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Combs clearly reveres Mandel and credits her with helping him survive some trying episodes, including the news that he was HIV-positive.
As for Mandel, she's made a habit of having somewhat complex relationships with her patients. O'Malley was just one former patient who ended up working at ROHA. Another, a former "administrative assistant," found her sessions with Mandel so helpful that she wrote a gushing testimonial for one of ROHA's promotional brochures.
Currently, Mandel has at least three former patients working at either the River Oaks Health Alliance or the H.E.L.P. House -- a situation that, according to Shirley Bibles of the Texas Board of Social Workers Examiners, comes close to a breach of professional ethics. As for Combs, his alleged relationship with Mandel would definitely be "a violation of professional boundaries and would constitute a dual relationship," says Bibles.
"Either you're a client or you're not, or you're a business partner or you're not," adds Bibles. "You can't be both."
By most accounts, the 47-year-old Combs is an energetic, down-to-earth man with a rich business and public-service background. He was elected to the first of three terms on the Beaumont City Council when he was just 20 years old; he also once ran for Congress. One of his nonprofit enterprises, Bid Resources, matched up small and minority businesses with government grants. He has also committed significant time to helping agencies that serve gays, lesbians and people with AIDS -- making him a logical choice to run the city's first HOPWA grant program in 1993. Such experience would suggest that Combs should have known that accepting money, for whatever reason, from someone whose request for tax dollars passed through his hands was, at best, questionable behavior.
Combs admits that when he was the program coordinator, he never divulged that a HOPWA grant applicant also happened to be his therapist. Nor did he reveal that he was being paid by Mandel for what he calls "business planning and development."
Like Mandel, Combs had originally agreed to answer questions from the Press and provide information about his relationship with Mandel. But he changed his mind after several discussions that he requested be held "off the record," and other than verifying dates and other bits of information, offered only this statement:
"I have known JoAnne Mandel for several years. I know her to be a person of integrity and feel that the programs at ROHA have been a great help to many people."
In 1993, the year Tom Combs became the city's HOPWA coordinator, Mandel started a nonprofit organization, the River Oaks Health Association. In October of that year, the association opened the privately funded Transitional Living Center, a four-bedroom house where HIV-positive men could also receive case management services, spiritual guidance and intensive treatment for substance abuse.
Mandel's nonprofit submitted its first application for HOPWA funding in December 1994, and six months later, on June 14, 1995, City Council approved a $175,000 grant for short-term transitional housing at Mandel's new facility, a five-bedroom rental house on Brun. The following day, Mandel submitted a request to the Department of Housing and Urban Development for more than $1 million, which she proposed to use to buy and renovate two small apartment complexes, totaling 18 units.
Mandel noted that the city's HOPWA program coordinator -- Tom Combs -- "played a catalytic role" in developing her proposal, which would place the housing component in the hands of a management company while ROHA managed a "continuum of care system" that would allow residents to move gradually toward independent living.
(Combs said he did not collect a consulting fee for his "catalytic role" and stressed that he encouraged all HOPWA applicants to freely drop his name and job title when necessary.)
For reasons unknown at this point, HUD rejected ROHA's request for funding. But there were some unusual aspects of the proposal that might have caught the eye of someone at the federal housing agency. For instance, Mandel used the term "ROHA" throughout her proposal, without specifying whether she meant the nonprofit association or the for-profit alliance.
That is significant because among the "advantages" she mentioned in her proposal was that the "major" portion of the health care costs would be funded by third-party sources, such as insurance companies. Moreover, as "matching funds," Mandel pledged $432,000 in Medicare and Medicaid reimbursements for the partial-day hospitalization program -- which is run by the for-profit River Oaks Health Alliance, not the nonprofit association that applied for the federal funds.
Perhaps HUD recognized the possibility that uninsured homeless men with AIDS, who were otherwise eligible for HOPWA-funded housing, would be rejected in favor of those whose health-care benefits could pay the freight.
In March, the city housing department awarded Mandel an unrelated $750,000 grant to buy the H.E.L.P. House and to "provide for" counseling, mental-health therapy and substance abuse treatment at ROHA's partial-day hospital.
That means Mandel, who did not mention insurance companies, Medicare or Medicaid in that proposal, must either refer clients to appropriate service providers or have ROHA provide the services. If H.E.L.P. House residents received their treatment from ROHA, the associated costs would be covered by HOPWA funds earmarked for professional fees and contract therapists.