The St. Louis County health director says the county council is slow-rolling a measure to allow its government-run health clinics to hire physicians.
In a bill introduced nine months ago, the department asked the council to approve a three-year, $3.6 million contract that would authorize it to hire doctors from SSM Health to work at county-operated clinics.
“If they continue down this trend of not approving professional service contracts, that could essentially force me to close clinics and force people to have to seek care elsewhere.”
— Dr. Kanika Cunningham, St. Louis County health director
The county operates two health centers in North St. Louis County and one in south county. Dr. Kanika Cunningham, the director of public health, said the contract primarily puts staffing at the clinic in Sunset Hills at risk.
“To remove the department’s ability to provide a physician to maintain care, it is a problem for me, and it’s a problem for the community, and it should be a problem for the patients who utilize our services,” she said.
Cunningham said the money would also pay for SSM Health physicians to work at the department’s other clinics.
In an email, Chairwoman Rita Heard Days said she and other council members were concerned about potential entanglements between SSM and county officials.
“It is not a funding issue but a potential conflict of interest issue,” she wrote. “The Council’s questions have not been answered either by Dr. Cunningham or the County Executive.”
The council has for years raised concerns about whether County Executive Sam Page, an anesthesiologist, violated county rules through his affiliation with SSM Health. Representatives for Page and SSM have said his work is voluntary.
Days said she is also worried about Cunningham’s potential connections to SSM.
“In my opinion, we should be extremely careful regarding the perception of conflicts,” she wrote.
Councilman Dennis Hancock of District 3 said he remains concerned.
“Even though he hasn’t admitted he works at SSM, he volunteers at SSM,” he said. “The question is why would we be looking to go into a multi-million dollar contract [with the system]”?
Hancock said the council has met with the health department about the bill but wants more information about why the staffing is necessary, since the county already employs several doctors.
County spokeswoman Sara Dayley said Cunningham is not employed by SSM.
If the council doesn’t act before the current contract expires this summer, the clinic could lose services and patients could lose access to their doctors, officials said.
In letters and flyers, the health department has urged residents to ask their council members to approve the contract, saying the clinics serve Medicare, underinsured and uninsured patients.
If the bill isn’t approved, hundreds of patients could be forced to find a new provider, appointments will be canceled and treatments delayed, a department flyer says.
The county’s community health centers offer primary care, STD testing, immunizations and other services regardless of ability to pay. A recent federal designation allows them to receive higher reimbursement rates and better pricing on prescriptions.
Tensions over clinic funding
Tension between the executive branch and the county council has run high after a contentious budget battle earlier this year. The county faced an approximately $80 million shortfall going into 2026, and the council floated cutting services, including care at the three clinics.
It’s rare in Missouri for public health departments to operate their own clinics.
Running the clinics “is going to be a tough sell, if we take a hard look at these things,” Hancock said during budget discussions last year. “It’s going to be a much easier conversation to have than explaining why we went bankrupt.”
Democratic Councilwoman Shalonda Webb said continued operation of the clinics warrants review.
“If we can no longer sustain and provide clinical services and primary care services, how do we begin to talk about transitioning?” she asked.
Page had wanted to use Rams settlement funds to shore up the budget. The council disagreed and passed a budget that cut the county executive’s requested spending by nearly $50 million. The clinics remained open.
Still, Cunningham said it’s possible council members are effectively trying to close them.
“They did not put me in a position to close,” she said, “but if they continue down this trend of not approving professional service contracts, that could essentially force me to close clinics and force people to have to seek care elsewhere.”
This story originally appeared here.