Language Lockout

The working lives of people like Irania Sanchez, born in Nicaragua, represent New York’s dirtiest secret. For six years Sanchez, 34, labored for low pay in a vital industry in Brooklyn: She made coffins. She worked in a small shop, alongside a half-dozen other employees, all of them, like herself, undocumented workers trying to get by. Her wages were minimal—no more than $5 an hour—for long shifts and no overtime. But it wasn’t the pay or the hours that bothered her most. It was the problem of how to cope when her children, both of them born in this country and American citizens, needed costly medicine.

Here Sanchez came up against the twin obstacles that haunt most of the city’s estimated 500,000 undocumented workers: She spoke no English and had no health insurance.

The advice from her employer, Sanchez said, was simple: She should go to the government and get assistance. “He said, ‘They’ll help you,’ ” Sanchez recalled last week. So, when her baby, Gabriela, developed chronic, severe asthma, Sanchez took her to a city emergency room at Woodhull Hospital, in Bushwick, where sympathetic doctors treated Gabriela’s symptoms. But they also told Sanchez she would have to invest in several different medications, as well as an expensive pump that would help Gabriela breathe by cleaning out her lungs every few hours. To get the money to pay for this, hospital staff told her, she should apply for Medicaid.

At the building where Medicaid applications are taken in Brooklyn, Sanchez spent several hours waiting to be seen. When a social worker finally took her case, he rejected her application for what is called Emergency Medicaid, Sanchez said. She spoke no English and the social worker spoke no Spanish, so communication was limited, but Sanchez left feeling insulted and dejected.

She told this story as she stood in a drizzling rain outside the city’s central Medicaid office on West 34th Street with some two dozen other members of Make the Road by Walking, the Brooklyn-based organization that eventually helped Sanchez win an appeals hearing for her Medicaid claim.

The group was there to draw attention to their efforts to win passage of a bill pending in the City Council that would compel the city’s Human Resources Administration to provide interpretation and translation at offices serving large numbers of non-English-speaking people. The bill has already gathered endorsements from 44 of the council’s 51 members and only awaits the support of Council Speaker Gifford Miller and Mayor Bloomberg to become law. Miller’s support is expected. Bloomberg’s position is still unclear, but city officials say they are already providing adequate translation for those in need.

Dealing with the language barrier at government bureaucracies was a key issue raised by immigrant families back in 1997 when Make the Road began organizing in Bushwick, one of the city’s poorest neighborhoods. Andrew Friedman, a Brooklyn-born co-founder of the group, said most initial members had plans or ambitions to learn English, but those dreams were often thwarted or delayed by the difficulty in gaining access to language classes.

According to the New York Immigration Coalition, available English language classes in the city meet just 5 percent of the need. “In the national debate, we spend a lot of time being mad at immigrants for not speaking English, expecting them, as if by magic, to be able to go out and learn a new language while raising a family and holding down a job,” said coalition director Margie McHugh. Assisting those who want to learn, she said, “is the most important thing our government could and should be doing as part of a proactive strategy.”

Make the Road offers English classes for its own members, but the group also decided to conduct a survey of city welfare centers where families reported problems. Visiting nine welfare offices, the group interviewed more than 700 applicants, three-quarters of whom said they couldn’t cope with the bureaucracy because there was no one to interpret for them. Friedman, who is a lawyer, helped file a complaint under federal civil rights laws demanding that the city be ordered to comply with laws requiring interpreters. The Office of Civil Rights of the Department of Health and Human Services, which oversees Medicaid and welfare payments, looked into the allegations. In October 1999, the office issued a letter stating that people with limited English proficiency “were denied interpreter assistance during visits to public assistance offices” and that this lack of adequate translations imposed “significant barriers” on those seeking public assistance.

At the time, however, “Giuliani was mayor, and he just ignored it,” said Friedman. The group continued to agitate for change, and this summer it conducted a new survey that found that 60 percent of Spanish-speaking applicants had not been told by caseworkers of their right to an interpreter.

The new bill, Intro 38A, was introduced by councilmembers John Liu of Flushing and Gale Brewer of Manhattan. “The ESL [English as a second language] classes are all packed to the gills,” said Brewer. “There’s a waiting list to get in. People’s children shouldn’t have to suffer while they’re waiting.” The estimated price tag of the bill is about $5 million, but Friedman predicts that the cost will be returned to taxpayers once federally assisted Medicaid picks up a major portion of the cost of emergency care for children like Sanchez’s.

The language barrier is only the most obvious indicator of America’s great, unresolved debate about its immigration problems, in which the flow of illegal aliens is often depicted as creating a burden on public services. The flip side of the argument is that people like Sanchez and the others on the picket line with her on West 34th Street are doing most of the tough, low-wage jobs in this city and elsewhere around the country. They are the people laying bricks in almost every new building outside of Manhattan, the people cleaning tables in most of the restaurants in midtown, as well as those lovingly tending to the babies of middle-class families where both parents must work.

Several unions recently teamed up to fund an in-depth study of a few square blocks in midtown to find out how much economic activity was being carried out on the backs of undocumented labor. Dubbed the “Black Market Survey,” the results are still being sifted, but according to one participant, it revealed “an entire underground economy,” with otherwise upstanding, legal enterprises conducting business in cash and relying on a network of low-wage undocumented workers for basic tasks.

These are the workers, argue the unions, who labor in constant fear of being exposed for their status and, as a result, are most easily manipulated and intimidated by employers and least likely to be able to complain about illegally low wages and unsafe working conditions.

Make the Road by Walking is already making plans to take part in a huge nationwide effort being organized by the AFL-CIO to highlight the dilemma of undocumented workers. Starting later this month, a giant bus caravan of immigrant workers is set to depart from nine major cities across the U.S., converging on October 4 in Flushing Meadows-Corona Park in Queens, a borough where the latest census figures report more than 46 percent of the residents are foreign-born. Called the Immigrant Workers Freedom Rides, modeled on the great civil rights trips through a then segregated South in the early 1960s, the demonstration is aimed at creating a groundswell of support for new national laws to create a path to legalization for workers like Sanchez.

The end goal for the unions is to create a level playing field at workplaces and enlist new members, while hopefully providing Sanchez and others the on-the-job benefits their hard work deserves, thus keeping them out of Medicaid offices altogether. “This city is beginning to look like the New York of the early 20th century,” said Ed Ott of the Central Labor Council, which is organizing the October rally. “For labor, to be in this movement to legalize these workers just makes sense.”


Hospital Holiday

In 1997, as government officials prepared to impose vast changes in the way health care services are provided to the poor, New York hospitals won $1.25 Billion in federal funding to cushion the impact.

The money was allocated by the Clinton administration, which was persuaded to do so by two of its then staunchest allies, health workers leader Dennis Rivera and hospital association chief Kenneth Raske. The idea behind the funding—dubbed the Community Health Care Conversion Demonstration Project—was that the money was needed to help health institutions cope with the potentially wrenching switch from the traditional fee-for-service method of providing care to Medicaid recipients to that of managed care, whereby health care providers would be paid a set amount per month. The managed-care change was viewed with suspicion and apprehension by both hospitals and their unions, which feared the cost-saving system would cause drastic reductions in income and result in closings and layoffs.

Rivera, head of 1199/SEIU, which then had 120,000 members and now has more than twice that number, and Raske, president of the Greater New York Hospital Association, used their combined clout to win the federal help. The aid package was crafted with the assistance of then vice president Al Gore, who was preparing his presidential bid.

So overt were the project’s politics that part of the deal was struck in November 1996, when Rivera brought Governor Pataki over to talk to Gore at the Al Smith dinner in the Waldorf Astoria—the Catholic Church’s annual political event. The timing was as crucial as the politics: A few months later, Pataki won a waiver from federal regulators that allowed the state to move up to 2.4 million New Yorkers receiving Medicaid into managed-care programs. One month after that, the $1 billion-plus project was awarded to the state.

The theory was that the funds for the project, which were to be phased in over several years, would be generated by huge savings in New York’s $24 billion Medicaid budget, half of which comes from the federal government. Hospitals, in turn, would use the extra money to retrain staff and expand facilities needed to provide basic care.

Health advocates at the time feared that the money would do little more than shore up the hospitals financially, rather than improve or expand health services for the poor—the project’s declared intention. They also suspected that, left unchecked, much of it would go to large and powerful voluntary hospitals that provide relatively little access to the 24 percent of New Yorkers who lack any medical insurance coverage.

Now, six years after the project was initiated, a study by a New York City advocacy group asserts that those concerns were well founded. Funds have been doled out with minimal oversight by state officials charged with administration, the study says. In some cases, money has gone for uses never anticipated in the original proposal, states the report issued this month by the Commission on the Public’s Health System, a nonprofit organization that monitors health services. The commission, which sued the state to win access to the records, found that only two of 44 private, voluntary hospitals in New York City that received funding bothered to file a required final report on how initial grant monies were expended.

