Howard Brown Health Center (HBHC) has, since its founding in 1976, been as rocky an institution as it has been significant to the community.
It has weathered a number of controversies and scandals over the past many years, including the 2005 arrest of Michael Andersen, senior development officer, for possession of crystal meth.
However, the most recent crisis, ostensibly due to financial mismanagement of funds of the Multicenter AIDS Cohort Study (MACS) grant, placed the organization at the brink of closure in 2010. Today, reports from Howard Brown's lead management strive to indicate that the organization is getting back on its feet.
Over the last several months, Windy City Times has been investigating the health of this important organization. In this first of a series of pieces, we consider the significance of recent staff changes, possible issues of organizational morale and questions about the shifts in the emphasis on research and services. They indicate, at the very least, an organization in flux and reveal that Howard Brown Health Center (HBHC) may be poised to be not just a different organization financially and structurally but in the nature of the resources it provides to the community.
Staff turnover and changes are not new at HBHC, which has seen several executive directors over the course of its 35 yearssometimes in quick succession. In early 2010 came the shocking announcement that Executive Director Michael Cook would resign and Chief Financial Officer Mark Joslyn would be let go, and it has been widely held that their departures had to do with the alleged financial mismanagement.
It was soon announced that Jamal Edwards, who had been general counsel to the HBHC board, would become the new executive director. The former attorney at Kirkland and Ellis had served on the boards of the AIDS Legal Council of Chicago and Vital Bridges, but otherwise had no previous experience with managing or working at a health agency. His salary of $265,000 is one of the highest in health agencies in Chicago and that has proven controversial in light of his inexperience running an agency the size of HBHC. [Edwards has responded at length to the questions about his salary in a previous interview with Windy City Times.]
Edwards came on staff with a declared mandate of instituting changes. Following widespread community sentiment and calls for change (including one from this paper), the entire board, except for two who came on after the MACS grant issue, will be made up of new members by next month. Edwards brought on new members of the executive team, including Chief Financial Officer Editha Paras and Chief Development Officer Chuck Benya. In an interview with Windy City Times at the time, he spoke of his confidence in both.
So it came as a surprise to many when it was announced that both were departing.
Paras was put on administrative leave and left soon thereafter, and Benya resigned.
Around the same time came news that Dr. Robert Garofalothen chief research officer at HBHC, medical director of adolescent HIV services at Children's Memorial Hospital and associate professor of pediatrics and preventive medicine at Northwestern University's Feinberg School of Medicinewas put on administrative leave.
When asked at the time and as previously reported by the Windy City Times, Edwards said, "There were some concerns raised by staff and patients that we are looking into and as soon as we are finished looking into those, we will take whatever action is appropriate." He also said it was a personnel matter.
According to Garofalo, Children's conducted an investigation into the issues offered as rationale behind his administrative leave and fully supported him. When asked to elaborate on the nature of the charges, Garofalo declined to comment but added "the full support of Children's Hospital speaks for itself."
When contacted about the investigation, Julie Pesch, spokesperson for Children's Memorial, said, "As far as personnel matters, the hospital really cannot comment on any of that." She said that the hospital was "pleased that Rob Garofalo has relocated his research and clinical activities to CMH." Asked to clarify if she was saying that the investigation had to do with personnel matters and that she could not comment on those, Pesch responded, "I really don't know if it did or not."
Garofalo has taken his research projects, including 12 researchers and a significant amount of research funding, to Children's Memorial. While Windy City Times does not yet have a conclusive number, it is safe to say that HBHC saw a number of personnel changes, not entirely uncommon for an organization in the midst of change. However, Edwards' response to the departures caused the spotlight to turn upon his managerial style and decisions.
Seeking out trouble?
