Code Red

The bleeding won't stop. The city health director's job remains a revolving door as Dr. Hugh Stallworth is vanquished in a fierce bureaucratic battle.

Dawn Anderson, the former auditor who'd been lauded as the person who was going to right the ship in the fiscal department, also left the department in January 2004.

Stallworth says Anderson received "absolute pressure to get certain things done in a certain way -- not just from Melba but the mayor's office also. And all of it was not an above-the-board kind of thing." He declined to elaborate, saying only, "It was a bad, bad scene, and it was something that I couldn't protect her from because my bosses were in cahoots with my second in command [Moore] to get this thing done."

The final straw for Stallworth was the push from the mayor's office, spearheaded by Rita Kirkland, to purge the department of the clinics.

Joe Keylon
"It was a bad, bad scene": Dr. Hugh Stallworth tried to 
heal St. Louis' ailing health department.
"It was a bad, bad scene": Dr. Hugh Stallworth tried to heal St. Louis' ailing health department.

"What they were talking about was not really a partnership but shifting the responsibility of a particular function over to someone, some group that I did not believe held the expertise to do it," Stallworth says.

It was clear to Stallworth after the contentious November 2003 meeting "that I was not going to be able to do the kind of quality job that I am capable of and know that is needed, know that was needed in that situation. And I have high standards for myself and my staff. I attempted to change the system; that didn't work. The system didn't want to be changed."

On January 29, 2004 -- the day before he met with Mayor Slay to discuss his status as department leader -- Stallworth gave his two-weeks' notice.

(Phone calls to Mayor Slay, Rita Kirkland and Melba Moore for this story were not returned.)

In early February, the advisory board grappled with how to proceed in the wake of Stallworth's resignation. Some members say resigning en masse was discussed. Others deny that. Speaking on background, one board member likened the choice to that facing U.S. companies operating in South Africa during apartheid: Does one stay and try to change the system from the inside, or by remaining, do they become part of the problem?

The members of the advisory board chose to stay and soon decided to ask the mayor to let the full twelve-member board serve as the department's interim director.

On February 13, two weeks after Stallworth bid a reluctant farewell, Dr. Rick Kurz told the advisory board that Jeff Rainford had informed him that Melba Moore would become interim director and would report to the board.

Kurz admitted that the board serves in an advisory capacity and has no legal ability to make decisions. Nonetheless, the board pressed ahead, offering its recommendations on the budget and the department's vision. The members made a commitment to open up their meetings and encouraged the public and the media to attend while they debated the health department's future and struggled with the immediate issue of cutting $1.6 million from the budget.

The advisory board considered Kirkland's proposal to rid the health department of the STD, tuberculosis, HIV and immunization clinics. The members also discussed adding disease investigators and a public relations professional. The medical community balked at the STD clinic closings, worried that cash-strapped teens who didn't want to tell their parents about their predicament wouldn't find free and confidential services at other clinics.

It took five months for the board to come to essentially the same conclusions Stallworth had reached back in November. The STD and tuberculosis clinics needed to stay. The HIV clinic couldn't be closed, because the grants that funded it couldn't be passed around based on budgetary whim. Immunization shots went to the independent, federally qualified People's Clinic. The entire lab stayed open for business. The only services that went to ConnectCare were the hepatitis A and B vaccinations. The total savings of the tentative budget is just over $1.2 million.

The City of St. Louis Board of Estimate and Apportionment recently approved the plan. It must still go through the board of aldermen before it receives a final blessing.

The question of whether the STD clinic will survive the 2006 budget process is uncertain. Some board members favor shipping the work out to independent clinics. Others aren't convinced. For now, no one seems to favor losing TB clinics.

The advisory board also has other big problems to solve. With only seven months remaining on the lease of its Grand Avenue headquarters, the health department has yet to find a new home. It is also a department devoid of a qualified, experienced leader. The board says it can't get involved in the department's day-to-day operations and must rely on Moore to provide accurate information.

When asked about the quality of department management since Stallworth left, Sister Betty Brucker says, "I think Melba Moore is bending over backwards to do what is right and to get the place straightened out, and I think that for the most part, from my perception, she certainly has the support of the staff."

Says Rick Kurz: "I was sorry to see he resigned, but frankly, that's water under the bridge at this point in time. It's not something anybody's going to fix, so we're going to move along in a positive way to [take care of the] health of the city of St. Louis."

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