Clinical Depression

To scores of other Dade County residents who've been fighting on the same fronts, a chronicle of Lucinda's life for the past eight months sounds like deja vu. They've all been battling the AIDS virus; many are single parents, and more are struggling to stay drug- or alcohol-free. On top of all that, they've been in constant combat with the Economic Opportunity Family Health Center to get their rent paid.

"From month to month I don't know if I have a place to live," says "Lucinda," who doesn't want her real name used because she swears if the people at Family Health Center (as most refer to it) knew she was complaining they'd drop her from the rental assistance program altogether. "The problem is the landlord doesn't get any rent check. Now I've received several eviction notices. We kept telling Family Health, 'You gotta pay the bills,' and people were getting evicted. And they said they didn't have the money. But I know they do."

Last fall the center received almost two million dollars in federal funds to help about 280 AIDS patients pay their rent for a year. The money, supplied through a program called Housing Opportunities for People with AIDS (HOPWA), is doled out by the City of Miami to agencies throughout Dade. Family Health Center, a large segment of whose clients are HIV-positive, was awarded more HOPWA money than any other agency in the county. But long before the year was up, unbeknownst to City of Miami officials, the center had spent more than $500,000 in excess of its twelve-month allotment and had accepted more than 550 AIDS patients for HOPWA rental assistance. It had even secured a $340,000 line of credit to help make the monthly payments.

But who was getting the money? Every day Family Health Center caseworkers were bombarded with complaints from anxious tenants and angry landlords -- all of them wondering what happened to their rent checks, which the center is supposed to mail directly to the landlord. Many clients faced imminent eviction and had to be referred to other agencies for emergency assistance. Others demanded meetings with Family Health Center officials and managed to get their checks mailed, one or two months late, while landlords tacked on late fees. Word of the disarray spread quickly through the AIDS community, and people flocked to HOPWA advisory board meetings to seek assurance that they wouldn't find themselves abandoned and homeless. Exclaimed one former client who currently receives HOPWA rent assistance through another agency: "It's the talk of the town."

The talk died down some in July, when the HOPWA board voted to recommend that $1.2 million in unallocated HOPWA funds be granted to Family Health Center. That was the sum Frankie Swain, vice president of the center and a member of the HOPWA board, estimated it would take to satisfy the commitments they'd made. "We made the decision not to have anybody homeless, so we enrolled people in excess," Swain declared to the board.

The past year has been one of the most difficult in the distinguished history of the Economic Opportunity Family Health Center, which since 1969 has provided medical, dental, psychological, and social services to poor and marginalized residents of Liberty City and parts of Brownsville, Little Haiti, and Hialeah. Some 70,000 clients annually avail themselves of one or another of the nonprofit corporation's health clinics, drug-abuse treatment facilities, and in-school programs. Family Health Center is one of the largest minority employers in Dade. Jessie Trice, its president and chief executive officer, has been honored with innumerable local, state, and national awards for her innovative work. A 67-block stretch of NW 22nd Avenue, the western border of the center's main office, was named Jessie Trice Boulevard in 1994. In a community that has faced challenges and setbacks of vast proportions, from devastating riots to unsettling influxes of immigrants, Family Health Center has come to stand as a monument to accomplishment and pride. "But it's not what it appears," contends former board member John Aldrich, who also worked at the center.

Indeed, like monuments that have weathered decades of bitter storms and blazing sun, the center is showing cracks. Without restoration work, crises such as this past summer's -- in which at least a few hundred AIDS patients were threatened with eviction or were actually evicted -- will continue to undermine the institution. A controversial $2.3 million housing complex for people with AIDS, which the center is building with federal funds, is behind schedule. Recent audits have brought to light lax or nonexistent controls on accounting and record keeping. Payroll funds were so short last winter that some employees say they drew lots for checks; dozens of staffers have been laid off or fired during the past year. Two of the agency's well-regarded drug-abuse treatment programs were cited in a 1996 state Health and Rehabilitative Services (HRS) evaluation as having "inadequate" success rates.

These troubles have arisen during troubling times. Publicly funded health centers, which once were considered noble and effective weapons in a nationwide battle against poverty, have fallen victim to governmental retreat. Already some have closed because they couldn't adjust to newly competitive conditions in the health-care industry -- conditions unheard of when they came into being.

Criticizing Family Health Center or its administrators is not undertaken lightly. Decades of crucial contributions to the lives of Dade County's disadvantaged black residents have built up an aura of altruism that armors the agency against attacks by skeptics. But over the past year or so, employees and clients have been less reticent.

"It has been there for a purpose, and it served that purpose very well. But there comes a time when an organization loses its focus, to the point where it exists not for its clients but for its highly paid administrators," says Zeph Annakie, a former accountant at the center.

