By Chris Lane
By Jeff Balke
By Aaron Reiss
By Angelica Leicht
By Dianna Wray
By Aaron Reiss
By Camilo Smith
By Craig Malisow
Yet every morning, he had to produce a doctor's note or appear before Mandel for an assessment of his health. Finally, he appealed to the H.E.L.P. House's on-site manager, who shielded his truancy from Mandel.
"I said, 'Man, you know how sick I am, there's no way I can make it every day,' " he says. "He didn't mind, but they were always telling me that if I didn't go, I'd have to go back on restriction."
Mandel had another hard and fast rule, one that went hand in hand with her mandate that residents attend the Wellness Program. Former H.E.L.P. House social worker Susan Ray says Mandel often denied HOPWA-funded housing to HIV-positive men who did not have Medicare or some other form of comprehensive health coverage, an act of discrimination discouraged by the federal government. Mandel even turned down potential clients with Medicaid, which only covers 30 days of mental-health treatment a year.
Why? In order to get the highest reimbursement rate -- 80 percent -- Mandel had to have more Medicare patients than those who were on Medicaid. Otherwise, the reimbursement rate would drop to around 65 percent.
"I was told to make sure I brought in two Medicare clients for every Medicaid," says Susan Ray. "For HIV-positive people to be on Medicare, they usually have to be really sick. But every time I wanted to admit someone who was on Medicaid or had nothing, I would have to fight with her.
"I had to lie to several very eligible men that we didn't have room. And it was killing me, because we had openings."
Ray and others say that Mandel became increasingly concerned with her bottom line -- to the detriment of her clients, who, having few options, were at her mercy. They say basic needs, such as decent food, security and infection-prevention measures -- all things Mandel was obliged to provide under the HOPWA contract with the city, if not as a conscientious caregiver -- were denied the H.E.L.P. House residents.
Mandel also takes a hard-line approach as a landlord. HOPWA regulations allow one-third of residents' income, usually welfare or Social Security benefits, to be charged as rent -- if, in fact, they have an income. If not, they aren't required to pay anything. But Mandel requires that eligible H.E.L.P. House residents pay the first month's rent, plus a $100 security deposit, before they can move in. And residents with no income -- or those, perhaps, who simply find themselves a little short -- are referred by Mandel's house manager to other social-service agencies for rental assistance.
Steve Berk says that during a brief period when his benefits were suspended, Mandel sent him to Harris County Social Services, where he received a $109 check. He turned $100 of that over to the H.E.L.P. House, only to be given a receipt stating he still owed $47.
"She told the manager to tell me to get it from my mother," Berk claims.
O'Malley says he and others decided to take action after Berk confronted Mandel with his Medicare statements and she repeatedly ducked his requests for a detailed accounting of his treatment. Finally, with the help of another employee, O'Malley managed to get Berk's records for one month, which showed that he had supposedly attended an incredible 89 separate therapy sessions in January.
O'Malley made copies of Berk's treatment plan and Medicare billing records and was about to take them to the FBI when he found documents that revealed Mandel's unusual relationship with one of her patients: Tom Combs, an aide to U.S. Congresswoman Sheila Jackson Lee.
O'Malley knew that Combs was once the city of Houston's HOPWA program coordinator. Before leaving to join Lee's staff in June 1996, Combs helped local AIDS service providers secure several million dollars a year in federal housing money in the form of HOPWA grants.
Combs had been with the city for about a year when he became a patient of Mandel's. O'Malley found weekly records showing that Combs attended ROHA's partial-day hospitalization program from 1994 through early this year. Under state licensing requirements for community mental health centers, day-program clients -- in this case, patients in Mandel's Wellness Program -- are required to attend four hours of group and individual therapy sessions a day, three to five times a week.
That would seem to be quite a burden for Combs, whose current employer, Congresswoman Lee, routinely demands 60- and 70-hour work weeks from her aides. O'Malley says he never saw Combs at ROHA. Tiffany Baugher, a Wellness Program counselor-in-training, says she saw him at sessions about once a month.
But what really floored O'Malley was Combs's apparent business relationship with Mandel. He found evidence that the therapist had been paying Combs's rent, car note and insurance directly, as well as providing the congressional aide monthly cash stipends. Indeed, Combs acknowledges that, until recently, Mandel paid his bills as compensation for consulting work he has performed since 1995 for the River Oaks Health Alliance.
As a congressional aide, Combs is paid $54,000 to work in Lee's Houston office. Somehow, though, between work and his daily therapy sessions, Combs always managed to fit a lot of consulting hours into his busy week: He drives an Infiniti Q45 and lives in an $800-a-month high-rise in Montrose.