The Ravalli County commissioners have made it clear they have problems with the county's family planning clinic and will consider refusing federal funding, an action that would effectively close the program.
At a recent meeting, commissioners raised concerns about the Title X grant funding the clinic receives so they have yet to sign an order granting the clinic almost $39,000 for the fiscal year.
Commissioners have until Aug. 8 to sign the task order. If they decide against it, the county's family planning program will be eliminated.
"It'll shut down the program," said Judy Griffin, director of public health for Ravalli County. "It'll not only shut down the program, there are people who will invariably lose their job.
"It will have a definite impact on my office."
The grant, distributed by the Montana Department of Health and Human Services, is entirely funded with federal dollars.
Last week's discussion on the Title X funding will continue on Aug. 4 at 2 p.m. in the commissioners' meeting room.
"We need to resolve this," Griffin said. "I'm running on a new fiscal year. I'm accruing debt here on this, and it needs to be taken care of.
"We've never had any problem in the past signing the task orders. It's always gone smoothly."
The county's family planning clinic provides annual exams, pregnancy tests, contraceptives, pap tests, STD testing, nutrition, education and counseling.
Griffin emphasized that her clinic does not perform abortions, nor does it schedule appointments in Missoula or transport patients to receive abortions.
"We're required by Title X to tell women their pregnancy options," Griffin said. "If they choose to get an abortion, we give them phone numbers.
"We don't coerce anyone to get an abortion. People make their own decisions."
Commissioner Matt Kanenwisher said he had three issues with the county's family planning program.
First, Kanenwisher said, he believes public health serves to protect citizens from communicable diseases and that pregnancies are not a public health issue.
"In my mind, pregnancy is not a disease state. An unplanned pregnancy doesn't make it anymore so," he said. "You can say it's a social problem, and you can argue there is a role for government to take some action in that. I don't believe that's the case."
Secondly, Kanenwisher noted the clinic's stocking of emergency contraceptives, such as the morning-after pill. He said that while it's easy to fall into the debate of whether the pill is considered an abortion or not, that's not the problem he's focusing on.
"It's not an abortion debate; it's a role of government debate," he said. "To me, the question is, is it a proper role of government and public health to provide that form of contraception ... is that a public health issue?"
The third issue Kanenwisher identified was that the family planning clinic provides contraceptives as well as access to all the clinic's services confidentially, without informing minors' parents.
"That crosses the line that I cannot cross," he said. "In no way will I position myself between a minor and its parent. ... To me, that's a sacred relationship that I can't interfere with."
Kanenwisher said he and his fellow commissioners were wondering if they could pick and choose at some level what the federal funding could be used for within the clinic. They wanted to hear from a representative with Montana Health and Human Services, he said.
Commission chair J.R. Iman echoed Kanenwisher, saying the commissioners hope to confirm the requirements under the grant.
However, Griffin said there's no way to pick and choose what to fund.
"We can't do that," she said. "You have to take the whole task order as is."
The Ravalli County family planning program has 465 clients, including 155 teens. Last year, the clinic served 461 unduplicated patients, 336 of those below poverty level and 88 percent without any form of insurance.
The clinic is funded by both the Title X money and about $30,000 a year of in-kind funds from the county's general fund. If the Title X funding is turned away, the clinic won't receive the in-kind dollars either.
The health department has eight employees. Including Griffin, there is a part-time nurse practitioner, three nurses, an emergency preparedness coordinator, a bookkeeper and an administrative assistant.
This year's Title X funding was $11,000 less than the previous year, which forced the department to hold only two clinic days a month, down from once a week.
Griffin said that while denying Title X funding could eliminate positions in her department, she emphasized that the citizens are the ones who lose.
"The flip side is the impact that it will have on this county," she said. "It's going to be a real issue. It's going to put this county in dire need because Sapphire (Community Health Center) has since closed down. Not everyone can access doctors.
"It affects everybody. It's just kind of a domino effect when you really think about it."
Reach reporter Whitney Bermes at 363-3300 or firstname.lastname@example.org.