In one instance, Brookdale Hospital, one of Brooklyn’s largest institutions, used $7 million of the $9 million it received to make its computers compliant with the 2000 millennial change. In another, Beth Israel Medical Center in Manhattan used funds to create a primary-care clinic catering to Japanese-speaking residents of Hartsdale, an affluent Westchester County community.

“This was a demonstration project that was supposed to have been about improving health care for low-income people,” said Judy Wessler, co-author of the report and the group’s director. “Instead the money has been flowing to hospitals with little or no accountability.”

The misspending is only the most recent exposé of the hospital establishment by Wessler, who, for more than 30 years, has been a keen-eyed watchdog of health services for the poor. She worked first for MFY Legal Services on the Lower East Side, where she helped to establish low-cost primary-care clinics, and later for the Community Service Society and the Children’s Defense Fund. She also served as health policy analyst for former Manhattan borough president Ruth Messinger.

As the managed-care conversion project evolved, Wessler, along with colleagues Dr. Diana Williams and Sandra Opdycke, joined a task force including the union, District Council 37, AFSCME, which represents workers in the city-owned public hospitals that care for the bulk of the city’s low-income and uninsured residents. The group tried to shape the way the federal funds would be allocated, asking regulators to direct money to local community-based health providers, clinics that are key to providing primary care to low-income New Yorkers. They also pushed the feds to press hospitals receiving funding to spend at least some of the money on an expansion of primary-care services, and to guarantee access to health services for all residents.

There were some partial successes. Hospitals were ordered to include primary-care services, and to account for their handling of patients without insurance coverage. The group also was able to persuade regulators to change the initial funding formula so that institutions, such as New York’s public hospitals, would receive funding proportionate to their efforts to care for uninsured and low-income New Yorkers.

An early analysis by advocates, however, found “serious flaws in reported data” by some hospitals, according to the report, which were reported to state officials. The findings forced the state to re-address its allocation formula for the project. The group may have been too effective, however. Shortly after the advocates successfully challenged the data’s accuracy, the state stopped providing them with information.

In February 2002, Wessler submitted a Freedom of Information request to the state Department of Health seeking final reports submitted by the hospitals for the project’s first cycle of funding, along with site visit reports by state inspectors. The group also requested proposals submitted for the project’s second and third funding cycles. Health department officials initially provided only partial records, and then in July, they ceased cooperating altogether.

Wessler then contacted Ray Brescia, an attorney at the Urban Justice Center, a nonprofit legal-advocacy group. Last December Brescia filed suit in New York Supreme Court. About three weeks later, the state finally began handing over the records.

“Clearly, they weren’t going to give [Wessler] the information she was seeking,” said Brescia. “They didn’t claim any privilege under the law not to release the information, they just didn’t produce the reports.”

A spokesman for Raske’s hospital association said that all funds had been expended appropriately. As in its dealings with the advocates, the state health department didn’t bother to respond to Voice requests for comment. But an agency spokeswoman suggested to The New York Sun‘s Julie Satow that the agency’s laid-back approach was intentional. “The program was specifically created to provide hospitals with flexibility, and our oversight reflects this flexibility,” said the spokeswoman.

So casual was the agency’s monitoring, the commission’s study found, that seven hospitals received grant monies for the project’s second and third cycles of funding without even completing full applications to the agency or accounting for how they had spent the previous cycle.

In some cases, even the state’s own inspectors couldn’t figure out how the money was being spent. In a June 2001 field report on Staten Island University Hospital, a state monitor wrote: “There was an issue with the report that 90 percent of the funding had been expended by the hospital, while considerably less than 90 percent of the activity represented in the workplan had been accomplished.” Without further explanation, the monitor added: “This has been straightened out.”

Said Wessler: “We are supposed to have been provided with all the records, but we can’t figure out what went on there.”


Pataki’s Sick Department of Health

George Pataki and Carl McCall have pivoted the gubernatorial race around school issues, but the biggest business in Albany is health, with hospital, adult- and nursing-home, and related interests spending $18 million on lobbyists last year—$11 million more than education groups and twice as much as any other state stakeholders. In keeping with that state-recorded level of gaudy influence peddling, the Department of Health (DOH), which consumes $34 billion of the state’s $90 billion budget, has been a political cancer throughout the Pataki years, literally sick with scandal.

Even after a recent New York Times exposé of the department’s abusive mismanagement of the adult- and nursing-home programs, Pataki is dodging accountability, with much of the media failing to focus on a record of gubernatorial malpractice that has cost lives and tainted the delivery of vital services.

This story is a diary of disrepute, recounting the sometimes familiar and sometimes unreported scandals, culminating with the sordid new saga of the state’s worst-rated HMO and Child Health Plus provider, a window into just how medical care is compromised in New York. The chronology of CarePlus’s rise—from bare-bones startup to one of the top-paid contractors in the governor’s best-advertised health program—involves a cast of characters from Pataki’s personal counsel to a convicted lobbyist to several major fundraisers and donors.

Let’s start at the top. Dr. Barbara DeBuono, the health commissioner for Pataki’s first term, was the sister-in-law of his personal attorney Richard Farren, a close friend of Pataki’s since their days at Dewey-Ballantine more than 30 years ago who’s handled all his real estate and tax matters for decades. Her selection was such a fait accompli that Dr. David Skinner, the president of New York Hospital and a member of the governor’s health transition committee after Pataki’s election in 1994, recalls that the group “didn’t recommend a commissioner,” adding: “Pataki had his own idea—Dr. DeBuono—and he just did it.”

Skinner should know, because he hired her when she left the administration in 1998, giving her a $300,000-a-year job with the newly merged Columbia Presbyterian and New York hospitals just months after her department approved the deal. DeBuono lost her lofty hospital post when she was caught shoplifting $8.86 worth of hot dog rolls, bagels, goat cheese, and dip at an upstate supermarket. She currently works for Pfizer, the pharmaceutical giant whose interests at DOH are promoted by the same high-powered lobbyists who represent the tawdry adult-home industry.

Executive Deputy Commissioner Dennis Whalen, the department’s No. 2, who actually served as interim commissioner for most of a year, was caught taking a Mont Blanc roller ball pen, four Brooks Brothers shirts, Yankees tickets, a tie, and three years of repeated dinners and lunches from two mysterious lobbyists who raised a half-million dollars for the governor’s 1994 campaign. Even when Whalen—who returned gifts including jewelry and clothing to the lobbyists—was found by the State Ethics Commission to have violated the Public Officer’s law, the new commissioner, Dr. Antonia Novello, kept him on the job. She fined him one week’s salary—$2652—and later gave him a $4825 raise (though a notation on state records indicates the raise was held up, and DOH officials declined to answer Voice written information requests about this or any other matter).

It didn’t seem to matter that the commission found that Whalen had met with the lobbyists, Rabbis Joseph Goldberger and Joseph Menczer—known in the corridors of Albany power as “the two Josephs”—23 times in three years, a record for access in a department known for its closed doors. Nor did it matter that the Brooklyn-based rabbis, owners of a dress shop and kosher supermarket, had included DeBuono’s brother-in-law Farren as a partner in one of their less successful health care ventures while she was still commissioner. Whalen survived even though one client of the two Josephs, nursing-home operator Lawrence Friedman, went to jail in the largest Medicaid fraud in state history, having so prospered at DOH that his annual state payments soared from $4 million to $47 million.

Joseph Chiseri, another deputy commissioner, was forced to quit after belatedly informing officials that Friedman had offered him a $20,000 bribe. Chiseri, who was one of the earliest Pataki contributors and was described in the Times as a “key contact” for the governor’s office within the 6000-employee department, rubber-stamped Friedman’s applications even when they sought approvals outside the scope of his job.

As Attorney General Eliot Spitzer zeroed in on Friedman, the department circled the wagons, ordering all executive staff to report any law enforcement contacts. Department spokesmen threw up their hands at Times questions, making no effort to explain how Friedman, who paid the Josephs a half-million dollars, had managed to become the first nursing-home operator ever to avert a final state audit after earlier independent ones uncovered serious irregularities. DOH officials did finger one of the governor’s top aides, Jeff Wiesenfeld, for introducing them to the two Josephs, both of whom were named to Pataki’s post-election transition team and honored by him, one with a silver clock at a Williamsburg dinner.


The investigation of another nursing home represented by the Josephs—whose applications for additional funding whisked through DOH—led to the demotion, and eventual retirement, of the department’s director of health facility planning, Charles Murphy Jr. The Ethics Commission found that Murphy asked a second lobbyist representing the home if they were hiring employees in the Albany area, suggesting his wife for a job. Murphy then got clearance from his DOH superiors for his wife to take the job by erroneously assuring them she would have nothing to do with the kind of applications he reviewed. The commission’s notice to Murphy found that the firm “actually hired your wife specifically to do the work” he supervised, and that he wound up handling five matters in which she was directly involved. Murphy’s wife, who is still working for the lobbying firm, told the Voice her husband was “cleared” in an administrative hearing and was collecting back pay from the department.