Windy City Times was forwarded an email dated May 3, sent by Edwards to the closed Yahoo! group C3EO, whose membership consists of the directors of nonprofits in the Chicago area. In it, Edwards wrote, "It's come to my attention that a few of our former employeesand 'former' for very good reasonsmay have been seeking employment with some of your agencies. I think we all benefit from this list by sharing information of all kinds, and particularly about resources, including human resources. So I'd like to offer myself as a resource in that regard regarding any former employees of HBHC whom you might encounter. Many of you know that since I joined HBHC we've had to do a lot of clean up, coming out of a very troubled past. Please feel free to check with me before hiring any senior level person who list[s] HBHC as a former employer or mentions as a reference or other affiliate. Email, call [...], snail mail, is fine. I'll be happy to share what I know. After having a few recently of my own, I'd be happy to help others avoid a bad experience if I can. Hope we can all do that in return."
The email provoked some anxiety and shock amongst community leaders and former employees. Of these, only Benya would speak briefly on the record, saying, "In my opinion, Howard Brown needs a leader dedicated to the organization. Jamal Edwards' message to the C3EO message board is disturbing and yet not surprising. It reflects that Jamal Edwards is wasting his resources when he should be focused on the viability of the organization."
The email does not, so far, appear on its face to have violated legal standards, particularly since Edwards did not name any employees. Asked about the legality of the mail, IIT Chicago-Kent College of Law professor Carolyn Shapiro said that the email was "unusual," but suggested that the matter of whether it was legal or not would require greater legal scrutiny.
Ethan Cohen, an attorney with the Equal Employment Opportunity Commission, added, "We do have to tell people that there's no law that protects you against difficult bosses. There are laws that protect you against discriminatory bosses but not difficult bosses." Cohen was not speaking to the case of Edwards in particular but remarking on the issues of workplaces tensions that might lead to such emails.
To date, we do not know if any former employees have decided to take action on the email. Curious to know about the email as common practice or not in the workplace of nonprofits, we also spoke to Michael Kaplan, executive director of the Cascade AIDS Project in Portland, Ore., who said, "It certainly doesn't seem like a best practice scenario in human resources management. Certainly, I would advise any and all colleagues who sought my opinion to always check references but I don't know that I would ever send out a bulk email to a group of people I worked with [and say that] you might want to be cautious about hiring any of my employees. It certainly doesn't look like a best practice but I don't know any of the circumstances."
Emphasizing that he was not privy to all the details, he also said he had never seen an email like this one, "It just seems not the most advised."
Windy City Times asked Edwards about the possible effect of the news of the email on company morale. He responded, "To talk about something as being unusual, I don't see how that's meaningful right now. What I will say for better or for worse, because it seems that people will insist on making this legal and appropriate thing something of debate, and something that appears to be untoward and improper: We're not going to do anything. So our official policy going forward will simply be to confirm dates of employment for people who worked here, period. That's all I have to say."
The sending of the email indicates that Edwards is willing to speak with a public bluntness that is not characteristic of general practice. (Although the email was sent to a closed group, it is nonetheless an email.) It mirrors his public assertion, made in an earlier Windy City Times interview: "As we continue to change and improve, there will be changes where people may not fit within that new direction. … Everybody should expect more change. There's no way we can deliver a new Howard Brown where everything stays the same. … Any staff that's not supportive of that will not continue to work at Howard Brown."
Garofalo goes to Children's full time
Adding to all of this is the fact that the departure of Garofaloa researcher who has been conducting what colleagues describe as groundbreaking research into the matter of adolescent sexual health, particularly that of trans youthhas meant some attrition in research prestige and funding.
At this time, both parties have said that the parting was mutual. Garofalo has also said that he was never put on leave by Children's and his work there continues unimpeded. The research he takes with him represents a significant dollar amount and monetary benefits to the organization. According to Garofalo, the amount is, over "… a million a year," Garofalo is now the director of adolescent HIV services at Children's Memorial Center for Gender, Sexuality, and HIV Prevention, and it recently announced that its current NIH-funded projects include a three-year text-messaging study to improve adherence to medications among HIV-positive youth and a five-year HIV-prevention intervention project for transgender youth.
Research projects and grants do not simply help fund the organizations in which they are housed but provide a degree of prestige and intellectual community.
Garofalo's peers consider his research groundbreaking.
