Complaints of racial and sexual discrimination spew from inside the Kansas City Health Department.

Communicable Unease 

Complaints of racial and sexual discrimination spew from inside the Kansas City Health Department.

Mel Bowie gets paid to tell people they're HIV-positive. Sometimes they don't want to hear it. A public-health specialist for the Kansas City Health Department, Bowie tries to persuade people to come in for counseling. Once he visited a couple to break the bad news to the husband. The man's wife rushed into the kitchen, yelled that she was going to kill herself and reemerged with a butcher knife. She began to cry. Her husband was going to die, she shouted. No one would take care of her kids. It took several minutes for Bowie and the husband to wrestle the knife away from the strong woman.

"That really made you think about the type of work you do," says Bowie, who has been with the health department since 1984.

Kansas Citians with health insurance don't have to think about the health department much. But the KCHD, which was created more than 100 years ago, provides crucial city services. The department oversees the city's food inspectors and rat exterminators. It measures air quality. At its on-site clinics, kids get free immunizations and adults receive no- or low-cost treatment for sexually transmitted diseases and tuberculosis. Department workers take health education programs to elementary schools and daycare centers, and KCHD nurses visit community centers to check up on senior citizens' physical well-being.

"The only time the public hears of us is when something goes wrong," says department employee Michael Swoyer.

Lately, however, the public has heard quite a bit from the health department. At the end of October, trace amounts of anthrax showed up at the United States Postal Service's underground Stamp Fulfillment Services center, which processes collectors' stamps. Investigators confirmed that mail from the anthrax-contaminated Brentwood facility in Washington, D.C., had found its way to Kansas City. KCHD employees fielded phone calls from a worried public, conducted interviews with stamp-center workers to help determine the extent of their possible exposure and handed out antibiotics.

With the public wanting to know whether the city could withstand a large-scale bioterrorist attack, the health department's director, Rex Archer, quickly became a familiar face on television.

That was fine with Archer, who came to the department in the summer of 1998. For years he has pushed for a better plan to slow the spread of communicable diseases.

In case of a massive bioterrorist attack, the health department's workers wouldn't be on the front line in the same way as firefighters and police or paramedics and emergency room physicians. But they would be at ground zero when it came to providing the critical information each of those groups would need to coordinate their efforts. The faster hospitals and emergency-service providers were in touch with each other and with the department, the faster a potential outbreak of any deadly infection or toxic chemical could be identified and treated. Archer uses a highway analogy to describe the need for better coordination. "You wouldn't think of the interstate highway system where two bridges don't meet over the road," he says. "But we frequently don't come together and say, 'These are our priorities.'"

Away from the spotlight, however, all is not well at the health department -- and some employees think that has to do with the department's internal priorities.

Last February, an employee survey showed that the department's employees had been infected by a culture of boilingdresentment. Workers and managers don't get along -- almost 10 percent of the staff has turned over in the last year -- and the department is clogged with allegations of racial discrimination. Many current and former employees wonder how the department will be able to handle a citywide crisis if it cannot solve its own.

Last fall, the Kansas City Council wanted to make city agencies more receptive to residents who don't speak English by hiring more bilingual employees and by printing city documents and posting city information online in more than one language. In November 2000, the health department formed a diversity council, made up of seventeen volunteers who had been recommended by their supervisors, to look at the same issues. But after a few meetings, the diversity council's focus began to shift as members realized they couldn't meet those progressive goals when no one was addressing basic discrimination complaints.

For years, life at the health department had been tense. Employees felt undervalued by their managers. Minority employees believed their white counterparts had an automatic edge among those reviewed for promotion. Vacant jobs rarely were posted in-house; outsiders scooped them up, limiting opportunity for advancement, especially for clerical staffers. Mel Bowie, who is a member of the diversity council, believes that promotion practices had the effect of segregating many of the black and white employees into different KCHD buildings around town.

