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March, 2004

Marin AIDS Commission Dissolved
By Karen Nakamura

The Marin AIDS Commission is no more. It presented its letter of dissolution to the Marin Board of Supervisors on March 2. Its last full meeting was held January 22. The last Executive Council meeting was February 12. It was at this meeting that the Commission voted to dissolve itself. In its place will come another group more tightly aliened with Ryan White CARE Act/Title I guidelines.

At loggerheads for several years over distribution of the federal Ryan White funds, the Marin Department of Health and Human Services (DHHS) and the Marin Aids Commission (MAC) agreed last fall to hire an outside consultant to sort out the mess. On January 22, that consultant, Micheal DeMayo, presented his "Marin County AIDS Commission Assessment: Findings and Recommendations" to the Marin Board of Supervisors. Overall, it was favorably received and deserves an in-depth examination.

DeMayo pinpointed a lack of understanding about the Ryan White Title I requirements and planning guidelines as the core of most problems between MAC and DHHS. History shows that this confusion came about when the CARE Act was implemented in 1990. MAC was already established as a community-led organization. It was natural then to incorporate it into the federal structure. Because Marin's Ryan White funds actually filter through San Francisco and receive less than 10% of San Francisco's EMA (Eligible Metropolitan Area) funding, full Title I compliance in Marin was not required. As a result, some CARE Act responsibilities were, according to DeMayo "inconsistently implemented." This inconsistency led to the disconnection between Title I planning guidelines and the Commission's operations.

In conjunction, DeMayo found some Commissioners were unfamiliar with basic stipulations of Title I planning bodies and had been given little orientation into Title I rules. Nor did the group strictly adhere to Robert's Rules of Order, the parliamentary bible used in almost every government meeting. DeMayo noted that things were further complicated by the fact that DHHS received no funding to manage adequate orientation.

Because of this lack of comprehension and implementation of Title I guidelines by both entities, important responsibilities were not undertaken. One of these is a comprehensive "needs assessment" of consumers and providers. The report concludes; "The value of conducting such a needs assessment cannot be underestimated. It provides information that is often unavailable from any other source, particularly the subjective needs of clients and an identification of gaps in services that provider reports to DHHS do not include."

The all important priority survey, for example, written by DHSS and presented to the Commission last year by its then representative, Karen Wuopio, was shown to be inadequate under Title I guidelines. This survey should have been more extensive, included the entire community and given more than an hour for respondents to formulate their answers. It should also have been conducted every two to three years. And, while it ended up being the basis of funding cut decisions, the distinction between needs and funding priorities was not made.

"This was a difficult and controversial decision-making process for all involved." The report concluded. "The fact that many of the providers that receive funding were serving as Commission members, consistent with Ryan White regulations, created a tense working relationship between the Commission and Health and Human Services staff and contributed to great frustration on the part of some of the AIDS Commissioners."

The report continued. "The challenges facing the Marin AIDS Commission are quite significant and have become, in some instances, insurmountable barriers to effective community planning... Nearly everyone interviewed agreed that the Commission couldn't operate much longer without making significant changes to its composition and operating systems and policies."

Therefore, DeMayo concluded, "The current Commission and its membership should be dissolved. A newly configured planning body should be assembled that is committed to fulfilling the requirements under Title I for Marin's award."

So what happens now? A newly configured planning body is being assembled. At this point, an independent review panel has been put together and includes several former Commissioners. Two of them are the last chairman, Betsy Gornet, Director of Hospice, and Sparky Spaeth of Health and Human Services. These two women took responsibility for naming the rest of the review panel. When asked how this came about, Ms. Spaeth stated the decision had been made during a phone call to Gornet. This is not exactly Robert's Rules but Ms. Spaeth claims that the DHHS has the authority to take such an action.

However, one of the questions DeMayo asked in his conclusion was "How will it be decided who becomes a member and what will the membership process be?" Other ex-commission members include Edward Dipesa, Mark Haven, and Roy Bateman and a representative of the San Francisco office.

At that final meeting of MAC, Sparky Spaeth stated that all provider services would go out to bid, though current contracts would be maintained until September to ensure smoothness of transition.

Outgoing Commissioner Gregory Giorgi, a nine-year member of the MAC, who stayed with the organization to the bitter end, expressed concern about the letter of dissolution. While he was a signatory, when he asked for a copy of the letter, he was told he and other past commissioners weren't allowed to see it until it was publicly released at the Board of Supervisors meeting in March. Giorgi had simply wanted to make sure that the final product was the same as the verbal reading to which he had agreed.

"It's this game playing that made many Commissioners angry in the first place. On last year's priority survey, we weren't informed it was coming before hand or that the survey would determine funding. Prioritization of need didn't translated to prioritization of funding as far as many of us were concerned. DHSS didn't explain that top providers would get full funding while bottom services would be drastically cut. We wanted level funding. How were Spaeth and Betsy Gornet given the authority to name the Independent Review Panel? It's an example of the lack of following Robert's Rules of Order that DeMayo decried and plays into the perception of favoritism and backroom dealing. Hopefully, having to follow Title I requirements will correct this and put an end to the inequalities that plagued the Commission for the last three to four years."

 

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