I've been writing and re-writing this post for nearly four months while the turmoil surrounding the Whitman-Walker Clinic (WWC) has continued to unfold. The matter recently came to a head on Monday, April 27th, during a public roundtable concerning DC Council Member David Catania's allegations that the Clinic has been mismanaged and has drastically strayed from its original mission to serve the GLBT community. This issue is at once quite personal and politically volatile, as I have many friends on both sides of the debate and understand that much of the gay community has very strong and polarized opinions on the matter.
I love the WWC and have served there for nearly three years as a volunteer STD screener, HIV tester and results counselor at the Gay Men's Health and Wellness Clinic (GMHWC). As such, I have been given an inside and informed perspective on many of the issues at stake and feel compelled now, more than ever, to voice my opinion. My objective is not to point fingers and lay blame, but to weigh in on the findings of the recent roundtable and to offer some hope on how we might move beyond this potentially destructive impasse.
The WWC, a trusted provider of health care to the local GLBT community for the past few decades, has been gay from the get-go. Appropriately, it was named for two, famed 19th century Washingtonians, the gay poet, Walt Whitman - a nurse during the Civil War - and Dr. Mary Edwards Walker - a Union Army physician, who was both awarded the Medal of Honor for her valiant service and defamed for assuming traditionally male roles in her time. Borne out of the Gay Men's VD Clinic that operated out of the basement of the Georgetown Lutheran Church in the early seventies, the WWC was officially chartered in 1978, to serve, first and foremost, the health needs of the GLBT community, when no one else would.
The Clinic's success in meeting the needs of gay men soon prompted its leaders to expand the scope of its services to include a wider range of social and medical services for gay men and lesbians. With the advent of the AIDS crisis in the eighties, the WWC became the sole beacon of hope for the predominantly gay men suffering during the early days of the epidemic. And it was during this time that the WWC again broadened its reach by providing health services to all those afflicted with HIV/AIDS that had been marginalized by mainstream society.
But sadly, this early gesture of solidarity to help those beyond the GLBT community has now diluted the Clinic's mission and purpose under its current CEO, Don Blanchon, and Board of Directors. In the process much of the GLBT community has been left by the wayside. The Clinic's gay identity has been rapidly stripped away in recent years at a time when GLBT-specific services are needed more than ever.
In my role as a STD screener at the Clinic, countless times patients have told me "Thank God the Clinic is here; as otherwise I would have had no where to go." Or worse, they'd say that their healthcare provider discriminated against them or was insensitive to their unique sexual health needs as a GLBT person. Although Whitman-Walker's administration still maintains that the Clinic will forever continue to provide GLBT-specific services, the perception of the community is that these days are certainly numbered. A couple weeks ago, if you hopped onto the Whitman-Walker website, it's mission statement still read:
Whitman-Walker Clinic is a non-profit community-based health organization serving the Washington, DC metropolitan region. Established by and for the gay and lesbian community, our Clinic is comprised of diverse volunteers and staff who provide or facilitate the delivery of high quality, comprehensive, accessible health care and community services. Whitman-Walker Clinic is especially committed to ending the suffering of all those infected and affected by HIV/AIDS.
Whitman-Walker Clinic's Mission Creep?
I am very familiar with the Clinic's simple, yet powerful mission statement, as I and many other gay, lesbian and trans individuals were driven to volunteer or to seek care there knowing we were giving directly back to our community or would receive medical care geared specifically to our needs. Yet sadly only weeks ago, in the midst of the mounting controversy surrounding the Clinic's alleged mismanagement, the WWC Board officially voted to change its mission to the following:
Our mission is to be the highest quality, culturally competent community health center serving greater Washington's diverse urban community, including individuals who face barriers to accessing care, and with a special expertise in LGBT and HIV care.
So I'd ask you to be the judge by comparing the above two mission statements and deciding for yourself whether this change reflects a movement away from the Clinic's historical roots.
