No Privacy or Pride at Workfare Evaluation Site

No Privacy or Pride at Workfare Evaluation Site

Note: the writer of this article did not speak with anyone from the block association, the community board or with Councilmember Duane’s office regarding this story. Phone calls to the reporter were not returned.

New York Times, October 13, 1997
by Joe Sexton

NEW YORK — The welfare recipients in the overcrowded waiting rooms of H.S. Systems on West 45th Street are called by number, not by name.

Ordered to the Manhattan clinic so the city can determine whether they are too sick or disabled to work for their benefits, they sit or stand with their canes, walkers and braces, waiting to be examined. To keep crowding down, the city tells them they must come alone. Some must hold on to urine samples while waiting.

One morning, a woman furtively filled out the psychological portion of her medical questionnaire, unable to shield one answer — “attempted suicide” — from the man next to her. In a public hallway, women stood waiting for their physicals, their handbags tearing at their paper gowns, leaving them partly exposed.

The day’s traffic was heavy: Fifteen doctors examined roughly 350 welfare recipients, in theory reviewing medical records and questioning people with lengthy, imperfectly documented histories. An additional 375 recipients gave blood and urine samples.

The stakes were serious — the doctors deciding who was well enough to clean the city’s streets or public toilets, the welfare recipients aware that they would lose their benefits, including medical coverage, if they were ordered to work and did not.

“It is humiliating and sad,” said Nemrod Shayne, adding that he was at the clinic because his back had been seriously injured in an elevator accident in 1994. “But there is no option.”

Health Services Systems, a private, for-profit clinic, is an essential part of the city’s aggressive effort to require able-bodied people on welfare to work for their benefits.

The administration of Mayor Rudolph Giuliani says that using a single, city-financed operation is necessary to discourage fraud and inconsistency in evaluating welfare recipients, and that it is pleased with the performance of H.S. Systems. The clinic — the only place in the city’s five boroughs where such evaluations are conducted — receives $6 million a year from the city.

But interviews with recipients, advocates for the poor, government welfare workers, mental-health professionals and others, as well as an examination of state records, reveal many troubling aspects of the city’s evaluation system:

  • Officials with H.S. Systems say every recipient is given an evaluation of at least 20 minutes, but numerous recipients say theirs lasted only two to five minutes, that doctors regularly disregard the medical information recipients offer, and that language problems can make basic communication impossible. H.S. Systems says its 15 doctors conducted 80,200 examinations of welfare recipients last year.
  • Two staff doctors at H.S. Systems have at one time been placed on probation by state authorities. One was found guilty of “inappropriately prescribing controlled substances” and the other was cited for “patient neglect” at a nursing home. A third physician, who still works at H.S. Systems as a consultant, was placed on probation last year for what the state called “gross negligence” in treating two emergency-room patients.
  • When recipients appeal to state officials to challenge the city’s determination that they are fit to work, the city’s decisions are overturned or withdrawn in 40 percent to 50 percent of cases. These recipients, who can have their benefits extended during the hearing process, are either granted new examinations or exempted altogether from their work assignments.
  • Medical oversight of H.S. Systems is minimal. The New York State Department of Health has not conducted a comprehensive review of the company in more than a decade, even though it has occasionally been cited by the state for faulty operating procedures, improper infection control and inadequate record keeping.
  • The city, citing crowding concerns, instructs recipients not to bring a relative, nurse, counselor or others to the examinations, and several people who went to help recipients said they had been ordered out of the clinic by doctors and staff. Initial interviews of recipients with psychological problems are conducted in public spaces, and not by doctors. Recipients are not given the results of their exams unless they specifically request them.
  • Welfare recipients found by H.S. Systems to be “employable with limitations” — cleared, for instance, to do only indoor work, because of severe asthma — repeatedly wind up having to do inappropriate or even dangerous assignments, according to a lawsuit brought by the Legal Aid Society.

This is partly because H.S. Systems fails to specify what those limitations are, said a lawyer for the society, whose suit accuses the city of wholesale violations of federal and state laws protecting the rights of the disabled.

Relatives of a woman who died while at her workfare job, as well as a man who claims to have been left disabled as a result of having to work for his benefits, have also sued the city and H.S. Systems.

“If people, including poor people with multiple medical problems, must be made to work, this system is the antithesis of how it should be done,” said City Councilwoman Mary Pinkett of Brooklyn, who conducted public hearings in August into the performance of H.S. Systems. “All the administration wants H.S. Systems to do is move people along the line, and get doctors that will help move those people without asking too many questions.”

