Within minutes, the 11th-floor lobby of One Judiciary Square had converted into a hall of prayer. On a Tuesday morning in early March, some 50 District ministers had packed into the antiseptic holding bin outside the mayor’s office—kneeling, in some cases, right down on the carpeted floor—and proceeded to raise hands, sing hymns, and project skyward their urgent prayers.
The intended beneficiaries of the clergy’s divine intervention? The mayor’s soul, approximately 1,200 D.C. government employees, and D.C. General Hospital.
Mayor Anthony A. Williams had tried his damnedest to avoid these religious rabble-rousers. After all, hadn’t some of these same ministers—the Rev. Willie Wilson foremost among them—once linked arms with the mayor and proclaimed that they were ready for a new day in municipal government? A day when the city’s public hospital would stop hemorrhaging tens of millions of dollars a year. A day when hospital management would be accountable and services would be delivered efficiently. A day when the city’s poor would have access to comprehensive, quality health care.
But then, when that dawn arrived—in the form of a Williams administration plan to shut down inpatient services and clinics at D.C. General, the District’s only public hospital, and replace them with a privatized network of primary-care providers—the ministers all of a sudden changed their minds and demanded that the sun never rise.
The “pray-in” at the mayor’s office on March 6 began a little after 10 a.m. and continued for 30 minutes, then 10 minutes more, until before long the protest had exceeded an hour. Williams finally agreed to meet. “It was clear when the mayor arrived that he felt under siege,” recalls the Rev. Robert A. Gessert, executive director of the Council of Churches of Greater Washington.
The mayor had a holy war on his hands. And in this moment of great political need, he put his faith in the one member of his cabinet who had the most experience delivering salvation: Deputy Mayor Carolyn N. Graham, who’s also the Rev. Graham, an associate minister at Israel Baptist Church in Brookland.
Graham had been deployed to mediate the session—and help deflect some of the political heat. Her credibility with believers in the social gospel would be a big help: Graham oversees the agencies most critical to the health and welfare of D.C. residents—the Departments of Human Services, Parks and Recreation, and Health, as well as the Office on Aging. She juggles many of the city’s most challenging human-services crises—including, of course, the controversy over the aging, ailing, much-beloved, and deeply symbolic D.C. General.
“I see what I do as ministry—ministry in the form of government,” says Graham of her job as deputy mayor for children, youth, and families in a city where 36 percent of children live in poverty and 19 percent of those under 18 have no health insurance. “It is a calling. Within the Christian context, we are called to take on those that have the least.”
The mayor needed Graham to cast the health-care debate in just that kind of language. The deputy mayor had often mesmerized secular congregants at One Judiciary Square with impassioned sermons on children’s welfare, child abuse, and foster care. Her reverberating voice and steady cadence had lent added moral authority to Graham’s efforts on behalf of the city’s youngest and most vulnerable citizens.
But at this seminal moment in the D.C. General debate, Graham fell mute. After her brief opening prayer and remarks, the predominantly male African-American ministers in the room largely ignored Graham as they proceeded to savage the mayor and his health plan. “[Her influence] was little or none,” recalls the Rev. Graylan Ellis-Hagler, who preaches at Plymouth Congregational Church on North Capitol Street NE.
“The scripture warns that you cannot serve two masters,” continues Ellis-Hagler. (Ellis-Hagler, it must also be noted, ran as an independent candidate for the mayor of Boston 10 years ago.)
The real question is: How well does Graham serve even one master? Graham oversees the most radioactive assortment of departments and agencies in D.C. government. These agencies handle some of the city’s most complex and troubling social service issues: Homelessness. Welfare. Foster care.
In his inaugural address, Williams vowed that trash would be collected on time, that potholes would be filled, that city government phones would be answered politely. But he also declared an even more demanding benchmark: that his administration be judged not just by shorter lines at the Department of Motor Vehicles, but by its compassion and commitment to the city’s children and most vulnerable. His administration would tackle the tough problems and make difficult decisions.
So on Dec. 7, 1999, Williams made Graham his catalyst for that to happen. Yet, it seems, Graham has been a catalyst for something else: Nearly every agency under Graham’s jurisdiction has suffered some type of nuclear meltdown on her watch. Mentally retarded residents of the city have died of apparent neglect. Homeless people have frozen to death on city streets. Agency directors—like Department of Parks and Recreation Director Robert Newman—have resigned under scandal.
