Commissioner Shannon Whitfield's insistence on raising the rent 8,800-percent for Primary Health Care Centers' clinic in Rossville is being met with dismay, incredulity and a willingness to settle the matter in court.
"We disagree with the commissioner," said Diana Allen, CEO of PHC and its six clinics.
During a meeting with PHC administrative officers, she rebuked Whitfield's claims that the Rossville facility has cost the county more than $1 million since opening in 2008, that it has relied on taxpayers footing its utility bills and insurance premiums.
"It sounds like we mooched — that we've taken advantage of the county," said Chief Operations Officer Melanie Forsythe.
Noting that they had not been asked to pay for utilities until this fall, Chief Financial Officer Julie Hackney said that changed this past August.
"The biggest misunderstanding with the public is that we're costing the county," she said. "Now that we're paying for utilities, we cost the county nothing."
Non-profit PHC was incorporated 38 year ago, with a single clinic in Trenton. Thirty-eight years later, PHC has full service medical facilities in Catoosa, Chattooga, Dade, Polk and Walker counties.
Having been with PHC for 17 years, Allen recalled how and why the expansion to Rossville and later to the other sites came about.
The building now occupied by PHC has previously been a branch of the state's Public Health Department and had provided space for the Department of Family and Childrens Services.
But budget constraints caused the health department to close and DFCS moved to new, purpose-built offices in Rock Spring. After that, the county-owned building sat vacant for about four years with only minimal, if any, maintenance being performed, PHC officials said.
"I contacted Commissioner Bebe Heiskell," Allen said. "We had an opportunity for an expansion grant, one that would provide additional funding to hire staff."
Many of those being served in Trenton were not natives of Dade County, they were traveling around the mountain, and with Hutcheson hospital scaling back on its McFarland Avenue clinic, there was a growing need for medical and dental care.
Heiskell suggested the empty health department building as a possible site, "she saw there was need for health care in Rossville," with few strings attached.
Allen recalled the building's condition had deteriorated —there were serious issues with moldy walls, floors and ceilings; its roof leaked and there was some structural damage (including a breached exterior wall) — to the point that critters were its sole occupants.
A Georgia Department of Community Affairs grant allowed PHC to move into the building and expand its mission of serving the underserved.
It was that roughly $400,000 grant that Commissioner Whitfield seems to reference when asserting the county paid for renovations necessary to make the building on Suggs Street useable.
Allen said the DCA grant was awarded specifically for renovation of the site. Heiskell applied for a grant that included stipulation of it being used to provide community health. The county acted as the fiscal agent for the grant that was 100 percent state-funded.
"The county gave us space and got health services," Allen said.
PHC accepts patients who have no health insurance, who can qualify for a sliding fee for services scale; those with private or company insurance; and those with Medicaid and Medicare.
Though it has a physical presence in five counties, PHC's patients come from Tennessee, Alabama and far-flung counties of Georgia. It is a federally qualified health center, meaning federal money is available to provide medical care in low income/high poverty areas.
Primary Health Care's Rossville Clinic 2010-2016
Patients served: 4,335 average yearly visits.
Total patient visits: 74,062 (total for 7 calendar years) — 10,580 annual average
Federal poverty level: 80 percent at or below 200 percent FPL, majority are at 100 percent FPL
Uninsured served: 48 percent yearly average
Medicaid coverage: 37 percent yearly average
Medicare coverage: 13 percent yearly average
Commercial insurance: 1.5 percent yearly average
Current employees: 26 (23 are full-time)
Physicians: 2 (1 full time, 1 part-time)
Family nurse practitioners: 3 (2 full-time, 1 part-time/PRN)
The services provided include adult medical care (acute care, physical exams, check-ups, immunizations, diabetes/hypertension and other chronic disease management), infant and children services (acute care, sports physicals, screenings) and testing and screenings or businesses. PHC also provides general dentistry for both adults and children.
In addition to treatment, PHC provides case management services and assists patients filling out paperwork required for Medicaid, food stamps, the Affordable Care Act, and acts as a liaison with schools and other providers of social services.
"We connect the dots," Forsythe said. "We try to meet every need."
Sandy Matheson, the director of community relations and development, said PHC provides services that otherwise would be beyond the reach of the community it serves.
"We help keep families together, "she said.
The disagreement with the commissioner is not about what PHC provides but about its finances.
Allen said that while Whitfield uses a valuation of more than $1 million for the property, its value on the county tax rolls is about $350,000.
While it has leased the site for $1-per-year, administrators point out that PHC took over a building that was essentially a shell in 2008. Aside from fixing the roof and doing "band aid repairs" on it HVAC system, all maintenance and upkeep has been performed without county funding.
"The building was un-rentable, it wasn't suitable for use or for renting," Allen said, contradicting the commissioner's assertions.
As to not paying for insurance, Allen pointed out that the county, as landlord , is responsible for insuring its building and grounds. PHC, like any renter, pays for its liability and malpractice insurance.
Stipulations included in the DAC grant require that the facility must be used to provide community health services and cannot be sold without the county repaying the grant amount.
The lease is renewable for five-year periods, but since August there has been no formal agreement between the county and PHC.
Allen said that two weeks after Whitfield's being elected in 2016, she contacted him via email to discuss the Rossville facility.
In April, the commissioner wanted to meet, she said, and in May, PHC agreed to review costs associated with the building's utilities.
The county secured an appraisal of the building, presented it to the PHC board, "and he asked what we wanted to do?" Allen said.
Whitfield has told the PHC board that he wants monthly rent of $8,800 for a three-year period. He has also asked that the Rossville clinic, which has had no signed leasing agreement since Aug. 31, pay three months of back rent.
"Rather than coming to us with a proposal, the commissioner did nothing until he said 'here's an appraisal of its fair market value,'" Allen said. "We offered to pay $2,500 a month ($6 a square foot) which was doable — our board could approve that — and is comparable to what we pay at our other clinics."
The administrative staff agreed that the use of grant money has allowed the clinic to hire and retain skilled staff while at the same time making it possible for PHC to pay for and maintain its electrical, plumbing, security, telephone and tech systems.
"If it (the former health department building) is worth anything, it's because we're here and have been maintaining it," Allen said.
While Walker and PHC are at loggerheads, Matheson said it is more often the case that counties approach PHC about partnering with them.
"We bring value and support," she said. "We are able to provide a safety net that no other entity could provide.
"We've stepped up to fill a void created by the local hospital failing. The health department cannot fill the need — we accept referrals from health departments."
In addition to its Rossville clinic and a clinic at Gilbert Elementary School, in LaFayette, the PHC corporate offices are located in a county-owned building that is diagonally across from Commissioner Whitfield's office in LaFayette.
The impasse over rents and leases includes the corporate office (the school system has control over the Gilbert site) that will eventually be resolved by PHC relocating to Catoosa County. The PHC board has approved purchase of what once housed the rehabilitation and hospice services of Hutcheson Medical Center.
Located directly across the street from what was Hutcheson, then Cornerstone and this week becomes CHI Memorial Hospital - Georgia's emergency room entrance, the building will require substantial renovation and remodeling before PHC can relocate.
When asked what will become of the Rossville clinic if no agreement can be reached, Allen said PHC intends to keep a satellite clinic in Rossville even after eventually moving to the Fort Oglethorpe campus.
"What keeps us going is the people we help every day," Matheson said.