Clinics, HIV services come under county scrutiny

This story was reported for the San Diego News Network on April 29, 2009. Sources gave Hoa Quach exclusive interviews.

See original copy of story.

Allegations of misused federal funds, poor patient treatment, and a case manager pressuring a patient to have sex have prompted the county to investigate the delivery of services at community clinics.

The county Compliance Office’s investigation focuses on allegations related to the delivery of contracted HIV services provided by community-based organizations, which receive Ryan White funds – federal funds for HIV/AIDS services. The complaint focuses specifically on Family Health Centers of San Diego and the San Ysidro Health Center.

The county said it cannot comment on the investigation, but findings and a resolution can be expected in 30 to 45 days.

A spokesperson for the federal government’s Health Resources and Services Administration (HRSA) said it “cannot speculate on the allegations….but HRSA expects that its grantees provide quality care that affords patients with dignity and respect.” Additionally, Ryan White funding is “competitively awarded.”

Mike Spradley, the community relations manager for Special Delivery San Diego, a meal-delivery service for people with HIV/AIDS, cancer and other illnesses, sent a complaint to county supervisors and other elected officials earlier this month. On April 21, the office of Supervisor Greg Cox responded that the complaint is being investigated by the Compliance Office.

Spradley said patients frequently complain to him about shoddy care and disrespect at the clinics.

“I do not see how things could get any worse,” he said.

Spradley said one county staffer in particular is the source of the clinics’ problems. He’s asked for the staffer to step down or be terminated.

San Ysidro Health Center president and CEO Ed Martinez said confidentiality laws prohibit him from addressing complaints regarding the staffer.

A homeless patient — who requested anonymity for fear his access to care would be affected — said he was pressured into a sexual relationship with his case manager at the Family Health Centers of San Diego North Park clinic.

The case manager invited the patient to stay at his home, the patient said. He stayed two weeks, but left after the case manager pressured him to have sex and use methamphetamine, he said.

The patient said the case manager no longer works at the clinic, but he did not know why.

A second patient — who also requested anonymity — said clinic employees at the FHCSD North Park clinic harassed him when he tried to use a clinic bathroom. While he was inside, the patient said an employee opened the door and asked him to leave.

The patient filed a complaint with the FHCSD executive director, Fran Butler-Cohen. In an e-mail response, Butler-Cohen called the incident a “perfect storm [of] miscommunication,” according to Spradley.

Butler-Cohen did not respond to two phone calls and two e-mails requesting comment.

Tom Buehner, a former employee at the San Ysidro Health Center, said patient care at the San Ysidro clinic is bad, too.

Buehner — a doctor who has worked with HIV patients since 1990 – said that while he worked at the clinic, he was the only doctor available for the care of HIV patients at the Health Center’s Elm Street clinic. Though he is unsure of the exact number of patients he cared for, he said he was told the number was approximately 400.

Buehner claims he was told he couldn’t spend more than 15 minutes with one patient. He said patients were “treated like cattle.”

“It was impossible to do the primary care and HIV care in 15 minutes, and on top of that, offices were not properly stocked,” he said.

After Buehner voiced concern, the policy was changed to allow him up to 30 minutes, he said.

He said staff was improperly trained, too. Buehner said once a Spanish-speaking patient came to the clinic after hours. Buehner asked an employee to translate for him. Instead, Buehner said, the employee asked the patient to leave because it was after hours.

“The patient ended up in the E.R. a couple days later,” Buehner said. “It was that lack of compassion I couldn’t understand.”

Buehner said he filed 10 complaints with the clinic’s medical director, Matthew Weeks. Buehner said Weeks only replied to one complaint to tell Buehner it was “redundant.” Buehner was fired on March 16.

Sources said an HIV specialist resigned from the San Ysidro clinic last week, and it is unclear who is treating HIV patients there. That could jeopardize the clinic’s Ryan White funding.

Martinez maintains that the San Ysidro clinic “abides by the highest standards of ethics and care.”

Spradley said he complained to a specific employee when patients raised concerns. He named the one employee in his complaint, and has asked for the employee to step down. San Diego News Network has declined to name the employee, pending the investigation’s outcome.

The county is unable to release information regarding specific complaints against the employee because they are considered “confidential personnel matters,” said county spokesperson Holly Crawford.

“Health and Human Services Agency takes all allegations of fraud, waste and abuse seriously,” Crawford said.

According to HRSA, the San Ysidro Health Center parent company Centro de Salud de La Communidad San Ysidro, received $14.8 million in federal funding, and Family Health Centers of San Diego received $8.98M in federal funding this fiscal year.

San Diego is classified as an Emerging Metropolitan Area, which means more than 2,000 AIDS cases have been reported in the last five years.

The San Diego HIV Health Services Planning Council is responsible for planning and allocating Ryan White funds to programs throughout San Diego County. Patients have testified before the council regarding treatment at the two clinics, Buehner said. This includes which services (not providers) to fund, how much funding, who will receive services, and how.

Community clinics that provide HIV/AIDS care in San Diego County may receive Ryan White funding in three ways: directly from the federal government, from the state and from the county.

Spradley said he hopes the investigation’s outcome raises “the standard of care and community resources for all patients.”

“When tax payer dollars, the standard of patient care and public trust are involved, government oversight is always needed,” Spradley said.