A Sick Situation

How Did El Pueblo Clinic, Once A Lifeline For Tucson's Poor, Hit The Skids?

By Emil Franzi

JUAN SMITH IS in his 50s, he but looks a lot older. Except for a couple of tours in 'Nam as a combat Marine, he's spent his entire life on Tucson's southwest side, where he was born, grew up, married, and raised his family...

...And drank the water.

Juan has cancer. It's in remission for now. He was never able to get a straight answer about why it happened, and he knows that's a hard call. Maybe he got too close to Agent Orange, maybe he shouldn't have smoked for 25 years, maybe it's genetic. But several of his neighbors neither smoked nor went to 'Nam and they've come down with cancer and lupus and leukemia at early ages.

Feature The lawyers said they'd take care of it with a big lawsuit against the people who spilled the chemicals that soaked into the groundwater. Years later, they settled the suit, and Juan got his share--a whole $1,300. Part of the deal locked up all the files so no one else could get at the facts.

They set up a special clinic in the area for longtime southside residents with health problems that possbily came from the chemical spills. The doctors are pretty good, and they take care of Juan's exams and prescriptions--but now there's a new problem.

His 29-year-old daughter, who's married and lives in the next block, has been diagnosed with cancer, too. And clinic offcials say they don't have enough money to add her to their patient list...

More stoic than bitter after years of being lied to and about, Juan is wondering why.

EL PUEBLO CLINIC, one of Tucson's oldest established resources for medical assistance to the poor, is facing severe problems.

That's the view of a number of observers, including Pima County Board of Supervisors Chairman Raul Grijalva, Kino Hospital Director Dr. Richard Carmona, Pima County Health Director Dennis Douglas and Pima County Manager Chuck Huckelberry.

The clinic's crisis came to a head at the end of June, when El Pueblo Board President Rose Augustine resigned.

A long-time leader in environmental and health issues, and a victim of TCE poisoning, Augustine blasted the current clinic board for "division, nepotism and cronyism."

She pointed out the organization had lost its executive director, deputy director, medical director, registered nurse and administrative assistant--and replaced none of them, while instead choosing to hire a $250-a-day consultant. Most of those positions are still vacant.

Meanwhile, some clinic patients claim they're being dunned because the TCE clinic portion of El Pueblo hasn't paid its bills to medical vendors. Augustine says some of those patients may be facing collection agency threats. But El Pueblo's current leadership says that would only occur if the patient dropped out of the TCE program but continued using the vendor.

El Pueblo Clinic has faced adversity before, but never of this magnitude. Formed in 1972 as the Tucson Free Clinic, and originally housed near the University of Arizona's main gate, the organization changed its name and re-incorporated in 1987. Now in a building donated by the City of Tucson as part of the El Pueblo Neighborhood Center, 101 W. Irvington Road, the clinic has been at its present location since 1983.

As El Pueblo Clinic concentrated more on the needs of the south and west sides, it became the natural place to handle many of Tucson's TCE-generated health problems.

TCE STANDS FOR trichloroethylene, an industrial solvent. It causes cancer in laboratory animals, and studies have linked it to connective-tissue diseases, birth defects and auto-immune problems in humans. Tucson's underground water supply is contaminated with TCE--most heavily, it's believed, around the old Hughes Aircraft plant near Tucson International Airport. For years TCE and related substances went undetected in Tucson's groundwater, apparently increasing the rate of cancer and other diseases among southside residents.

It was as the collection point for TCE relief funds that the controversies at El Pueblo Clinic really began.

Several years ago, both Pima County and the State of Arizona began funding a seperate TCE Clinic as part of El Pueblo by contributing $250,000 each per year. These two sources made up a major share of El Pueblo's funding for all functions. United Way, other governmental grants including state tobacco funds, state healthcare funds for the poor, private insurance and those few who actually paid for services made up the rest of El Pueblo's revenues.

But last year the Pima County supervisors, by failing to include the $250,000 they'd promised El Pueblo for its TCE programs in their 1996-'97 budget, pushed the clinic into the red. Meanwhile the state cut its TCE contribution to $130,000.

The plan by some supervisors was to take the funds later from the county's contingency budget. Unfortunately, during the many fiscal crises that occurred when the GOP majority of Mike Boyd, Paul Marsh and Ed Moore ruled the board, the supervisors spent that contingency money on other priorities, including subsidizing the chronically money-losing Copper Bowl.

