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Friday, August 16, 2002

A Fig for Newsom

Haight Ashbury Free Clinic Doesn’t Support Care Not Cash

By Carol Harvey

The baby grunted again…. “If you're going to turn into a pig, my dear,” said Alice, seriously, “I'll have nothing more to do with you.”...

“Did you say pig, or fig?” said the Cheshire Cat.

“I said pig,” replied Alice; “and I wish you wouldn't keep appearing and vanishing so suddenly: you make one quite giddy.”

One day the Haight Ashbury Clinic's dove logo and a link to its website appeared on CareNotCash.org. The next day, like the Cheshire Cat, they were gone – at the clinic's request.

In a July 16 Chronicle op-ed promoting his Care Not Cash initiative, Supervisor Gavin Newsom wrote: "I have joined with medical professionals and organizations such as Dr. Pablo Stewart of the Haight Ashbury Free Clinic ... in support of comprehensive reform of how we provide care to homeless San Franciscans."

In his July 16 Political Notebook, "Winning Care Not Cash," Samson Wong echoed the statement: "Newsom has constantly emphasized the medical community's support [repeatedly citing] ..."Dr. Pablo Stewart of the Haight Ashbury Free Clinics."

Earlier, Ken Garcia had introduced another Free Clinics player into the debate, in a July 2 column titled "Homeless measure makes sense: Care Not Cash plan should make ballot." Garcia quoted Dr. Frank Staggers, Jr., medical director of the Free Clinic's substance abuse programs: "We're seeing Third World-type poverty and malnutrition, and anything that gets these people more food I would support."

In a leap of logic, Garcia then incorrectly connected Staggers to the proponents of Care Not Cash: "That will explain why ... compassionate people such as Dr. Pablo Stewart of The Haight Ashbury Free Clinic ... are solidly behind Newsom's plan."

In an interview, Staggers denied the association: "I am an apolitical advocate for homeless people without polemic or agenda."

Ken Garcia's column suggests that both Staggers and the Haight Ashbury Free Clinic medical staff en bloc support CnC. Yet on July 17, 2002, Majett Whiteside, administrator at the Free Clinic told me, "CEO Dr. Darryl Inaba states that we have not accepted or adopted an official policy on the Care Not Cash initiative."

On July 18, I called Inaba and asked him directly, "Does The Haight Ashbury Clinic or any of its doctors support Care Not Cash?"

"We have written clarifying letters to the editors," he replied. "To date, none have been published. This has me concerned about the objectivity of the papers. My biggest concerns are: How does he [Newsom] assume that the 2,500 people on GA are all addicts? And where are they are going to go right away? I don't know of 2,500 more slots for treatment or beds in the city."

"Has the clinic ever come out in support of Care Not Cash?" I asked.

"No," Inaba answered. "We haven't decided whether we are for or against it. To be honest, we've never taken any vote. Several doctors, Dr. Joseph Elson, medical clinic director, and a psychiatrist here, Dr. Adam Nelson, are strongly opposed. He [Ken Garcia] is quoting a doctor, and saying it represents the Haight Ashbury Clinic. The doctor is not authorized to speak on behalf of the Haight Ashbury Clinic."

He continued, "Dr. Stewart supports that initiative. He has worked here many years as a real advocate for homeless rights and care. He is frustrated over the lack of resources for [them]. He has probably been misled that this [Care Not Cash] is going to give them more care. I have heard him tell people in the newspaper that this is his own personal opinion, but Gavin and everybody else keeps quoting him as the Haight Ashbury Clinic."

To counter the mistaken impression that the clinic supports Newsom's proposal, Inaba sent out a press release on July 18 with the heading: "Haight Ashbury Free Clinics Take No Official Position on Care Not Cash November Ballot Measure."

The statement is worth quoting at some length:

Haight Ashbury Free Clinics, Inc. (HAFCI) today announced that it has taken no position on the Care Not Cash November ballot measure that changes the way the city approaches the dispensing of homeless services.

“It has come to our attention that several of our employees have taken public stands on this ballot initiative, either pro or con, and we want the public to know that Haight Ashbury Free Clinics, as an organization, has not taken an official position on the measure," says Darryl Inaba, HAFCI's Chief Executive Officer.

"While we support an individual's right to speak out on matters of public policy, any statements attributed to HAFCI employees in regard to the Care Not Cash initiative are their own personal opinions, and not the official policy of our organization," added Inaba.

"Our clinics provide medical outreach and services to the homeless and the underserved at no cost to the individual," said Inaba, "and we will continue to do so no matter how public policy regarding the homeless is changed in our city."

I asked Staggers, "How do you answer the claim of Newsom's Care Not Cash folks that the Haight Ashbury Free Clinic is solidly behind their new proposal? Ken Garcia has written an article suggesting you support Newsom's Care Not Cash initiative."

