Coudriet testifies on D.C. AIDS spending

Testimony of Jeff Coudriet

Vice-President, Gertrude Stein Democratic Club
Ryan White Planning Council Representative, Gay and Lesbian Activists Alliance

D.C. Council Committee on Human Services
Sandy Allen, Chair
February 25, 1998

Good morning Madam Chair and members of the Committee. My name is Jeff Coudriet and it is an honor and a privilege for me to be here today to testify on behalf of GLAA and the Stein Club. I have been testifying on behalf of GLAA on AIDS issues for over 10 long years and happily there is at least some good news to report, amongst all the other news you'll also hear here today. Before I go much further, however, we all want to thank you for having this oversight hearing today and applaud your commitment and compassion in getting to the heart of some matters and hopefully working towards some solutions with us. I also urge you to think about having an oversight hearing about the Agency for HIV/AIDS specifically at some point in the near future. The exercise of stern but loving oversight is one of democracy's greatest gifts and we will be actively egging you all on to continually dig deep, find out the facts of what is going on, and work on solutions. The best way to get rid of the control board and others is to get the job done ourselves, not that they're doing all that great a job themselves!

The good news out there is called protease inhibitors. Protease inhibitors are a new class of drugs that are being used to treat HIV/AIDS. In combination with other drugs, a therapy called "triple combination", these drugs have enabled many people to stay alive longer, stay healthier, and have markedly reduced the mortality rate from HIV/AIDS in cities around the nation. We are all grateful for the public/private partnerships which have delivered these drugs to sick people, especially to sick poor people with HIV/AIDS. The bad news is that these drugs are expensive and once a patient is on them, they cannot go off them (or so the current science on the matter says) without the risk of creating dangerous mutations of the HIV virus and risking the re-explosion of HIV cell production in a person's blood stream. In other words, once you're on these drugs, you've got to stay on them. These drugs are rather fussy as well — you have to take them on the proper schedule and in the proper way — for example, some medications require that you take them on an empty, or a full, stomach. There are many public policy issues that the rise of these new treatments brings to us, as public policy makers, as activists, and as simply people who care.

The biggest one is funding. I won't beat you up about this just yet, since I know that you will be having a budget hearing in March that I will, of course, be testifying at. But we will have to address funding for the AIDS Drug Assistance Program (ADAP) to insure that as many people as humanely possible can get these drugs because they are keeping people alive. These drugs have also had an impact on the provision of primary medical care as well. Whitman Walker, DC General, and several other institutions, are facing a greatly increased caseload of people coming in the door for primary medical services, and medical tests, that these new drug treatments require. This has strained their resources tremendously. I serve on the Metropolitan Washington Ryan White Services Planning Council, and we truly have been straining to keep up with providing federal funds for these services, in addition to making a very substantial, multi-million dollar contribution to funding the ADAP program over the last couple of years.

But providing medications and the medical care and tests necessary for these treatment regimens to be a success is not enough. There are indeed other issues at hand. For example, a homeless person with AIDS might not be a good candidate for these life-saving drugs if they don't have the stability in their life necessary to comply with the intricate drug regimen that these new drugs demand. Things like proper food and shelter are highly necessary for a homeless person, or many other just plain poor persons, for them to be successful on these treatment regimens. The HIV planning council is trying to do everything it can to help meet these needs, along with other federal programs to address housing and other needs, but the federal resources that DC receives, by themselves, are not enough. We need to make a bigger commitment here at the local level to funding AIDS programs as the caseload has continued to grow, there is more that we can do for people now days with these new drugs and thus more people have been coming in the doors of AIDS service providers all over town looking for services and so we just want to plant this concept in your heads here today because these issues are going to need to be addressed in the budget hearings next month.

I want to talk about contracting and procurement problems, and I know that you're going to hear a bunch of horror stories here today, but I'm not going to pretend to be some expert on the issue, but I want to touch on some themes of responsibility and accountability and share with you some of my strategies as a fellow legislative branch type person and hopefully provide some suggestions and strategies to resolve some curious problems that we face here in DC with our HIV/AIDS programs.

One issue I'd like to address is what we call the "maintenance of effort" problem. In the federal Ryan White statute, local jurisdictions, such as DC, which receive these federal funds for HIV/AIDS programs must continue to provide the level of locally funded HIV/AIDS services that they provided before the Ryan White program started. In other words, a jurisdiction is not allowed to reduce local funding for these things now that the federal "gravy train has pulled into the station." Well the federal gravy train is a pretty good one, and we are all fortunate to have that federal funding, but there are two specific concerns that we have about both the local funding stream and the federal funding stream and that is — is this money really being spent? Year after year, for more years than I care to think about, this has been a very serious question. We have faced too many September 30ths with chaos and panic reigning over at AHA. We have faced the end of the fiscal year without local money being spent to the max, and without federal money being spent to the max. This just cannot happen, I am sure you can agree.

