A Precarious Prescription

John Roberts is a 41-year-old unemployed laborer whose assorted body ailments force him to walk slowly, with his hands clutching his stomach. To visit a doctor, Roberts must have good luck. He waits in line with maybe 100 other people at a free clinic in Parramore, hoping that in a first-come, first served arrangement, he is among those that doctors have time for.

"They have more people than they can take care of," says Roberts, standing outside the clinic, Health Care Center for the Homeless, just before a rain storm last week. "Most times, they have to turn away people."

That could soon change if the clinic's plans for expansion are approved. Encouraged by meetings with city commissioners, the Health Care's board of directors voted Aug. 23 to negotiate to buy a $285,000 vacant lot at Westmoreland Drive and Church Street, three blocks from where the clinic is now located. The board has enough money to build a two-story complex, tripling the size of the existing center.

The move makes sense on several levels: Not only would the clinic have more room for its 100 volunteer dental, medical and optometry staff, it also would be located in the same block as other agencies that handle low-income clients -- the Orange County Specialty Clinic and Women, Infant & Children's Supplemental Food Program. Grouped together, the agencies could benefit from the close proximity to each other, especially the secondary care offered by the Specialty Clinic. "This allows us to share services and share personnel," says Michael C. Pinell, chairman of the clinic's board.

But Pinell and the clinic's board are running headlong into a city policy that unequivocally says that no new social- service agencies -- or the expansion or relocation of existing ones -- should be allowed in Parramore, a west downtown neighborhood where the population of 6,000 includes at least 1,000 homeless people living in shelters. (There are likely many more homeless in Parramore, considering how difficult it is for census workers to count indigents.)

The city's concern is that there is an "over concentration" of such agencies in Parramore and that they have had a "negative impact on the area's stability and prosperity." Despite the services provided by such agencies as the clinic, the policy has been championed by many of Parramore's residents and business leaders.

Clinic administrators decided to ask the city council to reconsider the policy at an Aug. 6 meeting, in part because they had new arguments and in part because the city has been sending mixed signals to clinic administrators since December. That was the last time the city said no to the clinic's plans for expansion. (At that time, clinic administrators wanted to relocate across the street from their current Parramore Avenue location.)

This time, the clinic argued that the city was placing it in the wrong category. It is not a social-service agency, its administrators argued. Nobody sleeps at the clinic overnight. Patients aren't referred by nearby shelters. And the clinic doesn't exist primarily to serve the homeless. Half of its annual 9,600 patients are low-income residents of Parramore, according to Paul McGlone, the clinic's president. He says his medical center is best defined by the definition of clinic found in Orlando's code book: "a facility which provides treatment."

"A licensed social worker cannot provide medical service," says Becky Cherney, a member of the clinic's board of directors. "We're a medical facility that serves the poor."

Besides, the clinic has been working with Orange County officials to be part of a network of nine primary-care providers in the metro-Orlando area (including a clinic for the East Colonial area coming Sept. 17 and one in Winter Garden in 2002). Under the deal with the county, the Parramore clinic would accept 1,000 of the county's patients. In exchange, the county would provide partial funding and the use of its x-ray machines, lab and pharmacy. The network should prevent low-income patients in other parts of the county from being drawn to Parramore, Cherney says. "Sometimes they've had to come downtown but now they won't," she says.

Not everyone is so sure. Many Parramore business leaders and residents, who often fail to agree on community issues, are trying to work together to block the expansion. It's not that they are opposed to the homeless, they say. It's more a question of the future of the neighborhood. On the one hand, the city has spent hundreds of thousands of dollars building new middle-class homes and a school in Parramore. So why should it allow the expansion of a clinic that might draw more low-income and homeless people?

"I'm not in favor" of expanding the clinic," says Mercedes Clark, who has lived in Parramore 30 years. She ran for city commissioner in 1998 and was the nursing director of Orange County's Health Department for more than 20 years. "I know they probably need to expand services but I wish they would consider other options."

Adds Betty Gelzer, another Parramore matron: "We need to help people here but we don't need any more `agencies` in this area."

William R. Kiley, president of Miller Bearings, a ball bearing manufacturer and one of the top four employers in Parramore, has written a letter, pleading with city leaders not to allow the expansion. "Miller and its neighbors support charity work," Kiley wrote. "However, allow us the chance to clean up and present a respectable Parramore district."

Opponents of the expansion see the clinic as a rallying point, fearing that if the center relocates and expands, it will allow city leaders to bend the rules for other social-service agencies in Parramore. "If they don't enforce the ordinance now, how or why would they ever enforce it again?" asks Phil Cowherd, who owns 82 Parramore rental units.

Clinic opponents are joined by an unlikely ally, their commissioner, Daisy Lynum. Lynum, Cowherd, Clark and other west-side residents often quarrel at council over the future of Parramore. But against the clinic they are united. "This is a way of repackaging a social-service effort and calling it medical care," Lynum said Aug. 6.

But other commissioners weren't listening. In a rare show of the council's strength, five of the seven commissioners said they would support the clinic. And another, Mayor Glenda Hood, encouraged administrators to move forward. (The mayor later retreated to a more characteristically limp-wristed view: If the clinic is a clinic, the mayor would support it, according to her spokeswoman, Susan Blexrud. If it's not, she wouldn't support it.)

Why would commissioners shoot Lynum down? In part because they seemed to believe in the project. "It's a no-brainer for me," says District 6 Commissioner Ernest Page. He says the benefits outweigh the negatives: The clinic helps to decrease the number of low-income patients visiting emergency rooms, and Parramore needs a better medical center.

Indeed, District 3 Commissioner Patty Sheehan argues that it would be cruel for city leaders not to approve the facility. "Some people spend their entire day having to take a bus to fill their prescriptions or work out their Medicaid payments," she says. "If we can lessen that burden, if we can help to make it a one-stop thing, then I think that's humane."

