Unembraceable You

The news that there would be no money came early last week, a few hours after Audrey Gassama arrived in New York City to observe how the AIDS community up there takes care of its own.

She had barely unpacked her bag when a phone call from Houston reminded her just how dismal things had become back home. She was told that the Harris County Health Department had made its Ryan White CARE Act allocations for 1997, and the Loving Arms Foundation, of which Gassama is executive director, had been stiffed. Not one dollar of the $8.1 million in federal grants distributed to local AIDS care providers was directed to the only daycare center in the city dedicated to families affected by the HIV virus.

No doubt Gassama had hoped for better, but she probably wasn't too surprised that Loving Arms was passed over entirely by its most critical source of funding. On August 1, citing a single act of contract noncompliance, Harris County had canceled Gassama's 1996 Ryan White grant, wiping out roughly $115,000 from the foundation's budget. Other grants and donations have kept the facility open, and Gassama and her staff are still able to provide medically managed care to 34 children a day, five days a week, in a cheerful two-story red-brick house in the Third Ward.

For how much longer, though, is anyone's guess. Gassama was counting on the '97 Ryan White grants -- the county has awarded more than $400,000 to the foundation over the last two years -- to carry Loving Arms through to spring. At that point, a smaller award from the state is expected, as well as a $1.5 million grant from the city of Houston for an expansion that will include 50 apartments for low-income families with HIV-positive children.

But now that Harris County has shut her out, Gassama fears Loving Arms will have to close.

"It's not looking too good," she says.
Loving Arms's situation may be the most dire, but the foundation is certainly not alone in its struggle to provide services to people with AIDS. The 1997 Ryan White allocations mark the third consecutive year that small, community-based agencies with a mostly black and Hispanic clientele have had their funding cut. As chair of the AIDS Minority Caucus, a group of about 15 organizations that coordinates services in minority communities, Gassama has been the most vociferous critic of that trend, which began in August 1994, when the County Attorney's Office ruled that targeting minority groups through the Caucus constituted an illegal setaside.

Just last spring, Gassama told the Press that Sue Cooper, director of the county's HIV-services division, had "sabotaged" the efforts of the Minority Caucus at a time when the rate of HIV had fairly exploded among people of color, especially women ["In Denial," by Brian Wallstin, April 25].

That may seem harsh, but the fact is, before the elimination of the so-called setaside, the Caucus got results: By 1995, the number of blacks and Hispanics partaking of AIDS-related services increased from about 45 percent of the reported HIV cases among those groups in 1992, when the Caucus was formed, to nearly 67 percent.

This was no anomaly. For years now, the U.S Department of Health and Human Services, which bestows the Ryan White grants, has urged local governments to support the community-based agencies, which are more easily and readily available to minorities. The feds even made a point of reminding Cooper of that following the county attorney's ruling.

According to an August 1994 letter from Eric Goosby, the director of the federal Division of HIV Services, Harris County was expected to "insure increased services to these communities through a variety of methods, including increased minority agencies' participation in service delivery."

In response, the county unveiled a new funding formula, the results of which have only exacerbated the conflict. Two years ago, Harris County awarded $5.1 million in Ryan White grants to about 50 agencies; in 1996, the county received $6.6 million, but funded only 40 care providers. In 1997, just 35 agencies will divvy up the $8.1 million allocation.

"Two years ago, the Minority Caucus had 11 members that received grants," Gassama says. "Last year, we had four."

This year, the county eliminated grants to two more Caucus members: Loving Arms and the Association for the Advancement of Mexican Americans, the city's largest community-based service agency for Hispanics. Despite the apparent trend toward a concentration of care, Cooper, the county's director of HIV services, says that there has never been evidence to prove that HIV-positive blacks and Latinos aren't being served.

"Our job is to make sure the clients are being taken care of," Cooper says, "not that individual agencies get funded. And the clients are being taken care of, there is no question about that."  

That may be true -- for now. But minority care providers fear that many new HIV cases in their communities will go untreated because the county has made it harder for them to obtain everything from case management and medical services to transportation and counseling.

It is still hoped that the reduction in services in minority communities will be reversed, but no one's holding his breath. A year and a half ago, amid complaints that the funding process was unfair to minority care providers, County Judge Robert Eckels appointed a committee to study the issue. King Hillier, chair of the local Ryan White Planning Council, which sets the county's funding priorities, says progress has been made, but it's come slowly.

"Recommendations were moved forward to the county and the planning council has moved forward in adoption of those recommendations," said Hillier in a recent interview. "We're still awaiting responses from the county judge's office and purchasing."

