County’s AIDS Program Is Mismanaged, Audit Says

Los Angeles County’s AIDS program is so mismanaged that it spent nearly $547,000 in federal funds on employees who didn’t even provide AIDS services last year, according to a report released Wednesday by the state auditor.

The bottom line, the auditors found, was that the county’s Office of AIDS Programs and Policy--one of the nation’s largest such entities--”cannot ensure that it spends funds appropriately or [that] its contractors provide needed services to people living with AIDS.”

The county office also failed to spend federal funds on specific AIDS projects for which they were allocated, and thus did not fulfill some of its program objectives, auditor Kurt Sjoberg and his staff concluded.

“As a result, the federal government is not receiving the service for which it paid,” the auditors concluded.

In fact, the county AIDS office actually monitored only 13 of the 241 contracts it gives out each year to community groups to provide $74 million worth of medical care, mental health counseling, child care, transportation and other services.

As a result, auditors said, AIDS officials have no idea whether those groups are providing adequate services to the tens of thousands of AIDS patients who rely on them. Moreover, in the 5% of the contracts the AIDS program did monitor, state auditors found that they had identified “significant flaws” in services provided to patients, problems serious enough to jeopardize the quality of their care.

County Health Services Director Mark Finucane concurred with each of the audit’s findings in an official response. He was in Washington on Wednesday and unavailable for comment, but his acting chief of operations for public health, Dr. John Schunhoff, said the department considers fixing the problems identified in the audit as one of its highest priorities.

Schunhoff said department officials knew that $547,000 was spent on employees not actually working for the AIDS office and that the program was supposed to be reimbursed. “That’s what I thought was happening,” he said in an interview. “It turns out it wasn’t.”

Earlier this year, Finucane placed Schunhoff directly in charge of the AIDS program after it had gone without a permanent director for more than a year. Schunhoff said he shared the auditors’ concerns, particularly about the program’s failure to properly monitor the $74 million that goes to the dozens of community groups providing services to AIDS sufferers.

In five of the six county contract “reviews” examined by auditors, the county staff had not been able to determine the quality of medical care or even the appropriateness of the services provided. Such problems are especially significant when it comes to AIDS patients because any small change in their condition should be used to determine whether or not the drugs they are given are working and if others could work better.

And 67% of the actual contractors reviewed by auditors provided services “at levels below contractual requirements.”

One contractor was paid $90,000 annually to treat 400 adolescent clients, but only provided services to 10 during the first five months.

To fix such problems, Schunhoff said, the department has brought in an administrator from the New York state AIDS Institute to take direct control of the program. That director, Charles Henry, started Monday and “will have as his first task making sure the recommendations are implemented,” Schunhoff said.

Some community activists said the health department should have taken more aggressive measures to fix problems a long time ago.

“I think it’s a vindication of what we’ve been saying all along: The county has been using AIDS as a cash cow to feed the bureaucracy for the past 10 years,” said Michael Weinstein, president of the AIDS Healthcare Foundation.