And on the explosive issue of D.C. General, Graham’s been thoroughly missing in action. She’s left it to one of her deputies, Department of Health Director Dr. Ivan C.A. Walks, to speak for her on the issue, leaving many of her colleagues to doubt her own faith in Williams’ health-care plan.
“[City Administrator] John Koskinen has played the point person for the mayor on D.C. General,” notes Sharon Baskerville of the D.C. Primary Care Association, which promotes health-care options for the District’s underserved. “[Graham] has not played a role at all.”
Graham’s defenders argue that she has been a skillful behind-the-scenes broker during the D.C. General debate. “She’s not one to see her name flashed up in lights,” argues Dr. Bailus Walker, chair of the Mayor’s Health Policy Council. “She’s not been out front shouting….She’s a very thoughtful person. She has some very good insights. She tries to sit back and listen to everyone.”
For her part, Graham explains that she has played the role assigned to her. “I’ve had a very low profile in D.C. General,” she says in an interview. “The project was led by the Department of Health. They were the experts. We all deferred to them.”
“We’ve got a good story to tell,” Graham adds. “We’ve just got to tell it in a different way.”
Certainly no one in the administration should know the importance of delivery better than Graham. She should have foreseen the provincialism, the protests, the prayers. She should have known that the proposed shuttering of a hospital—especially the District’s only public hospital, popularly regarded as an inviolable safety net for the poor—would rally unionized hospital workers, D.C. councilmembers, and citizen activists.
That’s because Graham, among the supposed political neophytes who fill the mayor’s governing circle, has lived through it all before.
Graham’s first tour of duty came during the Marion Barry and Sharon Pratt Kelly administrations. After earning her master’s degree in public administration through the National Urban Fellows program, Graham worked in the District’s State Health Planning and Development Agency, climbing to director in less than four years. And she left quite a legacy: Graham completed the 1989 District of Columbia Health Plan, which remains to this day the blueprint for health-care delivery in the District. Budget cuts in the ’90s eliminated funding to update that plan, but the Department of Health plans on releasing a revision this September.
The 1989 health plan offered a comprehensive analysis of the city’s health-care system and the population it serves. And, although it was written back when the city had 628,000 residents and no Public Benefit Corp. managing its public hospital and clinics, the document remains relevant. Indeed, many of the significant issues the report identified remain on the District’s front burner 12 years later: “Several findings…suggest a large unmet need for primary care in the District, including the fact that many patients seek care in hospital emergency departments at very late stages in their illness,” the report notes in one section.
“I would say two things about it,” says Dr. Andrew Schamess, senior deputy director of primary care and prevention for the D.C. Department of Health. “The ’89 plan was a nice document. It has also served as a good guidepost for certificate-of-need decisions.”
Certificate-of-need decisions involve determining how many inpatient beds, obstetrics units, nursing facilities, and so forth a city should have given its demographics. Even in 1989, as the report notes, the District had a surplus of inpatient hospital beds, yet a shortage of primary- and preventative-care services—as it still does.
Just one year after Graham’s report was issued, a hospital-closing controversy erupted that bears some resemblance to the D.C. General brouhaha.
In 1990, Medlantic Healthcare Group, the owner of Capitol Hill Hospital, located at 7th Street and Constitution Avenue SE in Ward 6, asked the city for a certificate of need to close down its 140-bed acute-care facility and convert it into a nursing home. Medlantic contended that the hospital was bleeding close to $1 million a month because it cared for many indigent patients who lived in nearby neighborhoods. Medlantic argued that those patients might be served elsewhere—such as the publicly funded D.C. General.
Graham’s agency initially supported the conversion, backed by quantitative analysis from the state health plan.
But Ward 6 residents vigorously opposed Medlantic’s conversion plan—and D.C. councilmembers quickly hopped on board the populist bandwagon. Hospital supporters held rallies and protests—and even staged a few prayer vigils to persuade the city to keep the facility as a hospital. Then-Ward 6 Councilmember Harold Brazil filed a lawsuit to prevent Medlantic from closing the hospital’s emergency room and demanded Graham’s resignation from the health-planning agency.
Graham had a tough call to make. The numbers sided with Medlantic, but popular opinion didn’t. She could either agree with her own health plan and allow the acute-care facility to be closed down or play politics and keep the facility open. After two years of wrangling and an intervening court order, Medlantic sold the hospital to a group of investors in 1992. Graham essentially punted: She issued a certificate of need that combined acute-care beds and long-term care.