Thus, when the moment of truth came for El Pueblo's TCE program, the cupboard was bare.

The net result: Belt-tightening--the clinic's previous executive director, Dr. Thili Kulatilake, decided it was within her power to lay off TCE Program Director Cecilia Campillo, a move which enraged another group, called the TCE Program Health Advisory Board.

The TCE Health Advisory Board (HAB), created by the El Pueblo Executive Board, consists of folks living in the contaminated areas. While it's clear the TCE/HAB was appointed by clinic officials, one of the many areas of contention is that the TCE/HAB now appears to have taken on a life of its own, and is currently replacing its own members. Augustine calls it a "rogue board." She protested this development, and cites it as a further example of administrative muddle and usurpation of powers.

Long-time environmental activist and TCE program critic Myra Jones believes the group has degenerated into an unrepresentative, self-appointed body. "The constituency they represent consists of each other, not TCE victims," Jones complains.

The TCE/HAB also jumped into the 1995 city election fray by strongly opposing Proposition 200, the Clean Water Initiative.

Tom Stubblefield, chairman of the HAB and one of the incorporators, did not return a reporter's call.

And now the TCE/HAB has incorporated, with Stubblefield as president, its plan would appear to be to apply for health-oriented grants beyond TCE-related problems. That's a bit like the Pima County Planning and Zoning Commission, an appointed creature of the Board of Supervisors, incorporating itself and filling its own vacancies.

WHILE MOST OF El Pueblo's staffers were resigning for a variety of reasons, so were many of its board members. One local business type, who wishes to remain anonymous, quit after a few months because he found the task "hopeless."

"The board majority lacked any concept of professionalism and they wanted to micro-manage things they're unqualified to determine," he says.

As new board members came on and older ones left, the majority solidified around certain staff members, particularly TCE program director Campillo, according to Augustine, who herself served only eight months on the board and as president for six of those months. Several incidents brought matters to a boil:

Augustine invited to the June 24 meeting of El Pueblo's board two folks whose support the clinic obviously requires--Pima County Board of Supervisors Chairman Raul Grijalva and Kino Hospital Director Dr. Richard Carmona. Grijalva represents El Pueblo's major funding source, and Carmona oversees the clinic's principal creditor (El Pueblo Clinic owes Kino $171,000, according to Carmona, and the debt is climbing).

Augustine hoped for some meaningful discussion. However, according to several of those who attended this meeting, many El Pueblo board members barely concealed their contempt for the two officials. Some tried to keep Grijalva from speaking, while others strongly rejected Carmona's stated desire for full control of El Pueblo's administration as part of the solution to the clinic's problems and mounting debt.

One of El Pueblo's board members is former state Sen. Luis Gonzales. Long a player in southside politics, Gonzales has been out of office since 1982, when he ran a kamikaze campaign against then-Congressman Mo Udall in the Democratic primary. Gonzales has run unsuccessfully for office several times since then, including attempts at the Board of Supervisors and the Tucson City Council. During their long political careers on the southside, Gonzales and Grijalva have usually been at each other's throats.

Gonzales joined El Pueblo's board in March, along with several other new members. By June he was part of the personnel sub-committee that determined Campillo, the laid-off director of the clinic's TCE program, should be rehired with retroactive pay, thus canceling the decision of Acting Director Kulatilake and helping force her resignation. She's not the first El Pueblo manager to quit after being overruled by the directors.

Next, the directors decided to hire a consultant instead of replacing Kulatilake. But they interviewed only one candidate--former Tucson city councilman and recently retired state employee Hector Morales. They voted to bring him aboard at $250 a day, on a 90-day contract. Morales has stated he'd like to serve as the organization's executive director, a role he's essentially filling now.

Augustine says she tried to get another candidate interviewed for the position, but the board struck his name from consideration and didn't interview him. She and others believe the "fix" for Morales was already in.

These actions forced Augustine to join a number of former board members in resigning.

She says she was appalled that El Pueblo's TCE clinic:

• Can no longer add clients because of lack of money;

• Is reducing services to its 800 current patients;

• Lacks key medical personnel;

• Has had five executive directors in four years; and,

• Is in hock over $200,000.

Furthermore, Augustine alleges nepotism, based on the fact that two of the clinic's managers are sisters, and one supervises the other's daughter. She adds that her charge of "cronyism" applies to Morales' hiring.