Dr. Alicia Matthews is associate professor at the University of Illinois at Chicago's Department of Health Systems Science and she has been a collaborator and research partner of Garofalo. Speaking with Windy City Times, Matthews emphasized that Garofalo's work is significant because it is "grounded in community in that it was conducted at a place that the youth were familiar with, that they felt a part of, that they felt an affiliation with.
"The fact that it is now in a different type of setting where there may be other kinds of barriers for the youth to access those unfamiliar and less culturally competent spaces, those spaces which they feel they have no previous relationship to, may become barriers. But I think the major issue is that Rob, like myself and some other researchers view that their work is most appropriately situated in community and Howard Brown had been that community focal point around health and behavioral research work for many, many years."
About the effect of Garofalo's departure, she said, "I view it as a tremendous loss ... to Howard Brown as a whole, with potential long-term implications as a whole for the community."
Matthews also addressed the advantages for Children's Memorial of having him housed there on a full-time basis, saying that he "has always been a part of Children's but to be able to pull fully all of his research funding and research into their portfolio elevates them on a national level in terms of LGBT research. It's a tremendous win for them. They've been brilliant in terms of working with Rob and allowing the collaboration with Howard Brown because they recognize that that's where his work is best done. But it is also a very positive thing that now all those dollars come under their portfolio of funded research."
In addition, according to Matthews, Garofalo helped create "an intellectual community and collegial community ... that many investigators, especially younger investigators, aren't finding in their home departments or academic centers because this is a fairly specialized area, and so he and others have done a lot in terms of mentorship and development of junior faculty members."
Garofalo also spoke of regretting the loss of community-based research, saying, "When I first started at Howard Brown, there was essentially no youth research program so I'm really proud of not just what I accomplished but that I worked with some of the most incredibly talented and dedicated people I've ever come across and I'm incredibly proud of starting the BYC [Broadway Youth Center] and developing it and developing a research program that is really unprecedented nationally.
"We have a very broad-based and deeply rooted research program around HIV and LGBT youth, specifically trans youth and young men who have sex with men, that is unprecedented. I am very proud of the accomplishments and I leave with some sense of sadness because the model that I'd hoped to achieve was much more embedded in the community."
However, he also said that while the new location was a "gamechanger," he was excited to be working more closely with Children's Memorial.
Garofalo's departure from HBHC is also significant because he was named as a motivating factor in the large donation from the anonymous "Angel Donor" who gave HBHC a $200,000 gift used to match additional funds. This donor spoke at a December event commemorating HBHC having achieved its fundraising goal for that year and while he praised the facility, he specifically cited Garofalo's medical care of his son: "[My son] spent two months in the hospital and Rob was probably there as much as I was." Asked if the donor was still giving to HBHC, Edwards responded, "As far as I'm aware." Others have said he stopped his HBHC funding and moved his donations to Children's, but the donor has not responded to our requests for an interview.
In sum, Garofalo's move to Children's Memorial seemingly represents both the movement of research and individual donor funds and academic prestige.
However, while this signals some drop in funding, it may well be that HBHC is beginning to move away from a focus on the kind of research which once put the organization on the academic map. In response to an email asking about how much money departed with Garofalo, Edwards responded, "Dr. Garofalo performed important Adolescent HIV research, and his recent separation from HBHC has had an impact on our research department which, at this point, we are still assessing."
He added, "At the end of the day, Dr. Garofalo's departure is not insurmountable and our commitment to quality research continues and our plans include rebuilding the research program strategically and responsibly. We are working with Northwestern University and other research partners to add several new clinical and behavioral researchers and will soon be providing more details about our Research Visioning Project, which we have just recently begun. Because these changes are still evolving, we cannot quantify this issue at this time."
Asked how much HBHC money comes in from research grants, Edwards replied, "HBHC receives nearly $10M in government grants and contracts, a minority of which are research grants. The financial stability of HBHC does notand indeed should notdepend on research grants; nor does it depend upon the 'indirect expenses' associated with them, which is a past unsustainable practice we've recently abolished."
Edwards has emphasized that HBHC would focus on its mission of providing healthcare to the community and that these changes would have no effect on its services. Yet, according to an email dated May 13 and obtained by WCT, Howard Brown's Adult Case Manager Program will no longer have a Case Manager on Duty (CMOD) as a component of its program, saying that, "With increasing demands from clients and funders, we are no longer able to offer this service to folks"; the program was terminated May 27.
