Clinical Depression

Hounded by budget crises, unflattering audits, and general gripes about management, the Economic Opportunity Family Health Center circles the wagons

Trice's charismatic leadership has been a major factor in the agency's success in attracting big government money; all community health centers in good standing receive an annual grant from the federal Department of Health and Human Services (HHS), but most grants are awarded competitively, often through local government entities. Since she took the helm, the center has undertaken a steady expansion of programs, first in response to the wave of immigration, and later to the culture shocks of AIDS and crack. A satellite clinic was opened in Hialeah, as were health centers in the James E. Scott and Larchmont Gardens housing projects (the latter is now closed). An elderly-care facility made its debut, as did outpatient substance-abuse treatment and the Trice Center for Learning & Health, a day-care facility. The center runs drug-prevention programs at two elementary schools, a clinic for pregnant girls at a high school, and a residential drug-treatment facility for prison inmates. In 1987 Jefferson Reaves House -- Florida's first publicly funded residential drug-treatment facility that admitted women with their children -- opened to wide acclaim. "It had to do with the number of coke babies being born at Jackson," recalls Trice, her voice low and thick from decades of cigarette smoking. "We just believed it didn't make that much sense giving prenatal care when the product, if you will, was an addict. And at the time, there was no place that would take women with children." Several years later Family Health Center opened a residential program for men, a response to the problem, Trice says, of clean-and-sober women returning to their still-addicted partners.

But an HRS monitoring report this year found low completion rates at Reaves House and at the center's Day/Night drug-abuse program (a four-hour-per-day education and counseling service). Though the HRS monitors recommended that the center's substance-abuse license be renewed, the report deemed the completion rates -- 37 percent and 25 percent respectively -- "inadequate" and urged the agency to "identify the reasons why the majority of the clients are not completing these programs and develop a strategy that will eventually increase the rate to over 50 percent."

Willie Brown, the center's vice president in charge of substance-abuse programs, says he is doing just that. He adds that what the HRS figures don't show is the proportion of clients who finish the programs and stay clean, and insists that the center's success rate in that light is as good as or better than other local programs'.

Lately money issues have been the greatest source of concern. The center's most recent annual independent financial audit, issued this past June by Goldstein Golub Kessler & Company of New York, showed that Family Health's operating account was overdrawn by almost $600,000 as of January 31, 1996.

Chief financial officer Clarence Lawrence says the shortfall was simply due to a late reimbursement, and that $750,000 was deposited into the center's account the next day. Regardless, the audit uncovered other daunting facts, principally that financial transactions were difficult to follow because the accounting system was disorganized, making it impossible in some cases to tell whether payments were authorized and whether they were being disbursed from the proper accounts. Also, payroll expenditures weren't backed up by reports justifying the time employees spent on specific jobs, as required by HHS regulations.

Last December staffers had their own reason to complain about payroll issues. If they got paid at all that month, the checks were late. A brief Miami Herald story about the situation quoted Trice as saying vaguely that money was short because the agency was waiting for overdue payments. Employees who had pressing needs, she said, would be paid; others would have to wait. She later met with the staff to address any unresolved paycheck problems, Trice says now, and was confident the payroll was caught up.

But Ezekiel Poitier, who worked as a substance-abuse counselor at the center for five years and now works as a counselor at a local social-service agency, says he never got all the money that was coming to him. "We didn't get paid for a month," he recounts. "My whole bank account was totally screwed up. And they never paid me $125 they owed me, even though they said they would." Soon after, Poitier says, he was unexpectedly called into his supervisor's office one afternoon and handed a letter: He was being laid off because of "budgetary constraints."

But Poitier saw it in a different light. "I feel like it was personal," he speculates with lingering bitterness. "I gave them five loyal, productive years -- you don't handle people the way they did me. Perhaps I knew some things and they didn't wish me to be there."

Specifically, Poitier says, he was well aware of questionable record-keeping practices -- undertaken, he says, to try to ensure after the fact that patient logs reconciled with billings -- and had made it clear he wouldn't participate. "It had to do with documentation," he explains. "Signing off on things. If [staffer] Joe Blow left the agency and we're having an audit and Joe Blow's files aren't up to par, they're going to get someone to go through them and try to get them in shape."

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