The Shadow King

Ira Clark was hiding.

Somewhere inside county hall, the president of the Public Health Trust had decided it was better to stay out of sight during the county commission's annual budget hearing than to step forward and defend his agency's spotty record for meeting the medical needs of Miami-Dade's indigent community.

People kept asking, "Where's Ira?" Several commissioners openly called for Clark or any representative of the Public Health Trust to come forward. At one point in the meeting, it appeared that County Manager Merrett Stierheim's neck would break as he twisted and turned in his seat, scouring the audience for any sign of the president. The Houdini act seemed rather absurd because everyone knew Clark was in the building. Numerous people saw him there. But as soon as the commission's discussion turned to his agency, he disappeared faster than the last bottle of Viagra at a convention of geriatric nymphomaniacs.

Ira Clark: King of the Health Trust hill
Ira Clark: King of the Health Trust hill

While Clark's actions were curious, they were still very much in character.

You see Ira Clark does not stand before mere county commissioners and defend his use of the public's money. Ira Clark is far too self-important to degrade himself in such a banal exercise of democracy. Ira Clark is much more comfortable exerting power and influence in the shadows of governance, away from the harsh glare of public scrutiny.

The Public Health Trust operates Jackson Memorial Hospital and for years has reaped the benefit of a half-penny increase to the sales tax. With a budget of nearly one billion dollars, it is one of the best financed public-health agencies in the nation. Yet throughout this county, there are glaring gaps in service. For years county commissioners have repeatedly asked the trust to live up to its responsibilities to the community and do more. County Commissioner Katy Sorenson, for instance, has pleaded with the trust to adequately fund a clinic in South Miami-Dade so that residents there could receive 24-hour emergency attention. The cost: $1.9 million.

Every year Clark and the members of the Public Health Trust tell Sorenson they'll take care of the clinic and every year nothing happens. Well, this year that changed and it has touched off a royal battle.

Rather than waiting again for the trust to take action, Sorenson and her fellow commissioners stepped in, seized the money, and allocated it to the clinic themselves. And that was only the beginning. Led by County Commissioner Miguel Diaz de la Portilla, the commission mandated that the trust spend $1.7 million to provide insurance for all 8900 children on the waiting list for a preventative care program known as Healthy Kids. The commission also ordered the trust to pick up the cost of providing health care for jail inmates, an expense that costs the county commission $11.5 million per year. Why spend money from the county's general fund on health care for prisoners, Diaz de la Portilla asked, when those funds can be used to improve the quality of life of everyone else in Miami-Dade County? Besides, since most inmates are indigent, Diaz de la Portilla noted, it only makes sense that the Public Health Trust should pay for their care.

Diaz de la Portilla then took the $11.5 million now freed up inside the county budget and made it available for a slew of worthwhile county programs. Some of that money will be used to clean up and dredge the Miami River; $4 million will be spent developing programs and activities for children in local parks; the grass along county roads and medians will be cut more often; additional crews will be hired to clear vacant lots of debris and abandoned cars; new inspectors will be hired to track down unlicensed contractors; and $2 million will be allocated to cultural grants. The list goes on and on.

This year's budget hearing was without question one of Diaz de la Portilla's finest moments as a commissioner. And if it came at the expense of the Public Health Trust and Ira Clark, so be it. Last week the Herald criticized the commission for raiding the trust's piggy bank, even though the trust has more than $300 million in reserves. The Herald's criticism was not unexpected. The paper is fond of sacred cows, and they don't come any more pious than the trust and its members, a veritable who's who of the county's business community.

If the county commission deserves any criticism, it's that it didn't step in sooner. The trust needed the swift kick in the ass that the commission provided. My only fear is that the commission is going to revert to its old habit of ignoring the trust now that the budget process is over. Ira Clark and the Public Health Trust need to be dragged -- kicking and screaming if necessary -- back into this community.

Even with the few measures the county commission now requires the trust to finance, there is plenty to do.

Daniella Levine, the executive director of the Human Services Coalition, says the trust has "left itself vulnerable to allegations that they are not meeting indigent needs when they have such a large reserve of cash at a time when there are so many needs going unmet."

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