Whatever happens, it may not be enough to save the Loving Arms Foundation. Indeed, Gassama has come to the conclusion that the county intends to run the foundation out of business in response to her frequent criticisms of how grant funding is dispensed.

"This is retaliation," she claims.
Gassama points out that since the foundation opened in 1993, she has never failed to meet her contractual obligations with the county. In fact, Loving Arms has consistently scored among the highest in the county's own compliance tests. Last year, the average rate of contract compliance was about 74 percent. Loving Arms scored 91 percent; Gassama's only violation was her failure to produce an audit of the foundation's books on time.

That didn't prevent the county from awarding Loving Arms about $185,000 last January. That was some $80,000 less than the foundation received the year before, and Gassama and other under-funded minority agencies raised hell about it with, among others, U.S. Representatives Sheila Jackson Lee and Gene Green. Two City Council members hosted a "State of HIV in Houston" forum that explored the problem in detail.

Two months later, Gassama was notified that she was in violation of county purchasing regulations and given a July 31 deadline to produce the audit. Gassama met the deadline -- barely -- but she lost her funding anyway.

The county canceled the contract because the audit noted that, during 1993 and 1994, its first two years in existence, Loving Arms paid roughly $34,000 in undocumented expenses. The audit also reported that the foundation had fallen behind in payroll taxes to the IRS.

Gassama has never disputed the auditor's findings. When she first learned of the irregularities, she fired her accountant, and an audit released last month for 1995 reported that the foundation had since "implemented improved control procedures" that reduced undocumented costs to an "immaterial" level. The audit also noted that the foundation and the IRS had worked out a payment plan for the back taxes.

"I've done everything they've asked," Gassama says. "I've worked with them, I've written them letters, but they don't write back. They could separate those costs. The county could subtract the $40,000 until we get the whole thing straightened out. But they won't do it. It's just a big mess."

County Auditor Tommy Tompkins says the county's hands are tied by federal, not county, regulations. Tompkins acknowledged that Loving Arms has been cooperative with his office, and that there have never been any findings to suggest the foundation spends its money on anything other than caring for its preschool clients and their families. Still, he says, "the federal government will try to get the money from [Loving Arms]. If they can't, they'll come to us for it."

King Hillier, chair of the planning council, points out that every other AIDS care provider that receives Ryan White monies is required to provide timely audits.

"That," he says, "is over and above this issue of whether you're a minority community-based organization or not."

Hillier has a point, of course, but no other AIDS care provider in Harris County -- let alone the only one offering pediatric daycare to HIV-positive children exclusively -- has had its contract canceled in the middle of the year. That's somewhat surprising, considering that a number of agencies funded by the county have compliance problems of a more pressing nature.

One of those is the Harris County Hospital District, for whom Hillier toils as director of government relations. The district scored right around average for contract compliance, 74 percent, and was cited for an inability to locate client records. Even AIDS Foundation-Houston, the area's oldest and most comprehensive care provider -- not to mention one of the best funded -- only complied with 69.9 percent of its contract requirements. Among its cited problems were the unauthorized release of information, lack of personnel records and cultural insensitivity -- a criticism that doesn't surprise Gassama and other minority care providers.  

The irony doesn't escape Bob Hergenroder of the People with AIDS Coalition, who says that Harris County possesses "documented proof that some of these places were doing shitty work. But it's had no effect whatsoever, nobody questioned the contract, nobody looked at it.

"Loving Arms, on the other hand, has a contract compliance issue with the purchasing department over a legal document, and all of a sudden all hell breaks loose and you get a contract pulled. Obviously they weren't fraudulent. They violated a rule, and when you do that the law is out to get you."

Following a rather undiplomatic rhetorical pattern, Gassama says it's not the law that's hurt Loving Arms, but the enforcer -- Sue Cooper. She says the county's HIV-services director has even attempted to undermine her fundraising efforts by telling people -- including the feds at Health and Human Services -- that the foundation had shuttered its doors.

That's not true -- yet.
Cooper flatly denies she has "discriminated against" Gassama and Loving Arms. At the same time, however, Cooper is obviously aware that the foundation's survival is in jeopardy, yet seems peculiarly blinded to the consequences by a rigid adherence to her bureaucratic responsibilities. When asked if something couldn't be done for the sake of Loving Arms's young clients, Cooper replied:

"In this case, it's easy to become distracted from the issue because there are children involved. I don't think you really understand the process. There is a process, and those decisions have been made.

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