What went wrong at the Mecklenburg County health department?

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For months, the Mecklenburg County Health Department has weathered the fallout of major missteps in how it handled medical test results for a vulnerable population.

The health director, Marcus Plescia, resigned, along with several other top officials. There was a serious leak of private information, and discontent among staff.

Now county leaders are trying to figure out how to fix the department’s problems. The main theme of them: Disorganization, low morale and inefficiency.

Health Department director Marcus Plescia, at right

A series of reports presented to the county commission this week details just how broken the health department has become.

And alarmingly for both people concerned about public health and taxpayer money, County Manager Dena Diorio said this week that it could take a year and millions of dollars to pick up all the pieces.

Here’s what’s going on.

What does the county health department do?

The Mecklenburg County Health Department has its hands in a lot of different areas, but it’s mostly known as the agency responsible for public health.

For lower-income people, the health department runs clinics that offer immunizations, breast and cervical cancer screenings, STD tests and other health services.

The health department’s 800 employees also inspect restaurants, breweries, pools, lakes and rivers, and, after last summer, the water at the U.S. National Whitewater Center.

What alerted Charlotte to the problems?

Late last year, county officials became aware that a number of women were not notified of abnormal results of pap smear tests.

After a review the details became more clear. Between May and December 2016, a total of 300 women were given a pap smear through the Mecklenburg County Health Department that came back with abnormal results.

A nurse found that 185 of those women did not receive “adequate follow-up and notification” of abnormal Pap smear test results. Most of the women are in their 20s and either black or Hispanic.

The county commissioners were alerted to the problems in February and launched a review of the entire health department by early March.

What other problems were found?

Consultants brought in to review the department found a broader host of issues. A 250-page report released this week details some of them.

Its pages describe a “disjointed organizational structure” with weak processes, little strategic vision and not enough resources to do their jobs well.

  • A culture of “That’s not my job,” even at the leadership level.
  • Lax handwashing practices
  • Recordkeeping overly reliant on paper, with health department staff not entering in patient information into their digital medical file.
  • Poor communication between health department clinics and labs that test specimens.
  • Poor training.

Why does this matter?

The health department is often the primary health care for Charlotte’s most vulnerable populations.

An effective health department can also help keep health care costs down for everyone by keeping people out of emergency rooms for routine care.

How much will all this cost to fix?

The consulting firm that identified the problems (Navigant) helpfully provided a cost breakdown of what they’d charge to fix them. The total: just under $1.6 million.

This would include restructuring how the health department delivers care and how it handles customer service — as well as a rethinking of the executive staff.

What happens now?

A lot. The consultants are recommending many fundamental changes in structure — most of them with a high level of difficulty in implementation.

More than that, the health department will also have to rebuild trust.

“Things will get worse there before they get better,” Diorio said.

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Andrew Dunn
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