Clinical Depression

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

Health centers across the nation, Bice says, are experimenting with approaches to cutting costs in order to survive. "Some have cut back services," she reports, "and some have closed sites."

Committed to the idea that the need to provide subsidized health care is more pressing than ever, local health-care organizations that serve the indigent are trying different strategies to improve their own fiscal health. "There's absolutely no question we can't expect the federal dollar to continue to take care of what we're not getting reimbursement for -- all those people who have nothing," declares Beverly Press, executive director for the past twenty years of the Stanley C. Myers Community Health Center in Miami Beach. "Now we know that throughout the United States the message is loud and clear -- you must seek alternative funding, you must survive, and you must start getting business-astute. But our mission stays the same, and there are more to serve."

Press and the directors of several health-care nonprofits in Dade are banding together to form their own HMO as a way to pool resources and cut costs. And Family Health Center became a founding member two years ago of an association called Health Choice Network, a coalition of seven organizations formed as a co-op to share information, equipment, and purchasing, as well as to negotiate contracts with providers of specialized medical services.

Of course, there have been cutbacks, as well. Since this time last year, the number of Family Health Center case managers working with HIV-positive clients has been decreased by half. This coincides not with a drop in the number of HIV-positive clients, but with layoffs in the center's primary health-care departments. Many staffers, however, point out that with all the mid- and lower-level firings, administrators and supervisors didn't suffer nearly as much. Salaries weren't reduced, they allege; some managers even got raises.

Jessie Trice says she and her vice presidents haven't had raises in the past few years. But she refused to back up that statement by making public the center's records. The only document she would supply was an outdated list of salaries over $50,000, which was filed (as required) with the IRS last year. The current forms, Trice says, have not been completed. (In 1994 Trice's reported salary was $98,390; her vice presidents earned between $55,000 and $80,000.)

Former staffers also complain of favoritism, and worse. "There's so much nepotism," says one ex-staffer who requested anonymity. "Somebody walks in, they don't have a degree, they end up being in a managerial position. It's just gotten worse and worse: This one's daughter, that one's son. I had not seen anything like that in my adult career. Trice's daughter was working as a case manager. She was damn good. But when you get federal dollars, you sign an agreement that you won't do that. A lot of people in the community have a lot of resentment toward this agency, and one reason is because a lot of people there have caste-type attitudes -- it's absolutely pervasive."

Generally, nepotism is supposed to be avoided at agencies that receive federal funding. But each contract has its own rules that in some cases allow relatives to work in the same office. Trice says Family Health Center's policy manual doesn't mention nepotism. She confirms that, besides her daughter, her nephew and her grandson and his fiancee all were employed in various capacities at the center but no longer work there. Relatives who remain include her daughter-in-law (who met Trice's son after being hired) and Frankie Swain's nephew. "That may be something I need to look at more closely," she comments. "To be candid, I have not."

Sugar Hill comprises almost a block on the west side of NW 14th Place at 71st Street: five one- and two-story buildings in various stages of construction or renovation. The residents of these 23 apartments will not be ordinary tenants. They will have AIDS, and they will have qualified for a rent subsidy under the HOPWA program. Family Health Center began this $2.3 million project three years ago, and the agency has been deflecting criticism ever since.

AIDS patients generally express reservations about the location, an inhospitable section of town that has been decayed and drug-infested for years. (It's relatively close, though, to some of the offices where they go for food vouchers, bus passes, and medical care.) Many AIDS sufferers worry that the Sugar Hill complex will immediately become known in the neighborhood as the "AIDS apartments," deepening their sense of alienation.

"They're creating AIDS ghettos," thunders Luke Balboa, executive director of PWAC and an opponent of Sugar Hill. Balboa and other critics say it's not so much the AIDS label on the housing that bothers them but the location and the price tag, and the fact that in 1993 then-Miami city commissioner Miller Dawkins got his colleagues to set aside a big chunk of HOPWA money for permanent AIDS housing -- thus reducing the amount available for rental assistance. (With Dawkins now awaiting sentencing after owning up to federal corruption charges, PWAC has successfully lobbied the commission to move much of the money back into rentals).

Family Health Center administrators and city officials say Sugar Hill should be ready by the end of the year. But early this summer they expected it to open in August; before that the target date was November 1995. And from the looks of the construction site, it may take at least another six months. One of the biggest problems came to light this past May when the contractor, Tecina International, declared Chapter 11 bankruptcy. (The firm is still on the job; a smaller but similar HOPWA-funded Tecina venture overseen by a different agency is also late.)

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