Government & Politics

Possible contract-selection shenanigans could shift AIDS patients away from providers

The New Orleans Regional AIDS Planning Council, a public body that sets annual priorities for spending millions in federal money, may have improperly gotten involved in recommending a recipient of that money: a member of the council.

Aside from the possible conflict of interest, the new contract also has consequences for the patients themselves.

That’s because the organization, with no history, likely will take patients from existing organizations that have made inroads with the traditionally hard-to-reach and underserved African-American population.

Longtime AIDS activist David Munroe laid out these complaints in a letter to the New Orleans Regional AIDS Planning Council. But another official connected with the grant program said Munroe’s complaint letter was simply “sour grapes” because his own organization recently was denied a share of the money.

Even so, a federal official said Munroe’s conflict-of-interest complaint has merit.

At issue is the annual Ryan White HIV/AIDS money that is sent to 13 agencies in the New Orleans region from the Federal Health Resources and Services Administration.

Federal officials require a regional planning council to set priorities among several broad topics, such as medical and non-medical case management, primary medical care and outreach. However, the council isn’t supposed to be involved in deciding who carries out that work.

That responsibility falls to the city’s Office of Health Policy. That office seeks proposals, rates the responses and chooses the winning contractors.

Once the winners are chosen, the planning council approves budgets for each broad service category, and the health policy office determines how much each contractor can spend in each category.

This year, the policy office chose several contractors to handle case management, including Priority Healthcare in Marrero. The agency, which was incorporated in August last year , is run by Tamara Hagan. She not only is a member of the planning council, but she’s chairwoman of a council committee that oversees service delivery.

“Priority was a new organization but it ended up being funded,” Munroe said. “As someone who came into the picture as a member of the planning council and sitting on the service-delivery committee, the feeling is that they may be in cahoots with the Office of Health Policy.”

Hagan did not return several calls for comment.

Lawless said her staff rates and grades the responses, but only after the proposals are looked over by other interested parties outside her office – including members of the planning council.

“They read them and then we have a preliminary discussion, but they are not involved in selection of agencies,” Lawless said of her ad hoc advisers.

Having planning council members select the winners clearly would violate the federal regulations, a point that even Lawless acknowledges.

But David Bowman, a spokesman for the Health Resources and Service Administration said even having council members read the contracts is out-of bounds.

“They do not have the authority to review contracts,” he said.

Lawless said it’s been a long practice of her office to have all manner of AIDS experts help her review the proposals – including those on the planning council, some of whom also work for or run companies that provide services. She said they all sign a document saying they have no conflict of interest.

Still, Ashley, who took leadership just last month, said he’s not comfortable with council members reading the proposals in the future.

“If I am the chair right now, then I do not want any planning council staff or members involved in the grading, scoring or reviewing of proposals,” Ashley said.

Lawless dismissed the complaints of Munroe, who for years was chairman of the planning council before leaving office because of term limits. He went on to start his own AIDS service agency, In This Together, which the city reduced funding for in 2008.

“Understand that the individual who sent this letter is a disgruntled provider who raises similar concerns every year,” Lawless said. “It’s sour grapes.”

Lawless also said existing contractors not being re-funded is a result of them failing to live up to their contracts; she did not name any such contractors.

“We’re not trying to do anything punitive,” Lawless said, “but we’re building on the strengths of existing agencies.”

Priority Healthcare soon could be getting its first patients, at the expense of two of those existing contractors, said two patients of those providers, Desire-based Great Expectations and N’R Peace, which is on the West Bank. These two providers are the only ones in New Orleans that serve primarily African-American patients, many of them  poor, ex-incarcerated and substance-abuse clients.

Representatives for the two organizations, who still hope to get Ryan White funding from the city, acknowledged that they were asked to plan for the transfer of close to 300 patients, but declined further comments for this story.

The two patients, who each asked not to be identified because of the stigma attached to their health conditions, are not happy that they’re being forced to find new case managers after establishing strong relationships with their current providers. And they’re afraid that they’ll have to go to multiple providers to get all the services they now get in one place.

One client who received her primary medical care and case management at Great Expectations said she was “shocked” when told she had to go to a new agency, and that she was given no warning.

“They said I can choose [my new agency] but really I don’t have a choice,” she said. “It’s their way, not mine. So it’s like I’m being pushed out.”

The other patient moved to New Orleans in November. When her then-fiance became abusive, she left the house they shared but didn’t know where to turn because she had no family or friends here – neither did she have health insurance since she was within the three-month probationary period at a new job. So she called N’R Peace, whose staff got her into a shelter.

The case manager there, “gave me guidance and treated me like a family member,” she said. “I know they are paid to do things like this, but they really went above and beyond to help me. The case manager gave me her cell phone number and said to call her anytime if I had any problems.”

The agencies that will be receiving the new caseload – almost 60 from Great Expectations, and over 200 from N’R Peace– will have to expand capacity for their new intake. One agency, FACES, is a part of Children’s Hospital. Executive Director Barbara Boxer said that new appointments so far have not been overwhelming, but caseload was already expanding.

“But since clients can choose which provider they’ll be going to, it’s difficult to know how many of them will choose us,” she said.

Currently, they are sending staff over to N’R Peace to accommodate transferring clients who have difficulty with transportation.

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  • Rebecca Golden

    This investigation is paramount and must be continued. There is an urgent need to expose all wrong doing related to the escalating HIV/AIDS epidemic in our city. Cronyism and nepotism will only result in more deaths.
    Rebecca Golden
    Tulane University