For example, until 1996 the department's old clinic for sexually transmitted diseases was located in Todd Hall, a dingy building at one of the city's old public hospitals. (Until 1957, General Hospital, at 23rd and Cherry, was for whites only; black patients had to go to General Hospital II at 22nd and Holmes.) Blacks and whites both worked at Todd Hall, but over the years, Bowie says, many whites were promoted to an administration building at 1423 East Linwood (which had once been a Greek Orthodox church). Soon the church building's staff was largely white, and Todd Hall's was largely black. (Todd Hall eventually was torn down, but the Linwood building still stands and is now home to Habitat for Humanity; since 1996, the entire KCHD has occupied a green-glass-and-brown-brick building with a large atrium at 2400 Troost.)

"Over time, African-Americans stopped putting in for jobs," Bowie says. "We could see promotions going on race lines."

At the end of last year, the diversity council hired a consulting firm to survey employees' feelings about discrimination. All the department's employees had a chance to comment anonymously on how well the KCHD was functioning. Nearly 80 percent of the department's 185 employees completed the survey; 49 percent of respondents were black, 37 percent white and 4 percent Latino.

Some respondents thought the effort was a positive beginning. "The survey is good," one employee wrote. "New administration has already made me feel that there is a concern."

But three-quarters of the health department workers who filled out the survey identified racial discrimination as a problem at least sometimes; 42 percent thought it was often a problem. Forty-four percent reported that they had heard racist language or witnessed racist behavior; 23 percent responded that racist behavior was a frequent problem.

The hurt feelings cut both ways. "Whites are promoted from within consistently and blacks are not ... when it is very clear to all that the internal person is very competent. This needs to change," an African-American complained. Meanwhile, some whites felt that people of color were playing the race card. "Currently I see our organizations (one division in particular) tolerating unprofessional behavior, racist behavior and racist remarks from minority employees that are directed at white employees," wrote one.

The survey revealed other troubles. Fifty-six percent of the people who responded said they believed gender discrimination was taking place in the department. And 41 percent of female respondents thought sexual harassment was a problem. Echoing the race results, 44 percent said they occasionally heard sexist language or saw sexist behavior; 15 percent reported that they frequently encountered it.

"Division directors should keep their eyes in the right place when talking to females," one woman wrote. "Division managers are extremely sexist," wrote another. "This is shown in their preference for male managers -- in their language and in their jokes."

The report also revealed an uneasy relationship between managers and employees. A third of respondents felt their supervisors demeaned them, and one fifth reported that they never or rarely trusted their immediate supervisors. Twenty percent also believed their supervisors never or rarely rewarded them, and 19 percent thought their managers rarely, if ever, respected them.

"The supervisor and manager continue to threaten people's jobs openly to other employees, and that is wrong," wrote one respondent. "The supervisor even told people that came in for interviews that he had some people he would like to get rid of. They are very unprofessional, and they never have an issue with job performance -- just personal issues."

Nearly half of the workers surveyed didn't think that they had a fair shot at raises and promotions -- a figure that rose to 71 percent among staffers of the department's Health Education and Chronic Disease Prevention division, which is the home of many community outreach programs that warn people about breathing secondhand smoke or encourage them to eat right and exercise. "Pay increases within the health department are often issued to employees based on who they know and associate with, and not on that particular employee's work output," one worker complained.

To some, problems like these seemed overstated. One nurse who spoke with the Pitch on condition of anonymity characterized those who complained during meetings at which diversity issues were discussed as less-educated clerical workers. "The ladies just didn't understand the difference between professional and clerical," the nurse said.

But more-educated workers noticed the problems as well. Shirla Ransom has a bachelor's and two master's degrees and worked as a public-health nurse in the tuberculosis clinic. And while the department seemed all right when she first started, things soon turned. There were, she says, "a lot of in-house grievances, especially with promotions. It seemed like people were qualified, but they weren't getting hired." Ransom says that bad morale meant people were late completing reports or filling out bureaucratic paperwork -- though she adds, "I don't think anyone took it out on the patients." Still, fed up with the atmosphere, she left in October of this year.

