AIDS Care Pioneers Face Doubt, Turmoil : Fund Shortage, Staff Disputes Trouble Agency

The dental crowns are made of cheap acrylic at the clinic run by AIDS Project Los Angeles. Porcelain is now far too expensive.

APLA’s food bank now turns away new clients who earn more than $700 a month. The cutoff used to be $840.

Thirty-five staff members have been laid off, and the remaining 102 are organizing a union.

Three months after the head of AIDS Project Los Angeles quit amid a cash shortage and a staff revolt, the group has imposed an austerity program that appears to be resolving its financial crisis. But internal conflicts--some call it an identity crisis--continue to roil the organization.

Faced with a growing caseload and an epidemic that is claiming an increasing percentage of blacks, Latinos and heterosexuals, the organization, built largely by white gay men, must confront a series of troubling questions:

Which of APLA’s services are essential, and which can be sacrificed? Is APLA best suited to meet the needs of minority AIDS patients? Should it even try, with groups like the Minority AIDS Project and Cara a Cara springing up to meet some of the needs of blacks and Latinos?

Special Problems Here

Of course, such questions confront overburdened AIDS services organizations throughout the country as a result of the changing nature of the epidemic.

But as the largest AIDS services organization in Los Angeles, APLA must grapple with special problems. While New York has launched a pilot needle-exchange program for drug addicts and San Francisco hands out bleach and condoms, the Los Angeles County’s conservative Board of Supervisors has frustrated similar attempts to stem transmission of the AIDS virus among drug abusers.

In a sprawling county like Los Angeles, APLA must also grapple with unique geographical challenges: Should APLA, most of whose clients live in West Hollywood and Silver Lake, continue to attempt to serve the entire county, especially when Pasadena and Long Beach are organizing AIDS projects of their own?

“We can no longer be all things to all people,” said Frank Paradise, the agency’s interim chief executive. It is a humbling admission for a group that pioneered in providing services to people with AIDS in 1982, when support from the government was virtually nonexistent.

Paradise is backing up his words with action. Recently, he turned down a $100,000 government grant to open a day-care center for adults with AIDS because it would overextend the agency. Six months ago, APLA would have leaped at the chance to add to its portfolio of services.

What began as four volunteers in a living room mushroomed into an organization that encompasses a food bank, dental clinic, a 14-bed shelter called Our House, a “buddy” program, a transportation program, a telephone hot line, an educational program and a system of case management.

That growth was accompanied by a swelling bureaucracy. “We definitely became top heavy,” said Paradise, who has slashed APLA’s seven divisions to three.

Even after the layoffs, APLA has a paid staff of 102 and a budget of $8.2 million. Its thousands of volunteers man the hot line, act as “buddies” to people with AIDS, and drive patients to doctors’ appointments.

“It is one thing to keep up with the caseload,” said William Monsour, executive assistant at the project, who forecasts that APLA’s client load will increase to 3,500 from the current 2,000 over the next six months. “It’s another thing to be expanding services with shelters, case management, and all the rest.”

“The crux of the problem at APLA is that, until recently, they didn’t have the sense to say no,” added Bruce Decker, former chair of the California AIDS Advisory Committee. “For all the right reasons, they tried to do too much. Now they are facing a crushing burden in a county where the delivery of health care is an enormous problem, irrespective of AIDS.”

Others offer equally plausible explanations. Torrie Osborn, executive director of the Gay and Lesbian Community Services Center, said APLA’s early success led to aloofness and arrogance.

“They set themselves apart,” she said. “Their attitude was: ‘we’re the biggest and we’re the best.’ They grew isolated from the community from which they sprang.”

Under Paradise, APLA is beginning to build bridges to other AIDS services organizations. After years of going it alone, APLA is becoming an active member of the the United AIDS Coalition. In addition, two representatives from Being Alive, an advocacy group for people with AIDS, will soon be added to APLA’s board.

Insiders and outsiders alike worry whether publicly criticizing the agency will make things worse by scaring away donors, who gave the agency $5.7 million last year. Another $2.5 million came from the government.

“The dilemma is: how do we expose the problems at APLA without damaging the vital services we all depend upon?” said Dave Johnson, executive director of Being Alive. “The answer, I think, is to support the forces of change that are already at work at the agency.”

In the past several months, APLA has replaced its top financial, fund-raising and communications officers. A special committee of its board is conducting a nationwide search for a new chief executive officer. Paradise, whose strong suit is client services, took himself out of the running because he lacks the financial expertise he believes the new leader will need.

Bill Jones, APLA’s new director of development and a veteran of the Gay Men’s Health Crisis, a leading AIDS center in New York City, said he was appalled by the agency’s sloppy donor records. As much as $350,000 that had been pledged in a telemarketing campaign--the exact amount is in dispute--went uncollected because APLA failed to follow up the pledges with billings.

One reason for the disarray: fund raising was leaderless for a year as Jones’ predecessor battled, and eventually died, of AIDS.

Jones is also trying to wean APLA from its reliance on glitzy fund-raising events and to emphasize more sustainable sources of revenues such as direct-mail and major-donor campaigns.

The agency has been hurt by a phenomenon known as “founders’ syndrome,” said Mary E. Nalick, who is working at the agency as an intern this year as part of her studies toward a master’s degree in social work at USC.

The syndrome, said Nalick, “is characterized by founders’ inability to let go”--even after an organization has clearly outgrown their capabilities. Founders’ syndrome is common among rapidly growing businesses and organizations, but it is a thornier issue in AIDS organizations because of the overlay of sickness and death, she said.

Consider APLA co-founder and board Chairman Matt Redman, who began the organization with three friends, two of whom have since died of AIDS.

Although Redman, an interior designer by training, is universally credited with courage and vision for starting APLA, many employees and friends of the agency believe he should now step aside.

Redman’s intrusions into day-to-day affairs have become fodder for staff gossips. Two weeks ago, for example, while inspecting the Romaine Street warehouse where APLA is building new offices, the chairman decided he didn’t like the size and shape of certain rooms.

Witnesses said they were astounded when Redman signed an open-ended purchase order authorizing the construction crew to move the offending walls.

“It was not justified, and it was not within his authority,” said Paradise, who countermanded the order.

Redman blamed the incident on “a misunderstanding.”

Redman, who said he will step down when his term as chairman expires in June, acknowledged that he is a better organizer than a manager, but he staunchly defended his role at the agency.

“I don’t understand why some people are so focused on making us wrong,” he said. “For all our flaws, we have managed--and continue to manage--to take care of hundreds and hundreds of people.”

The APLA staffers who are organizing a union drive acknowledge the board’s early contributions to the organization, but contend that directors have grown increasingly out-of-touch.

More than two-thirds of the eligible workers have signed cards seeking an election that would establish the Hospital and Service Employees Union, Local 399, as their bargaining agent.

The organizers say client services are suffering as a result of staff cutbacks and rising caseloads. They believe a union would establish formal mechanisms for dealing with grievances and give them more input into policy making.

APLA’s board has retained an Orange County firm that specializes in derailing such attempts.