Officials with H.S. Systems declined to be interviewed for this article, as did officials with the Human Resources Administration, the city’s welfare agency.

But the clinic’s president, Yvonne Jones, testifying before the City Council in August, defended its treatment of welfare recipients. She insisted that the examinations were as thorough as necessary, and she emphasized that H.S. Systems had no “stake” in their outcome.

The High Volume Hampers the City

Nationally, states that require welfare recipients to work have adopted varying policies for those claiming to be physically incapable. But New York City’s experience is unusual because of the sheer numbers of recipients. Thus the scene inside the H.S. Systems office — not unlike that in a neglected public hospital’s emergency room — is daunting, as more than 700 people are processed daily.

Marlene Schonbrun, a mental-health counselor with a New York hospital, once accompanied a client, a paranoid schizophrenic, to his appointment at H.S. Systems. “It was dismal, confusing, kind of like a mill or a factory,” Ms. Schonbrun said. “He was asked questions that he totally misunderstood. He couldn’t register what they were saying. I do not know what he would have done had he been alone.”

Crowds and Long Waits at the Only Exam Site

Many of the recipients who go to H.S. Systems say they are offended by the clinic and its surroundings. The entrance is next to a storefront peepshow, and there is no special access for the disabled.

Inside, waits are long, tempers short. People are moved in bunches by security guards through the crowds, to have their blood drawn. One morning, the receptionist was observed openly mocking Spanish speakers.

In her testimony before the City Council, Ms. Jones of H.S. Systems said that the center had six psychiatrists, that half the staff was bilingual, and that recipients were treated with “dignity.”

Sarah Ramirez does not remember it that way. She worked for 10 years for the city’s Department of Health before she accepted a buyout package several years ago. She eventually wound up on public assistance. She was an outpatient at Long Island College Hospital, being treated for coronary heart disease, when she was ordered to work.

“I brought my documentation to the examination, but the doctor threw the papers on the desk and said he could not be guided by the information I gave,” Ms. Ramirez said. “He asked me questions, then didn’t wait for answers.”

Ms. Ramirez, 55, was classified as employable with limitations. She appealed the finding at a state hearing and was declared exempt from her work assignment.

Determining Limits for Perilous Jobs

Last year, 33,952 recipients were classified as “employable with limitations.” The Legal Aid Society’s lawsuit centers on the claim that those recipients are systematically assigned to jobs that are physically inappropriate, even perilous.

Three veteran caseworkers from the city welfare agency’s office at H.S. Systems confirmed that they often do not know what a recipient’s particular limitation is when they hand out workfare assignments. The forms the workers get concerning the recipients can typically say nothing more than “light work.”

The caseworkers say they have no choice but to give every recipient his or her computer-generated workfare assignment, whether or not it appears that they can do the job.

“We get the paperwork saying these people are employable, but we can tell by looking at them that it is a joke,” said one caseworker, who spoke on the condition of anonymity. “Their bodies are swollen or broken. The recipients can wind up doing any sort of job.”

Others charge that the mistakes have produced consequences both great and invisible, from death to scores of people quietly losing benefits after opting not to risk doing the workfare jobs.

Relatives of Marsha Motipersad, a 50-year-old woman with a history of serious heart disease, sued the city and H.S. Systems after she died of a heart attack last June during a lunch break from her workfare job in Coney Island. Doctors at H.S. Systems knew about the woman’s heart problems, but ultimately cleared her as employable, sending her to fill out time sheets in a sub-basement office in a public restroom.

Gloria Jimenez, 51, worked for 22 years in a belt factory. But suddenly unemployed when the factory closed, otherwise unskilled and suffering from severe arthritis in her hands, she wound up on welfare.

After her examination at H.S. Systems — conducted in English despite her ignorance of the language — she was found to be employable with limitations. But she was ordered to sweep the streets. She missed a day when the pain in her hands was too great, she said, and lost her benefits. She said she had to sell her personal belongings to pay the rent.

“I had worked all my life, and then I was forced to work at something I couldn’t do,” Ms. Jimenez said in Spanish. “The doctor never even looked at my hands.”

Officials with H.S. Systems, after listening at the City Council hearings to a day’s worth of personal accounts of mistreatment from recipients who had undergone examinations, said that they were disturbed by the reports, and that they would investigate.