The head of California's Office of AIDS got an earful from advocates and others during a hearing this week about problems with the state's AIDS Drug Assistance Program.
Among other issues, many people had trouble getting access to medication and data for dozens of clients was breached after the state switched to a new contractor last year to oversee enrollment and eligibility.
At an Assembly hearing Monday, May 8, Office of AIDS Chief Dr. Karen Mark explained how AJ Boggs had won the contract over Ramsell Corporation, which had done the work for almost 20 years.
Assemblyman Mike Gipson (D-Carson), who chairs the Select Committee on Infectious Disease in High Risk Disadvantage Communities, told Mark, "I'm just a little confused. How did AJ Boggs score so high technically but fail so quickly ... They failed so quickly and so early."
"Obviously, we made a mistake," said Mark. "They couldn't deliver upon what they promised to do."
"They lied?" Gipson asked.
"They couldn't deliver what they promised," said Mark.
Mark, who said ADAP serves about 29,000 people in California, said that Boggs' contract was terminated in March due to "material breaches." The California Department of Public Health took over the work Boggs was supposed to perform. (Two other contractors were also brought into the ADAP system, but major problems with them haven't been reported.)
Gipson also wanted to know why Boggs got the contract when its bid was more than $9 million over Ramsell's.
"I'm not sure that's necessarily correct, but I don't have the number in front of me," said Mark. She said that the process had "emphasized technical merit, and the goal was to increase functionality."
Courtney Mulhern-Pearson, director of state and local policy at the San Francisco AIDS Foundation, which is part of the state HIV Alliance, said that advocates had shared their concerns about the system changes, but their request for the transition to be delayed was denied. Officials had said "they couldn't be more ready," said Mulhern-Pearson.
Immediately, she said, "significant" problems appeared, and the state was "clearly not prepared," which resulted in "a lot of anxiety."
By last fall, the situation had "continued to get worse," said Mulhern-Pearson, who reported that affected clients included people who had traveled 50 miles to pick up their medications only to find they couldn't get them.
Advocates were treated as if they were "overreacting" and they weren't giving the changes "time to work through," she said.
Everything changed, though, when the security breaches were found. That was the first time it seemed that "the department understood these were bigger issues than just individual complaints," said Mulhern-Pearson, who has put the number of affected clients at 94.
The situation's improved, she said, but like other advocates who spoke Monday, she said she wants to see more legislative oversight and more transparency from the Office of AIDS, including a publicly available list of what remains to be fixed.
"There's a lot of mistrust among the community right now given the problems that came up over the last year," said Mulhern-Pearson.
Kevin Stalter, who noted that Mark didn't mention the data breach in her opening statement, said the state had stepped back "into the 19th century" after leaving Ramsell. Stalter said at least one friend of his "lives with the fear of losing his care."
"The ability of people to get their medication and keep their care is urgent and threatened" by the ADAP mess, he said.
Martha Ayala, an enrollment worker at APLA Health, said when the transition was made, "it was clear" the system hadn't been tested fully.
"Enrollment workers were not included in the testing of the new system," said Ayala, and "the new portal was extremely inefficient" and hard to use.
One client had to pay more than $500 for his insurance to be reinstated after a payment got sent to the wrong address, she said.
Craig Pulsipher, state affairs specialist for government affairs at APLA Health, said, "It can't be overstated how traumatic and how problematic this has been for everyone involved."
A Ramsell representative said Monday, "They could have called us. We've been around a long time. We may have been able to help. ... We're a little shocked at why we weren't involved at all."
Gipson indicated that legislators would work to help "make sure this doesn't happen again."
Boggs CEO Clarke Anderson didn't respond to a request for comment.