TREATMENT PROGRAM ACCUSED OF CHEATING

With nearly $2 million in annual city support, the Women's Alcoholism
Center is supposed to be one of the few safe places in San Francisco where
low-income women and their children can get help escaping drugs and
alcoholism.

But employees who have quit the nonprofit organization in frustration
charged in letters to The City and in interviews that the center had turned
its clients' addictions into a financially driven "numbers game" --
short-changing women on services and falsifying Medi-Cal information to
meet its own financial goals.

In the last two years, at least nine workers have gone to city Health
Department officials to complain that the program -- once a national model
for its cooperative structure of women supporting women -- was neglecting
those it was supposed to help.

The Women's Alcoholism Center programs offer a desperately needed social
service in The City, including three group houses where pregnant women and
mothers can recover from drug and alcohol addiction with their children at
their sides.

Yet more than a dozen former workers interviewed by The Examiner alleged
problems ranging from families being housed in buildings with broken
toilets and rodent infestation to directors ordering employees to falsify
Medi-Cal reports to make it look like the center deserved payment for
serving more clients than it actually had.

The string of complaints prompted The City's own contract manager to call
for a local and state investigation and ask that the organization be put on
probation.

"The situation is overwhelming," city contract monitor Martha Henderson
wrote to her superiors at the Health Department's substance abuse program
in 1996, when complaints started piling up. "I am under the opinion that we
should place the WAC program on temporary suspension, until we can
investigate the entire matter."

Instead of undergoing extra scrutiny, the center was given more grants by
The City.

Barbara Garcia, who took the helm of The City's substance abuse program
only two weeks ago, says it appears The City did not investigate the
complaints. She said she now plans to take a hard look at the organization.

"This concerns me greatly," she said. "The question is: What was done? As
far as I can tell, no action was taken.

"The Women's Alcoholism Center is an important program in our community --
especially since it helps such an under-served group: women," she said. But
"the use of public money is something we have to be very concerned about."

Mary Gomez Daddio, executive director of the Women's Alcoholism Center,
said the nonprofit has already addressed the problems first raised by staff
members in 1996.

"We've been very aggressive. We've answered all these questions to the
county," she said, adding that record-keeping policies have been tightened
and managers have gotten extra training.

The most serious allegations -- charges that workers were ordered to
falsify daily attendance counts -- were centered around the summer of 1996,
but employees who have quit recently say problems with the quality of care
at the center are ongoing.

Five former employees of the three Women's Alcoholism Center group houses
told The Examiner they were ordered to falsify attendance figures for
counseling sessions or over-report the number of people staying at group
homes.

They said the orders came in the summer of 1996, during a big push by
managers to justify the amount the organization was paid in city grants and
Medi-Cal reimbursements.

"They asked us to sign in clients that weren't there," said Sue Hans, a
former counselor who left in the fall of 1996 after protesting the
practice. "I had a pregnant woman who was out on the streets using drugs
for almost two months and I was told to sign her in as if she was there."

In a letter complaining about the situation to Health Department officials,
former counselor Shannon Carr said when she protested being ordered to
"fudge" the numbers, one senior manager told her: "I need to teach you how
to lie."

Daddio said that manager later denied making such an order.

As soon as she heard the charges, Daddio said, the organization
commissioned an audit.

The audit, given to city contract monitors, acknowledged that workers had
admitted to falsifying records. It found that, in a one-year period,
reports filed to The City by the center may have overstated attendance by
212 client contacts -- a difference worth about $24,000.

City substance abuse program director Garcia said the organization was not
charged for over-billing because The City determined that, over the year,
the center had provided more service than it was required to by its
contract.

The audit, however, did not address the question of whether workers were
instructed to falsify claims. Daddio said she believes employees
misunderstood management directives and were never ordered to falsify
records.

"It was only a 2 percent error for the entire organization," she said. "If
this was a general order to staff to falsify records, why weren't more
records falsified? There is no proof in the numbers."

Yet employees who worked at the center both before and after the charges of
falsification arose said the organization places a huge emphasis on "making
numbers" and cutting costs, often to the detriment of client care.

* Workers said buildings occupied by women and children in residential
recovery programs were poorly maintained and often unsanitary. In 1996,
health inspectors demanded the center clean up rodent infestation, peeling
paint, a broken toilet and a moldy bathroom at one group home, after
clients called to report the problems.

Daddio said maintenance problems were addressed as soon as administrators
were notified. Yet city records show it took health inspectors five months
to get the nonprofit to clear the violations.

* In addition to getting up to $211 a day for each woman who stayed in a
group home, the center followed the common practice of requiring the women
to turn over all their food stamps and most of their monthly welfare
checks. Yet former workers say the program often failed to provide the
women with such basic necessities as toilet paper.

Daddio blamed the workers, saying that monthly budgeting was up to staff at
each facility. Employees said there was often little or no money for
supplies. Daddio said each facility got $250 a month.

* Employees said there was no training for counselors, who were sometimes
brought in off the street with no credentials and put in charge of group
therapy programs teaching addicted women how to break their habits.

The program has positions for a number of certified psychologists, but
employees said the turnover was so tremendous, sometimes there were no
trained people in a given facility.

Daddio disagreed, and said the organization has increased the number of
certified workers at the center and is currently at full staff.

* While the program's contract with the county promises "therapeutic child
care" designed to address the psychological problems of infants and young
children of addicted mothers, the nurseries were so understaffed that the
program often didn't even meet the minimum teacher-to-child ratio of a
state-certified baby-sitting service, said employees. The state requires
one trained child care worker for every three infants or four toddlers, and
one for every 14 school-age kids.

Since the center is considered a parent cooperative, those standards don't
apply, administrators told The City in a 1996 response to the complaint.
But workers noted that, for four hours each day, the parents were busy in
their own therapy groups and unable to offer their children the individual
attention they needed.

"I did my best to make it at least a semblance of therapeutic," said
Elizabeth Korza, former child care worker. "But there was no way it could
be therapeutic with one trained person dealing with seven to 12 infants and
children."

The three group houses and one outpatient counseling facility run by
Women's Alcoholism Center receive funding based on how many clients they
serve. All the grants are administered through the San Francisco Health
Department.

Currently the center collects daily fees ranging from $124 for women who
participate in a day treatment program at the center's Lee Woodward
Counseling Center on Sutter Street, to $211 for pregnant mothers and
theirchildren, who get residential treatment at Mia House in
Bayview-Hunters Point.

Workers said the worst of the problems occurred during the spring and
summer of 1996, when managers told them the organization had fallen behind
in its client counts and ordered them to make up the difference.

But a batch of employees who quit in the last few months say similar
problems are continuing -- particularly with the organization's push to
justify $373,000 in federal grants it recently got for new and expanded
programs at its outpatient counseling center and one group house.

"The big message to us was get the numbers up," said Alisa Kriegel, a
doctor of psychology, who left her position as director of the
organization's Lee Woodward Counseling Center in October.

She said that although the center didn't have the staff to run the new
programs, employees there were pushed to recruit extra people and add them
to the already existing treatment groups.

"They didn't care whether people stayed with the program or not," she said.
"We were told if we didn't get the numbers up we would lose our jobs."

Daddio said she believes the employees are just disgruntled because they
were unable to meet the demands of their jobs, part of which is filling
their programs. "At Lee Woodward Counseling Center, the push is constant
for the numbers," she said. "You can't just sit in a counseling office and
wait for the clients to come in. It's very difficult work and not everyone
can do it."

)1998 San Francisco Examiner