, model these inappropriate behaviors, leading to a bad culture and a(n) inhospitable work environment for staff.”

Plescia did not return two Observer phone calls Friday.

Correcting problems

The findings come on the heels of an Observer report last week that detailed an internal Health Department review into the Pap smear lapses. A nurse found that substandard care posed a risk to patient safety.

Commissioner James said the county must now take a different approach to employee accountability.

“Management’s gonna have to be a lot tougher on employees who screw up,” he said.

Commissioner Pat Cotham added: “People pay professionals a lot of money for medical advice or financial advice but then ... they ignore the advice. We can’t make that mistake. We have to admit the problems and work to correct.”

This story was originally published July 7, 2017 at 3:29 PM with the headline "County Health Department tolerates ‘bad behavior’ without consequences, report says."