By Patrick Anderson
Addison Gilbert Hospital risked losing the state grant that pays for the operation of the Gloucester High School Health Center this spring when hospital leaders were reluctant to allow confidential access to birth control at the clinic, according to its former staff.
Debate about prescribing contraceptives erupted within a health center advisory board working on a response to the rise in teen pregnancies in Gloucester this year and turned public when the medical director and nurse practitioner resigned because representatives of Northeast Health Systems, the company that owns Addison Gilbert and runs the clinic, would not consider adding confidential prescription of contraceptives to the care offered.
Four months later, the debate continues at a special School Committee meeting scheduled tonight at City Hall on the subject of teenage pregnancy.
In their resignation from the clinic, medical director Dr. Brian Orr, who practices at Cape Ann Pediatricians and nurse practitioner Kim Daly, who left Cape Ann Pediatricians this month, said Northeast Health Systems representatives cited concerns about being liable for lawsuits from students with adverse medical reactions to birth control pills.
In response to the resignations of Orr and Daly, Addison Gilbert Hospital Executive Director Cindy Donaldson said Northeast Health Systems did not oppose prescribing birth control, but needed assurance that the community would find it acceptable and wanted the School Committee to vote on it first.
But according to accounts of the meetings from Orr and Daly confirmed by someone with knowledge of the talks, Northeast was under pressure from the state Department of Public Health, which provides around $79,000 a year to help fund the clinic, to consider offering contraceptives.
According to Orr and Daly, Reneé Aird, director of the Department of Public Health's School Based Health Center Program, told the advisory committee that Northeast's reluctance to provide contraceptives because of liability concerns was not "in the spirit of the grant," and that the state might look to find someone else to run the clinic.
That pressure, Orr said, helped push the hospital to open the decision up to the School Committee.
"If the (DPH) had not said that, the hospital would never said it was a School Committee decision," Orr said. "They were giving no ground until that came out."
Donaldson yesterday said the state had never indicated that the grant was in jeopardy to her or, to her knowledge, anyone connected with Northeast Health Systems.
"The state never said that to us. They never said the grant would be pulled," Donaldson said. "They did not tie our grant to that issue. I don't think it would make sense because we work with the state and city."
Donaldson said Northeast is anxiously awaiting the School Committee's decision on whether it wants contraceptives offered at the clinic, but she would not say whether the company's board of directors would accept the decision.
"I cannot speak for the board," Donaldson said.
The Department of Public Health supports providing birth control at schools.
Dr. Lauren Smith, medical director for the Department of Public Health, spoke at the School Committee's "blue ribbon panel" on teen pregnancy earlier this summer and expressed strong support for offering comprehensive reproductive care, including contraceptives, at school health centers.
The risks of contraceptives are less substantial than the risks of pregnancy, Smith said, and she was not familiar with any other school clinics not providing contraceptives for fear of liability.
A spokesman for the Department of Public Health said yesterday by e-mail that the school health center contract for Addison-Gilbert Hospital is not currently in jeopardy.
Aird said she was not allowed to speak with the press.
The Gloucester High School Health Center has been singled out as one of the best in-school clinics in the state by the Department of Public Health because of its involvement in the community and 94 percent student enrollment rate.
In an annual review of the clinic based on a site visit June 5, just after the resignation of Orr and Daly but before reports of a pregnancy pact at the school, Aird singled out Daly's work as an important contribution.
"In particular, we would like to acknowledge the level of commitment exemplified by Kim Daly ... As stated on our meeting, we credit Kim with developing excellent collaborative relationships within the school and with school nursing staff," Aird's review said. "The ultimate result of her efforts is a well-integrated clinic with the highest percent enrollment of any school based health center in the state."
While the clinic received high marks overall, areas outlined for improvement included concerns about staffing in the wake of the resignations and that the clinic was not providing the maximum amount of primary care services it could.
In Daly's time at the clinic, she worked three days each week and a second nurse practitioner worked the remaining two school days.
To replace her, Northeast promoted Scott Lannon, who had been working two days a week, to Daly's hours and has assigned an existing hospital employee to serve two days until a permanent replacement can be found, Donaldson said.
Orr was replaced as medical director by Dr. Peter Short, a long-time pediatrician and current Northeast administrator who works out of Beverly Hospital. Short attended at least one of the advisory committee meetings and, like Donaldson, was also wary of providing confidential access to birth control at the clinic, Orr said.
Daly said yesterday that while she had no issues with the work of Lannon, who started at the clinic in the middle of the last school year, she was concerned that an experienced, trusted female presence at the clinic was essential.
"It is not like I am irreplaceable, but it doesn't look like the community has filled the void," Daly said. "Now there is only one female clinician on Cape Ann."
Since the 15-member advisory board erupted in disagreement over the contraceptives issue in June, it has not met in its previous form and Donaldson said in the future a stripped down six-member version with representatives from the schools, city and hospital would meet. She said the size of the board had been reduced to make it more efficient.
Daly said she was disappointed that the new board would not have the same community interaction and involvement.
"My biggest issue is that at this point, it is not a collaboration, it is just a Northeast Health Systems clinic," Daly said. "Things were going great. There is not input from the people in the trenches doing the work."
The Gloucester School Department is currently working with Northeast Health Systems on a written contract spelling out the responsibilities and of both parties in running the health center.
Superintendent Christopher Farmer said yesterday that so far this year he had received informal reports that around 75 percent of students at the high school had enrolled in the health clinic, but that enrollment forms are returned all year and that the figure could not be directly compared with the 94 percent number cited by the state for last year.
Despite the state grant, running the high school health clinic is not a money-making situation for Northeast, Donaldson said, and the reason the company continues to work on it in the face of controversy is a belief in its importance to the community.
"This is something that Northeast feels is important to do itself," Donaldson said.
Patrick Anderson can be reached at panderson@gloucestertimes.com.