The last page of the survey gave employees room to describe the culture of mistrust. "I am constantly subjected to racial slurs by my immediate supervisor," wrote one. "I am afraid to approach him regarding his remarks for fear of retribution. I have seen what he is capable of. He uses his assistant to spy on his employees, and that person abuses that power. To be effective within my department, I have to play games. More often than not, I am just the pawn."

One respondent wrote that "the director of a division told me to my face that I was a slave." Another wrote, pessimistically, "Whatever the outcome of this survey is, it will be lost in the next two years. No good practices of treating each other with respect will evolve. Color is still and will always be the problem."

White respondents complained with equal bitterness: "I was going to apply for a supervisory position but was discouraged by others who told me that if I got that position, one or two others would 'yell discrimination.'"

One respondent's fears were still more pronounced: "Right now I don't feel comfortable filling out this survey because my supervisor may be watching -- keeping track of how long it took me to fill this survey out. If it took longer than he thinks, I'll hear about it in a meeting later. The environment is so terrible the entire building has negative thoughts."

Last May, a few months after the survey results arrived, the healing began. Archer and his staff brought their employees into the auditorium in two shifts. They turned down the lights. And there was Denzel Washington starring in Remember the Titans, an inspirational film about a black man hired to coach a newly integrated Virginia high-school football squad in 1971.

Based on a true story, the movie depicts a town in crisis. T.C. Williams High School in Alexandria is being integrated; a white shop owner has just killed a black youth. To make matters worse, Washington is brought in to replace the beloved hall-of-fame-bound white coach, played by Will Patton.

It's an entertaining film with a climactic state-championship game. A star linebacker can't play because he's paralyzed. A defensive standout the team desperately needs has been benched. Will he get a shot at redemption? Who will win? Will the proud coach decide, at the last minute, to turn to the white coach for help in drawing up the final play?

The film forces its black and white characters to learn respect for one another. At the end of the film, a character attending a funeral declares, "People say that it can't work. Black and white. Well, we make it work every day. We have our disagreements of course. But before we reach for hate, always, always we remember the Titans."

Archer says he can think of few, if any, movies that better address the challenges of diversity. Nevertheless, many KCHD employees already remembered the Titans -- they'd seen the movie. One nurse, who has since left the department, scheduled a sick day when the film was to be shown. "Talking to one of my supervisors, he was like, 'If you want to call in sick, do it now,'" the nurse says.

"I didn't understand why it was mandatory," says Nicole Bailey, a clerk who recently left the department. "If people have a certain idea in their head, watching that movie isn't going to change it." Afterward, the employees broke into groups to discuss what they had seen. "They asked us all these questions: How do we feel about this? How do we feel about that?" Bailey remembers. "To me, I thought it was too forced."

Some council members say their peers told them the movie was a good idea. "And there were some who said it was a waste of time," says Hilda Fuentes, who, with Archer, cochairs the diversity council.

But the movie was just the first step in a series of feel-good measures the diversity council has devised to improve life at the health department.

The KCHD also embarked on a secret pen-pal program that lasted about six weeks. Employees were assigned to communicate anonymously with one another by sending notes or small gifts. "People enjoyed the opportunity of getting to know people they didn't ordinarily get to know," Fuentes says.

Or not. "I didn't participate," says Shirla Ransom. "I didn't have time for it. That's a childish game to me. It doesn't help with diversity, for sure."

The council created an appreciation day and a committee to welcome new workers. Council members also have discussed an employee-of-the-quarter award. Some of these ideas have been in direct response to suggestions employees included in their surveys.

But in fact, the survey had given more serious recommendations for the diversity council. At various checkpoints throughout this year, the council was supposed to recommend, and managers were to adopt, three to five "priority areas" for the department to focus on improving. Within 180 days, "senior managers should begin formally holding subordinate managers accountable for improvements in each of the priority areas," and the council was supposed to begin making quarterly reports to employees telling them what actions had been taken.