The new statement clearly says to me that the WWC's goal is now to provide health services to everyone - all under-served populations - even to those who happen to be GLBT; which is far different from saying that providing GLBT services is central to its purpose. I would never have a problem with the Clinic expanding its services to other populations in need, as it has done for decades; however, in recent years it has become a primary care clinic for all under-served groups at the expense of its core GLBT mission. The very community that founded the Clinic has been moved from its center to the periphery, a change that has profound ramifications for those seeking GLBT-specific health services and has angered many who feel a vital health resource has been hijacked from them.
This action by the Board, which left me and Council Member Catania equally mystified, poses two questions in my mind:
Why did the Clinic's Board feel the need to make this change in the first place if, as Don Blanchon and its Board have been saying all along, WWC has remained true to its core mission and its commitment to GLBT services?
Why remove "established by and for the gay and lesbian community," except to de-emphasize the WWC's role in providing these services?
It appears to me, that the new mission was formed only recently to accommodate the dramatic changes brought to light by Catania's recent investigations. Chief among them has been the accusation that the Clinic's mission has been changed in practice while still projecting to its stakeholders and the gay community, its largest donor-base, that it has still been serving GLBT people just the same as it has in decades past. Although Blanchon and the Board vehemently refuted this claim over the past few months, their recent action only confirms in principle what many have observed in practice since Blanchon's arrival.
GLBT Programming Cuts
Having limped along financially for the past several years, in which annual revenue has decreased by 44%, the Clinic has now been crippled and has morphed into something entirely different from what its founders had envisioned. Blanchon and the Board have argued that shifting to a primary-care model that focuses just on the delivery of medical care, from its original comprehensive health services model, which offered a spectrum of both social and medical services, was necessary to keep the Clinic's doors open.
However, Catania showed that the options of providing social and medical services are not mutually exclusive in devising a financially viable business model for the Clinic; as six other current major GLBT health centers throughout the country have provided comprehensive social and medical services, all the while experiencing boosts in revenue. During this same time period, WWC has suffered a financial free-fall in its move towards a primary care, HMO-type model, which also counters Blanchon's claim that its financial downturn is due largely to the economy. If that's the case, why have these other clinics not suffered in a similar fashion?
As a result of this deliberate restructuring, the WWC has been steadily stripped of its gay identity right before our community's eyes. On the watch of the current CEO and medical director there has been an utter neglect of the Gay Men's Health and Wellness Clinic, which has been left to wither and die on the vine while other GLBT services, like the Lesbian Services Program, comprised of more than 18 support groups, a buddy program for chronically ill and homebound women, and a lesbian health clinic, have all been uprooted and disposed of entirely.
The Bridgeback Program, the popular Man 2 Man Prevention Program, Volunteer Services, and the Food Pantry have all been dropped, along with Women Over Fifty and Women in their Twenties, both of which have moved to a new home at The DC Center. Moreover, its recent relinquishment of sponsorship of the DC Capital Pride Festival, a role the Clinic assumed as sole presenter in 2003 after a six-year partnership with One-in-Ten; its decision to end its relationship with the AIDS Marathon Program; and a precipitous decline in the donations it has recouped from DC's annual AIDS Walk, are all further indication of its steady detachment from the GLBT community. Most recently on the chopping block was the Crisis Intervention Line, which was disconnected last month.
In 2008, Blanchon eliminated the Prevention and Education Team and curbed the mobile testing vans, which remained idle until just months ago. These decisions were made at the same time the Clinic was experiencing a 232% increase in new incidence of HIV infection, an alarming trend that continues to expand, resulting in the worst rates we've seen in decades. But what I find most troubling about these decisions is that the Clinic's stakeholders, the GLBT community, and in some cases, even the Board, were not made aware of Blanchon's intentions to dispose of any of the above-listed programs until after they were already discontinued, stifling any possible objection to their removal.
In a recent interview with The Washington Blade, an executive committee member of the Clinic's Board, said that when the need for another round of cutbacks became apparent in early December 2008, a special effort was made to preserve programs "most critical to the Clinic's core mission." He must have been speaking about the Clinic's new mission, as I struggle to understand how these actions stay true to the Clinic's original charge of being "established by and for the gay and lesbian community."