Staggers replied, "When he called, I told Ken Garcia, 'It is shameful that I am seeing third-world poverty.' The true context of my statement was the atrocious state of homeless care I see in San Francisco, not that I am supporting this or that. People have taken that third-world poverty quote and said, 'He must be behind Gavin Newsom.' I don't have a position [on Care Not Cash] that I am willing to state publicly. I have no comment. My position is as an advocate for the homeless. They are underserved, and they die quicker."

Garcia's placement of Staggers' statement immediately before Dr. Pablo Stewart's, the single Haight Ashbury Clinic M.D. who supports vouchers, shifted the focus away from Stagger's lifelong work promoting adequate health and social services for homeless people and toward Care Not Cash, suggesting a political position by association.

Staggers continued, "I'm an addiction, hypertension, and published stress specialist. I've been in this business since the 1980s and with the clinic since 1990. Before I came here, I was with clinics in Alameda County, and I direct a Hayward methadone program. I have designed homeless shelters and programs. I trained at Highland Hospital in Oakland. I was surprised because I thought it [allowing himself to be interviewed] was a way to get my feeling out there. He [Garcia] didn't do it that way. He said my words exactly. But it's just the way they're situated. I can't speak for Pablo Stewart.

"It [Garcia's quote] makes it look like, 'Dr. Staggers is saying he supports anything, so he must support this,' and I was say, 'No!' My emphasis has always been making sure the homeless have decent adequate services. Homeless people don't have enough psychiatric, medical, or social services. [What services there are] need more funding, just basic things like bathrooms, showers."

In our lengthy interview, Staggers drew upon his many years' experience as a medical provider to homeless people. He emphasized four points about the illness, suffering, and premature deaths caused by homelessness:

1. "We all know that homelessness wreaks havoc on physical and mental health. Homeless people live a shorter amount of time. One study by Drs. Goldman and Sacks around 1990 first showed that homelessness itself is a risk factor for premature death. Subsequent studies indicate if you are homeless, you have more chance of getting killed, you are at risk for AIDS or TB, for mental breakdown. Homeless people die prematurely. I always emphasize it is hard in San Francisco to find services for my homeless patients. We don't have enough services, and the services we have are at risk of getting budget cuts."

2. "It depends on the city, but a huge number of homeless people have addiction problems. Homelessness and addiction is a significant thing. Statistical studies [reveal that] the number of homeless people who have mental illness, mental illness and alcoholism, and mental illness, alcohol and drug addiction is huge. The overlap between addiction types and homelessness is also huge."

(I asked, "Newsom and his Care Not Cash camp are tarring the homeless with the addiction brush. People say that drug addiction leads to homelessness. People say homelessness creates drug addiction. What is the truth?")

3. "The truth is it can go either way. It's a two-way street. I can't count the number of folks who had decent jobs, were good all-American citizens, then got on drugs, and now they're homeless. We see that all the time.

"However, I have also seen the opposite. For example, most of the women patients I've got are routinely and repeatedly raped within a few days of being homeless because it is very hard to protect yourself. Many of my women have all these survival skills. They reverse their sleep patterns because if they stop moving at night, they'll get raped. They come in to me and they say, 'Doc, I can't sleep during the night. I have to keep moving at night in order to stay alive.' I support [the general public] being educated on how stressful homelessness is because that is not understood. You can tell people I have women who are repeatedly raped. Then they have post-traumatic stress disorder. This can lead to the use of substances in order to anesthetize the stress. People don't know that.

"A lot of people are one paycheck away from being homeless. I see patients who are normal folks who become homeless. They get raped, mugged, beat up. They totally become stressed out, and then they start taking drugs as the result of the stress of the homelessness. I see it all the time – homelessness leads to stress, which leads to drug abuse. I'm glad you asked that question because it is such an important issue that people don't understand. If you are going to write about it, I would be very grateful if you could get this information out there. Homelessness is a major physical and psychiatric stressor which can lead to substance abuse and addiction."

4. "Some take the position that there are plenty of shelter beds. You can't just count beds. You must ask, 'What is the quality and safety of the shelter?' A lot of homeless tell me, and I have visited those shelters myself and observed, that they are horrible and unsafe, especially for women. You are actually safer staying outside than sleeping in shelters."

In the end, Staggers waxed optimistic. "Most of the feedback I've got is positive. I have gotten a lot of calls from folks who took my statement in the Chronicle the right way. They said they were glad to see somebody talking about not enough services for the homeless. Everybody said that the statement that we have horrible poverty – its third world-quality – they said, 'People need to know that.’"

And, in fact, disinformation like Garcia’s will only undermine Care Not Cash's credibility. It may be that the sudden disappearance of support from the medical community will make this proposal nothing more than a visit to Wonderland and the birth of a baby, a pig, or a fig(ment) of Newsom’s political imagination.

Carol Harvey (carolharveysf@yahoo.com) is an artist and journalist. She has a BA and MA in Language, Literature, and History from the University of Michigan in Ann Arbor, and extensive teaching experience. An earlier version of this article appeared in the San Francisco Sentinel.