Politics & Government

STD rate is out of hand but is the county doing enough? Employees are afraid to talk

Mecklenburg County Health Director Marcus Plescia has vowed to restore public trust. Some employees believe his leadership contributed to issues that led to lapses at his agency.
Mecklenburg County Health Director Marcus Plescia has vowed to restore public trust. Some employees believe his leadership contributed to issues that led to lapses at his agency. dtfoster@charlotteobserver.com

For more than three years, Dr. Marcus Plescia has been trying to chart a new course for Mecklenburg County’s health department, pushing for a smoking ban, a publicly-run farmer’s market and other big-picture ideas.

But behind the scenes, some employees complain that the agency is struggling to perform one of its most basic duties: Providing competent medical care to the poor.

They say Plescia’s focus on lofty preventative health measures has diverted his attention from patient care at a time when the Charlotte metro area’s rates for sexually-transmitted diseases like gonorrhea, syphilis and chlamydia are among the nation’s highest.

Six current and former employees with direct knowledge of the agency’s management, patient care and laboratory operations told the Observer that the Health Department’s problems go beyond an admission earlier this year that a nurse failed to notify nearly 200 women about abnormal Pap Smear results.

They spoke on the condition that their names not be used because they are not authorized to speak publicly on their concerns and they fear reprisals from management.

They said a majority of nurses and health employees disagree with the direction of the agency and believe Plescia pays too little attention to troubles that imperil patient care.

Almost from the time he was hired in early 2014, they said, Plescia signaled that the department should focus less on so-called “high-touch” direct patient care and community outreach in favor of research and partnerships with universities.

Now, patients at county-run clinics on Beatties Ford Road in west Charlotte and Billingsley Road on southeast Charlotte often sit in waiting rooms three to four hours for appointments, sometimes receive inaccurate results from tests for pregnancy and sexually-transmitted diseases or don’t get needed follow-up after treatment, the employees said.

In one recent case, they said, workers did not tell a woman for a year that she had chlamydia even though she visited a clinic every three months for birth control treatment. In another recent instance, the agency incorrectly told a woman she was pregnant and she was unable to get a prescription for birth control before the mistake was discovered.

Through county spokesman Andy Fair, Plescia refused interview requests. But in a written statement provided by Fair, the county disputed the accounts. In the case of the woman who employees said had not been informed of chlamydia, the county said, “We do not believe this is accurate,” and said patients can call an automated phone system to receive STD results.

Regarding alleged errors involving a woman’s pregnancy tests, the county said it would need specific patient information to investigate the claim but that it was not aware of such a mistake.

But members of the Board of Commissioners, which sets policy for the county, said they have heard similar accounts from employees through anonymous emails. The Observer has obtained an audio recording of a meeting among Health Department nurses who aired their grievances and described problems within the agency.

“Everyone knew the clinics were burning and everyone let them burn,” an agency nurse told the Observer.

Theoretical vs. practical

Local health departments are the front-line of protection against threats to residents’ well-being. They help prevent epidemics and the spread of illness, including STDs and highly contagious diseases.

Taxpayers spend about $70 million a year for public health for Mecklenburg County’s 1 million people. The Health Department’s 800 employees are charged with a wide range of duties, regulating everything from restaurants and child care centers to swimming pools.

Most recently, public attention about the department has centered on its two health clinics. In response to questions from the Observer, County Manager Dena Diorio acknowledged in February that the agency failed to notify 185 women about their risks for cervical cancer following Pap smears.

County Commissioner Jim Puckett said last week the issues reflect the tension between providing direct patient care and Plescia’s vision for a department that focuses on research and broad health policy.

For example, he said, Plescia successfully lobbied leaders in 2015 to ban smoking from the grounds of government buildings and most parks and greenways, including places such as the NASCAR Hall of Fame, the Spectrum Center and CATS transportation centers. Puckett said Plescia defended the proposal by telling him the county should set a healthy example for residents to follow.

“I see a theoretical approach on health as opposed to what’s practical,” Puckett said before alluding to the Pap smear failures. “This is what happens when you take your focus off your core function.”