The department is addressing three priority areas: increasing trust, recognition, respect and reward; creating equal opportunities for employees; and creating an employee office or box for input and suggestions. But the quarterly reports indicate that attempts at solutions have been little more comforting than the exercise in remembering the Titans.

The report takes the form of a newsletter called "Together: A Journal of Diversity," which is distributed to all department employees. It describes what committees in the priority areas are working on. For example, the "trust and respect" committee report includes a tidbit warning employees about gossip, which can "destroy reputations, careers and lives," and recommends several ways to curtail it: Practice the Golden Rule, avoid hearsay, stay silent if you don't have anything nice to say and, "if you find yourself slipping into the darkness of gossip, steer the conversation to something positive."

The "equal-employment committee" responds to employee suggestions. One worker left this complaint in the suggestion box: "You all need to stop moving people around so much in this building. Stop the politics. Promote from within, give grant money as raises to employees. Stop your underhanded hiring." The committee's response: "The concern above raises many issues, not all of which can be realistically answered. For example, 'Stop the politics' is a goal that sounds good, but, when you think about it, it doesn't really address anything. What politics would you stop? In addition, grant money is given for a specific purpose, it cannot be used for raises (no one wishes that weren't true more than us!). It is also important to realize that change is inevitable. The direction of public health is changing. In order for the health department to be in concert with these changes, resoures, including staff, have to be realigned."

The diversity council reports to a leadership team that includes Archer and division heads. Archer often sits in on council meetings, and he has opened his door to all employees at the department. But even with a democratic process and Archer's having taken an active role and solicited input from others, the department has so far done a better job talking about its problems than solving them.

Archer allowed the Pitch only a thirty-minute interview to discuss the KCHD's problems. Archer says that having conducted the survey at all puts KCHD "leaps and bounds" ahead of other city agencies.

He downplays the systemic problems revealed in the survey by pointing out that, when broken down, the results show that employees who have been at the department for a long time are more unhappy than are staff members whose tenure has been shorter.

"Employees who have been here more recently don't see the same issues," he says, adding that other than the city's Neighborhood and Community Services office, no other agency in the city has more minorities in management positions. He points also to the department's designation by Missouri as a "model agency," one of only seven public-health departments so named by the state health office.

The state health department selected its model agencies based on how responsive they were to their communities and their governing bodies, and on what kind of long-range goals they were developing to improve health in their communities. After two years of planning, the model agencies will spend the next four years trying to make improvements throughout the state in the professional development of health-department work forces -- just the area the Kansas City Health Department seems to be struggling with. State health officials, however, were unfamiliar with the results from the KCHD survey. "They're their own private agency, so we wouldn't necessarily know," says Missouri Department of Health and Senior Services spokeswoman Nanci Gonder. "We wouldn't expect to know of surveys they've done with employees."

Archer won't address the state of the department before his hiring, but he offers the broadest possible explanation for its problems. "Three hundred years ago, we had issues with slavery. This society has struggled with diversity in many ways. We are part of that society," he says. "We're making slow, steady progress."

Mel Bowie thinks the council has great potential but that it hasn't reached department employees in a substantive way. "To put it in a baking term, we've made the mixture and put it in the oven, but the cake is not done," Bowie says. He believes activities such as the film and the pen-pal exercise address the social dynamics of the office but do not deal with the problems that caused those dynamics. Newcomers to the department may appreciate these warm-fuzzy programs, but longstanding employees still feel marginalized.

Stephanie Griffith, an HIV-prevention manager, left the department in November after two years. "We have not addressed the issues that really caused the diversity survey: hiring practices, diversity in management, cultural competency, dishonoring and devaluing and racial comments. That's an accepted feeling: This is the way things are," she says.

But the health department's internal problems don't seem to be causing alarm at city hall. Mickey Dean, the deputy director of the city's Human Relations Commission on Civil Rights, says his office has received complaints from the department's employees. But, he says, "I wouldn't say it's an inordinate number of complaints. It's nothing that has caught my eye." He investigated one complaint from a health-department employee in the spring and determined it to be unsubstantiated; he's currently investigating three others. And even though the commission is investigating only five other complaints from all the departments in the city, Dean says that since May, his office has received more complaints from city departments other than the health department. "Sometimes the number of complaints may not be indicative of what's going on, but I can't say anybody has come to me," he says.