"It's a black institution, so this is not about making them look bad -- the truth has to be spoken," asserts a former Family Health Center supervisor who still works in the social-service arena and requested anonymity. "A lot of people knew there were problems going on, but it just wasn't something you talked about; a lot of people feared for their jobs. There's an underbelly there that's not cool at all. People tried to tell me and I didn't want to believe it. I came to believe it."

The boxy brown building at NW 54th Street and 22nd Avenue that serves as the Economic Opportunity Family Health Center's main office is bounded by Olinda Elementary to the north, a shady park and public housing to the south and east. Inside the center's iron-fenced compound, couples and women with their children loiter under trees and sit on stone benches, taking a cigarette break or waiting for a ride home. Inside, spotless corridors lead to waiting rooms and medical and dental offices, a lab, conference and counseling rooms. The assortment of paintings, posters, and children's artwork mounted in the hallways brightens an otherwise well worn, starkly functional interior.

This is the domain of Jessie Trice. Although her five vice presidents exercise considerable authority, Trice has the final say about almost everything within these walls. Even New Times's routine request to view the organization's annual financial report to the IRS -- which by law must be available to the public during working hours -- is denied by staffers for several days when their boss is out of town and unavailable to approve its "release" personally.

A tall, handsome woman, elegantly attired, Trice addresses her employees cordially. They respond with deferential smiles. She attentively greets waiting patients, some of whom pour out their fear and anger at the multitude of indignities and obstacles they must surmount in the course of a day -- not necessarily incidents related to their experiences at Family Health Center, just the sheer inconvenience of being poor. She promises to find out why one woman is having trouble getting food vouchers, quietly tells one of her clerks that the line of waiting patients is getting too long.

The quality of medical, dental, and psychological care at Family Health Center is generally considered excellent. Many clients have complained, though, that they are subjected to disrespectful and neglectful treatment by staffers. "I don't even deal with Family Health Center [for medical care] any more," says Patricia Jackson, a HOPWA client at the center until a caseworker told her they couldn't pay her rent and sent her to another agency. "They think because we have the virus we are very ignorant. They act like we're contagious. We sit there all day long. But we're so afraid to talk about [condescending treatment], because what can one person do?"

John Aldrich and other former staffers say they complained about rude, inattentive attitudes toward patients -- treatment that Aldrich believes has driven people to seek help from other health-care providers, thus diminishing much-needed revenues from Medicaid and insurance reimbursements. "They treated the paying patients the way they treated poor folks, and that didn't go over too well," alleges Aldrich, who left the center in 1992 but returned briefly last year for a second stint on the board of directors.

About a year ago, after HOPWA client Alton Clements realized his landlord wasn't getting paid, he began keeping a daily log of his Rube Goldberg-like efforts to get someone -- anyone -- at the center to mail in a rent check on time. The log relates a year's worth of encounters that would raise the blood pressure of the healthiest man. A brief excerpt:

"April 30, 1996: [Landlord] called me at 10:25 a.m. to tell me that he has not received the rent check for March or April '96. Here we go again. I immediately called EOFHC. The person who answered ... told me to call back around 11:00 a.m. At 11:49 I called back. A new name -- Ms. Camcel said she would pull my file and call me back today with answers. Ms. Camcel never called back. May 1, 1996: At 9:15 a.m. I called EOFHC and talked to Ms. Camcel. She told me the request for my check was sent to the financial office, and that she would check it out. She said she would call back by noon today. Ms. Camcel never called back. I didn't expect she would. At 12:51 p.m. I called Ms. Camcel. She told me she hadn't had time to call the financial office. She said she would do that now, and get back with me in an hour. She never called back.... May 15, 1996: At 6:15 p.m. I received a call from my landlord ... telling me that he has not received any EOFHC checks yet for March, April, or May '96. I couldn't believe my ears."

Trice acknowledges that she has received other, similar complaints. "I have to say it's an area we spend an awful lot of time on," she declares. "Regardless of how limited our numbers are, it causes a lot of concern because I know how it is to depend on people like us. But," she adds, "the people who don't have complaints have not been as vocal as the ones who do."

A few months ago someone showed Trice a copy of Alton Clements's log, which he had submitted to city and federal authorities along with written grievances about the whole HOPWA program (not solely the Family Health Center's involvement). She called Clements and met with him and Frankie Swain, her vice president in charge of services to HIV patients. By then, though, Clements was no longer eligible for the HOPWA program because he'd begun receiving permanent disability income.

Alvin Moore, chairman of the center's board of directors, says the entire HOPWA snafu was "an oversight issue" that was worsened by alarmist AIDS activists. "If there have been any areas to criticize," says Moore, an administrator with the Metro-Dade Housing Agency, "it might be that those [Family Health Center] folk cared too much for what they were doing. I'd rather be criticized for that than not caring at all."