Windy City Times asked Edwards about this change during an interview and he responded, "I can't explain that. That's a decision made by managers at Howard Brown. I don't make every decision at Howard Brown. Although I believe that my staff and the managers here make the decisions they believe are best and appropriate."
According to one source, the change means that adults in distress who need case managers to respond to them will no longer have that contact; and the email goes on to say that, "For HIV-positive clients and patients not engaged in Case Management (but in need of a CM), folks should be referred to the AIDS Foundation of Chicago" and that "[y]outh will be referred to the Resource Advocates for Drop-In Services at the BYC." Windy City Times is further exploring this issue.
A recent press release stated that HBHC has received "the largest corporate/foundation grant in the health center's history from the GE Foundationthe philanthropic organization of GE," a grant of $250,000 "and a 3-year commitment of pro bono employee volunteer support from GE's Chicago base of over 3,000."
The agency was one of five recipients in Chicago.
Peter Muñiz, GE Foundation's Developing Health Business Champion, said the volunteerism component would consist of GE employees offering some "sweat equity" volunteerism (which usually includes painting, etc.) but that the greater emphasis is on skills-based work, which might include assisting any of the agencies with strategic planning or records management, for instance. The grant is site-specific, cannot be used for the buying of GE products or services, and will be monitored through periodic check-ins over the course of the two years. The funds must be used to increase access to healthcare to the community where the agency is located (Lakeview, in the case of Howard Brown).
In sum, it is quite possible that the agency will move away from or decrease its research focus and move towards more of a health service model and that it will eventually be a somewhat different organization than the one it is today.
Even in the execution of its services as a healthcare agency, however, it remains to be seen how far HBHC will continue to grow and innovate and to take its innovations into other parts of the Chicago community so that it is not simply the only place where LGBTQ people might receive culturally competent healthcare.
Edwards and others have often pointed out the vulnerability of, for instance, the trans community, in the absence of culturally competent care. That raises the issue of why HBHC has not been active in making sure that other healthcare providers also be trained in such care.
In an earlier interview with Windy City Times, Owen Daniel-McCarterproject attorney for Transformative Justice Law Project of Illinois, which provides free legal services to incarcerated or formerly incarcerated transgender and gender-non-conforming peoplesaid, "ultimately what needs to happen is that we need to have a shift in medicine where the status quo is not transphobic, racist, classist, homophobic medicine."
In contrast, New York City recently mandated that all its healthcare centers be trained in culturally competent care.
Asked what HBHC might be helping to do in this regard, Edwards said, "That's one of the exciting things for us to talk about next year. I can't talk a lot about it, but I can tell you next year we will be talking with the [Chicago health] commissioner and new mayor about it. It is an issue that we have talked about already with some of our health center peers, about their desire to get that kind of training and their desire to work with Howard Brown, to ensure that folks throughout the city have access to culturally competent care, and we've recently received a fair amount of new grants that we intend to use to expand the scope of services for LGBT people next year."
Over the many years of its existence, the community impulse has been to protect and aid the continuance of HBHC. However, recent events demonstrate that its many institutional and structural issues now require a closer and more thorough scrutiny.
Windy City Times has not discovered and does not currently anticipate discovering any villains or secret cabals controlling the power or demise of HBHC. The story of HBHC is a complicated one, with many moving parts, and it indicates that its various sectorsresearch, service, fundraisingmay not always be working with each other.
The most surprising fact about HBHC may well be that it has managed to survive for this long, despite its many problems and stumbles over the course of its history. There is, understandably, an impulse to simply move on. However, there is still a great deal of its recent past that needs to be uncovered.
Understanding that past would shed light on the very particular workings of the organization and ultimately help ensure that it does not keep repeating its history and falling into crises from which an already beleaguered community is then expected to rescue it. The literal and metaphorical health of the community depends on more complete knowledge.
Windy City Times will continue to push forward in its investigation and analysis of the issues that involve HBHC and the possible new directions it might take, both in services and research.