Laura Leeds, who ran the department’s Office of Continuing Care—which oversaw nursing and adult homes—left to become vice president for continuing care at the Health Association of New York State, one of the state’s top 10 spenders on special-interest lobbying last year ($633,707). The State Ethics Commission fined her $2500 in February, finding that she actively lobbied her former DOH colleagues on two occasions in 2000, even urging them to waive hospital reporting requirements. Concluding that this was an apparent violation of a ban on such contacts for two years after leaving state employment, the commission also cited e-mails she sent her former colleagues.

During Leeds’s tenure, the department drastically slashed its inspection staff and cut nursing-home fines, from 24 cases to two. “The goal of the process,” she told the Albany Times Union in 1998, “is to get people the care they need—not to punish people.” Saluted by industry association leaders for understanding that “you attract more flies with honey than vinegar,” Pataki’s DOH was blasted in a 2000 Daily News series that concluded it was “unable to keep up with patient abuse complaints or monitor the industry properly.” Despite profits that hit $1.3 billion, the homes were so understaffed that the U.S. Health Care Financing Administration criticized the state for overlooking serious—sometimes even life-threatening—problems.

Two audits by Comptroller McCall, one released this July and one in 1998, “uncovered thousands of cases where nursing home complaints were not handled properly,” with an incredible 1000 abuse or neglect complaints assigned to investigators who no longer worked at DOH and another 1200 assigned to uncertified investigators. Though complaints rose from 3000 in 1998 to 8000 in 2001, DOH failed for four years to file a legislatively mandated report on how it was handling them, allowing the backlog of unresolved cases to quadruple.

This official indifference was no accident, with Pataki announcing just three months into his administration, in 1995, a 16-point plan to “reduce onerous regulations,” and DeBuono proudly announcing that DOH would not longer “micromanage the daily affairs of hospitals, nursing homes, and other health care providers.” The same laissez-faire approach, even for a state-supported industry, also infected DOH’s oversight of adult homes, which provide housing without nursing care to 28,000 elderly and mentally ill residents.

It was Pataki who shifted adult homes from the Department of Social Services to DOH after industry fat cats donated over $87,000 to his campaign before and immediately after his 1994 election (they’ve given at least another $202,426 since). And it was the Pataki team that steered hundreds of the mentally ill into isolated and locked wards at nursing homes in apparent violation of state regulations, as the Times reported on its front page last weekend. The health department launched this punishing experiment in partnership with a nursing-home owner also represented by the two Josephs, Benjamin Landa, who gave at least $22,000 to the governor’s campaign and got over 200 subsidized beds in his four homes for these specialized units.

Just as Laura Leeds’s role overseeing adult homes was coming to an end, the department hired Susan Peerless, the longtime executive director of the industry association, as a special assistant to the commissioner on policies for the homes. The state lobbying commission is currently probing Peerless’s relationship with Coppola, Ryan & McHugh, the lobbying firm that represented Peerless’s group, the Empire State Association of Adult Homes, and once shared an office with it. She and the firm allegedly conspired to make a false submission to the commission understating Coppola’s fee, with some of the excess being paid to Peerless personally. Though documents supporting these allegations—which the Coppola firm vigorously disputes—have been revealed in an ongoing lawsuit, DOH has taken no action against Peerless.


Peerless has hardly been the only state official supervising adult homes who has incestuous ties to the industry. Marti McHugh, who left the governor’s personal staff to become the DOH assistant commissioner for intergovernmental affairs, is married to a partner in the lobbying firm. Right after Pataki took office, Robert Balachandran joined the administration as an assistant counsel in the governor’s office, advising him on adult-home policy, fresh from the firm whose largest client was the industry association.

The consequence of this intertwining, virtually conceded by an administration promising a clean-up plan before election day, has been a wholesale failure of enforcement, to the point of ignoring a legal requirement that a report be filed for every death that occurs in one of the homes (only three of 1000 were properly recorded). With the Empire State Association boasting on its Web site that it had convinced Pataki officials to adopt “a more reasonable” survey process and make “positive, sweeping changes” in “inspection protocols,” inspectors in the NYC office were cut from 25 to three.

“Witness after witness at our hearings,” the chairs of four assembly committees concluded in a June report on adult homes, “described situations where the state stopped enforcement actions, reduced fines, let bad operators off the hook, and under-funded enforcement offices.” Mental Health Committee Chair Marty Luster charged that “the result has been the untimely deaths of the most vulnerable of our residents.”

In addition to these DOH scandals of life-threatening magnitude, the department has also been bit by smaller stuff—including the bribery indictment of the state official leasing a new headquarters for the agency and the recent hiring, despite a hiring freeze, of the son of indicted state senator Guy Velella as a nursing-home auditor. The disturbing tale that follows is a prototype of DOH contracting that demonstrates how agency policies are influenced by politics to the detriment of patients.

In the weeks between Pataki’s 1994 election and inaugural, the new governor made it clear that he planned to move immediately to force Medicaid recipients into managed-care programs, a controversial experiment for which he sought a waiver from the Clinton administration just three months into his term. A band of good friends from his campaign was poised to profit from this potentially lucrative policy shift, executing an operating agreement for a Medicaid managed-care company called CarePlus by May 1995.

Incorporated that October, the untested company’s certification was fast-tracked through DOH by April 1996, qualifying it to cover Medicaid enrollees. Barbara DeBuono listed it that month as one of the firms ready to take Medicaid patients, saying it had met the state’s “fiscal test,” even though court records would later reveal it was unable to produce a financial statement two years later.

Protracted delays in winning Clinton approval of the switch—because of questions in Washington about its impact on the quality of care—forced CarePlus to find business elsewhere, applying in February 1997 for a contract under DOH’s brand-new and highly touted Child Plus Health program. It took until November 6, 1998—three days after Pataki was re-elected—before DOH finally sent the comptroller the first of a series of Child Health Plus and Family Health Plus contracts for the wired company, eventually totaling $218.6 million.

It also took years before CarePlus got rolling as a Medicaid insurer, but it now covers 70,000 enrollees. The tens of millions DOH has paid it for Medicaid—after it was designated by the department as a provider in five counties—comes on top of the $85,661,767 it’s so far received under its multi-year Child Plus contract (its Family Health Plus contract is just beginning).

CarePlus has prospered at DOH, though it came in dead last in the department’s fiscal review when it got that first major contract—for $13 million—and despite dismal ratings in surveys published by the department itself. In 1999 and 2000 (the latest years for which results are available), CarePlus was the lowest-rated of the 30 Medicaid managed-care plans in a DOH consumer survey, scoring “significantly worse than the statewide average” on eight of 10 questions put to members. It was in a league almost by itself, with the second-lowest plan getting six bad scores. Asked in one question if they would “recommend the plan to family or friends,” members said no about CarePlus more often than about all but one other plan in New York.

The department’s internal assessment has been kinder to the company than consumers have, finding in a January 2002 newsletter that there had been no deficiencies the previous year. However, its latest public report, issued in 2001 for 2000, found that CarePlus had the highest rate of primary care and OB/GYN turnover of any Medicaid plan in the state, more than twice the statewide average, and warned that such a rate “may disrupt continuity of care.” While the company did get passing grades on the department’s assessment in several other categories, it scored well below average on prenatal care, childhood immunization, and adult “access to health care services.”


Despite this record, the company’s state business is booming. Starting with one of the smaller Child Plus contracts, it now has the 13th largest of the 30 awarded, competing with major, established HMOs. After the Family Plus contract was awarded last year, its four-county coverage expanded to include Manhattan, while the company’s Medicaid enrollment has leapfrogged from a couple thousand. Its principals and their businesses, as well as its lawyers and other associates, have contributed $511,647 to the Pataki campaign and the state GOP committee over the years, giving $119,484 in 1994, when early donors were placing their IOUs.

The leading CarePlus players at the start were John Moore, a young fundraiser with a desk in the finance office of the 1994 campaign headquarters, and Bart Lawson, the longtime executive director of the Greater New York Health Care Facilities Association and a major bundler of adult- and nursing-home contributions to Pataki. Moore, who was described in business stories as the CarePlus founder, was initially listed on the company’s capital call as a $30,000 investor with a 13 percent stake, though that designation was quickly changed to show the name of Kathleen Moore, who sources say is related to John. John Moore and Lawson were soon made members of the company’s five-member Board of Managers, with Lawson becoming CEO and president even while he continued to run his nursing-home association.

According to half a dozen sources who know Moore, he was sharing an office at 110 East 42nd after the election with the governor’s then and current top campaign consultant, Kieran Mahoney, when he helped create CarePlus in 1995 and 1996. Richard Farren, Pataki’s lawyer and DeBuono’s brother-in-law who represented CarePlus during this period, told the Voice: “Moore was at Kieran’s offices for a couple of years. They got together shortly after Pataki was elected governor. I don’t know if they were partners or whether they were just sharing space. Moore was a self-promoter in the campaign, trying to show he had all these connections.” Moore is listed as a paid fundraiser in the 1994 filings, contributing ($3000) more than he was paid ($1157).

