Federal officials have cited the Baltimore City Health Department for deficiencies in its administration of a grant worth $1.5 million over three years for the care of AIDS patients and are considering disbursing the money through a community-based AIDS clinic.
The grant, funded through the Ryan White CARE Act, pays for early intervention services such as testing, diagnosis and treatment of people infected with the AIDS virus.
The money has been distributed by the city to five programs that serve thousands of patients annually. Without the grant, the clinics would have to find new funding sources or cut back on services and personnel, their directors say.
Baltimore's Chase-Brexton Clinic, which receives about $135,000 a year from the grant, has been asked by the U.S. Health Resources and Services Administration to step in and act as the "emergency interim grantee." The city will continue to administer the funds until the end of next month, according to a HRSA spokeswoman.
"HRSA saw the need for this funding and felt that to totally leave the patients without the services would have an extremely detrimental impact," said David H. Shippee, Chase-Brexton's executive director. He added that "the grant would have been pulled if we had not come up with a solution to the management problem."
City health department officials said yesterday that the city was never in danger of losing grant money. "Did HRSA say they were taking the money away? They said they'd like to change who administered the grant. HRSA knows it's important to get the patients seen [by health personnel]," said Dr. Arista Garnes, deputy health commissioner.
Though administered by the health department, the grant is awarded to a consortium of local AIDS care providers. Its members are the adult HIV services program at the University of Maryland School of Medicine, the Moore [AIDS] Clinic at Johns Hopkins Medical Institutions, Healthcare for the Homeless and the HIV-related treatment services of the city-run sexually transmitted disease clinics.
The large volume of AIDS patients served by the five programs was noted by HRSA as a compelling reason to find an alternative grant manager and to continue medical services without interruption.
Reasons for the switch cited in a HRSA letter written to the health department included inadequate patient demographic information; lack of documentation of funding and performance of programs, and general inconsistency of the grant application.
Health Commissioner Peter Beilenson said he had not yet received the letter. However, he added, "I know there is a consortium of different groups under this grant and they were looking at the best way of administering it."
"The bottom line is no money is lost to the city, so that's fine."
Pointing to the city's needle exchange program as one example of successful city projects, Dr. Beilenson said, "the Health Department has a long record of good service in terms of dealing with AIDS both in terms of prevention and in terms of providing direct care services."
But Baltimore AIDS activists say that the fact that HRSA will not allow the city to manage the grant is a sign of more widespread management problems within the city Health Department.
"It is very scary -- the city's grant application was obviously inadequate. . . . It perhaps points to other kinds of mismanagement," said Garey Lambert, head of AIDS Action Baltimore.
"These grants are not all that difficult to manage. The formula for responding to a federal government proposal for funding is pretty basic and to have left out things like financial reports and letters of support -- these things are fundamental to every grant you write. It is inexcusable and it smacks of incompetence."