Longtime Volunteers Alienated
And as GLBT programs continued to be eliminated, one respected past volunteer of the Whitman-Walker Addiction Services (WWAS) Program, Dr. David Schwartz, was struggling to prevent the hiring of a prospective counselor who expressed the belief that "gay sex is a sin." Despite his fervent efforts, the WWAS Program Director that had initially asked him to help with the interview process, dismissed his concerns and subsequently hired the individual as an addictions counselor, citing that at least one other current employee presumably held the same belief about gay sex. Dr. Schwartz's startling testimony follows.
Sadly, Dr. Schwartz's experience of being a dedicated WWC volunteer, only to be callously ignored and discarded upon expressing grave concerns about the Clinic's policies and procedures is nothing new, suggesting that a pervasive dysfunction in personnel management has troubled the Clinic for quite some time.
When I first arrived at the Clinic in 2006, despite occasional setbacks, the vibrant volunteer program was still thriving under Gray Border, then Director of the GMHWC. However, since that time the 'esprit de corps' of the volunteers in the GMHWC and related programs has undergone a noticeable decline, causing volunteers to leave in droves. As one employee of the Clinic put it, in his 20+ years working there, he had never seen the morale so low. Suddenly, its volunteers, the life-blood of WWC, were being treated as though they didn't matter and were expendable. Their suggestions on how to improve the Clinic fell on deaf ears and their concerns were continually ignored. This is not to say that there are not countless employees and volunteers who have persevered and continue make all the difference in the Clinic's ongoing successes. And they should be commended.
However, the compelling testimony of both Mary Murray, past WWC Volunteer Program Manager, and Dr. Terry Gerace, past GMHWC volunteer doctor, speaks volumes of the prevailing 'WWC culture' in recent times. As Murray indicates, there are far fewer volunteers at WWC now than Blanchon previously lead the DC City Council to believe, partly because he has continued to get rid of the many GLBT-focused programs. According to Murray, the true number is now closer to 150, rather than the 800 that Blanchon claimed during his testimony at the January 28th roundtable. There was a time when the Clinic boasted 800+ volunteers, but that was several years ago; most have since left out of frustration or have been forced out.
For more than three decades, members of the DC GLBT community have volunteered their time and opened their hearts and their checkbooks on behalf of the Clinic, with the understanding that their efforts and their donations were going right back to their community, at times when it seemed their government and society had abandoned them. However, private sector giving has fallen more than 57% since Blanchon assumed WWC's helm in 2006. I would contend that members of the GLBT community, perhaps historically the largest source of private sector donations, have finally wisened up to the fact that WWC is no longer sufficiently addressing their health needs and would rather give their GLBT-charity dollar to someone else. The Clinic's own 2008 data has revealed a demographic reversal in its client base since Blachon's arrival, showing that only 33% of its clients now self-identify as GLBT, the rest being heterosexual.
When Gay Men Became the Minority
Considering the GMHWC (then the Gay Men's VD Clinic) is the very entity from which the present-day Whitman-Walker Clinic owes its existence, I find it difficult to believe that the current Board and administration feel it is no longer part of its core mission. However, recent changes under the current CEO and medical director would suggest just that.
In January, the GMHWC was unceremoniously renamed, the "STD Clinic." You shouldn't be surprised if you weren't aware of this change, as the current administration didn't even bother to notify the many gay men (screeners, HIV testers and counselors, and doctors) that currently make up far more than half of the evening Clinic's volunteers. Although Blanchon and other gay Board members profess that the Clinic is still committed to the GMHWC, the following testimony submitted by a past dedicated volunteer doctor, Terry Gerace, suggests that is not the case.
In Dr. Gerace's own words:
One only has to walk into the Gay Men's Health and Wellness Clinic, to find the waiting room populated with women (and until very recently, young children) sitting side by side with gay and transgendered clients waiting for confidential HIV and STD testing. What used to be a safe and anonymous space for gay men to seek medical treatment, no longer exists.
What's more, beyond this shift in focus, the GMHWC has suffered serious shortcomings in its ability to deliver quality medical care, which Dr. Gerace enumerates in his testimony.
Unfortunately, as was the case with Dr. Schwartz, Dr. Gerace's volunteer service was also terminated after he raised concerns about Clinic practices.
