A newly installed South Carolina Republican congressman has asked for a General Accounting Office audit of four federally financed health programs in the state, one of them regarded as one of the most successful rural health projects in the nation.
All four of the "comprehensive" health programs serve primarily black people, and some black leaders point out that the four are the only ones among 33 health programs in South Caroline that have black directors.
The congressman is thomas F. Hartnett, who defeated Charles (Pug) Ravenel to win the seat in the congressional district that includes Charleston.
Hartnett called for the audit after meeting several days ago with a Charleston Medical Society subcommittee on health services, which had passed a resolution calling for the audit.
One of the programs under attack is the Beaufort-Jasper Comprehensive Health Services project, a highly regarded program that has received frequent favorable national publicity. Medical teams from Mexico and Nigeria recently visited its headquarters.
From its beginnings under the old Office of Economic Opportunity, Beaufort-Jasper has waged an aggressive program to get health care to poor people isolated in the islands and marsh-surrounded isthmuses of the coastal plain. There is no public transportation, so Beaufort-Jasper has created its own fleet of vans that carry sick people to and from its five modern clinics.
The project pioneered in environmental health from the start, when it built sanitary privies and put screens on houses. It has brought running water to more than 2,000 rural homes.
"I'm worried about the percentage of money these health care people are spending on administration," Hartnett said. "I'm not too familiar with all this. But these people are paid by what they call 'encounters,' and that can mean only a phone call. Why should they get $25 for an encounter,' when a private doctor gets only $10 for an office visit?"
But Roland Gardner, Beaufort-Jasper's director, said that Hartnett's figures "just don't apply to our kind of rural health program. We do get $25, but only when the patient comes through the door, and that fee is set not by us but by Medicare and Medicaid.
"The key to our success is that we literally deliver health care to people who can't get to doctors. We either bring them in or we furnish home health care -- and private doctors no longer even make home visits."
All four of the comprehensive health programs named by Hartnett have been audited by the departments of Health, Education and Welfare or Health and Human Services once a year and, at least as far as officials at Beaufort-Jasper know, there has never been a report of misuse of funds in its 10 annual audits.
"We would welcome a GAO audit," says Gardner.
Skepticisim of Hartnett's move by blacks grew out of what seemed to be a discriminatory selection of the four agencies. One of the programs -- in Orangeburg, S.C. -- is not in Hartnett's district. Two of the agencies, Beaufort-Jasper and Orangeburg, are not in Charleston County and are therefore not under the purview of the Charleston Medical Society.
The president of the society, Dr. H. B. Othersen, said the resolution has passed only a subcommittee made up of about 30 of the society's 400 members.
"Our executive committee will pass on the audit resolution on Jan. 6," Othersen said.
"I don't care what they decide," Hartnett said. "I'm going ahead with my request for an audit. . . ."