Bureaucrats Forced Closing Of Four Clinics

On April 28, the Detroit Free Press reported, "The Detroit Planned Parenthood League [PPL] has rejected $435,000 in federal funds in a dispute with the Department of Health, Education and Welfare, forcing it to shut down half of its eight clinics and turn away 6,000 patients." 

Rejection doesn't seem like a very precise term to describe Planned Parenthood's reluctant abandonment, in despair, of a 14 month effort to satisfy H.E.W.'s capricious, arbitrary, and constantly changing funding requirements.

The truth of the matter is that H.E.W. still has the money, Planned Parenthood has gotten the business, and the poor have gotten the shaft once again. 

Bureaucrats in Detroit and Chicago held a $435,000 carrot in front of Planned Parenthood. The carrot was just a "come on," never meant to be reached or eaten, but only to keep the animal running and running in an endless attempt to get it. 

"We have been paralyzed by H.E.W. regulations," says past PPL Chairperson Eve Kommel, now a volunteer. "We found we were spending more time and energy in playing politics and responding to federal caprice than on the job." 

Planned Parenthood, which provides birth control and family planning education and technology to thousands of Detroiters, submitted three detailed program plans over a 14-month period in an attempt to deal with a bureaucratie maze constructed by H.E.W.'s regional office, a Chicago consulting firm, and the Southeastern Michigan Family Planning Project (SEMFPP), which disperses federal family planning funds in this area. All three plans were rejected for varying reasons. 

Finally, on April 20, PPL Director Howard Lischeron wrote SEMFPP Director Seymour Brieloff in a last-ditch attempt to determine the guidelines for funding: 

"We are asking for written criteria which are internally consistent and definitive. Frankly, we must be assured that if the criteria are met, we will be approved, and hence able to remain open and continue giving service to those clearly in need of it. We cannot continue to attempt to react positively to perpetual changing criteria. Are you willing and able to provide us such criteria? . . . 

Apparently, we should have insisted back last spring on a clear, internally-consistent set of written criteria." 

At this writing, no response was forthcoming from Brieloff, who could offer only a pamphlet describing general guidelines dated January 1976. 

Instead, a draft report from a New York medical Consulting group hired by Planned Parenthood was leaked to the press, although the report was still being revised and was not yet final. Lischeron speculates that by the process of elimination, the leak must have come from the office of Aurelius Clayton, That, apparently, was the last straw for Planned Parenthood, which announced it would have to give up pursuing the federal funds and close its clinics at 1070 E. Grand Blvd., 9226 Kercheval, 5532 Michigan, and 13100 Puritan on June 1. At this writing, only the Teen Center on Puritan has hopes of reopening in the near future.

Although the bureaucrats apparently feit that Planned Parenthood 's medical and administrative practices were so deficient as to deny continued funding, our conversations with patients in some of the clinics in question produced only favorable comments. Since no names were asked nor given, there's no reason to believe these patients would support a sloppy clinic characterized by "questionable medical procedures" (Clayton's term) or low-quality service. Furthermore, they wouldn't entrust their health to a facility in such a condition. 

Some patients, in fact, asked where such allegations came from. We could only speculate that they came from the report of MCA, Inc., the Chicago consulting firm hired by H.E.W. to evaluate the clinics. Dr. Joe Stokes, a member of the consulting team, says they talked with patients in the clinics in preparing their report, but admitted that the conversations could hardly be verified. 

Only one conclusion can be drawn from the contradictions, confusion, and incongruity of the year-long dispute between Planned Parenthood and the bureaucrats: that H.E.W. has been demanding, capricious, and resistant to progressive change, and that the agency, for its own reasons, was determined to withhold the $435,000, thus bringing about the closing of four clinics. 

After H.E.W. had turned down Planned Parenthood 's first proposal, submitted on February 28, 1975, PPL came up with a much more detailed plan three months later. Both plans, which were examined by this writer, included specific recommendations for handling problems perceived by the League- with no prodding from the funding agencies. The second plan included a minutely-detailed budget, a thorough analysis of the results of a patient survey, and medical assessments of attending physicians. Even Brieloff was unable to explain H.E.W. 's rejection of this proposal, which he called "really good."

Controversy concerning the third rejected plan centers around a mysterious list of twenty recommendations developed by MCA, which H.E.W. claimed were not addressed in the final proposal. 

On October 17, 1975, then-PPL Director Kommel met in Detroit with several members of the MCA consulting team. Kommel insists that the parties to the meeting agreed to dispose of the twenty recommendations as invalid. Consultant Stokes says the recommendations were submitted to "compromises, revisions, and alterations." MCA President Robert C. Strom says Kommel's statement is "incorrect." 

SEMFPP Director Brieloff has a tape of the controversial meeting, which might shed some light on the situation. However, he refused to provide copies to Planned Parenthood board members, and also refused to allow this writer to listen to the tape. SEMFPP President Dr. Charles Berger failed to reply to our request to hear the tapes. A request for information by certified letter to H.E.W.'s Clayton elicited neither a reply nor an acknowledgement. Apparently, taciturnity is the watchword in the bureaucracy.

Our investigation of the "minor disagreements" between Planned Parenthood and the funding bureaucrats revealed the following bones of contention:

 (1) Planned Parenthood favored a centralized phone number, since two-thirds of its charts are kept at the main office and all the master charts are kept there. PPL argued that this would ensure that patients would receive correct instruction and advice, in addition to freeing valuable medical personnel from answering the telephone. MCA felt that stock answers were good enough for callers reaching the different clinics. 

(2) Since their inception, the four PPL clinics in question have never operated on a five-day, 40-hour week. The League feit that a large part-time staff on the days the clinics were open would make more effective use of their personnel -many of which prefer to work part-time- and provide better service to patients. MCA and H.E.W. wanted full-time help, which the League saw as a waste of time and money. If this is all the bureaucrats could find wrong with the four clinics, it hardly seems to justify all the grief Planned Parenthood has been subjected to, not to mention the closing of four needed clinics. 

H.E.W. obviously set out to do a number on Planned Parenthood, and they have succeeded- at least for the moment. In view of this, Clayton's statement on the closings-"The sad thing is that it's the patients who lose out in a dispute like this"- is that of a bureaucratie hypocrite. 

And one has to wonder about the $435, 000, which will now probably go to the Wayne County Health Department or to private clinics. Will other agencies have to account for the money as minutely and painstakingly as Planned Parenthood had to? We doubt it. 

In the meantime, on top of recent cutbacks in Medicaid, welfare, food stamps, and other areas, yet another needed service has been rendered increasingly inaccessible to poor people in this city. Where will it all end? 

Dorothy Sounders, whose work has appeared in the Michigan Chronicle, is a freelance writer who lives in Detroit.