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Fran Butler-Cohen |
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Dialogue with Tom Blair
(page 1 of 2)
AFTER 22 YEARS at the helm of the Family Health Centers of San Diego, Fran Butler-Cohen accepts responsibility for almost everything and takes credit for very little. “It’s not about me,” she says. But clearly, the phenomenal growth of the centers——from a small Barrio Logan storefront to 24 sites throughout the county——has occurred on her watch as executive director. Accredited by the Joint Commission (on Accreditation of Health Care Organizations)——“It’s not required, but we wanted to benchmark our level of care against other healthcare organizations,” she says——the centers are now moving toward a review for the Malcolm Baldridge National Quality Award. Butler-Cohen, an Alabama native, did undergraduate work at Ohio State before earning her bachelor’s degree in psychology at the University of San Diego and her MBA at San Diego State University. She and her husband have two grown sons.
TOM BLAIR: The San Diego Family Health Centers have been through several incarnations over nearly 40 years. Its original mission, I believe, was to serve the residents of the barrio who had zero healthcare. How did it all start?
FRAN BUTLER-COHEN: In 1970, there was a social service agency in Barrio Logan operated by Neighborhood House——with virtually no healthcare provided. One day, residents of the community borrowed the key, ostensibly for a meeting that evening. In reality, they took over the building. Laura Rodriguez had handcuffed herself to the front door, and there were eight community activists who occupied the building and took it over. Laura actually cooked for them in the little kitchen for eight days. Sheriff Bill Kolender was a young lieutenant on the San Diego Police SWAT team at the time. And he chuckles, now, and says, “I really didn’t know what we were supposed to do, surround the place? I mean, we had a bunch of Mexican grandmothers in the building.” But at the end of eight days, the city actually facilitated the transfer of the property to the Barrio Logan community. And shortly thereafter, they began to do medical services two days a week. It was called the Chicano Free Clinic, staffed by volunteer doctors, and they saw 150 patients a month.
TB: How many do you now see in a month?
FB: Well, about 450,000 a year——so about 37,000 a month.
TB: You’ve been with the center for more than half of its 40 years. What brought you to the barrio?
FB: It was 1986; I’d gone to Los Angeles to get a facility for patients with traumatic brain injury off the ground. I got that established, and a San Diego friend called and said, “There’s this little place down in the barrio that needs an executive director. You’re going to love it.” And I did——it needed help. So I came back——I climbed the rickety steps to the room upstairs where I met with the board——and I remember thinking, “God, I love this place.” At the brain-injury clinic, I couldn’t take Medi-Cal patients, and I certainly couldn’t take people without money. And sitting across the table from these families that were stricken with their injured child with so much promise——and not being able to take them into the program——bothered me greatly. So when I talked to the board of directors here and I found out [people without money] is all you get, I thought that’s the way healthcare should be; it’s a right, not a privilege.
TB: Within the past decade or so, the center began to expand its services rather broadly. How would you define the mission today?
FB: The mission really hasn’t changed: It’s to treat all people who are under-served or uninsured. And underserved can be anyone from a person who just lost their job in the economic downturn, and they don’t have insurance, to a young kid, fresh out of college and working at a company that doesn’t provide health insurance. All ages, all colors, languages; babies, seniors, pregnant women; dental patients, mental health patients.
TB: How many Family Health Centers are there now? And do they all provide the same services?
FB: We have 24 sites. The 12 medical clinics provide similar services in different areas. That includes three 40-foot mobile units that go to almost 100 facilities a month——from battered women’s shelters to underprivileged schools, from the Neil Good Day Center to the YWCA. And then we have two child-development centers to provide screenings for newborns to 5-year-olds. These are kids within our target population——basically lower-income families——42 percent of those kids fail developmental screenings. We have three mental health clinics and three dental clinics. And we have the largest, most-comprehensive HIV services center in the county.
TB: What’s your annual operating budget for all of these clinics and services?
FB: Sixty million dollars.
TB: Wow. How does that compare to your operating budget when you got here in 1986?
FB: It was $800,000——with no money to pay anybody. I kept getting calls from people we owed money when I first came here. So I went down to the County Building and I said, “I’ve got all these bills here. Have you written out all the checks?” “Oh, yes,” they said. “They’re all done.” But I kept getting the calls. So I went back to the county and said, “Show me what we’ve done.” And they said, “There they are, Fran.” And there’s the stack of checks. They just hadn’t mailed them because we didn’t have any money. So I said, “I’d better get busy fund-raising.”
TB: Your programs have not all gone forward without controversy. Your women’s clinic offers family planning that some groups object to. One of your mobile units operates the county’s only needle-exchange program, which has some vehement opposition. Some say the presence of the program in North Park increases crime in the area. How do you respond to the controversy?
FB: Needle exchange is less than 1 percent of what we do, and it’s probably gotten 80 percent of the attention. But we’ve worked with SANDAG, which does all the statistics, and we’ve worked with the police department, and there is no increase in crime——according to those two outside measures——that’s attributed to the needle-exchange program. None. We believe needle-exchange is just another tool to combat the spread of HIV and hepatitis, and to get people referred to rehab and detox. By the way, we’ve taken in almost a quarter-million more needles than we’ve given out. We’re basically cleaning the streets of needles and paraphernalia, and then trying to get people into some form of recovery.
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