Another campaign operative from 1994, ex-Pataki aide Jeff Wiesenfeld, whose wife is a CarePlus bookkeeper, said Moore was “a very significant fundraiser for the governor who reported directly to Patrick Donohue,” the deputy director of the finance unit. Wiesenfeld recalled that Donohue and Moore “had an apartment together on Park Avenue near 38th Street, close to the campaign headquarters,” a recollection other Pataki activists shared. Moore’s principal entry into the Pataki inner circle, however, was Mahoney, not Donohue, the sources recall.

Mahoney was also the chief campaign consultant for Westchester D.A. Jeanine Pirro, and Pirro’s husband, supercharged lawyer/ lobbyist Al, was given a significant slice of CarePlus from the start. A close friend of the Pataki family and a Westchester GOP ally for years, Jeanine Pirro was named to the governor’s transition committee, as were Farren and Lawson. Though the capital call lists Pirro and his law partner Phil Halpern as having invested just $10,000 apiece in the company, each got 8 percent of its shares. The top investor listed on the call, Breindy Melnicke, who is a major nursing-home operator with her husband, Michael, and is close to Lawson, contributed $960,000 and got a mere 7.5 percent stake.

Since other shareholders performing direct services for the company got discounted stock, it’s reasonable to presume Pirro, a registered state lobbyist who did not list CarePlus as a lobbying client at the time, was also given a break in exchange for professional help. Pirro’s filings with the state during the early Pataki years, when CarePlus got its initial DOH approvals, listed Kieran Mahoney as a lobbyist with Pirro’s firm.

By the time Pirro first registered as a lobbyist for CarePlus in 1999, he had reportedly sold his stock in the HMO and was already under federal indictment in a widely publicized tax fraud case. Mahoney was no longer listed as a Pirro associate, and Pirro’s new partner was Jeff Buley, the counsel to the State Republican Party who currently represents the Pataki campaign committee. While Pirro served his 17-month prison and halfway house sentence, his firm became Buley Public Affairs, continuing to represent CarePlus and Lawson’s nursing-home association. Pirro’s interest in the firm—which earned the highest per-client fee of any lobbyist in Albany—was placed in a trust while he was in prison, with his wife as trustee. Since his release early this year, he’s rejoined Buley, and is once again a consultant to CarePlus, which has paid the firm $183,288 since 1999 (part of an extraordinary $391,334 it spent on lobbyists in that period).


Another principal of CarePlus was Joseph Zappala, the Florida and New York businessman who’s been its board chairman since the beginning and is said to be friendly with Charles Gargano, the Pataki economic development czar. Zappala and a business associate of his from Boca Raton, Jerome Ansel, also a major CarePlus investor, have contributed a remarkable $225,214 to Pataki and the state party since 1994. Zappala invested $11,000 in the initial capital call and got 6 percent of the stock, an amount raised to 9 percent after Ansel kicked in $3 million (and got only a 7 percent stake). CarePlus is using a Florida firm Zappala is also tied to as its pharmaceutical benefits manager.

Sued last year by the Securities & Exchange Commission for failing to comply with subpoenas for testimony and documents “relating to his investment activities,” Zappala is a major Republican donor who was the national finance co-chair for George Bush Sr.’s inaugural in 1989. Zappala became the focus of a Washington furor when Bush named him ambassador to Spain though he spoke no Spanish, apparently qualifying by contributing $127,000 to the GOP. Pataki campaign operatives recall his periodic appearances at the headquarters in 1994, where he was still addressed as Ambassador Zappala.

The CarePlus centerpiece, however, was Lawson, whose personal, PAC, and association contributions to Pataki, totaling $180,096, are dwarfed by the hundreds of thousands he’s helped raise from nursing- and adult-home interests. It was Lawson who befriended Farren, meeting him at the campaign headquarters, by Farren’s account, taking him on golf outings sponsored by the Friends of Pataki, and retaining him as an attorney for CarePlus and other business. Acknowledging that he “worked for CarePlus for a few years on other matters,” Farren insisted he was “out” of his CarePlus representation by the time it won its first Child Plus contract.

Incredibly, the last of a half-dozen DOH officials to approve the contract was an attorney from legal affairs, and he signed off on July 28, the same day Farren’s sister-in-law DeBuono announced she was resigning. She did not leave until November, simultaneous with the DOH memo that sent the contract to the comptroller for confirmation and payment.

Lawson was also the one who agreed to hire Wiesenfeld’s wife as a part-time bookkeeper at $35,000 a year, allowing her to work at home for CarePlus and two other Lawson entities. “I knew Bart from the campaign, and when my wife was ill, I called him up and asked if he had any need for an offsite clerical employee,” Wiesenfeld said. Wiesenfeld, who has since left the executive chamber, where he was special assistant to the governor, insists he never interceded with DOH on Lawson’s behalf, precisely what he was accused of doing on behalf of the infamous two Josephs.

Lawson has become a pivotal player in Pataki’s Albany not just because of his legendary fundraising prowess, but because of his ironically close ties to the governor’s No. 1 union backer, Dennis Rivera. Indicted in the early ’80s for paying to have a trailer used by Rivera’s striking union blown up—and then submitting the $5000 payment for Medicaid reimbursement—Lawson was acquitted at trial. He subsequently sued the union for conspiring with prosecutors to have him indicted. But now the two are quite friendly, having negotiated labor agreements for years.

The combined power of these associations has no doubt helped CarePlus prosper at DOH. Going back to the original bid process in 1997 and 1998, the department had to reopen the door to let CarePlus in, having rejected them when the 24 contracts were first awarded. The company got the worst fiscal rating from the evaluation team of any of the 32 bidders, failing to fully disclose their board, expense and revenue projections, target population, budget, subcontractor reimbursement plan, and other key matters. It was given points for complying with a financial statement requirement though it simultaneously contended it couldn’t provide one in a suit filed by two executives who’d left the company dismayed.

A DOH memo, dated four months after the contract period had started, explained that CarePlus alone was being added to the bid winners this late because “additional service capacity is needed in the areas they proposed to serve.” One other contractor was selected past the deadline—but that had occurred at least a month earlier—and, ironically, it turned out to get the second lowest ratings in subsequent consumer surveys. But the worst provider, with the consistently lowest scores, snuck in as the final bidder—more a matter of juice than justice.

The emergence of CarePlus from the sinkhole of DOH is merely a slice of life in the Pataki reign—an era that will be remembered as a sad moment in the ethical history of the state.


Research assistance by Sandy Amos, Yi Chen, Jen DiMascio, Rebecca Eisenberg, Ross Goldberg, Matteen Mokalla, Will St. John, Clementine Wallace, and Emily Weinstein


Emergency Landing

Seventeen-year-old Katie* and her grandmother Maria got their very first glimpse of the Big Apple last month. But what brought them here from Boston wasn’t a Sox-Yankees game or The Lion King or even more-than-ever patriotism.

Katie needed an abortion. Fast.

She wasn’t the only one. Latisha, 30, arrived on the same day from Philadelphia and rode the subway to the same clinic where Katie and Maria sat in the waiting room. “There were all these people getting off the train. I’d never had so many people bumping up against me in my life,” Latisha says of her first rush hour in midtown. “Then this lady comes out of nowhere, grabbing my arm and screaming, ‘You don’t have to do this! I’ll be your baby’s godmother,’ and I’m like, ‘Miss, can you get off my arm?’ ”

Katie and Latisha are among the thousands of out-of-towners annually who find their way here for an abortion. Already a beacon for reproductive rights, New York this month will become the first city to require abortion training for OB residents in public hospitals, thanks to a mandate from Mayor Michael Bloomberg. It’s also one of the few places free of parental consent laws and mandatory waiting periods. With competition among dozens of providers keeping costs down, getting an appointment in NYC is often faster and cheaper than getting one closer to home.

The phenomenon of women traveling to far-away clinics actually has a name: “abortion tourism.” But usually the flow is from countries where abortion is illegal, or close to it. Best known are the estimated 7000 Irish women who journey to England every year for the procedure.

Yet with 86 percent of all U.S. counties lacking even a single provider, American women have more in common with their Irish sisters than we’d like to think. For many in the Northeast who need a second-trimester abortion, New York City is the only choice. In nearby Philadelphia, Boston, Rochester, and Buffalo, clinics that offer the procedure are scarce and getting scarcer, with full schedules and high fees, and almost none will end a pregnancy past 20 weeks.

Drawn by the promise of reasonable access, women with no other option keep coming to New York. In 2000, according to the city’s Department of Health, nearly 1700 traveled here for a second-trimester termination—more than six per working day. It’s a procedure that often requires two or three days, because the cervix is first dilated with sterile sticks of seaweed, called laminaria, which expand over the course of many hours, and varying stages of pain and discomfort. That means patients need a place to lay their head, whether or not they’re able to pay for one. Those poor and determined enough come prepared to crash on a subway train, a park bench, or the backseat of a car, like Lisa, a college student from Maine who recently drove down with two close friends and three sleeping bags.

