Local Planned Parenthood affiliate's loss of accreditation could mean gaps in services
The long-term viability of eight women's health clinics operating under regional affiliate Planned Parenthood Golden Gate (PPGG) was thrown into question Aug. 6 when Planned Parenthood Federation of America (PPFA) announced that the affiliate would lose its accreditation.
The clinics — which serve roughly 55,000 clients, predominantly women living at or below the federal poverty level — will still be allowed to operate but must stop using Planned Parenthood's nationally trusted name beginning Sept. 3.
Some news articles immediately following PPFA's announcement referenced confidential internal conflicts to explain the break, but financial documents and the accounts of several former employees gathered by the Guardian suggest that the organization had reached a precarious financial position that made it difficult to meet accreditation standards.
"To not have a Planned Parenthood in San Francisco is like heresy," a former PPGG employee told the Guardian. Yet this person and other former coworkers attributed this outcome to dysfunction at the senior management level of PPGG and said the national organization had little choice but to take action.
The Bay Citizen reported that 30 members of PPGG's medical services staff sent a letter to Harrison and PPFA executives in October 2008 to raise concerns about "the misappropriation and mismanagement of PPGG's funds." The letter charges that "executive staff's personal expenditures are excessive and are not aligned with the mandatory fiscal restrictions. Flagrant use of PPGG funds to pay for personal belongings, personal services, and exorbitant technology products is seemingly unchallenged and not subject to the same financial scrutiny that clinic supplies and staff salaries are, for example."
A former PPGG staffer noted that employees had tried in the past to sound the alarm, including going to the media. Another noted that they had been made to sign a confidentiality agreement on leaving the organization, a practice that was common within PPGG.
While the current CEO, Therese Wilson, did not return numerous phone calls seeking comment, she was quoted in a fairly sympathetic San Francisco Chronicle article referencing the economic downturn and inability for many of the clients to pay as reasons behind the agency's financial woes. While the recession, cuts to state funding to nonprofits, and other external factors have clearly had an impact, documents suggest that things were going awry before the recession hit full force.
An internal PPGG document provided to the Guardian displays the agency's on-hand cash reserves compared with other affiliates, suggesting that the reserve ratios were at or below the minimum required by Planned Parenthood national for all but one year from 1998 to 2007 — and well below that of other affiliates of similar size. That is a key requirement for meeting accreditation standards.
When we asked Elizabeth Toledo, a Planned Parenthood Federation of America (PPFA) spokesperson, about this apparent pattern, she said she could not comment because she had not seen the documents. She also said the accreditation reviews were confidential. "Understanding the true financial picture for health care providers takes a very in-depth evaluation," Toledo said. "PPFA and PPGG were working together over the last few years to resolve fiscal challenges."
The Packard Foundation, a major donor to Planned Parenthood, awarded PPGG a $30,000 "organizational effectiveness" grant last year to "select a talented, external provider to help them think through some of these challenges." The grant expires in September, according to spokesperson Dan Cohen.
In an era marked by high unemployment, economic instability, and deep cuts in public funding for health services, Planned Parenthood clinics provide an increasingly important safety net for uninsured and low-income clients in need of birth control, screenings for sexually transmitted disease or cervical cancer, abortion services, or information on sexual health that isn't manipulated by a pro-life agenda. As things stand, women in rural communities seeking abortions often must travel very long distances to clinics, and any gap in services resulting from a PPGG accreditation loss could further broaden those geographical boundaries.
Since financial problems are at the root of the San Francisco-based affiliate's problems, the PPGG clinics — which are located in San Francisco, Alameda, San Mateo, Sonoma, Marin, and Mendocino counties — are in an especially precarious position without national support, despite operating as a separate entity from PPFA. Planned Parenthood affiliates Mar Monte and Shasta Diablo plan to take over some of the existing clinics or cover gaps in service area by opening satellite centers, Toledo told us. "It's unusual to have a disaffiliation," she said. "But it's not unusual for national committees to have a reallocation of service area. That part is well practiced." She added that "every effort possible will be made" to ensure continuity of care.
The Mar Monte affiliate operates clinics in the Central Valley, Sacramento, the Sierra region, the San Joaquin Valley, and Silicon Valley. The Shasta Diablo affiliate covers areas in Butte, Contra Costa, Lake, Napa, Shasta, and Solano counties, with locations in El Cerrito and Walnut Creek. Depending on clients' starting points, travel times could lengthen considerably and waiting rooms could become more crowded if the current PPGG clinics can't stay afloat.
It's too early to say just how PPGG staff members and patients will be affected by the loss of accreditation. However, it became obvious from Guardian interviews and more than two dozen Web comments on the Guardian's online coverage of PPGG management woes that there was a high level of employee discontent at PPGG. Former staffers even keep in touch through a sort of club titled "PPGG PTSD" — a humorous reference to being shaken by the experience of working there. Yet while many were angered by the affiliate's administrative problems, they nonetheless remain dedicated to the mission of Planned Parenthood.
"I'm a senior citizen who hasn't needed birth control in quite some time, yet I remember when I was a young woman without resources who depended on PPGG for basic health care," noted "Ellen," a commenter. "They provide more than just reproductive services. They found an early cervical cancer, and I'm alive today as a result of the early diagnosis that they provided.
"It's a tragedy that the current and recent trustees and management ruined such a fine organization," she continued. "A friend of mine is a talented and dedicated nurse with a background of serving low-income women. She resigned from PPGG a year ago because she couldn't handle the mismanagement any longer. I hope one of the nearby chapters is able to take over the PPGG clinics. In any case, current PPGG management and trustees need to go."