While none of the others who resigned from the board were quite as strong as Augustine in their condemnation of El Pueblo's practices, at least two stated their objections in letters of resignation. In August 1996, Teresa Salinas wrote:

"The turmoil that exists in the clinic of late is very disturbing and nonproductive...board members cannot be effective in moving the organization forward under this environment."

At about the same time, Norma Stephens left the board, and wrote in her resignation letter:

"I'm personally aware that more resignations are forthcoming, and this does not bode well for the clinic. My concern is that this type of instability may affect funding and ultimately hurt the people who depend on the clinic for healthcare. It's unfortunate that a few self-interested individuals have been able to create such division within the board that at least four board members will have resigned before the dust settles. This saddens me because those leaving have been very active and dedicated members, but it's understandable if they are feeling the same level of frustration as I am."

Both of these resignations took place before Augustine came on the board--which contradicts Morales' claim that Augustine caused most of the division and management problems. As Morales was coming in the door, Augustine was going out, and Morales admits his view of her comes from listening to secondhand accounts of her tenure.

CARMONA, GRIJALVA AND Augustine all believe the only long term-solution to the problems of the TCE clinic is to leave it at El Pueblo, but place its administration under the county's Kino Hospital. This, they argue, offers the most cost-effective way to serve patients. And since the county picks up most of the tab, this would leave El Pueblo functional and unabsorbed, yet still administratively responsible to its largest funding source.

After all, El Pueblo Clinic handles more than TCE--it also takes care of homeless, pregnancy care, and low-income citizens with other medical problems.

With the elimination of supervisors Ed Moore and Paul Marsh during the last election, the current crop of supervisors is far more friendly toward Kino Hospital and subsidized southside healthcare in general, making this move more politically feasible, not to mention the fact that it would fit nicely into the county's new "Integrated Health" program, which pulls together assorted county health programs under one director--currently Carmona--and reduces the Board of Supervisors power over them.

And still friendly to El Pueblo Clinic--even though they're skeptical about its current leadership--the supervisors voted to reinstate in the current budget the $250,000 annual appropriation for the TCE clinic. But Grijalva and County Manager Chuck Huckelberry want to see a real financial audit, and they're demanding an answer to charges El Pueblo officials have co-mingled TCE funds with other El Pueblo accounts.

In addition, United Way has escrowed its $65,000 contribution pending a full financial report.

Morales points out the audit should have been done much earlier to comply with United Way procedures. He has an accountant working on it, but nothing short of a full, professional audit by someone chosen from outside the clinic will satisfy many critics. Augustine goes further, demanding the County Attorney or state Attorney General conduct an investigation into all aspects of El Pueblo's problems.

Huckleberry says the Supervisors will not simply turn the allocated funds over to the TCE clinic, but will first subtract debts owed the county. Augustine wants them to go further and pay other vendor debts from the allocation. But Morales contends the appropriation was made with no strings attached, and he's trying to meet with Huckelberry to resolve the matter.

Naturally, El Pueblo's current board objects strongly to Kino management taking over anything--no one wants to clip his own wings. But the problems aren't getting any smaller, the deficit is growing, and TCE patient services were clearly deteriorating. The question remains--who's at fault?

And a new, and very serious question, has been raised concerning patient confidentiality.

In violation of federal law, patient vendor and insurance records have been loosely handled, and some directors on El Pueblo's current board are allegedly reviewing many of those files, which include names, social security numbers, codes for medical procedures and prescriptions, and the vendor supplying the service. Those alleging the improper handling of records faxed copies to The Weekly.

Morales says he's attempting to discover how the confidential information was leaked, but he denies El Pueblo's current board is involved.

ALTHOUGH HE LACKS a background in medicine, Morales does have the respect of most of the players, who see him as a man sincerely trying in doing a good job. Even Augustine doesn't question that, only the quality of his information.

Morales has some ideas about how El Pueblo can recoup: He hopes to expand services for the main clinic to become a primary care supplier to at least one HMO, which he believes would eventually guarantee financial stability. But in the short term, he still needs a friendly Pima County government and big bucks from the supervisors and other sources.

Augustine points out that the TCE victims have been abused twice--once by the polluters who caused their various ailments, and once again by the lawyers who settled their class-action case for token individual amounts, while scoring big legal fees in the process.

As a TCE victim herself, she hopes they won't be victimized again by those in the very clinic set up to help. TW

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