Now I know that Tony Cooper, the Council's auditor, has left for the lottery board (and he did a very good job by all accounts here at the Council) and I'm not sure if a new auditor has been picked yet, but I think a comprehensive audit of the Agency for HIV/AIDS would be a darn good thing. I think we need to settle the maintenance of effort question once and for all as far as local funding is concerned, and we need to take a good hard look at the federal funds as well. Are they being spent? There is considerable doubt in the community that they are. I strongly urge this Committee and the Council in general to get in the ball game on this one and take no prisoners. What we all need are some "hard facts" to determine what really is going on. This is an accountability issue, of course, and it looks like it's going to take independent accountants to figure it all out. Your committee might have this information, or it may not, but I know that as of last week, the Fiscal Oversight Committee of the planning council did not. I serve on that committee, and I know that having this information would be of great value to us. I do find it amusing and sad that the ‘control board' can spend millions of dollars on consultants and what not and ignore public health issues. It seems terribly short sighted to me! Fortunately, this Committee has both the power and the mandate to look into these issues and there is no better exercise of democracy and home rule here in DC than having our own Council take the matter in hand and get some things done.

There is another accountability issue that I would like to address — it's an issue that has dogged the HIV/AIDS community for years in some ways. I'll start with the positive angle first. I think everyone would like to see people with HIV and AIDS working at the AHA--the commitment, expertise, and know-how that people with HIV/AIDS would bring to AHA as employees is immeasurable. Now we're not asking DC personnel to "out" anybody's HIV status — such a notion, of course, is repulsive to all of us, but there are many other things that we don't know about the personnel at AHA. Now I know that we don't particularly know how many people work for the DC government, or how many school children are enrolled in the schools, or even, until recently, how many dead people were collecting retirement checks, but we should be able to figure out how many people actually work at AHA, what their basic job descriptions are, and what the source of funding is for their position. For example, some people undoubtedly are funded by DC funds; some are funded with Ryan White Title I, II, etc, funds; and still others are funded by US Center for Disease Prevention funds. The problem is — no one really seems to know for sure.

Now there have been many changes and transitions over at AHA lately in personnel, and really, change is ok, we are not against change, but I think it would help all of our abilities to analyze what DC is doing in the field of AIDS to know this information. It would be nice to know how many people at AHA are HIV+ or living with AIDS. We don't need to know their names, ranks, or serial numbers, or their position titles. Just a raw number would do I think. Other cities around the country have been quite successful at recruiting and employing people living with the disease but we just don't know where we're at here in DC, and we frankly suspect that we're not doing too well at this. We don't think that there should be any quota for HIV+/AIDS persons for employment at AHA or anywhere else, but it is something we generally value, think would be a useful and illuminating presence at the agency, and on top of all that, the city just might get some darn good employees in the bargain. If the committee could demand a report out of the acting agency director on this, and/or from DC personnel, I think that would help establish a good "hard fact" basis for us to judge what is going on over at the agency. So there's another ‘action item' for the committee to dive into.

Finally, I have a little moral tale to tell, in the nature of a suggestion to the committee about how to get what you want out of an unresponsive agency. Several years ago, my previous boss, a Congressman from upstate New York, had the pleasure of serving on the House Appropriations subcommittee on Agriculture. Now I know that sounds pretty boring, but the subcommittee actually had funding jurisdiction over some interesting programs such as WIC and food stamps. Now there was this political appointee who served as the regional administrator for the Farmer's Home loan program for the NY region. That's a program that helps low income people in rural areas qualify for guaranteed home loans. Now this political appointee wasn't too supportive of the program and year after year, for a few years, he did not spend the money available to the NY region that was appropriated by Congress, the legislative branch.

Does this remind you of DC? This situation irritated my boss, of course, because he wanted to see low-income rural people get homes, so he decided to do something about it. During the appropriations process that year, our office drafted an amendment to the agriculture appropriations bill that stipulated that we would defund this political appointee's regional staff allowance by the same percentage that he failed to spend the money on the home loan program the previous year. I can't remember if we faxed him a copy of our amendment, or just made its existence known, but he responded to us within a matter of days, he pledged to spend his full appropriation in the future, and frankly, the matter was taken care of.

Now that's an ‘attention getting' approach I realize, but in this city's administration I think that the public issues of gravity we are discussing here today can stand such a level of attention. The moral of my story — the council can and should do whatever it needs to do to compel performance from the executive branch of the DC government. The legislative branch is an equal branch and must act accordingly at all times. I think that we can get 9 votes on this council, or whatever it takes to make a veto-proof majority over the Mayor, to accomplish whatever objectives the council wants to achieve. For too long in the DC government there has been a go-along-to-get-along sentiment. I can assure the Chair that she and the committee can set performance goals and get accountability reports from even the most recalcitrant bureaucrat with just a little creativity, persistence, and intelligence.

In conclusion, there are many complex issues out there, and these are just a few, that have and will continue to tax the patience, intelligence, and compassion of all of us, but it is work that we must do. These issues involve sick, often poor, people and we have a moral responsibility to make home rule work for them too. I urge the committee to be bold, searching, inquisitive, and unforgiving in its work. I urge the committee to have very regular oversight hearings several times a year on health and AIDS issues. And finally, I thank you all for your time, your caring, your open minds, and your commitment to moving forward and getting things done.

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