Many of the Board's medical missteps mentioned by Dr. Gerace may have been avoided, if not at least been better informed, if Board Members were more versed in GLBT-health related issues; which brings me to another matter that the Clinic needs to address. Of the 22 WWC Board Members (now 21, after Jim Sandman's recent departure as Board Chair on April 24th), only one is a physician - meaning that the overwhelming majority of the Board may not have sufficient understanding of medical issues, particularly those facing the GLBT community.
Not only would it be helpful to have more gay physicians on the Board of Directors of an organization that is supposed to be a GLBT-focused medical facility, especially one that has decided to move towards focusing on a medical delivery model, but also, members of the Board should make regular visits to observe how the Clinic is functioning. In my nearly three years volunteering at the Clinic, I (like Dr. Gerace) never saw a Board Member at the GMHWC, which is still running every Tuesday and Thursday evening, as it has been for years.
The Christmas Massacre
Compounding the accusations that the Clinic has moved away from its GLBT focus and grossly mishandled its finances, damning evidence was presented by Catania (a series of emails between employees, Blanchon and senior HR personnel) and testimony was given by the Clinic's current Director of Annual Giving, Robert Benish, showing that the Clinic violated federal law by withholding employees' 403b pension contributions for an unauthorized time period without investing them.
Catania then suggested that the Clinic likely implemented this practice to pay its outstanding financial obligations instead of rightfully placing those amounts into employee pensions, where they could reap the benefit of the market's recent rebound - an opportunity now lost to Clinic employees. Catania said it was not his intention to pursue this matter beyond ensuring that it would be rectified moving forward.
For a detailed account of this matter, see the following testimony by Benish.
Ironically, the issue regarding the laying-off of several long-standing Clinic employees (the "Christmas Massacre") this past December, which Blanchon and the Board have claimed to be the sole motivation for Catania's investigations, was addressed far more aggressively and persistently at the roundtable by Council Member Jim Graham (one of the most instrumental figures in founding the WWC; as well as a past Board Member and President). Council Member Graham found it inconceivable that Blanchon could have fired individuals such as Dr. Patricia Hawkins and Barbara Chinn, both senior staff members at the Clinic for more than 20 years, just days before Christmas without severance. The Board was not even informed of this specific decision until January 2009. Graham, clearly angered, asked of Blanchon, "Whatever possessed you to take this action?" He also questioned how not providing appropriate notice and severance benefits to such long-standing, devoted employees could be justified considering the disastrous state of the Clinic's financial system, incapable of accounting for the many wasteful financial decisions brought to light during the roundtable. Mistreatment of such valuable individuals is a testament to the Clinic's recent level of managerial dysfunction.
But perhaps the most egregious action the Clinic has unintentionally committed in my mind, as a gay man living in the middle of the District's modern HIV epidemic, has been its creation of a vacuum in the area of GLBT sexual health and HIV/AIDS prevention, in which other organizations and available funds have not moved in to address these public health issues, because our community was left to believe that WWC had those bases covered. Thus, for all the good WWC has done over the years promoting the health of and advocating for GLBT people, in recent time, it has propped itself up as the prevailing voice of the this community's health needs while simultaneously moving away from its provision of GLBT-specific services. And though its efforts to remain at the forefront of combating HIV in our community have helped so many, not being transparent about its recent mission change until pressed by Council Member Catania has set us back in our fight against the many epidemics now plaguing our community. As such, we must now work extra hard to recover lost ground in our battle against HIV/AIDS.
Finally, I would be remiss if I didn't mention the role Arnold & Porter LLC (A&P) played in this whole conundrum. In response to Catania's pointed allegations, the WWC Board retained A&P in February 2009 to conduct an audit and independent investigation of the accusations. The firm found overwhelmingly in favor of the Clinic, refuting most of Catania's claims. However, Catania expressed that the firm's "so called" independent investigation of the Clinic was a "total white wash," as its flawed sampling methods and conflicts of interest ran so deep that the credibility of its rushed report, which appeared to be more an advocation of Blanchon than an audit, may have been severely compromised. The Board stood by the veracity of the report's conclusions; however, Catania listed the following evidence supporting his concerns:
Jim Sandman, Chair of the Board when A&P was selected, previously had a 30 year career with the firm, 10 years of which he was a managing partner.