When it opened in 1969 in an abandoned elementary school, the Economic Opportunity Family Health Center was one of the first community health centers in the nation. Back then the idea of neighborhood medical services was practically unheard of, recalls Dr. George Simpson, the center's first medical director. "We had a health system, but no organized approach to the health of the community," says the bespectacled Simpson, a former surgeon who now directs Jackson Memorial Hospital's family medicine clinic and sits on the Family Health Center's board of directors. "The War on Poverty began to ask questions about what causes disadvantaged people to have bad health: One, they couldn't afford it. Two, the facilities weren't accessible. And three, the attitudes and approaches of the providers weren't acceptable. Poor people were looked down upon, scorned. Black people are kept waiting while all the white people are seen, and when he comes in the room the doctor sits down and says, 'What's the matter with you, nigger?' Think that didn't happen? That was the way of life and in many ways it still is, and as bad as it used to be."

Proceeding from the premise -- revolutionary, at the time -- that social, cultural, economic, and psychological conditions all affect one's physical health, the center hired social workers to go out into the community and learn from clients about their living conditions and lifestyles. Then-project director Dr. Lynn Carmichael recruited young doctors from a family-medicine residency program he'd started at the University of Miami -- the first such program in the nation, according to Simpson. An extensive training program helped neighborhood residents earn their high school equivalency diplomas and learn nursing and technical skills; often they too came to be employed at the center. "It gave jobs, it was a site for training, it was the largest employer in Liberty City," says Simpson, adding that Family Health was the first center of its kind in the state to include alcoholism treatment in its mental-health programs. "It offered a place for new black providers to start off. It was a force in the community."

Simpson expresses surprise at the current allegations of mistreatment of poor clients. "The general approach is one of support, respect, and concern as well as competency," he says.

When Simpson left the center in 1976, the board had begun looking for a site on which to construct new offices. In 1980 Family Health Center moved into its present headquarters, overseen by its newly hired president and CEO Jessie Trice, who previously had served as director of nursing for the Dade County Public Health Department.

Trice, now 66, works in a modest second-floor office whose jalousie windows overlook the baseball diamond at Olinda Elementary. Although she now makes a comfortable living, she has known abysmal poverty. Growing up near Pahokee, in the Everglades, she picked beans and potatoes and sorted sugar cane along with her family. Like many black women coming of age in the Forties in the Deep South, she found that the best of her limited educational and professional opportunities was the chance to attend Grady Memorial Hospital School of Nursing in Atlanta.

After graduating in 1951, Trice worked as a nurse at the segregated hospital. Ten years later, newly divorced, she came with her two children to Miami, where her mother and brother had already moved. Her first job here was as an R.N. with a county health clinic in South Miami. In 1966 she earned a bachelor's degree in nursing from the University of Miami. In 1975 she took a leave to study for a master's in public health at the University of Michigan; upon her return she was promoted to director of nursing for the health department. She was appointed to the White House Conference on Children during the Nixon administration and is a former vice president of the state board of nursing. A past president of the Washington-based National Association of Community Health Centers, she still makes frequent lobbying visits to the capital. Locally, she is as well connected as any citizen with a street named after her could be; she counts among her friends U.S. Rep. Carrie Meek and Dade County Commissioner James Burke.

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."

Poitier isn't the only one to raise the specter of record-keeping irregularities. Says John Aldrich: "I've seen people sit with stacks of records falsifying visits," inserting information that wasn't true, sometimes even to the point of asserting that clients had come to the center for appointments when no such documentation existed.

During the HOPWA crisis, when dozens of desperate Family Health Center clients sought help from the People with AIDS Coalition (PWAC), that group complained to the City of Miami and the U.S. Department of Housing and Urban Development (HUD), which funds the HOPWA program. PWAC administrators also took affidavits from several clients who asserted they'd been required by Family Health Center caseworkers to sign undated forms indicating they'd received services they had not yet received but ostensibly expected to in the future. (The complaints lodged by PWAC, which also accused the city of mismanagement and lack of oversight of the HOPWA program, have so far gone unanswered, according to Luke Balboa, PWAC's executive director.)

Similar allegations arose again in July, in a report authored by the Metro-Dade Audit and Management Services Department, which allocates federal Ryan White Title I AIDS funding -- a source distinct from HOPWA -- to local organizations. Family Health Center received almost $1.9 million in Title I money this past fiscal year.

The audit revealed a pattern of record-keeping errors and omissions, including instance after instance in which the center was reimbursed for services that hadn't been documented. In one case the agency billed the county for three days of day care for a child who was absent from the day-care facility on those days. Some files showed the converse -- that services had been provided but not billed for. Among other irregularities: Professional licenses and certifications were missing from some staff files; several client files contained signed blank forms; several clients apparently received more assistance than they were legally entitled to; and most client files lacked at least some paperwork required for Title I funding, including patients' proof of eligibility.

