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Sidebar: HEO's Priorities For Action SKEPTIC: Henry Stevenson-Perez says HHS's agenda offers few services to Hispanic members of the public. For years, Hispanic health professionals have contended they are severely underrepresented in the Department of Health and Human Services (HHS), a situation that they say jeopardizes HHS's ability to serve a rapidly increasing Hispanic population in the United States. HHS itself conceded this in a document released last September, "Hispanic Agenda for Action: Improving Services to Hispanic Americans." The agenda, a directive from Secretary Donna Shalala, lists a series of actions the department must take to increase its level of Hispanic employment and to provide services-Medicare, Medicaid, access to clinical trials, research monies-to the rapidly growing Hispanic population. Some HHS Hispanic workers laud the agenda as a step-initiated from the highest administrative levels-to improve Hispanic employee relations in the department as well as the department's relations with its Hispanic "customers," or people who use HHS services. Others, however, view the document-and the remedies it prescribes-with a jaundiced eye. They base that skepticism on what they say is HHS's 20-year history of studying problems facing the department's Hispanic work force, then ignoring the studies. The change from consensus to action "has not happened," declares Maria Domitilla Segarra, director of the office of minority health concerns at the Substance Abuse and Mental Health Services Administration (SAMHSA) in Rockville, Md. Segarra, a member of the Department Working Group on Hispanic Issues, which wrote the agenda, continues, "The bottom line is, all of this stuff is disparate; there is no focal point, no staff group, nobody to pull it together. I often see meeting after meeting going back and rehashing old stuff instead of just moving ahead." The agenda outlines several actions to improve the treatment of Hispanic employees and customers. But it also acknowledges a number of problems that HHS's Hispanic employees say need to be addressed. Among these are calls for the department to increase Hispanic representation in its work force; to communicate with Hispanic customers in a language they understand; and to collect health data on Hispanics and increase their participation in clinical trials. According to HHS statistics on its FY1996 work force, 1,451, or 2.7 percent, of its 53,579 career employees are Hispanic. The National Institutes of Health's Hispanic employee level is particularly low at approximately 270, or 2 percent, of the total NIH work force of 13,309 workers and only 39, or 1.7 percent, of the 2,279 employees with higher professional ranking ranging from GS-13 to GS-15. In the September 19 introduction of the agenda to employees, Shalala stated that the low numbers of Hispanic employees at HHS will have an effect on how the department carries out its responsibilities to the U.S. Hispanic population. She pointed out that "there are more than 27 million Hispanics in the United States" and "Hispanics are projected to become the largest minority group in the country. It is critical that we build upon our efforts to serve this group and all minority communities in ways that are culturally sensitive and effective. Part of doing this means addressing the severe underrepresentation of Hispanic employees in our HHS work force." Underrepresentation of Hispanics at HHS is only part of the story, say members of the HHS Hispanic Employee Organization (HHS-HEO), a 20-year-old group with several chapters that represent employees of the Public Health Service (PHS), NIH, the Centers for Disease Control and Prevention (CDC), and other HHS agencies. The HEO is not a labor union with bargaining power; rather, it focuses on the needs of HHS's Hispanic employees and customers. At an HEO retreat last September 7, participants reported cases of discrimination, harassment, and a general indifference to Hispanic issues within the department. Top-level HHS administrators addressed the retreat, and all were willing to discuss how to increase Hispanic representation in the department. But left to the employees in breakout sessions and to a prominent spokesman for Hispanic causes were talk of discrimination, harassment, and downsizing of workers who are Hispanic before those from other ethnic groups. 'GREAT RISK': Hispanic activist Raul Ysaguirre alleges discrimination on the part of the federal government. There is great fear about coming out in public and stating one's problems with HHS. Raul Ysaguirre, president of the National Council of La Raza in Washington, D.C., a national Hispanic advocacy group that grew out of César Chavez's California farm workers' initiative, told those assembled for the September retreat, "Some of you are doing this at great personal risk." The reason there is such risk to Hispanics, says Ysaguirre, is that "the protector of our rights [the federal government] is discriminating against us." The agenda does not acknowledge that discrimination exists in the department. Rather, it recommends that HHS's divisions devise "a short term and long term plan of action . . . for developing the capacity to deliver quality services