A&P had a previous history of doing pro bono work for WWC.
2 of the 3 report authors had performed this previous pro bono work for WWC.
These same authors were alleged friends and colleagues of Sandman.
A current WWC Board Member is the wife of a current member of the firm.
Although the Board voted to hire A&P to perform the audit on February 3rd, there is a report that the authors had discussed the matter with Board members prior to the January 28th roundtable.
A&P interviewed 27 individuals, of which 8 were Board Members and 12 were currently employed senior WWC staff, indicating that 74% those interviewed had a current vested interest in the Clinic.
Only 2 of the interviewed individuals were even slightly critical of the Clinic.
Although many in the gay community may disagree with this post, my comments are not meant to divide us; rather, their purpose is to address some of the grave concerns I have with how recent actions by those currently leading the Clinic will affect the future health of the District's GLBT community - all of which Council Member Catania addressed at the recent roundtable. Having volunteered there for quite some time and spoken with so many people affiliated with the Clinic - Board members, clients, volunteers, and health providers - I can say with informed confidence, that something needs to change and that David Catania's decision to probe into the Clinic's management is appropriate and timely. Moreover, if I am misinformed on some of the points I've raised, it still stands that the perception of the DC GLBT community is that the Clinic is no longer sufficiently addressing its healthcare needs, a charge that Council Member Graham reminded us, is specifically mentioned in Article 3 of the WWC Articles of Incorporation.
We Must Save the Clinic from Itself
I have held my tongue for too long on this subject for fear that my comments would only present barriers to future organizational collaboration. I also feel that many others who could shed light on this matter feel it would only distract us from important public health work that needs to be done, for these same barriers have historically plagued progress in the fight against HIV/AIDS. However, only by contributing to this discussion and addressing the dysfunction that has lead the WWC to its current state can we ever bring about the substantive change needed to tackle this modern epidemic in our community. This begins by acknowledging mistakes that have been made and then moving beyond them.
Regardless of where one's opinions fall, we must realize that in the end, all parties involved want the Clinic to succeed, especially at a time when HIV/AIDS is hitting our community so hard. We need to get through this most trying time in the life of the Clinic.
Before leaving the roundtable, Councilmember Graham asked Blanchon, "Do you acknowledge that you have made some serious mistakes?" He responded, saying, "Yes, in hindsight I would have done things differently." Graham then said, "so there is an opportunity to make amends...as many of these issues can be made right even today."
In truth, we've all made mistakes. In bailing out the Clinic in 2005, Catania perhaps could have put in place greater oversight in how those funds were spent; and the GLBT community could have pressed the Board to be more aggressive in preserving the programs most vital to our health. That said, the heavy-handedness, dishonesty, and utter disregard for WWC personnel demonstrated by Blanchon and the Clinic's management team are inexcusable. Moreover, the Board's abdication of so much of its responsibilities to the CEO and disengagement from the issues most critical to the Clinic's viability are equally indefensible.
However, many of these mistakes were acknowledged at the roundtable, and I am confident that the DC Council, the new Board Director, June Crenshaw (bless her for stepping into this role at such a tumultuous time), and Blanchon, whatever his ultimate fate with the Clinic may be, can now begin to rebuild WWC together. If the Board moves forward with Blanchon, his sincere dedication to the Clinic and his acknowledgement of past mistakes that he is willing to rectify will go a long way to set the Clinic back on the right course. However, if the Board decides to go forward with a new CEO, I am confident they will make the right choice. Regardless, the foundation for future progress and cooperation has been been laid, and it's now time for the Clinic to relax its defensive posture, take heed of the concerns raised at the recent roundtables, and return its reputation to its rightful place.
Otherwise, as Catania said, the Clinic will continue to "disappear before [our] eyes," just at the time our community needs it most. And this simply cannot happen; as the GLBT community desperately needs this Clinic now and for generations to come.