"There are systemic problems, and they have begun to address them," says Audit and Management's Dan Wall. "There are still some other specific issues we're going through with them." Wall says he expects to work with the center for another few weeks to correct the problems and make adjustments. "If things aren't able to be sufficiently documented," he adds, "then we would disallow payments [to make up the difference next year]." In any event, the center's Title I funding will be reduced for the coming year, by at least fifteen percent. Among the factors that prompted the reduction, according to Wall: "Past performance."

Family Health Center responded in writing to each of the problems raised in the 1995 financial audit: "Management concurs with this finding and will implement the necessary procedures in accordance with the recommendation." As to the allegations made by clients and former staffers regarding record keeping, Trice contends, "If people are saying we falsified records, that would go against the grain of what this agency is all about. We're all human and subject to making mistakes, and there may have been some mistakes made, but to intentionally falsify records -- if that was brought to our attention, whoever the culprit was would not be here."

Frankie Swain says one case manager was responsible for most of the mistakes found in the patient files reviewed by Audit and Management and has been fired, and that much of the missing documentation cited in the audit report was actually recorded but not placed in the files that were inspected by the audit team.

About 80 percent of Family Health Center's $20 million annual budget is supplied through federal grants; the rest consists mostly of revenue from patient fees and Medicaid payments -- reimbursements from the government for each Medicaid patient seen by a health-care provider.

Along with federal support come the inevitable rules and requirements, chief among them the mandate to serve people who can't pay.

This is a growing problem for every one of the 850 federally funded clinics nationwide. All of Dade's five community health centers are grappling with unprecedented external challenges to their own well-being. While the amount of funding the agencies receive for primary health care -- basic medical and dental services -- has remained stable over the past several years, other factors have made operating more expensive.

Public-health experts say the proliferation of private health maintenance organizations (HMOs) may pose the biggest threat. HMOs are in direct competition for Medicaid patients, who now represent attractive revenue, thanks to recent changes in federal law that allow higher reimbursement rates. Coincidentally, the number of uninsured (and therefore unprofitable) patients is growing. "There's a lot of pressure at health centers to come up with the money to expand services so the uninsured can be taken care of," explains Yvonne Bice, spokeswoman for the National Association of Community Health Centers. "But the grants they get from the federal government have been flat for a number of years. So that's a struggle -- when you're looking at most of your patients with either Medicaid or no insurance at all. And you have to have a funding source."

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.)

Sugar Hill is an expensive project. Its per-unit cost -- more than $100,000 -- is about twice that of other AIDS housing developments in Dade. Shelbourne House on Miami Beach, for example, cost $66,000 per unit. Experts on low-income housing say many factors probably combined to drive up costs: It's expensive to develop in an inner city neighborhood; the properties were in bad shape to start with (one building was demolished, four needed extensive renovation); and the project's small size undoubtedly added to the per-unit bottom line. Still, marvels Cordella Ingram, director of the Miami Supportive Housing Corporation, a branch of a New York nonprofit that assists developers of special-needs housing, "$100,000 is pretty exorbitant."

Family Health Center directors argue that the venture will improve the blighted neighborhood, but critics see other priorities. "Rebuilding the inner city is important, but this much money could have been used to build twice as many apartments somewhere else. So is this best for people with AIDS?" asks Donna MacDonald, former director of the Miami Coalition for the Homeless and a dissenting voice on the HOPWA advisory board that approved the Sugar Hill project.

No one expects vacancies at Sugar Hill once it opens -- there's simply too little affordable housing for AIDS patients in Dade. But when Patricia Jackson recalls her Family Health Center experiences, she can't envision herself as one of the new tenants.

Jackson and her landlord signed a contract with the center this past February for twelve months' rental assistance. But it never did pay her rent; another agency took care of the matter for four months, then sent her back to Family Health Center, where she was told flatly that all the housing money had run out. Served with an eviction notice, she sought help at the Metro-Dade Office of Community Services, which provides up to two months' emergency rental assistance. That ran out in October, but by then Jackson had learned about the extra HOPWA money the city had earmarked for Family Health Center, which she hoped would kick in when the time came.

Jackson, who lives with her eleven-year-old son in a small apartment over a store in Little River, says she began calling the agency even before the end of October, just to make sure everything would be arranged on time. They kept telling her she was on the waiting list -- confusing, given that she'd signed a contract several months earlier. Fortunately, she and her landlord discovered she might be able to qualify for assistance through a different HOPWA agency.

While she awaits word on that application, she has given up on Family Health. "The lady had first told me I'm number five on the waiting list, and now I'm number eighty-seven," Jackson says. "I'm so tired and so stressed out. I can't keep going on a dream, and that's all they're offering -- a dream.


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