Luckily, she didn’t have to camp on the streets. Instead, she found the Haven Coalition, a grassroots group of about 20 women who are willing to house abortion patients for free. Last month, Haven celebrated its first anniversary of offering couches and meals to virtual strangers. In the past year, volunteers have hosted 39 patients, most under age 21, some from as far away as Newfoundland, many whose trip to New York was their first one ever.

Among them was Katie, the Massachusetts teen, who was nearly 20 weeks along before her grandmother, a warm woman with a funky purple dye job, suspected something and coaxed her to the doctor for a regular checkup. The procedure would have been doable in Boston but was delayed by the parental-consent requirement. Even though Maria is Katie’s legal guardian and was more than willing to give consent, the clinic demanded an official state ID, which Katie—a city kid with no need for a driver’s license—did not have. Getting one took exactly two weeks, pushing the pregnancy past the clinic’s limit.

After several phone calls to providers all over New England, someone finally told Maria she’d have to make the trip to New York. “Talk to a woman named Catherine,” Maria remembers the voice on the phone saying. “She’ll help find you a place to stay.”

The late Flo Kennedy once quipped that if men could get pregnant, abortion would be a sacrament. In that alt universe, Catherine M., the founder of Haven, might very well be the patron saint of abortion access. Her name, which has been concealed here to protect her safety, is almost legend among providers and activists. Malika A. Lévy of the Greater Philadelphia Women’s Medical Fund says that if a client is past 21 weeks, “we know we’re sending her to New York. It’s really a pleasure and relief to be able to say, ‘Don’t worry, we’ve got a group of women there who can house you and help you get around.’ ”

As the hot line director at the National Abortion Federation in the late ’90s, Catherine could raise $1000 for a needy woman within a day. “I still can,” boasts the 25-year-old, and sometimes she does, even though that’s not really her job anymore.

Working the phones in Washington, Catherine heard every story imaginable. She took calls from women who were bleeding regularly and fitting into their size-six jeans but were in fact 22-weeks pregnant; teens who’d been too paralyzed by fear and shame to tell their parents; women who had been to “crisis pregnancy centers”—funded by “Choose Life” license-plate sales and anti-choice groups—and lied to about how far along they were; women who wrongly believed they had a 50 percent chance of dying from an abortion; aunts and grandmothers of girls who had been sexually assaulted. Sometimes Catherine would even get a call from a woman who had just been told at her mid-pregnancy sonogram that the fetus was anencephalic—a defect in which part or all of the brain is missing—and that her OB either didn’t know how or didn’t want to perform an abortion for her. “There are so many reasons why women need second-trimester abortions,” says Catherine.

For Latisha, finding out she was 21-weeks pregnant was a total shock. She had just started school again after 12 years of working two jobs to support her two sons, now 10 and 12, and was on Depo-Provera, an injected contraceptive. But within days of her first class she landed in the emergency room with a chest infection, where a doctor came bouncing in with the news. “I was like, ‘What? That’s impossible. I’m not showing. I’ve got no symptoms. And I’ve been getting my period every month.’ ” She stared straight at the doctor and held up her arm. “You must have mixed up the charts. Here, look at my wristband.”

But Latisha was indeed pregnant, and not once did anyone at the hospital mention the word abortion. She was worried the contraceptive could lead to a serious birth defect. “The doctor told me that I could come back for amnio at six or seven months and they could tell me if there was something wrong with the baby,” she says. “Right. But by then, what could I do about it? I wasn’t going to take that chance.” The minute she got home she opened the yellow pages and began calling every clinic listed. “I’d call and they’d say, ‘We don’t go over 20.’ ‘We don’t go over 18.’ ‘We don’t go over 16.’ ” Finally, on the fourth call, a woman directed her to call the Choice hot line, which in turn directed her to NYC. “I told the clinic I could maybe pay for one night at a hotel, but not two. Then I talked to Catherine, and she told me she had some people I could stay with. The best part about everything was Catherine,” says Latisha.

Even with help from Haven, Latisha ended up dipping into her savings account to get through the ordeal. Close to 90 percent of U.S. abortions happen in the first trimester, at a fee of approximately $350. But a second-trimester procedure costs four times as much, and the women who are more than 12 weeks along are often those of least means. Nearly one out of three are between 15 and 19 years old, and many are on Medicaid, which in most states doesn’t cover an abortion.

“Sometimes they don’t know they’re pregnant for a couple months, and then they’re dicking around with Medicaid,” Catherine explains one evening over a cup of coffee. Then they’re hit with fees of $1500 to $2000, not including travel expenses and missed work. “As they’re trying to raise funds, the pregnancy is getting further and further along, the price is going up and up, and the likelihood of finding a provider is dwindling,” she says, talking faster and faster, shifting her long hair from one shoulder to the other. “It’s like they’re chasing the fee.”

A recent study published by the Alan Guttmacher Institute confirms the effect of money on reproductive choices. In a survey of women whose Medicaid wouldn’t cover an abortion, up to a third of those asked said they continued the pregnancy against their wishes. Leslie Rottenberg, senior director of social services at Planned Parenthood, has seen this happen again and again. “A lot of these women give up,” she says. “It takes a lot of work to find the right person to call.”

Other women, like Katie, are pushed into their second trimester by parental-consent laws or mandatory waiting periods. Thirty-two states now require parental consent or notification, and 26 mandate state-directed counseling and/or a waiting period of up to 24 hours. In Mississippi, second-trimester abortions increased 17 percent after the state implemented a one-day waiting period.

State-ordered delays are not just patronizing. As Catherine points out, 24 hours of waiting can turn into a week, and “a week can mean $800,” not to mention a more physically taxing procedure. At the hot line, Catherine noticed that she was sending a lot of the most desperate women to New York, where a second-trimester abortion can run relatively low at around $1000. But when they asked her, “Where am I going to stay?” she didn’t have an answer.

After more than a year at the hot line, Catherine left for a counseling job at a clinic on Manhattan’s West Side. One day she got a call from a colleague across town who had a patient desperate to get an abortion but in need of a place to stay; could she possibly sleep on Catherine’s couch? She could. “After that, I was hooked,” says Catherine. She began asking other counselors and friends if they would take people in, and hooked up with two women from the Brooklyn Pro-Choice Network who’d been hosting for years. In June 2001, she made Haven official by gingerly recruiting volunteers and offering her services to three of the city’s largest clinics. She has since registered with the National Network of Abortion Funds.

Without really intending to, Catherine re-created a network that existed pre-Roe v. Wade, when abortion was legal in New York State and almost nowhere else. Back then, some 350,000 women with unwanted pregnancies flocked to the city. “There was a whole East Coast ‘underground railroad,’ ” writes Robin Morgan, a noted feminist and former Ms. editor, in an e-mail interview. Volunteers made referrals, raised money, and baby-sat for people who couldn’t get child care. The corps deliberately remained informal and unnamed, “a leftover from the days when we were already all doing the same thing illegally.”

Catherine believes her generation may be breaking down class and race barriers in a way the second-wavers did not, but she admits Haven needs diversifying. “Almost all of our volunteers are white, and almost all the patients are black or Hispanic,” she says.

Still, expanding the operation in general is a tricky endeavor. Up until now Catherine has only recruited by word of mouth, meeting with each prospective volunteer for a couple of hours to gauge their emotional maturity and commitment to abortion rights. Over dinner she scans for any hint of discomfort in their eyes, any wavering in their voices. She says one woman ended up confessing, “To tell you the truth, I hate the idea of abortion. But I’m trying to test my boundaries.”

Catherine also checks in with every patient after they’ve been hosted. “My greatest fear is that someone will sneak by,” she says. “It’s such a sensitive time for these women. There is enormous potential for damage.”

The other obstacle in recruiting is that when it comes down to it, very few women are willing to open their homes for such direct activism. “This is practical feminism rather than theoretical feminism,” says Catherine. “Maybe it takes a little bit of madness, a little insanity to say, ‘Let’s go back to my house and cook dinner together.’ We’re taught to set boundaries.”

Jennifer Baumgardner, co-author of the 2000 book Manifesta and a Haven member, says it’s real work to move beyond principles and politics. “What actually needs to be done is harder and more direct than saying, oh, let’s make sure Bush doesn’t appoint a right-wing Supreme Court justice,” she argues. “There are so many things that are more critical that have to do with access, and hosting is one of them. Paying for people’s abortions is another.”

That’s actually another cause that young New York women have taken up. Around the same time that Catherine founded Haven, a few Barnard and Columbia grads started the New York Abortion Access Fund, an independent source of financial assistance that mostly aids nonresidents who can’t get Medicaid. In just one year they’ve helped 50 women.