Challenging start

County Manager Dena Diorio, who is Plescia’s boss, has stood by him and given no indication publicly about whether his job is in jeopardy. Some commissioners have suggested complaints about the health clinics and Plescia’s leadership are overblown.

Plescia came to the job at a time of tumult in the agency.

For years, the county paid Carolinas Healthcare System to provide medical care, but that changed when officials voted to end the arrangement before Plescia was hired.

“There was distrust and there was a struggle to get everybody on the same page,” Commissioner Pat Cotham said of the transition from Carolinas Healthcare to county control. “I don’t know if (Plescia) understood the history. I don’t know if he knew about all the angst before his arrival.”

Since the Pap smear lapses became public, Cotham said, Plescia has taken steps to address longstanding issues.

“He’s taking it very seriously,” she said. “He seems to be determined to get it right.”

Commissioner George Dunlap has repeatedly defended the county’s response to the Pap smear failures.

In March 31 email to county officials, Dunlap questioned the performance of some of the agency’s nurses, not Plescia or other managers.

“It has been established that there were multiple problems since some of the nurses came over from Carolinas Health,” he wrote.

Citizens ‘screwed’?

Plescia is paid about $240,000 a year, making him one of the top-paid figures in county government.

When he started as health director in February 2014, he brought a sterling reputation. Cotham recalled thinking he might be overqualified for the job.

From medical school at UNC Chapel Hill to the Centers for Disease Control and Prevention, where he ran a cancer prevention program, his work focused on the poor. He treated AIDS patients in the South Bronx, N.Y., during his residency training in the early 1990s. He spent time as a doctor on the Cherokee reservation in Western North Carolina while he was at the CDC.

At Mecklenburg’s health department, current and former employees said, Plescia has tried to create an “academic” agency more focused on broad policies than the day-to-day operation of clinics. They said he describes the approach as “low-touch, high impact.”

That meant officials felt discouraged from participating in more health fairs and other outreach events designed to prevent the spread of sexually-transmitted diseases, which have hit the southeast United States particularly hard, employees said.

The Charlotte metro area has a rate of 30.7 syphilis cases per 100,000 people, compared to the national rate of 7.5, according the federal Centers for Disease Control and Prevention.

Despite assurances from management to address inefficiencies, employees said, the clinics operate so poorly that nurse practitioners can only see 15 to 18 patients a day.

A nurse practitioner in a private office would see up to 30 patients on a normal day, they said.

The result, employees said, is that taxpayer money is wasted and patients don’t get the care they need.

“Citizens are being screwed,” one nurse said.

‘Lack of leadership’

County leaders have vowed make sure lapses in Pap smear follow-up won’t be repeated. They have hired consultants and ordered reviews to determine what changes are needed.

Investigators from the county’s Human Resources department have already submitted a report that spreads blame from workers to supervisors and managers.

But they found management showed a “lack of leadership” in identifying the extent of the problem and correcting it. The report also concluded that supervisors and managers failed to respond to concerns raised by employees.

The findings reflect a common complaint among some employees. They said Plescia’s leadership has created a culture in which employees are afraid to tell managers bad news.

As a result, they said, when employees discovered a nurse had not contacted patients about Pap smears, Plescia did not learn about it for nearly a month.

At a recent meeting, County Commissioner Trevor Fuller said he has heard from health department workers who fear retaliation if they report concerns to management.

“They feel like they are being silenced,” Fuller said. “People who feel free to articulate things to management, (feel) management minimizes their concerns.”

Plescia has said the doesn’t understand why employees did not come to him right away about the Pap smear lapses. He said it is likely that they wanted to learn the extent of the problem before alerting executives.

In interviews and press conferences, Plescia has said he believes the failure to contact women about Pap smear results was mainly caused by one nurse who did not perform her duty. He acknowledged incidents in which patients were given inaccurate results after HIV testing, but said those mistakes were isolated and not signs of systemic issues.

In an address to county commissioners last month, however, Plescia said he wants the on-going reviews to restore the agency’s credibility.

“This process is to rebuild public trust,” he said. “I expect this will lead to suggestions for improvements.”

Clasen-Kelly: 704 219-2667, @FrederickClasen