to Hispanic customers." Included in these plans are instituting recruitment initiatives, promoting hiring opportunities, targeting Senior Executive Service (SES) positions-policy-making posts in the department-for Hispanics, and ensuring that Hispanics are represented in the applicant pool for temporary positions. According to HHS's FY1995 data as published in the agenda, 2.61 percent of 536 SES posts were filled with Hispanics. However, only 1.73 percent of these (eight positions) were career appointments or appointments of individuals who were career government employees. The remainder-six positions, or 8.11 percent-were political appointees of the Clinton administration who need not have risen through the ranks at HHS. Some HHS Hispanic employees are hopeful that the objectives of the agenda are realized. "I tend to be on the positive side of this equation," states Pedro Morales, director of the Office of Equal Employment and Civil Rights at SAMHSA. "Given an opportunity, this is something that the department will want to implement because of the impact this will have in delivery of services to our customers." He hopes the employment objectives will be met. "According to the census data on professions, the census is showing 5.2 percent Hispanic physicians. If the Public Health Service [the uniformed, professional service corps within HHS] would match the 5.2 percent, it would make us very happy." SAME OLD, SAME OLD: Biochemist and community organizer Beltrán Navarros notes that the items in the department's Hispanic agenda have been identified before. "Secretary Shalala kicked off what our Hispanic Employee Organization thinks is a really exciting and much-needed initiative," states health policy specialist Joseph Baldi, Health Resources and Services Administration (HRSA) Border Health Coordinator. Baldi deals with issues related to the health of populations residing in communities located near the U.S.-Mexican border. But others have seen this kind of departmental initiative before and are skeptical that implementation will ever occur. "We do applaud Dr. Shalala for taking a stand [in the agenda]. We just don't like the stand she's taken," asserts oncologist Henry Stevenson-Perez, a tenured senior investigator at the National Cancer Institute (NCI) and president of the HHS-HEO. He is especially critical of the agenda for offering little in the way of services to Hispanic customers, who, he points out, are "taxpaying contributors" to the U.S. government. Biochemist-turned-community organizer Beltrán Navarro, who runs the Latino Economic Development Corp. in Baltimore and was asked to participate in the HHS-HEO by Stevenson-Perez, has met with HHS officials to discuss Hispanic workers' problems and the agenda. However, he notes that the problems and course of actions identified in the agenda are nothing new. "I see that everything that has been said has been studied and is there [in previous documents]." Someone, Navarro maintains, needs to say, "Let's start!" More than 100 federal employees, administrators, and community-based organizational leaders attended a Sept. 7, 1996, Hispanic Leadership Retreat to discuss how to improve services offered to Hispanics by the Department of Health and Human Services (HHS) and the working environment at HHS for Hispanic employees. Retreat participants set priorities for a new vision of the Hispanic Employee Organization (HEO), a group that represents Hispanic employees of HHS. Members narrowed the list, and HEO leaders presented the list in an open letter to Secretary Donna Shalala. In the letter, they asked Shalala to consider incorporating following policies in her initiative, "Hispanic Agenda for Action: Improving Services to Hispanic Americans." An HHS commitment to immediate financial support for Hispanics that is equivalent to the financial support provided to the historically black colleges and universities, for comprehensive approaches to education, training, and access to HHS programs working through public/private partnerships with community-based organizations, schools (K-12), institutions of higher education, corporations, and government. An HHS commitment to the financial support of comprehensive public health, education, and social service delivery sites, starting with the immediate release of $50 million for a community-based demonstration project in the Baltimore area as a model for national implementation. An HHS commitment to customer service policies that are Hispanic-friendly, enforce civil rights laws, establish cultural competency standards for training all employees, and proactively address the issues of language barriers in education, information dissemination, and access to HHS programs. HHS provisions of equal access for Hispanics to HHS services and programs, including health, education, technical and other support services, and resources. Coordination of equal-access activities at all levels of government (federal/state/local). Replacement of current HHS Equal Employment Opportunity programs with diversity programs that have fixed terms for employee-elected officials, rotating among the minorities. Revisions of the HHS grievance systems. Undertaking of an independent, anonymous survey of employees concerning grievances. Establishment