The numbers involved aren’t vast, but the effect on individuals is huge. Baumgardner herself has hosted three times. Once she took home an Orthodox Jewish woman from upstate who couldn’t eat off her dishes. “She got on a bus in the middle of the night. She told me very matter-of-factly that her boyfriend would kill her if he knew what she was doing,” she says. Another time it was a teenager who was all alone. Though Baumgardner says hosting engages her on a deeper level, she admits the intimacy can be grueling. “It’s not only awkward for me, it’s awkward for the person I’m hosting—I try to give them respect and privacy, but it’s pretty hard because I live in a studio, so they’re sleeping 10 feet away from me,” she says. “It’s ironic to me that a right that’s based on the right to privacy is now practiced in so many unprivate ways.”

Still, the women who’ve been hosted bubble over with gratitude. “I’d never been through an experience like that before,” says Latisha, “where people had treated me so nice, you know, strangers helping each other. Catherine’s little group made me feel so comfortable.” Maria was also moved: “I told Catherine, any time she knows someone who needs shelter in Boston to call me.”

In September, though, this little group will need a new leader. Catherine is moving back to her native Canada to begin the ultimate act of practical feminism: She is going to medical school so she can add her young face to the graying population of abortion providers. This decision feels as natural to her as the French she still speaks with her family. And perhaps it is also a way of making good on the help she received a decade ago, when she needed an abortion at the age of 14. “I came to this work feeling like my life had been saved by this procedure,” she says, “and I’ve made my life my thank you.”

* Names of patients and family have been changed to protect their privacy.


Women who need help from Haven should ask for a referral from the clinic of their choice. Women who’d like to volunteer should write to

If you are in New York City and need an abortion, call the Women’s Healthline at 230-1111 (in both the 212 and 718 area codes). You can also look in the yellow pages under “Abortion Providers.” (Ignore “Abortion Alternatives,” which lists anti-choice “Crisis Pregnancy Centers.”)

If you are a New York State resident without health insurance, Medicaid funding is available. The folks at Planned Parenthood will get you going on the spot; they provide services up to the 20th week of a pregnancy. Call them at 212-965-7000. After 20 weeks, call the Women’s Healthline at the number above.

If you live outside of New York and need help finding a provider and/or funding, call the National Abortion Federation hot line at 1-800-772-9100. This group helped 40,000 women last year.

To donate to the New York Abortion Access Fund, send checks to: NYAAF, FDR Station, Box 7569, New York, NY 10150-7569 or go to —J.B.


The Welfare-Reform Catastrophe


WASHINGTON, D.C. — The recession is turning so-called welfare reform into a catastrophe happening before our eyes. That’s the bottom line behind a myriad of technical reports and barely comprehensible bureaucratic phrases of a group of experts meeting here today. Pulled together by the Kellogg Foundation for a long-term assessment of the welfare system, they warned that millions of children and immigrants are being hurt by workfare rules. In addition, more and more poor people have no insurance. Just over 39 million Americans are without health insurance. Nine million of them are kids.

Unemployment rose to 8.2 million in November, up from 5.7 million a year ago. With 33 states reporting an increase in welfare caseloads. States are already cutting back social service programs. Florida, for example, is cutting Medicaid, long-term care, child protection, and home and community services for the elderly, reports the Center on Budget and Policy Priorities, a public interest group that tracks welfare. Medicaid and other health services are being cut in several states including Massachusetts, California, Kentucky, Illinois, Washington, Florida, Arizona, and Indiana.

Since workfare began in 1991, welfare caseloads have dropped from 14.4 million recipients to 5.8 million as of June 2000. About two thirds of those going off welfare are working. More than half of these people have incomes below the federal poverty line. Half of them have no health insurance. Only 43 percent who are thought to be eligible for food stamps get them. It’s harder for people with chronic diseases or mental handicaps to make it off welfare. Black and Latino welfare recipients have a more difficult time finding jobs than whites.

It gets worse. There is rank discrimination against immigrant children who, unlike their parents, are American citizens. “Thirty-three percent of citizen children with immigrant parents lack health insurance, compared with 19 percent of children with citizen parents,” according to one report issued at the conference which summarized the foundation’s Devolution Initiative.

The recession means 1.1 million more children are in jobless families, according to Deborah Weinstein, of the Children’s Defense Fund. By passing the Personal Responsibility and Work Opportunity Act (PRWORA) in August 1996, Congress did away with the cash assistance entitlement of Aid to Familes with Dependent Children welfare system and replaced it with a time-limited, work oriented system of block grants to the states called Temporary Assistance to Needy Families (TANF).

While the economic boom sucked some welfare recipients into the low-paying job stream, the TANF block grants remained nominally unchanged, but because of inflation actually declined by some 13.5 percent, according to the Childrfen’s Defense Fund.

The welfare cuts fall directly on 5.3 million families headed by single moms. There are 800,000 families run by men, according to the Institute for Women’s Policy Research.


High-Priced Consulting for a Low-Service HMO

Most of Bill Thompson’s “financial consulting” clients are not revealed on his Board of Ed disclosure forms. The most disturbing one that Thompson did list, however, was Managed Healthcare Systems Inc., where he earned a total of $65,000 in 1997 and 1998, according to his tax returns. A black-owned HMO whose principals worked at the highest levels of the Reagan administration, the company is shrouded in scandal.

Last year, New York Attorney General Eliot Spitzer forced the MHS, which specializes in recruiting Medicaid recipients for its HMO, to repay the state $2 million for Medicaid services that patients never received. Spitzer also put Jean Moise Millien, the director of an MHS clinic, in jail for up to three years after he pled guilty to stealing $275,000 from Medicaid. Spitzer’s press release revealed that MHS knew for years that Millien’s clinic, Stuyvesant Heights Medical Group, was largely run by “unsupervised physician’s assistants and nurse practitioners” and that patients “were consistently complaining that they were having difficulty getting services.”

Yet, said Spitzer, the company “failed to take corrective action or properly oversee its subcontractor.” MHS portrayed itself as “a victim” of the clinic when they settled with Spitzer.

The State Health Department also revoked Millien’s physician’s assistant license in November 2000, finding that he’d run the clinic since 1991—four years before the MHS contract began—without on-site supervision by a licensed M.D. The Department also found that the clinic corporation had been dissolved by state officials for tax delinquency reasons in 1994 and that Millien had a prior criminal record. Spitzer said a doctor from Pennsylvania came to the clinic once a week “to sign charts” for a while, but “eventually stopped coming altogether.”

An MHS affiliate left a similar trail of complaints in Pennsylvania—where it became the subject of Philadelphia Inquirer exposés in 1996 and 1997, before and during Thompson’s employment. According to one study, it was three times as likely to refuse to pay for days of hospital care as the state’s next most stingy HMO. The “focus of six special state and federal audits” and a onetime target of a Pennsylvania grand jury, according to the Inquirer, the company took a reported $119 million in profits and executive bonuses from its Pennsylvania Medicaid work alone in the early ’90s, making it the “most profitable HMO” in the state.

Anthony Welters, the principal owner of AmeriChoice, the Virginia-based parent of MHS, was a top Reagan transportation official, gave $20,000 to Pennsylvania GOP governor Tom Ridge, and has given over $56,000 in recent years to Republican candidates and committees across the country. Clarence Thomas is the godfather of one of his children. Thelma Duggin, another top executive, worked in the Reagan White House and at the Republican National Committee under Lee Atwater, the engineer of the Willie Horton campaign.

Thompson said he’d known Welters and Duggin since 1992, when they started trying to do business in Brooklyn, and that he “bumped into Tony” in 1997 and Welters offered him a consulting job that started that June. Charged with “reaching out and helping them obtain business,” Thompson said he “spoke to community organizations.” Though he says he “never visited an MHS clinic”—including the Stuyvesant Heights one near his home—he insists that MHS is “a good company.” While Thompson’s tax returns indicate that AmeriChoice paid him $35,000 in 1998, his disclosure forms report no income from the company.

Thompson is quick to point out that he wasn’t the only prominent Brooklyn Democrat to wind up on the MHS payroll. Assemblyman Al Vann was hired, as was DeCosta Headley, a Democratic district leader, Ed Miller, a campaign aide of Congressman Ed Towns, and Chris Owens, the son of Congressman Major Owens. “I don’t think Al and Chris are getting involved in anything that’s not 100 percent benefit to the community,” said Thompson, apparently oblivious to the higher standard demanded of a candidate for so powerful a citywide post as comptroller.

Related article:

The Banker Who Broke the Law
by Wayne Barrett with special reporting by Gregory Bensinger
Should the Board of Ed’s Bill Thompson Advance to the Next Grade?


Platform to Nowhere

Unlike the Republican platform, the Democratic platform firmly supports a woman’s right to choose abortion. After that, the Dems offer just a trifle more than the GOP. Instead of an explicit commitment to universal health care, the platform promises “affordable” opportunities for insuring children, widening the scope of Medicare coverage to include prescription drugs, and opening up Medicaid to help people kicked off welfare. Elsewhere, hewing to the Democratic Leadership Council’s fetish for technical detail, the platform proceeds in tiny increments.

Major points:

  • Pro free trade.

