The idea was as simple as it was brilliant: Bring the doctors to the patients.
Perhaps that's why Peak Vista Community Health Centers' Ronald McDonald Care Mobile — an RV with two medical offices — finds itself stuck in the bureaucratic muck of the federal grant oversight process. In true Catch-22 fashion, the feds wanted to fund the mobile medical office because it was nontraditional... and now federal auditors are calling foul because the grant money, $1.3 million, was used nontraditionally.
At the heart of the spat is a mobile care unit that's actually working. Started in 2008, the doctor and dentist office on wheels began traveling to poor neighborhoods and rural areas to help kids who don't have medical care. They come to have cavities filled, broken bones set, infections treated.
"There's a lot of people in our community who don't know how to access the system," says Pamela McManus, Peak Vista's senior vice president. "[Also] transportation is a big deal for many of our patients."
When working in a neighborhood, Care Mobile staffers tell families about Peak Vista's 16 area clinics with free or low-cost health care for nearly 60,000 local people annually. Peak Vista always accepts new children, seniors and pregnant women, with a waiting list for other adults.
Since the RV moves daily, parents are urged to take kids to the nearest clinic in the future. Much grant money went for more staff in traditional clinics to handle new patients referred from the RV.
Therein lies the problem.
Turns out, the federal grant requires every Care Mobile patient be offered a full range of services, and it funds those services. But the grant also requires that every new patient continue to receive primary care at the mobile clinic.
"It's so much easier telling a mom that's got a very sick baby to come back in three days to a location, versus the mobile van," McManus says, "because we don't know where the van will be, or [the patient] can't get [to the van]."
Donald White, spokesperson for the Department of Health and Human Services, Office of Inspector General, says his audit found problems with Peak Vista's handling of three federal grants. That isn't unusual across the country.
In some cases, White's office has recommended that money be returned, but White found that "Peak Vista is financially viable, has the capacity to manage and account for Federal funds, and is capable of operating ... in accordance with Federal regulations."
Peak Vista says it's corrected all the issues — except the one involving the mobile unit. It has added 6,000-plus new patients using American Recovery and Reinvestment Act funds, and those people can't all be getting physicals and root canals on the RV.
It's unclear what this conundrum means for Peak Vista's federal funding. White doesn't know.
"We do the audit and we make recommendation," he says.
That was asking the Health Resources and Services Administration to "consider the information presented in this report." The Indy contacted HRSA's press office, but as of deadline, spokesman David Bowman still hadn't responded.
Meanwhile, the RV motors on. But McManus says she's waiting to hear from HRSA, adding that Peak Vista — which relies on nearly 50 grants, all with specific requirements — is concerned with following the rules.
"Compliance is important to us," she says, "not just because that's what the grantor said, but because it's the right thing to do."