of an ombudsman type of employee committee for dispute resolution. Development of specific mentoring programs for Hispanics, and identification of Hispanics with promising career potential to ensure that they receive mentoring and career development opportunities. Targeting of decision-making jobs for increased Hispanic representation. These mentoring programs should be in addition to and in collaboration with HHS programs. Establishment of a strong HHS policy that investigates and reprimands agency managers who retaliate against HHS employees who advocate for increased Hispanic services. Establishment of an HHS program to recruit non-certified Latino health professionals trained in Latin America who can provide Hispanic customer service expertise in HHS programming while also receiving federally supported training to become certified to practice their health profession. Establishment and implementation of a strong HHS employment policy that requires a diverse applicant pool, strict adherence to federal equal opportunity regulations for the severely underrepresented Hispanic work force, and a five-year recruitment program aimed at the Hispanic community, with built-in accountability for managers. HEO should continue to participate in developing HHS policy on Hispanic issues at the highest possible level in the Office of the Secretary. The HEO leadership should also be appointed to the HHS Secretary's Advisory Board on Hispanic Issues, the steering committee for the Hispanic Agenda for Action. HEO and interested supporters should establish a national nonprofit organization with paid staff to advocate for Hispanic issues, sponsor conferences, and so forth. The recommended name of the organization is Hispanics United for Government Employees Inc. (HUGE Inc.). The HHS-HEO structure should be reorganized to be an umbrella organization, with chapters representing the HHS operating divisions as needed, with an organizational charter directly from the HHS Secretary. The HEOs should establish a stronger partnership with existing community groups representing Hispanics/Latinos. HEOs should build coalitions with other organizations and establish improved communication methods, including a rapid response network for responding to Hispanic issues. Segarra points out that the current agenda is not the first time anyone in HHS tried to create a consensus document about Hispanic concerns. Former Surgeon General Antonia Novello, who served during the Bush administration, "had tried to get all of these documents of consensus [and] translate them into a Hispanic Action Agenda," says Segarra. But nothing much materialized from it. To date, months after the agenda's release and after the presidential election, there has been no change in employment situations or in HHS's "customer service" to Hispanics, charges Stevenson-Perez. "There's no demonstration that they intend to close these gaps in customer service," he maintains. In fact, he states, the department has reneged on several promises: to pay for a Hispanic customer training conference and to include the residents of Puerto Rico in the tally of HHS's Hispanic customer base. Stevenson-Perez explains that the department removed the training conference from the final agenda; and, in a hair-splitting move, the agenda listed Hispanic customers at 27 million, which excluded the 3.5 million Hispanics residents of Puerto Rico. Yet, as Stevenson-Perez points out, those Puerto Rican residents are HHS customers. But sources within HHS report that, to date, the initial stages of the agenda have been put into place. The Departmental Hispanic Steering Committee, formed by the agenda under the direction of HHS Deputy Secretary Kevin Thurm, has met. HHS agencies all submitted plans mandated by the agenda by the deadline of Oct. 30, 1996, and these plans are now being analyzed. The next steering committee meeting was set for this month. HEO's Role The Hispanic agenda is inextricably tied to the activities of the HEO, which was chartered by HHS in 1981. The precursor of the HEO began meeting in 1975-76 and "advocated for greater recruitment and hiring of Hispanics," states HRSA's Baldi. The HHS-HEO has participated in departmental and agency studies on Hispanics since 1979. Novello's initiative was fairly broad. She held meetings around the U.S. in cities with large Hispanic populations to discuss Hispanic community health-related issues. In June 1993, a report entitled "Recommendations to the Surgeon General to Improve Hispanic/Latino Health" -familiarly known as "TODOS," which is Spanish for "everybody"-was issued. "TODOS" cited many of the same issues noted in the agenda. Nothing resulted. According to Stevenson-Perez, in 1995, under pressure from the HEO, Principal Deputy Assistant Secretary for Health Jo Ivey Boufford rereleased the "TODOS" report for review and recommendations by HHS's agencies. Boufford also organized the group that produced the agenda. Because of the sympathetic ears of Boufford, HHS Assistant Secretary for Management and Budget John Callahan, and Shalala-all but the last of whom participated in the September HEO retreat-some see that this may be the right time to get some action on both Hispanic employment and customer service issues from HHS. "It is