    Pro new tax incentives to assist individuals in setting up private IRA-type retirement funds to supplement Social Security, a move that would be a bonanza for Wall Street but have no real effect on the working poor–who have been losing income during the Clinton boom.

  • Weak gun proposals.

    Instead of uniform gun registration, the platform calls for kid locks on new handguns and background checks, but says nothing about existing guns. And nothing about assault weapons, whose import from China was okayed by Clinton and Gore.

  • After all the gush about children, supports “affordable” education.
    No commitment to true public education as the nation has known it throughout its history. Despite all the gush about children, the platform supports only “affordable” education.

  • Nothing specific on the environment.
    Scarcely believable given Gore’s green spin.

  • No straightforward public financing of elections.
    Mired in deep controversy over his own fundraising activities, Gore still refuses to back straightforward public financing of elections, opting instead for gobbledygook like a “public-private, nonpartisan Democracy Endowment, which will raise money from Americans and finance congressional elections, with no other contributions allowed to candidates who accept the funding.”

  • Categories

    Pinching Pennies

    What does a mayor do when he has to pinch pennies? He goes after New Yorkers who have pennies.

    Gone is the brash dreamer who once drew gasps with a proposed West Side sports complex estimated to cost billions (although two minor league baseball stadiums adding up to $175 million are full steam ahead). Faced with criticisms of his management of the Wall Street-generated $3.2 billion surplus, the now more reserved mayor has indefinitely postponed the personal income tax cut promised during his Senate campaign and put a hiring freeze on most city agencies. No longer aiming to leave the city in a blaze of higher-office glory this year, he’ll be damned if Democratic mayoral wannabes will get to say Rudy Giuliani left the city in a fiscal bind.

    City Hall machinations mean little to Ada Bloom, a 73-year-old widow from Woodside, Queens. She spends most of her days in a small one-bedroom apartment, despairing of the mice that have started invading and the paint that is flaking off the walls. And she worries about losing her independence should she fall ill.

    But an ongoing struggle with the city’s Human Resources Administration, which has ordered her to reimburse it $144,000 for the Medicaid dollars spent housing her husband— now deceased—in a nursing home, elicits one political opinion: “I thought Giuliani was a good man, I really did. But now I think he is bad.”

    Her husband, a navy veteran and former postal worker, developed Parkinson’s disease several years ago and required nursing home care. The monthly fee of approximately $7000 would have quickly dried up Bloom’s modest savings. So when her attorney, Bernard Krooks, advised her to sign a declaration refusing to pay for the care of her husband and therefore qualifying him for Medicaid, she did. Elder law attorneys say this maneuver is perfectly legal and a last resort among seniors who fall into an awkward income bracket—too low to pay typical nursing home charges of $120,000 per year for a sick spouse, but too high to qualify for Medicaid, which mandates a maximum of about $80,000 in savings and $2000 in monthly income.

    Bloom knew she was taking a risk. The city could come after her, Krooks said, and bring her savings down to the Medicaid-mandated level. The same week her husband of 49 years passed away, she received the letter from HRA.

    “I couldn’t sleep for days,” Bloom says. The ongoing dispute with the city, she says, “is hanging over me like a nightmare.”

    Attorneys say hundreds of seniors across the city share Bloom’s troubles, and HRA has stepped up its collection efforts in the past year. But with the city contributing—and, therefore, technically recouping—only 25 cents for every Medicaid dollar spent, senior advocates are confused by the city’s zealousness in pursuing cases where it could look the other way. HRA did not respond to a call for comment but several weeks ago told a Channel 4 reporter that the agency “takes all steps to negotiate a reasonable settlement and is sensitive to any hardship issues resulting from these payments.”

    Presuming the city gives back the state and federal share of the Medicaid reimbursements, the motive may extend beyond saving what, relative to the city’s overall costs, amounts to mere pennies. To this administration, it could be just the principle of the thing.

    A federal court decision last month found that the city “systematically prevents otherwise eligible individuals from obtaining” public assistance. In doing so, the city has more than halved its welfare expenditure since 1994, reducing it from $894 million to an estimated $405 million this fiscal year. But a recent report by the Urban Justice Center found over half of all food stamp applications were rejected in 1999. Food stamps don’t cost the city a dime. They are fully reimbursed by the federal government.

    Critics say HRA’s stinginess is not surprising given the philosophy of Commissioner Jason Turner, which he encapsulated in a December 1998 statement suggesting that some battered women may be fakers trying to gain special consideration for public benefits.

    But New Yorkers were treated to a taste of the Giuliani administration that could have been this June, when the mayor announced an ambitious program to enroll nearly 1 million uninsured New Yorkers in public health care programs. The idea, he said, was inspired by his own struggle with prostate cancer. But State Comptroller H. Carl McCall’s office says funding has not yet been specified for the initiative, dubbed Health Stat. And Patrick Markee of Coalition for the Homeless says, “I’ll believe it when I see it.” Health Stat head Deputy Mayor Anthony Coles’s office referred inquiries to the mayor’s press office, which did not respond.

    Although she is still negotiating with the city, Bloom does not hesitate to spread word of HRA’s practice to fellow seniors and the media. But her fearlessness ends when she considers the possibility of losing her savings. “I don’t want to be on Medicaid. I don’t want to depend on anybody,” she frets. She sounds like just the kind of New Yorker Rudy might like.


    Presidential Prescriptions

    Democrat and our wooden-yet-slightly-wacky centrist Democrat? The substantive conflict, most pundits will tell you, has to do with health care, though exactly what is not immediately clear. Since Bradley unveiled his health proposal in September, the two have been trading technical yet not terribly enlightening jabs over how they propose to fix the world’s most expensive health care system, which happens to leave slightly less than one-fifth of the country and some one-fourth of New Yorkers without health insurance. Consider the baffling statement Bradley made at the Apollo last week:

    “We’ve talked a lot about my health care proposal in this campaign. In these terms—it’s a disability. The disability under medicaid, it saves the same amount of money, it’s the same services, it’s the same benefits. The only difference is that now if you have HIV, you can qualify for insurance. And if you are in a neighborhood, you get a health—you get a community health benefit. That’s the only difference.”

    Herewith the Voice hopes to make the difference between the two Democrats’ health care plans a wee bit clearer. For starters, the Bradley plan is decidedly more elaborate than Gore’s. Bradley’s massive revamp would mandate coverage for kids and give poor people tax breaks and subsidies to help pay for private insurance. Perhaps the most controversial element puts many people who are now on medicaid—the government health care program for the poor and disabled Bradley was trying to talk about at the Apollo—into the private insurance plans that currently cover government employees. The idea of doing away with medicaid has brought outraged squawks from some advocates for the poor, but Bradley promises he’ll replace the safety-net program with “something better.” By his own estimates, which have been criticized as unrealistically low, the sweeping changes would cost $65 billion a year.

    Gore has a somewhat sleepier proposal—or nonproposal, according to Bradley supporters—that would increase coverage by expanding government programs, such as Medicare and the Children’s Health Insurance Program. His biggest promise is to get all children access to affordable insurance by 2005, a not terribly ambitious goal, according to most policy types.

    Bradley claims he’ll extend health coverage to 95 percent of the population within his first few years in office, while the vice president’s program would “easily get to 90 percent of the population within eight years or so,” says Irwin Redlener, Gore’s national health adviser. But Kenneth Thorpe, a health economist who has analyzed both plans, figures that both proposals would have strikingly similar results, with Gore’s plan resulting in about 88 percent coverage as opposed to 89 percent for Bradley’s plan.

    So the real question is not how much insurance coverage the Democratic contenders would provide (not enough, in both cases) but how they’ll do it and whether their strategies will put us on the road to universal coverage. While Bradley may have the more dramatic plan, the Gore camp has earned prudent-choice points for being the opposite: slow and respectful of the political realities that brought down the Clinton plan in 1993.

    “Gore’s proposals help lay the next paving stones on the path towards universal coverage,” says Gore supporter and Manhattan assemblyman Richard N. Gottfried. Gottfried admits there’s still a lot of paving to do on the long stretch between upping the income limit for the Children’s Health Insurance Program and dropping the eligibility age for medicare from 65 to 55, as Gore promises to do. Nevertheless, argues Gottfried, who chairs the state assembly’s health committee, Bradley’s big alternative represents the wrong road entirely. “To get to meaningful universal coverage from Bradley’s plan,” says Gottfried, “we’d have to back up and start all over again.”

    The reason Bradley bugs Gottfried-style health reformers—the kind that still hope for a single-payer, Canadian-style system that would insure everyone—is that he proposes handing over some $258 billion to private HMOs. “These are the same companies that are causing the number of uninsured to rise in the first place,” says Mark Hannay, director of the Metro New York Health Care For All campaign. “Most advocates think that’s continuing to feed the beast.” Because that “beast” can eat up as much as 30 percent of the health dollar in overhead costs, as opposed to somewhere around 4 percent for medicare and other public programs, Bradley critics fear his proposed subsidies (or vouchers, as they like to call them) would buy profits instead of decent health benefits.

