But not everyone was as thrilled with the new funding arrangement. The state health department, which regularly locked horns with Clem over such issues as AIDS testing, had lost clout. And the agencies that had previously received HRSA demonstration grants now had to ask Lance Clem and the governor's council for their money.

When Congress passed the Ryan White act, one of its caveats required that agencies that had received HRSA funds be given priority for the new program. But to get Ryan White funding, those agencies had to form a consortium that would make requests of the grant administrator.

Former HRSA grant recipients in the Denver area formed a consortium that left DHH in charge of distributing the money received through the governor's council. But the Denver consortium's bylaws created a catch for other agencies that wanted to join the group (and get a share of the Ryan White money): In order to join the group, an agency had to already be funded. For small agencies that relied on public donations or were just starting up, this stipulation proved an insurmountable hurdle.

Although several Denver agencies were cut off from the Ryan White funds, Clem saw to it that other parts of the state received a share. He contacted agencies across Colorado that had received small amounts through CAP's annual fundraiser and convinced them to form three more regional consortiums.

"If it hadn't been for Lance, we probably wouldn't have received any Ryan White funding," says Nielsen, of the Western Colorado AIDS project, whose territory covers every community west of the Continental Divide except those in the San Luis Valley.

"There was nothing here," she continues. "Families were having to deal with this horrible disease without any help or support. Lance had hearings up here to explain how to apply for Ryan White funding and brought the council so that we could tell them about our problems. It felt like someone in Denver finally cared."
But several members of the Denver consortium didn't care for Clem's positions. For instance, he told the consortium that he was troubled when small metro agencies weren't allowed to join up. Under federal rules, he pointed out, although agencies weren't eligible for Ryan White Title II funding unless they belonged to a consortium, there was nothing in those rules that required they already have a funding source.

Clem moved into deeper waters when he began challenging councilmembers for voting on funding applications that affected their own agencies. In particular, he singled out councilmembers who were either employed by DHH, like Harmer, or those with direct ties to the department, such as Donna Good, Webb's special assistant for health and family issues.

Their voting especially galled him, Clem says, when he saw the DHH application for Ryan White funding in the summer of 1991 and "the range of exorbitant salaries paid to doctors and other employees at DHH for providing care services to persons with HIV." Clem's ire focused on Dr. Adam Myers, Denver General Hospital's director of oncology, one-third of whose $250,000 salary was covered by Ryan White funds that year.

"Yet he spends only about 1 percent of his time with AIDS patients," Clem says. "And for what? These are city employees. If there was no federal funding, they would still have to provide the services. My own private doctor sees fifty to sixty patients with HIV and makes half as much as Myers."
But Myers, who is also the consortium's lead administrator and runs its meetings, contends that he spends between 35 and 50 percent of his time on AIDS work, doing research and treating patients. Using Ryan White funds to support his salary has allowed DHH to hire staff to handle some of his other duties, Myers says, so he can devote more of his time to AIDS, including running two clinics devoted to AIDS-related blood and cancer disorders.

"I have always been a bit puzzled by Mr. Clem's preoccupation with my salary," Myers says. "I don't set my salary, the city does. My colleagues in private practice make twice what I do. Those of us in the institutions aren't here because of the salary; we're here because we're dedicated to what we're doing. And we in Denver enjoy an excellent reputation nationally for the work we are doing here."
In his suit, Clem claims that not only did council voting present a conflict of interest, but that using Ryan White funds to supplement salaries is illegal. He'd repeatedly brought these same issues before the Governor's AIDS Council, he says, but other councilmembers weren't nearly as alarmed. "I think part of the problem with what happened to Lance was that he thought this was such a major issue and the council didn't," says Rush.

But Skip Tjach, chairman of a citizen's committee appointed by the council to oversee fund distribution, was outraged when he learned that most of DHH's money went to administration. "They listed other duties that I thought were bogus," says Tjach. "The committee officially recommended to the council that [DHH] funding be cut back."

His committee members thought the matter was important enough that they raised the issue on several occasions, Tjach adds. But the council still approved DHH's funding.

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