Lyon-Martin remains open, but future is uncertain

  • by Seth Hemmelgarn
  • Wednesday February 2, 2011
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Lyon-Martin Health Services, the San Francisco-based clinic that provides health care to women and transgender people regardless of their ability to pay, will stay open for now.

As of Tuesday morning, February 1, about $200,000 had been raised in donations and pledges since last week, when the board abruptly announced it was going to close the clinic in days due to it being more than $500,000 in debt. Clinic officials said that they could stay open if $250,000 was raised in the next month.

However, the board's future appears to be in doubt, and it's still unclear where the clinic's approximately 2,500 patients would go if it closes. It is not accepting new patients.

The clinic is named after pioneering lesbians Phyllis Lyon and her wife, the late Del Martin.

Dr. Dawn Harbatkin, Lyon-Martin's medical director and interim executive director, couldn't say Tuesday how much longer the clinic could stay open.

"That's the answer everybody wants," she said. She said consultants are helping to "sort out the answers."

At the finance and planning committee meeting of the city's Health Commission on Tuesday, committee members appeared concerned about current board members continuing in their roles.

The board's financial oversight skills are being questioned, and they had announced the clinic's closure without having made any plans for what would happen to patients.

Committee Chair Steven Tierney asked Harbatkin if she was okay with the board remaining.

Harbatkin expressed support for the board, saying, "We're continuing with our current board for now." She said the board's "been working very hard for many years."

But some on the city's Board of Supervisors are less supportive. Supervisor David Campos held a meeting in his office Thursday, January 27 with Harbatkin, Supervisor Scott Wiener, Department of Public Health Director Barbara Garcia, and Lyon-Martin board President Lauren Winter.

Asked in an interview if he thinks the clinic's board should resign, Campos said, "I think the board has to figure that out for itself, but what I can tell you is this board, under its current structure, does not have the trust of the city, and I don't think it has the trust of the public. That board has to be restructured."

As for the possibility of the city providing money, Campos said, "I think the city can provide some assistance, but we're also talking about the city being in a situation where the city doesn't have any money."

Supervisor Ross Mirkarimi has called for a hearing with the supervisors' budget and finance committee. That hearing will be held Wednesday, February 16.

Mirkarimi said he's asked to see "all the financial data in some genesis that explains a little bit better how [the clinic] accrued such a substantial debt" with almost no notice to others.

Mirkarimi said he didn't know whether the clinic's board should resign but he said the situation "definitely speaks to a level of ineptitude or dysfunction that has to be corrected ASAP."

In response to a question about whether Lyon-Martin would ask the city for more money, Harbatkin said, "I understand that clearly there is no free money. The city has budget troubles of its own, but we are looking at ways we can work together."

At Tuesday's health committee meeting, John Gressman, president and CEO of the San Francisco Community Clinic Consortium, indicated that federal officials would require a new board and finance director for the clinic if it were to continue receiving federal funding.

Lyon-Martin is a consortium partner and receives federal Ryan White HIV/AIDS Treatment Modernization Act funding. In addition, the clinic is a federally qualified health care provider for homeless patients.

The clinic is also a subcontractor on a contract the consortium has with the city's health department.

Garcia told the committee that the clinic's board did not understand financial management, but she also said that the clinic's previous executive director Teri McGinnis hadn't fully disclosed financial information to the board.

McGinnis, whose November resignation hasn't been fully explained publicly, didn't respond to an interview request.

The public health director said Harbatkin has done "an incredible job."

Debbie Pappas, who has been Lyon-Martin's finance director since April 2010, declined an interview request, as did board member Kimberly Gillette.

Board Chair Winter and board treasurer Peter Balon didn't respond to interview requests. Other board members couldn't be reached for comment.

Lyon-Martin officials have said that their audits had been "clean," but they have not provided copies of those audits.


Patients' futures unclear

At Tuesday's meeting, Garcia said that about 1,000 of Lyon-Martin's patients are part of Healthy San Francisco, the city's health insurance program for uninsured residents.

Tangerine Brigham, the program's director, said health officials would be reaching out to others to "see if they're interested and able to take on other patients."

The city appears determined to find spots for patients if that needs to happen. Garcia said that Brigham is "looking at if we do have to close, how do we do that in an appropriate manner?"

According to Harbatkin, under Healthy San Francisco, transgender patients can get primary, mental health, and emergency care �" anything other than surgery.

Harbatkin's been working on a transition plan in case the clinic does close to ensure that all patients have somewhere to go, but the process is "complex." Lyon-Martin's patients include people living with HIV, Spanish speakers, and many others, so "there's not a single strategy" for all of them, she said.


Plans for debt

Lyon-Martin's debt includes money that had not been billed to Medi-Cal and Medicare for mental health services for two years, according to Harbatkin.

She said typically, "at most you can backbill one year."

However, state Senator Mark Leno (D-San Francisco) is working with the state's Health and Human Services Agency to try to get a waiver for Lyon-Martin with reimbursements.

Harbatkin said the clinic is a federally qualified health care provider and "there were a lot of things around billing that we didn't fully understand." She said that consultants are helping to look at that situation.

In addition to Lyon-Martin's other debt, the clinic took out a $600,000 loan in 2009. Balon said last week that they've been paying that off, but a large amount remains.