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Improving Indigent Care: My Call From Trani


I have read and listened with great interest to the fallout from and responses to your April 8 exposAc, “Losing Patience” (Cover Story). It was written within the tradition of the journalistic adage to “afflict the comfortable and comfort the afflicted.”

Unfortunately, there are some who sit in places of great comfort who simply do not comprehend that this kind of research by the media can be used as a monitor to show those who work in government and other positions of responsibility that they are not always the experts. We should listen and take heed rather than find ourselves defending the indefensible.

In all that Virginia Common-
wealth University President Eugene P. Trani has ad-
mirably given back to the commonwealth through his commitment and sensitivity, those sentiments must still be carried out in the attitudes of staff when sent into the community as his proxies. Trani called me after reading the April 8 article that documented the pros and cons of the Virginia Coordinated Care for the Uninsured program, known as VCC. He expressed deep disappointment that I did not use the Style interview to defend VCU in the midst of this ongoing controversy.

For the sake of clarity, in the context of the article I simply confirmed information that I knew to be true. Community physicians had in fact been told that a waiver had been applied for that would expand the use of the $104 million in federal funding for the program to include more community doctors who could possibly serve more people, resulting in a more efficient program. No such waiver existed and still does not exist.

Though I greatly admire VCU's growth and contributions during the nearly two decades of Trani's leadership, I find it necessary to make clear my key principle of public service. Mainly, it is that one must never compromise integrity for political expediency.

The news of service deficiencies within the VCC program was not new to me. I am entrenched in this community and have long served to improve health care to all segments of our society. I have direct connection with the clergy and the community doctors who were mentioned in the story and people who have been associated with the service.

Exposed problems only serve to help us make programs better. This is why I am mystified when public servants are surprised or dismayed at public criticism whether from the press or from those people they are being entrusted to serve.

I spent eight years on the Board of Medical Assistance Services; four years on the Virginia Health Services Cost Review Council, three years on the Medical College of Virginia Hospital Authority Board; and four years on the Board of Health Professionals. In addition, I was vice president of the Virginia Premier Health Plan, owned by MCV. If anyone knows the strengths and weaknesses of health care in Virginia, it would be me.

The VCC program is far from being a failure and has proven to be a successful and major catalyst between the community and the hospital system. But there are key lessons that must be learned from the obvious snafus in the administration that have now been disclosed. Those lessons are:

• Attention and dedication to indigent care is crucial for the Richmond area and Virginia. Trani is to be commended for his legacy in that regard. Because this program must be continued after his departure July 1, there must be some key changes. Incoming President Michael Rao would do well to learn from Trani's initial example. Early in his administration, he spent hours meeting with and learning from the smart and savvy community people, including the doctors. Ultimately, it was assigning this personal touch to staff administrators that caused a level of sensitivity to be lost.

• Rao must take inventory of the management of programs from the top down. An agency is no better than the efficiency and competence of the people who run it.

• Never become too big to build relationships on the grass-roots level. This article would never have been needed had the public servants on all levels of this program been connected to and sensitive to the communities that felt underserved.

• Involve the users of the program. They should be invited into the process of fixing the problems and creating preventive policies on the front end. This would engender trust, openness and mutual respect.

• Simply concentrate on doing a better job. Whether it will take sensitivity training, a stronger code of ethics or closer scrutiny to everyone from medical administrators to the receptionists, there must be accountability for the conduct of how patients are treated. This does not preclude self-scrutiny to assure that people are moving through the process smoothly, expeditiously and respectfully receiving quality health care.

• Finally, by all means, while listening, never be afraid to speak truth when approached by the media about problems. Health care from the local to national governments is one of the most complex issues of public policy. There is no shame in saying we are still working to get it right. The VCC will be an excellent program when conducted with dignity.

Terone B. Green

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