But opponents of the clinic expansion allege that commissioners are willing to outvote Lynum because they don't want the clinic in their districts. "Parramore is going to stay the dumping ground it's always been in order to protect all the districts except Daisy's," Cowherd says.

It hasn't gone unnoticed to clinic opponents that the clinic's board is made up of influential members. Bruce Gordy, a dentist and former city commissioner, sits on the board of directors as do representatives of both of the city's largest hospitals, Orlando Regional Healthcare and Florida Hospital. Professionals from Valencia Community College, Xerox Corporation and the law firm Morgan Colling & Gilbert also sit on the board. Additionally, some of the city's top 10 churches support the clinic, according to its president, McGlone.

That's a group that could easily intimidate city commissioners, opponents argue. "City leaders made a law to help the politically powerless clean up their neighborhood," says Ray Cowherd, Phil's cousin and business partner. "Now, 18 months later, they're bending the rules for the politically powerful."

But the chief reason that commissioners seem ready to vote against Lynum may be that she left herself with few options when she began negotiating with clinic administrators for a new site. Over a three-hour lunch in July, Lynum told Cherney she would endorse any of three locations in Parramore. Each was considered an eyesore by Lynum.

One of the locations was a group of flophouses on Westmoreland Drive. Another was the recycling plant on Orange Blossom Trail at Polk Street (which was facetiously called "Best slum area" in Orlando Weekly's annual "Best of" issue). And the third location was a warehouse across the street from the site of the proposed new clinic location.

The clinic's board tried to secure each of the sites, but they all proved to be impractical. Lynum says she pointed out the locations because she thought they were outside the boundaries of Parramore's no-agency policy. Then she discovered that the policy also covered the sites she was recommending. "I like to be helpful, not a hindrance," she says.

Even so, she was harshly condemned by several property owners. "I thought what she did was politically astute, but morally and legally corrupt," Phil Cowherd says.

Not only were eyebrows raised over the ethical concerns Lynum raised -- using health care as a bargaining chip -- but also because she appeared to weaken her own position that the clinic should not expand in Parramore. If these other Parramore locations were acceptable to her, why not a lot that's been vacant for several years? "These `locations` were all within a stone's throw from our current site," says Pinell, the board chairman. "It doesn't make sense. To me, it's a non-argument."

Another strange political maneuver occurred in early August, when the city's chief administrative officer, Richard Levey, wrote an e-mail to Becky Cherney, saying the city would help the clinic if it changed its name. "Why are you still using that name with the revised concept?" Levey asked. "Continuing to use that name will lead to difficulties in permitting. Why can't you change it?"

The e-mail might have been standard operating procedure to Levey. But it appeared that he was trying to sneak the clinic into its new location, as if a name change would alter the composition of the clinic's patients. Indeed, the clinic intends to change its name at the new location to Neighborhood Family Health Center.

"Richard Levey writing these people and telling them to take 'homeless' out of their name, can there be anything more disgusting than that?" asks Phil Cowherd, who owns 82 rental units in Parramore. "How can you, through subterfuge, break city law, then expect the rest of us to have confidence in the city or respect for its laws?"

The name-change isn't as shaky as it might appear, however. None of the other eight clinics in Orange County have homeless in their names, even though they serve roughly the same client base.

Clinic opponents also would like to know why the clinic needs to expand when Orange County already maintains a clinic in Parramore. "We've got a clinic," says Gelzer, who runs a Parramore day-care center. "Why can't we go to the Orange County clinic?"

But Orange County is discontinuing its primary-care services at the Westmoreland Drive location, turning over 1,000 low-income patients to the Health Care Center for the Homeless. As it does for patients at other clinics, the county will pay for these uninsured clients. "Our case load is going to increase," says McGlone, the clinic's president.

Still, opponents of the expansion wonder why the clinic can't relocate near one of the major hospitals. After all, the clinics exist to decrease the amount of traffic in emergency rooms. Orlando Regional has seen up to 280 patients a day in its emergency room, causing eight-hour waits, according to Dr. Pinell, who, in addition to his volunteer time at the clinic, is the vice president of physician services and quality management at ORMC.

Indeed, when the Winter Park clinic came on board two weeks ago, administrators argued that it needed to be located close to Florida Hospital. But Pam Steinke, manager of the county's health-services division, said the clinic had to be close to the hospital in order to share its x-ray machines, labs and pharmacy -- not to intercept low-income patients.

Part of the "he-said, she-said" tone of the conflict is that city leaders have never defined what a social-service agency is. Neither has the state code, except in cases of child-development agencies.

The dictionary provides two definitions of social service. But both of those are ambiguous as well. One mentions "government-funded" agencies and facilities, which doesn't fit the clinic's profile. Except for its outreach program, 90 percent of the clinic's $1.2 million budget comes from private donations, according to figures provides by the clinic's staff. Florida Hospital and Orlando Regional are among the larger donors, giving $100,000 each annually.

Another definition defines social service as the "provision of welfare work, assistance and advice" to the poor. But this second definition fails to mention the medical aspect of indigent care.

City-planning department employees hope to iron out that ambiguity this week. They met with clinic administrators on Aug. 30 to discuss the clinic. If administrators don't like the city's decision, they can appeal to the city's municipal planning board or again ask the city council to consider the issue.

But expansion opponents are unlikely to accept a favorable decision, either. They are marshaling resources in case they have to take their case to court.

Caught in the middle are the indigents seeking medical care. Except for sketchy details, most of them are oblivious to the political battles being waged around them. "We need to talk to Glenda Hood," says David Butler, a 43-year-old homeless man who broke his back in a car accident. "We need to focus on staying. A lot of people need this clinic."


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