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New clinic lifts hope and anger

The operator says the Shores will benefit, but a critic says it's a waste of tax

SILVER SPRINGS SHORES - January 21, 2012

Published in the Ocala Star-Banner on Saturday, January 21, 2012 at 9:20 p.m.

This community soon will have an expansive new medical clinic.

Construction of the 21,000-square-foot facility, called Langley Health Services, is well under way. It will feature pediatric and adult care, dental and podiatric services, radiology, a pharmacy and mental health treatment.

Workers with ABC Masonry work on building a wall at the new Langley Project Health Clinic that is under construction
on Midway Terrace in Silver Springs Shores on Jan. 12.

Project Health Inc., a nonprofit medical clinic operator in Sumterville, is building the new clinic along Maricamp Road to replace the Family Medical Center at the Shores, a store-front office further down Maricamp Road that focuses on uninsured and low-income patients.

But the project also encapsulates the debate of the merits of the Obama administration's 2009 economic stimulus plan.

In addition to the current construction jobs created by the federally funded $5.2 million project, Langley Health Services will field a full-time staff of roughly 40 people.

Despite that, a former medical director at Project Health's parent clinic suggests the Shores project — albeit worthwhile in trying to improve access to health care in the Shores — is literally too much of a good thing.

Dr. Robert Carraway maintains the facility is too oversized for the community it is intended to serve, and as such is a taxpayer-funded boondoggle waiting to happen.

Carraway characterizes the clinic as a local and health care equivalent to Solyndra — the defunct California solar energy company that took $535 million in federal loan guarantees and went bankrupt, and is now the subject of a congressional investigation spearheaded by Republican U.S. Rep. Cliff Stearns of Ocala.

Three federal grants

Project Health's newer foray into Marion County is happening where the neighboring Moose Lodge had once planned an RV park.

The clinic group, which also operates the Thomas E. Langley Medical Center in Sumterville, started in 1974 as a health care provider to local farm workers.

Project Health first entered Silver Springs Shores in 2008, opening a 2,500-square-foot clinic in a strip mall. In 2009 the group received three federal grants under the American Recovery and Reinvestment Act, or ARRA, which is the formal name of President Barack Obama's stimulus plan.

According to federal records, the awards included:

$5.2 million to build the new clinic in the Shores

$722,815 for a system to digitize patients' records

$272,133 to pay salaries of a pediatrician, a nurse, a staff assistant and part of the salary of a physician's assistant.

The grant for the employees' salaries was intended to keep the Shores clinic from closing, federal records indicate. At the same time, Project Health reported to federal officials that its patient base in the Shores continued to grow with the grants in place.

Among the 46 community health centers in Florida that received stimulus funding, Project Health got almost half of the total amount for new construction projects. And its $6.2 million total was the most in the state for those clinics, the government's database of ARRA grants shows. The new Shores facility will be about half the size of the 41,000-square-foot Langley Medical Center, and offer almost all of the same services. Its arrival has been heralded as a community win.

In October, just after Project Health broke ground in the Shores, County Commissioner Mike Amsden called it “good news” and “an investment in the community” by Everett Kelly, the clinic's president and CEO and a former longtime Republican state lawmaker.

Noting the number of people who will work there, Amsden added, “That is positive. That is job creation.”

“It is our goal to make sure everyone in Marion County has access to health care,” Kerrie Jones Clark, CEO of the Heart of Florida Health Center, the community health clinic serving Ocala, said in an email.

“We appreciate the support Langley will bring to the Shores to treat low-income and uninsured patients. We hope they will have a positive impact on the health of the community.”

Steve Purves, president and CEO of Munroe Regional Medical Center, said the community's safety-net hospital appreciates any effort to reduce its burden — especially to its emergency room, a frequent destination for people who are uninsured or otherwise cannot afford care.

“We want to work with anyone who can improve access to medical homes (or primary care) and expand health care to the uninsured and people who can't afford to pay their medical bills, especially if it's organized enough to educate the public about accessing care from them instead of going to the emergency department,” Purves said.

Too big, critic says

Yet Carraway, an internist from Yalaha, maintains the project is a “huge Taj Mahal” that is more than the community — or the taxpayers who funded it — needs.