    Bradley supporters respond that those public programs that Gore would build on are already being farmed out to private companies. Indeed, HMOs are already serving—and sometimes, when they’re not profitable enough, backing out of serving—medicare recipients. And, in New York, most medicaid recipients already have to sign up with HMOs. That, says Bradley aide Margy Heldring, is just one of the problems with the lumbering program for the poor that’s become central in the Gore-Bradley battle. “Medicaid is second-class health care. It has excellent benefits on paper, but often there are few providers to provide them,” says Heldring, who notes that only one out of 17 dentists in New York State accepts medicaid.

    Many health advocates agree that there would be an upside to mixing the poor in with the rest of American patients. “It’s a very good idea to have everyone in the same system,” says Susan Dooha, director of health policy for Gay Men’s Health Crisis. But even so, Dooha worries that by getting rid of medicaid, which is strictly regulated and now covers around 100,000 New Yorkers with HIV, “we’d be trading in a known quantity for a pig in a poke.”

    Alas, we may not have a chance to learn much more about that pig. As the primaries wear on and Bradley’s chances fade, the specifics of his plan seem less and less the point. Just a handful of years after the Clintons’ reform effort tanked, coming up with a health care proposal at all may be Bradley’s contribution. “At least he put something on the table,” says Howard Berliner, a professor of health policy at the New School and policy consultant to 1199, the city’s largest health care workers union, which has endorsed Gore. Berliner thinks even the staggering expense and confounding details of Bradley’s plan could help wake people up to the issue. “He’s saying, ‘Hey folks, it’s worth it, it’s health care.’ ”


    Kids: Mandatory coverage. Would provide subsidies up to 300 percent of poverty level.

    Medicaid: (now for poor and some disabled): Would provide subsidies for people now on medicaid to buy private insurance. Medicaid still in place for long-term care.

    Medicare: (now for those over 65 and some disabled): Would provide optional prescription drug benefit.

    HMO reform: Supports right to sue HMO if harmed.


    Kids: Would raise cutoff for Children’s Health Insurance Program from 200 to 250 percent of poverty level.

    Medicaid: Believes incentives to enroll children in program should be greater.

    Medicare: Would allow people 55 and over to buy in. Offers prescription drug benefit capped at $1000.

    HMO reform: Supports the right to sue.


    No Relief

    One month ago, the Voice published a letter from Magie Dominic, a 54-year-old poet and theater veteran, whose life was knocked off its axis following a traumatic accident two years ago. In the letter, Dominic described how her subsequent need for public assistance had turned her life into an odyssey of lines, fruitless appointments, and bureaucratic rejections. Dominic is still trying to get some relief, as she explains in the letter below:

    Things happen to me. Things some people find unbelievable. So I’ve been documenting my life, in ink. Some of the ink is red. It comes from the heart.

    I’ve been writing about emergency assistance, Medicaid and food stamps, and laws written to make things impossible. About bureaucracy and long lines.

    A mixture of emotions overcomes a body waiting in these relief lines. Relief isn’t one of them. These lines can shatter a person’s self-
    confidence. Their will to live.

    In May 1999 a new welfare system went into effect in New York City.

    People had to return to main offices, fill out new forms, and wait for new cards.

    I was warned. “The lines are going to be very, very long. I’m warning you now, so you don’t write about it anymore.” Words I’d written had come out in the Voice and my caseworker had phoned.

    I was told to report to the first floor of a 14th Street building, for a form, then take it to a building 10 blocks away.

    The next day, in the morning, lines were long and chaotic.

    A well-dressed man screamed into a wall phone. He screamed with a rage bordering on tears. He’d been waiting three hours. He’d arrived early and waited outdoors. Had a job interview which now he’d missed and no one would talk to him here. A little girl clung to his knees.

    People tried not to stare, and looked at their documentation, their child if they had one, their cart if they were homeless. He continued to scream, but how could he cry? He was a grown man in a suit, in public, with a small child holding his knees.

    After an hour I was told there was no form. To go to the third floor and wait.

    In the elevator to the third floor, a man in his twenties or thirties paced frantically. People moved to the corners. He’d lost his job, he said. He’d lost his insurance. His teeth were aching and he was in pain. He’d applied for Medicaid three months ago but received nothing. He had no job, no insurance.

    When you lose your job, you lose your dignity.

    When you lose your job in New York, you lose your teeth.

    Forty-four million Americans have no health insurance of any kind.

    No one in the elevator headed for the third floor had health insurance.

    This man needed medical intervention. The phrase “human capital approach” is often used when intervention is needed. It equates a person’s value with the amount of money they’ll make in a lifetime. Women have less value than men. The homeless have zero value. The often unemployed have zero value.

    On the third floor, caseworkers and clerks were overwhelmed, understaffed, and at a breaking point.

    A homeless man, heavy jacket stained with soup or coffee, held a newspaper and laughed hysterically. He had a thick scarf tied around his waist. He was dressed for a storm.

    Several people sat in plastic chairs and rocked back and forth. Some of them wore headsets.

    A guard walked by dangling a nightstick. It wouldn’t have to be used. The implication was clear.

    A middle-aged woman in front of me kept wiping the area beneath her eyes. She was neatly dressed, alone, and crying. She kept turning around as if she were looking for someone.

    A woman I’d seen before was there again. A thin, homeless woman, probably in her seventies. She’d been in Brooklyn the day I was sent there weeks ago. She sat with perfect posture, in a worn suit and worn hat. An organized broken cart. Possibly an organized broken heart. She was an old, homeless woman who refused to surrender her dignity.

    People were confused and crowded the front desk. They yelled at clerks and clerks yelled back.

    The place was combustible. There was a commotion and people jumped on chairs to see. There was no gunshot, but the room filled with the feeling anyway.

    I saw a young man lying on the floor, silent, near a desk.

    A guard said he’d had a seizure. He’d been there the day before and also had had a seizure. He wasn’t taking his medication, the guard said. Another guard stood at a distance.

    I told the main guard that I’d had seizures in the past. That I could talk with the young man if he wanted me to. He looked at me without speaking. I said I’ll tell him how important it is to take his medication. I walked into an area where ordinarily I would have been forbidden. The man had a hand across his forehead. I knelt beside him and said, “I’ve had seizures in the past. It’s really important to take your medication.”

    He said, “They won’t give me my check. I don’t have money for my medication. They won’t give me my check and I’m not leaving this hospital until I get my medication.” Then he corrected himself, “I mean office.”

    If the man lying on the floor was ripping off the system, he had a bizarre way of celebrating the fact.

    After four hours, I was sent to the building 10 blocks away with the form and told to wait for a new card. Unlike the old cards, which contained images of tired, expressionless people, the new cards have only a name and a series of numbers. The new cards are faceless.

    After four months of waiting, I didn’t receive Medicaid. I did receive permission to buy $250 worth of food, for which I’m very grateful. I bought non-perishable food that will last for months.

    I may never receive food stamps again. I hope I never need them. The system may change again in August. Everything is unknown. I bought a few bags of apples for the homeless in my area. On the scale of things, these apples are worthless. The problems of the poor, the working poor, the homeless, are of such magnitude they require immediate assistance— from everyone.

    This week I walked to a library with computers for the public, signed a waiting list and, when my turn came, walked to the terminal.

    A man was seated in front of it, right hand covering his face. I touched his arm and he jumped. He’d been sleeping. He picked up a cloth bag, then awkwardly gathered bags hidden beneath the table. He was wearing two jackets and three shirts. He was wearing all of his clothes simultaneously because his body had become a hanger.

    He was a homeless, middle-aged man, sleeping for 30 minutes at terminal No. 1, and I was about to uproot him, so I could read about the hungry.

    He apologized without looking up. He apologized for being exhausted. For being in the chair. For having all these bags. He apologized for everything. His body was filled with shame.

    There’s a difference between guilt and shame. Guilt is: I made a mistake. Shame is: I am the mistake.

    Tonight I received a letter from a friend. She asked, “Where are the homeless? I don’t see them anymore.”

    The homeless are hiding between cracks in buildings, behind dumpsters in cardboard boxes. They’re 60-year-old men with paper cups filled with pennies. They’re 70-year-old women wearing worn-out felt hats. They’re men who’ve gone crazy. They’re in Orange County being arrested for drinking a Sprite. They’re standing on subway platforms pretending to have destinations.

    The homeless have no soap, no towels, no toothbrushes. They have no money, no food, no shampoo. They have shopping bags, memories, and newspapers.

    They have nowhere to wash, nowhere to sleep, nowhere to stand. They have nowhere to sit, they have to keep moving. They try to vanish.

    The homeless and hungry and sick are being ignored, abandoned, and stepped over.

    A system responsible for this needs to be torn apart before it explodes. Needs to be transformed, before it destroys everyone.

    The willful neglect of one part of society will have a domino effect.

    There’s an old saying: “In hell, the chopsticks are very long, so long people can’t reach their mouths and they starve to death. In heaven, the chopsticks are the exact same length, but in heaven the people feed one another.”