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A dispute between the city government and the executive staff at the Seward Community Health Center led to a stiff rebuke from staff at the Health Resources and Services Administration, the federal agency that oversees the health center program, and came close to derailing a grant application brought forward by health center leadership earlier this month.

At issue is who has the final say over grants pursued by the health center, a question nominally addressed by an agreement between the two bodies, but made murky by contrary interpretations of the agreement and the federal regulations that govern community health centers.

The Seward Community Health Center is a clinic that receives a grant from the federal government for the purpose of providing primary care, especially for uninsured or underinsured patients. 

The City of Seward sponsors the health center in an arrangement known as a co-applicant partnership, in which the two bodies together bring a health center application to HRSA. This was first done at the initiative of the city, which appointed the first health center board.  

The disagreement erupted over a grant application prepared by health center Executive Director Craig Ambrosiani and subsequently altered and submitted by city staff without the knowledge of the health center’s board of directors. This invited the ire of HRSA, which sent a letter days later chastising the city.

Representatives for the city and for the health center declined to go on the record when asked about the grant, with the exception of Finance Director Kris Erchinger who gave the Journal a brief statement on the subject.

The entire sequence took only a matter of days. Ambrosiani submitted the grant, originally intended for a, “community-based program that would work toward the prevention of substance use … contracted to a locally based organization,” between 24 and 48 hours before the deadline, according to an email he sent to the health center’s executive committee.

The day of the deadline, city staff reviewed the application and appear to have discussed some concerns with Ambrosiani. Staff subsequently modified the application. When he next saw the grant, Ambrosiani writes in the email, it had been rewritten seeking funds to provide, “therapy services through a contract with a local behavioral health organization.”

The amount of the grant was unchanged at $145,000.

City Finance Director Kris Erchinger confirmed that the city altered the grant application.

“The application that was submitted to the city … was not consistent with the purposes for which the city was told the grant would be submitted,” Erchinger said. “And because the CHC executive director told the city manager to make whatever necessary changes you feel you need to make, then the city made those necessary changes.”

While Ambrosiani did say in an email to city manager Scott Meszaros that the city could make changes, he appeared to be surprised by the scope of the changes, suggesting in a later email that the edits were drastic enough to have diverged from the purpose originally approved by the health center board.

“Hi Scott, thanks for getting this submitted,” Ambrosiani wrote. “We do need to discuss further as our board only authorized a grant for improving community partnerships and outreach.”

In an email obtained by the Seward Journal, HRSA representative Jeanine Baez summarizes points from a conference call with city and health center staff, in which she says that HRSA regulations require the health center governing board to retain control over health center operations.

“SCHC’s board of directors is vested with the authority to approve Health Center Program applications,” Baez wrote. “The City of Seward may not reserve approval authority or have veto power over the SCHC’s board of director’s required authorities and functions. This means that the City of Seward cannot override an application approved by the SCHC’s board of directors and submit a different application or one that has not had their approval.”

Although HRSA objected to the city’s changing the grant application, the agency extended the deadline so that the grant could be reexamined and resubmitted, pending approval by the health center’s board of directors. The grant has since been submitted with that approval, Ambrosiani said during Tuesday’s City Council meeting.

Disclosure: The author’s spouse is employed part-time at the Seward Community Health Center.