Hiring of two billing clerks and two secretaries/scheduling clerks

HLTH 553

Case Study Term Paper

Case Study: “Arizona Grants Manager on the Spot” by Gary Crum, Ph.D.

Your county in rural Arizona has a major, chronic social problem: you have a sizable migrant worker population every month of the year, depending on which crops are ready for planting and harvesting, but virtually no local health care providers are willing to treat them since many of the workers are undocumented or are otherwise not eligible for government assistance. Some are under-insured; in other words, they have some insurance help, but the payments are not high enough to attract many doctors to serve them. Besides, there are few local doctors around there anyway.

The local government through the county health department has therefore applied for two major grants. One is a construction grant from a federal agency and the other is a personnel/operational grant from a local charitable foundation. With these two grants, the county hopes to build a new clinic building and to initiate a clinic program to serve the health needs of its poor migrant workers. The multimillion-dollar project is as follows:

A. With Federal Funds to be furnished in three payments over 18 months from date of funding:

1. Construction of the clinic building of 6,000 square feet and small parking lot, including purchasing lab equipment and an X-ray machine

B. With local foundation funds allocated to the county in five yearly payments (to start 15 months after the federal funds are received to allow the personnel and equipment to be in place as soon as possible after the building is projected to be finished):

1. Hiring of two primary care physicians and four nurses (RNs and LPNs)

2. Hiring of two billing clerks and two secretaries/scheduling clerks

3. Hiring of maintenance/janitor personnel (1.2 Full Time Equivalents)

4. Support of the cost of keeping the clinic solvent while it serves nonpaying (and low paying Medicaid) patients for at least the first five years of operation

The federal funds were received—and the Foundation also pledged in writing its future funds after sending the first year’s allocation to allow the county to begin recruiting personnel when appropriate. Much jubilation is felt in the community with the news of the success of these two grant applications, and especially among the migrant workers.

At first, things go very smoothly, and after many months the building project nears completion. All the personnel needed are hired and leave their current jobs to move to the area. The local newspaper touts the new day which is about to dawn for the migrant workers.

Then catastrophe strikes. The Saturday before the clinic is to be completed and begin operations, at 11:00 a.m., the nearly-finished building is hit by a tornado and completely demolished—a total loss of the building—though no people were injured.

There is insurance to rebuild the building, but it will take another 18 months or so to reach the same place in the clinic project’s progress as before the tornado hit.

You are the grants manager living about 20 miles away in the county seat and hear about the tornado and damage almost as soon as it takes place. You must immediately contend with the following issues:

1. The building is lost and the federal money is 98% spent—and no project report of “completion” can be sent to the federal agency, obviously, until the insurance is received and the project starts again from scratch. You will miss the originally negotiated completion date by as much as two years.

2. The many staff members recruited and hired are already arriving into the area (only one person hired already lives around there) to begin work in the next week and there is no insurance to cover their particular unfortunate situation. They have no civil servant protections because they have not completed their probation periods, so there is no legal obligation to find them work elsewhere or to provide them with any financial help.

3. It may be hard to get the local foundation, which has limited funds, to do much more to help you even though they have a community-oriented, “do-gooder” outlook—more so than the federal agency might have. Besides, the federal grant funds have been allocated and you do have insurance for the clinic costs.

The County officials are dealing with the many media calls, the community anguish, and are also fielding calls from worried employees who have just heard their new worksite is not going to be ready next week, or anytime soon. As the grants manager, you are called around noon by the County Manager to give her and her top management team, in four hours, a detailed recommendation for what needs to be done.

Page 1 of 2