The health department is more diverse than other city departments, where, on average, 47 percent of the employees are minorities and 28 percent are women. At the health department, 62 percent are minorities and 68 percent are women.

But while rcher has made efforts to diversify his management team, most middle managers who directly oversee the largely minority lower-level staff are still white. Fuentes, however, who is a Latina, points to herself as an example of positive change taking place at the department over the last few years: the hiring of more people of color in key management slots. Archer appointed her chief of the department's maternal and child-care division.

"The new people can change that culture," Fuentes says.

Frank Thompson, an African-American whom Archer recruited as a public health planner, says he knew Archer was committed to making a positive change when he hired Fuentes. Thompson says Archer chose Fuentes over a white candidate who had good connections at the state level and might have helped the department leverage additional funds. But, Thompson says, Archer chose Fuentes because he believed she would make the department a better organization.

Still, the diversity council has accomplished little in the year since its inception. It's still trying to implement a plan to post open jobs in-house before they are made available to outsiders. Such an action would be what council member Michael Swoyer calls "low-hanging fruit" -- some tangible accomplishment the council can pull off. But it has proven to be more difficult than simply posting a piece of paper on a bulletin board. Some positions are considered "open" but can be filled only if money becomes available. Other jobs can be filled immediately. The challenge is communicating to employees which jobs are which.

Another idea would turn the council itself into a kind of arbitration office, where aggrieved employees could file complaints. But that fruit hangs a little higher on the tree, Swoyer says, and he doesn't know when that plan will be implemented. Nevertheless, he feels the council is doing its best to move forward. "I think it's made a good start, but we need to move beyond the start," Swoyer says.

However, the council's members are aware that employees are getting impatient. "There is a concern the council is not producing," says member Cynthia Davis. "We have to put something out there."

"Morale has not changed," Bowie says. "People who are concerned continue to ask, 'What are y'all doing?'"

Archer says it is clear his department runs well.

"We have made significant progress in our ability to not just work together, but handle an emergency situation," Archer says. "The bottom line is, when I walk through the department, I see people working together. We meet our goals and our responsibilities."

Even before the "emergency situation" with anthrax in October, the department had been putting in place a plan to address bioterrorism, training hospital staff and ambulance crews to warn the department if unusual numbers of people report particular symptoms. The department has also established fax lines and e-mail accounts to handle questions from area physicians who might require information about how to respond if their offices become inundated with sick patients.

At the heart of the new plan is the department's hope to hire thirty people. These new staffers would study data at area hospitals to identify trends and head off an outbreak. "We might be able to find something way ahead of time if we could look at the doctors' data," says Cheryl Woods, the KCHD's spokeswoman.

But paying for thirty new employees won't be easy. Last year the KCHD's budget was $17.5 million -- $7.7 million came from the city, $4.8 million from state contracts and $5 million from the federal government. For 2002, the department has requested $8 million from the city. The department's chief financial officer, Vickie Steinly, doesn't think the department will get it. "The way the economy is going, we're going through budget crunches just like any organization in the private sector," she says.

"Asking [the city] for new positions doesn't make a lot of sense," Archer says. Instead, he's hoping for increased assistance from the federal government, which has included funding to improve readiness at the state and local levels in antiterrorism legislation Congress is considering.

In any event, those new employees may be entering an unhealthy environment.

"Whenever an organization operates under a low morale, you can still get the job done, but not on a high level," Bowie says. "It won't show up on paper, but you can see it on people's faces."

And some current and former employees worry that, with the new concentration on crisis-preparedness, prescriptions for solving the department's deeper problems will go unfilled. "Ten minutes ago we were just talking about diversity," Griffith says, describing the atmosphere at the job she left last month. "Ten minutes before that, we were talking about something else. We don't complete any trip that we start. We just react."


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