For more than 45 years, the federal government has helped low-income and uninsured residents access primary medical care through grants to health centers throughout the nation. The West Oakland Health Council (WOHC), a nonprofit that formed in 1968 and now runs multiple health centers in the East Bay, was one of the first organizations in the country to receive this funding from the Health Resources and Services Administration (HRSA). For many years, the West Oakland nonprofit, with its strong ties to the African-American community, served as a model for urban health clinics, treating local residents who couldn't afford to pay for their care.

More recently, however, WOHC leadership has run a dysfunctional operation and failed to meet the needs of patients in the community, according to federal officials. And soon, the critical safety net that the organization provides in West Oakland may unravel altogether. That's because HRSA has determined that the nonprofit has neglected many of its obligations as a recipient of federal support and has decided to terminate its funding to WOHC in March.

WOHC, which received $3.4 million from HRSA in 2014 and reaps other fiscal benefits from its status as a so-called "federally qualified health center," has appealed HRSA's decision. At the same time, several other East Bay healthcare nonprofits, with support from county health officials, have also applied for HRSA Health Center Program funding in hopes of ensuring that the region does not lose those critical dollars — even if WOHC does. Regardless of the outcome, healthcare advocates say the future of primary care access for many West Oakland residents remains uncertain — and that it's the most vulnerable patients who stand to suffer the consequences.

If Oakland loses the federal funding, "It would hit the area hard, and for people of color in particular, it would be an enormous hit," said Reverend Thomas Harris, a West Oakland pastor and former longtime member of WOHC's board of directors. "People's livelihoods are at stake here."

WOHC currently runs seven facilities, including the West Oakland Health Center, the East Oakland Health Center, and additional clinics in Oakland and Berkeley. According to HRSA data from 2011 to 2013, nearly all of the organization's patients were people living in poverty and the vast majority of them were African American. In 2013, 41 percent of patients were uninsured and 43 percent of patients had insurance through Medi-Cal or the Children's Health Insurance Program — both government-sponsored programs for low-income people.

The patients also have high rates of chronic illness and other problems. In 2013, 32 percent of all patients suffered from hypertension, 13 percent suffered from diabetes, and 9 percent were homeless. The organization provides a range of services, including primary medical care, dental, vision, mental health services, and substance abuse recovery.

Federally qualified health centers like WOHC also have significantly higher Medi-Cal reimbursement rates than centers without the federal designation. That means the government insurance program covers a much greater portion of the cost of care for low-income patients than typical medical facilities. The specific rates are not publicly disclosed and are different for each health center based on location: in general, federally qualified centers can receive hundreds of dollars more per Medi-Cal patient visit simply because of the HRSA designation.

In exchange for those benefits, HRSA monitors the health centers and reviews them for compliance with a number of specific requirements. After a three-day site visit in June 2014, HRSA found that WOHC was failing to comply with fifteen different requirements — and was compliant in only four categories. According to a 34-page HRSA site visit report obtained by the Express, the feds found that the organization was failing in a wide range of categories, including accessibility to its facilities, staffing, and financial management.

While a few of the findings appeared to be relatively minor, many were tied to seemingly systemic problems and some were directly related to patient services. HRSA found that some patients were failing to complete needed testing possibly because of limited services at certain locations. HRSA auditors further stated that the organization has violated its own policy by failing to properly review patient satisfaction with its limited hours of operation — 8:30 a.m. to 5 p.m., weekdays only.

WOHC's after-hours system is also poor, HRSA auditors wrote, noting that patients calling in the evening were not warned to call 911 in emergencies and were not given appropriate assessments by on-call operators. The organization also lacked a clear sliding fee policy for low-income residents and was failing to make patients aware of their rights to access care regardless of their ability to pay, HRSA auditors wrote.

According to the feds, the health center also lacks necessary contracts or memoranda of understanding with area hospitals regarding referrals and hospitalizations. That means that WOHC does not have formal arrangements and policies for transferring and tracking patients in emergency situations or with other medical issues that WOHC facilities can't address (such as mothers in labor). At the time of HRSA's visits, officials also determined that basic staffing records were missing, such as proof of immunizations.

Finally, HRSA auditors raised a number of concerns about governance and financial management. Auditors stated that there was a void in medical leadership at WOHC, because the organization's longtime executive director, Dr. Robert Cooper, was also the nonprofit's health services director (positions that HRSA said must be separate). WOHC also lacks a chief financial officer, chief operations officer, and chief information officer and doesn't have a plan to deal with ongoing financial challenges. The nonprofit's board of directors has also failed to properly evaluate the performance of the executive director.