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Kirkland estimated the savings at $4.6 million.
Before Liberman would agree to anything, he said, "I want to know first how our director feels." Then he added, "[The] city's main motivation -- and I am sympathetic to it -- is to get their budget down."
"No," Kirkland shot back. "The city's primary focus is to make sure we are streamlining our operations."
Sister Betty Brucker, the retired president of St. Mary's Hospital and a board member, expressed her reservations about making such a drastic change without involving the Regional Health Commission, which recently began a study on streamlining the city and county health departments. "Why couldn't there be some joint planning?"
"I have no problem with that," Kirkland said, "except that right now, we do have a deficit, we do have to get out of this building....We don't have the luxury of time right now."
Stallworth, meanwhile, disagreed with Kirkland's calculation of how much money would be saved by eliminating the clinics. He said that some of the clinics she wanted to cut were funded by outside grants -- not city money.
Liberman wondered whether the health department was the only place the city could find the cash to stop the hemorrhaging.
"No, this is not the only place and there is only one other place to get this kind of money is [sic] public safety -- shutting down fire houses, cutting back the number of police officers," Kirkland replied.
"My position is very clear," Liberman said. "This man runs the Department of Health. We are the board. If he is for it, I am for it. If he is not for it, I have great concerns. I have been around here for a long time; he is the first director for health....the first we have had on this job who is effective....."
Kirkland tried a different tack. "We have a lot of respect for Dr. Stallworth. But I don't want you to feel like you have to pick between us. We are a team -- or we should be."
Though Kirkland saw ConnectCare as the panacea to the budget woes, others questioned ConnectCare's competence.
Reverend Jerry Paul, president and CEO of the Deaconess Foundation, advised: "The only thing I would encourage you to do is to be straightforward about this. This is a cost-cutting measure.....You really don't have confidence in ConnectCare."
Said Stallworth: "The two things that concern me are [shutting down the] STD and TB [clinics]," he said. "And we have talked about this, so I'm not back-dooring anyone in my concerns about this."
Kirkland snapped back, "So we have talked, so we have talked, so we have talked."
Stallworth opposed the move because ConnectCare did not have the health department's experience in treating STDs. In the first nine months of 2003, the health department handled 839 gonorrhea cases, while ConnectCare had treated only 80.
"We have seen them in the morning until the night -- nothing but STD cases," argued Stallworth. "We have a level of expertise because we are connected with the CDC [Centers for Disease Control and Prevention]."
Later in the meeting, Stallworth cited a state health department report that indicated the city health department's STD clinic had outperformed the rest of the state.
"Where did those numbers come from?" Kirkland demanded. "I want to see the whole report."
Stallworth also vigorously opposed the idea of gutting the TB clinic, noting there was a tuberculosis outbreak spreading through homeless shelters among children, families and elderly people who "go back and forth in between homelessness, having a home, not having a home, back and forth."
As for immunizations, Stallworth explained that the health department had already started a campaign to encourage families to use independent, federally funded health clinics instead of the health department. The number of shots they'd administered had dropped. Only a few weeks earlier, he had submitted a strategic business plan to the mayor that would have kept a small staff on hand to administer immunizations, continue providing hepatitis A and B shots and branch out into a money-making travel clinic.
Immunizations and the travel clinic could be sacrificed. But Stallworth was upset that the mayor didn't talk to him about the strategic business plan that he'd assembled with his staff.
"We have talked about this plan," Kirkland said. "I can't sit here and not let that go."
Stallworth insisted he heard nothing from the mayor.
"Yes, you did," Kirkland interrupted. "Wait, stop."
"No, excuse me just a second," Stallworth said. "Let me finish, let me finish."
"This is very inappropriate, Dr. Stallworth," chided Kirkland. "I don't want to leave today with the sad misnomer [sic] that we have not talked to him. We have. We talked to him for two hours."
Liberman suggested that Kirkland put in writing the proposal she wanted the board to endorse. "It seems we have to decide if our director wants to go that way or how far he wants to go."
Kirkland pushed back: "There is one boss for the city of St. Louis and that is the mayor. And we both work for the mayor."