Susan Cooper, the state Health Commissioner, had insisted in a letter to Madlock the previous week that the Shelby County Health Department agree to accept the full $1,345,000 in Title X federal funding which the legislature had appropriated to Shelby County for family planning services in the coming fiscal year.
Faced with a deadline for deciding by Friday, June 10, Madlock asked for and got an additional week to respond. In a letter to Cooper sent on Wednesday, June 15, the Shelby County Health Department head agreed to accept the full funding due Shelby County but made her acceptance contingent on two conditions.
Madlock spelled out her conditions: “First, acceptance of the increased funding level is not directly associated with a specific case-load…Secondly, in the event that Shelby County is unable to support the level of expansion necessary to fully earn all of the additional available funds, the County will seek to subcontract with qualified health care provider(s) to provide Title X services.” Her acceptance of the full funding was “contingent upon the State granting Shelby County the authority to enter into such sub-contracts following purchasing policies and procedures of Shelby County Government.”
In other words, Madlock was saying that she would not commit the county Health Department to handle every available case. She has consistently insisted that her department lacks the physical resources to do so, even with the full funding. And, she said in effect, unless her department had the authority to sub-contract with back-up agencies of its own choice, there was no deal.
The backstory of all this lies in efforts this year by a Republican-dominated state government to disengage family planning services from any involvement with Planned Parenthood, the massive non-profit chain which is the largest national provider of gynecological services, including abortion, and which has historically shared Title X contracts with county health departments in Tennessee, notably in Davidson County (Nashville) and Shelby County.
A bill sponsored by state Senator Stacey Campfield (R-Knoxville) and passed by both chambers of the Tennessee General Assembly had explicitly eliminated Planned Parenthood from any share in the funding or administration of Title X family planning services. Though Planned Parenthood boasts a full array of family-related services it is a major provider of abortions, especially for low-income women, and social conservatives begrudge it for that reason.
Subsequent to the Campfield bill’s passage, an add-on clause of still unexplained origin was discovered in the bill that, in effect, invalidated that portion of the measure.
Undeterred, Lt. Governor/Senate Speaker Ron Ramsey and other GOP opponents of Planned Parenthood, supported by Governor Bill Haslam, pressed for administrative elimination of Planned Parenthood from Title X programs. Hence Cooper’s de facto ultimatum of last week to both Madlock and her counterparts at the Davidson County (Nashville) Health Department that they accept full funding and full responsibility for Title X activity.
The Davidson County department signaled to Cooper its unconditional acceptance and simultaneously indicated this would mean a drop in the number of cases that could be handled. Madlock refrained from such an unconditional acceptance last week, and this week’s formal response to Cooper left her position unchanged. Though both she and Planned Parenthood’s Shelby County director, Barry Chase, said on Friday there had been no direct communications between them for several weeks, the bottom line seemed to be that, as Madlock said last week, Planned Parenthood continued to be on her list of hypothetical family service partners.
In Shelby County as in the nation at large, Planned Parenthood has served as a funded agent for family planning services since 1970, when President Richard Nixon signed the Family Planning Services and Population Research Act, which created the Title X program.