time for action," claims Segarra, who is both disappointed and frustrated with the department's previous efforts to deal with Hispanic issues. "The opportunity [for action]-not fiscally, but time and good will-is now." The HEO retreat briefing materials include statements about problems within the department. Among these are charges of discrimination against Hispanic employees. "The HEOs frequently receive individual reports that confirm the obvious: It is virtually impossible for Latinos to get hired to HHS positions," the briefing materials state. Although many participants at the September HEO retreat complained about discrimination in hiring and promotion, Hispanic employees receiving pink slips before other employees, and numerous large and small acts of discrimination or retaliation against them for supporting Hispanic employee or community causes, few were willing to go on record to The Scientist. Several sources say that the only case in court involving alleged discrimination against a Latino scientist is one that Stevenson-Perez is pursuing against NIH. However, he refuses to discuss his case on the record at present, hinting that it would be legally disadvantageous for him to do so. These sources note that Stevenson-Perez has access to the highest officials at HHS as president of HEO and that he was the moving force behind the action leading to the agenda, but he is prohibited by NIH from doing scientific research. Some sources contend that this is in retaliation for his activities on behalf of Hispanic employees, pursuits that he devotes his time to now. Despite allegations of discrimination at HHS, there are two Hispanic administrators: Ciro Sumaya of HRSA and Nelba Chavez of SAMHSA. Others, too, have moved through the HHS ranks. "I'm sure those problems [discrimination] exist, and I'm sure they exist in the intramural program in the NIH and the extramural program," says microbiologist Ernest D. Marquez of the National Institute of General Medical Sciences (NIGMS), who now is head of the NIH-HEO. Marquez, whose six-year NIH career has been devoid of discrimination, is an NIH success story: "My own history at NIH has been one of very rapid progress." Richard Martinez, scientific review administrator at NIGMS, also has suffered no discrimination. "Professionally, I can't complain. It would be ridiculous to do so," because he has no personal experiences to complain about, he states. But Martinez, too, says he knows of cases in which discrimination has occurred. Because many HHS employees are members of the commissioned corps of PHS, they do not have access to Title 6 or 7 discrimination suits-legal rights that most workers have to file discrimination actions. Furthermore, PHS commissioned officers do not have access to a grievance procedure independent of their supervisors. Even those civil service workers who are not restricted by being PHS officers and could bring a discrimination suit do not, explains an Equal Employment Opportunity (EEO) officer at HHS on condition of anonymity. The EEO officer states that the grapevine makes sure one who complains has little chance for future employment. "Heads of labs won't touch you." The HEO's priorities both overlap and are broader than the agenda's priorities. At its September retreat, the HEO devised a list of priorities for action. On October 2, it presented this list of priorities to Shalala. Among these are establishing "a strong HHS policy that prohibits, investigates, and reprimands [agency managers] who retaliate against HHS employees that advocate for increased Hispanic services," replacing the HHS Equal Employment Opportunity programs with a revised grievance system and ombudsman-type committees to resolve employee disputes; and creating mentor programs for Hispanic employees. For Hispanic HHS customers, the group called for equal access for Hispanics to all HHS programs; $50 million in support for a community-based demonstration public health, education, and social services project in the Baltimore-Washington area; and fiscal parity in HHS funds between historically black colleges and universities and Hispanic-serving institutions as defined in Executive Order 12900, Educational Excellence for Hispanic Americans. Signed by President Clinton on Feb. 22, 1994, the order supports funding of educational opportunities for Hispanics. It attempts to bring Hispanics to parity with African Americans by giving additional support to undergraduate institutions whose student population is greater than 25 percent Hispanic and to health-professions schools with Hispanic enrollment greater than 9 percent. Stevenson-Perez makes it clear that if pressuring HHS does not yield a response to the HEO's requests, the HEO will do what it needs to do to have its case heard-including going to members of Congress. But he adds that the HEO does not wish to see an increase in lawsuits against HHS. "That's everything that the HEO initiatives stand against." He hopes HHS and the HEO can "come up with immediate, cost-effective, win-win solutions to the problems we've identified." Myrna E. Watanabe is a science writer based in Yonkers, N.Y.

Hispanics At HHS Note Progress, But See Problems With Action Plan

Jan 19, 1997

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