Carraway worked at Langley Medical Center for five years, the last four as its medical director. He left in October, he said, after a falling out with Kelly over the operation of the headquarters facility.

Prior to his departure, though, Carraway said he was positioned to see the data related to the expansion, and he doesn't not believe the community can sustain the new venue.

“It doesn't make sense that they should be spending all this money on something that has been shown to not be all that viable,” Carraway said recently.

“It would not have happened were it not for the stimulus,” he said. “They're throwing out money that will ultimately go to waste.”

As planned, the Langley satellite in the Shores would double the size of the other federally qualified health clinic serving Marion County.

The Heart of Florida Health Center near downtown Ocala covers 10,000 square feet in offering medical, dental and mental health services primarily to low-income and uninsured patients.

According to Clark, its CEO, the clinic treated 6,138 individual patients in 2011.

Another clinic within the region, the Leesburg Family, Pediatric and Women's Care facility, offers family and internal medicine, pediatric care, family planning, laboratory and EKG services in a 13,308-square-foot building in Leesburg.

According to Linda Williams, marketing director for Winter Garden-based Community Health Centers, the operator of 11 local clinics across Central Florida, about 7,200 patients visit the Leesburg site yearly.

Those numbers, however, reflect “unduplicated” patients; many of those patients make multiple visits, meaning the number of people through the door could be two or three times those amounts.

The facility where Carraway now practices — the Community Medical Care Center, also in Leesburg — serves more than 7,200 patients a year in a 5,000-square-foot building, according to the clinic's website.

That clinic, Carraway noted, offers treatment from two or three doctors and other specialists who volunteer their services, two dental rooms, nutritional services and a “de facto” pharmacy, through a staff nurse who obtains many common medications from pharmaceutical companies.

The facility's patient load mirrors the population growth within Silver Springs Shores. According to the Marion County Growth Management Department, the Shores' population increased from 16,002 to 23,778 between 2000 and 2010, and the community added 3,895 new homes during that time.

Kelly, Langley Medical Center's CEO, said in a recent interview the current Shores clinic treats about 50 patients a month.

Carraway said he is not irritated as much by the Project Health's plans as he is with the federal government's approving and funding the project.

“It doesn't take a genius to figure out this was not a reasonable expenditure of money,” Carraway said.

“It was one of those things where they came up with a whole bunch of money and said, ‘Let's spread this around.' Out of nowhere you're getting this Christmas present.

“It's a wise investment,” he added, “but not to this extent. It's just so excessive.”

As Carraway figures it, the satellite site is four times bigger than it needs to be, based on patient-visit statistics and his own experience. Thus, three-quarters of the government's grant is being wasted, he said.

The grant process

Obtaining that money wasn't easy, it appears.

Martin Kramer, spokesman for the federal Health Resources and Services Administration, which oversees community clinics across the country, said in an email that 620 community health centers applied in 2009 for $3.2 billion in ARRA construction funding.

Of those, 86 received grants in fiscal year 2010. That list included Project Health's request for the Shores project.

The grant recommendations were reviewed and scored by a panel of independent experts, Kramer said.

The top scorers were based on things like increases in the patient base or in the number of patients with incomes below 200 percent of the federal poverty line; creation of construction and health care jobs; and a “reasonable” budget justification that demonstrates how the expense helps meet the goals outlined in the proposal.

Kelly acknowledged that the stimulus program was the prime driver of the expansion plan.

“We couldn't expend that kind of money, and it would be a big mortgage,” Kelly said. “We would not have gone through with it had it not been for the grant.”

Still, he believes the shortage of medical care within Silver Springs Shores — particularly among low-income and uninsured patients — justifies the size and scope of the project.

“We could sit side by side with Heart of Florida and I don't think we'd meet the needs of Marion County,” Kelly said.

Kelly said he's familiar with Carraway's criticism, which had also been submitted to the Langley Medical Center's board of directors.

“Bob's a good doctor. He's a good practicioner. He's got a good rapport with his patients,” Kelly said. “But he's dead wrong.

“We've done our research. We know the need is there. It'll take time but we think it could eventually do better than (the Langley Medical Center).” Kelly said.

“I'm sure we're going to do well.”


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