Strangely, when asked about that hospital-closing controversy now, Graham only laughs. She quickly shifts the conversation to what she considers her more triumphant moment in health-care reform, which came not in the District but in Broward County, Fla., where she served as head of the human-services department starting in 1992. Graham’s biggest accomplishment there, she says, was successfully privatizing the county’s three primary-care clinics, placing them under the supervision of the North and South Broward Hospital Districts.
That experience presumably could have helped Graham “tell the story” of D.C. General privatization. Had she chosen to speak up.
Graham left Broward County in 1995 to become national director of the Girl Scouts. She later worked as a consultant to the National Council of Churches, examining health-care issues in Harlem. She moved back to the District in 1998 and did a stint assessing human-services delivery with the D.C. Financial Responsibility and Management Assistance Authority, otherwise known as the control board.
Williams said he had chosen Graham because she was an aggressive advocate for the city’s children. And Graham insists that she’s a die-hard reformer. But when asked about her one fire-in-the-belly desire as deputy mayor for children, youth, and families—the signal cause that truly inspires her—Graham offers up a surprisingly technocratic response: “The one thing that I said to the mayor when he appointed me is that I want to create a comprehensive network of services in this city, and we’ve moved aggressively in that direction.”
She cites her extensive work on the city’s Safe Passages Children and Youth Action Plan as an example. The program reads like a grab bag of public policy initiatives and numerically oriented goals involving children, including a computerized tracking system so District agencies can swap information about the city’s youngest residents. There are five major goals, according to the D.C. government Web site:
* Children are ready to learn upon entering school.
* Children and youth are succeeding in school.
* Youth are developed into successful young adults.
* Children, youth, and their families are healthy.
* Youth-on-youth violence is reduced, particularly in school settings.
In fact, Safe Passages is a strange program for Graham to choose as her emblem on behalf of D.C.’s children: It trumpets sweeping, pie-in-the-sky goals, most of which are nearly impossible to measure.
Even Graham’s own colleagues acknowledge the program’s essential emptiness. “When you scrape below the surface, what’s the substance there?” asks one Department of Human Services (DHS) administrator, who asked not to be identified.
“Her heart is in the right place,” the administrator continues. “[Graham] has a real focus and desire to serve children. The real difficulty has been translating management into action.”
Graham’s real desire, whisper DHS officials, was to create a cabinet-level department for children’s issues. But when new DHS Director Carolyn Colvin came on board this spring, Colvin trumped the deputy mayor and quashed the idea.
Graham experienced her first meltdown two days before she even started the job. On Dec. 5, 1999, the Washington Post published a follow-up to a March series of stories that poignantly chronicled how the multi-million-dollar agency within the DHS charged with protecting some of the District’s most vulnerable residents had profoundly failed. The December articles investigated more than 100 deaths of the mentally retarded and developmentally disabled, which might have been preventable.
The articles unleashed a firestorm of outrage, municipal hand-wringing, and a few federal investigations. So on May 22, 2000, the deputy mayor appeared before a joint session of the D.C. Council’s Committees on Human Services and Government Operations.
“It is no mystery to anyone that the Williams administration inherited a government that was completely decimated as a result of years of disinvestment, mismanagement, and poor performance,” Graham told councilmembers interested in finding out what had gone so wrong with the city’s Mental Retardation and Developmental Disabilities Administration (MRDDA). “Over the last 90 days, we have mounted an aggressive, rapid effort to improve the MRDDA system and remove imminent threats to life and safety. We have already begun a new system of services.”
Graham sounded all the right new-government themes. She said that she had ordered various examinations of the agency, including a review of its overstretched case-management system. Court orders arising from Evans vs. Williams, a class-action lawsuit filed by former residents of Forest Haven, the city’s shuttered institution for the mentally retarded and developmentally disabled, dictated a client-to-case manager ratio no higher than 60 to 1. But, in the community-based residence programs, that ratio was clearly too high to serve clients well. In a revised compliance plan filed with the court, the city vowed to reduce caseloads by half.
The mayor announced the objective at his 2000 State of the District address. Graham even enshrined the promise as one of the goals on her D.C. government performance scorecard: “Increase MRDDA case management staff-to-patient ratio by 100% (1:60 to 1:30).” And in a Nov. 26, 2000, article she wrote for the Post, Graham stated that the yardstick had been met: “We also have…hired 25 caseworkers at the Mental Retardation and Developmental Disabilities Administration to cut caseloads from an average of 60 to 30.”
“Much remains to be done, but we are well out of the gate,” the article continued. “In years past, attempts to remedy problems have been piecemeal….[W]e are making good progress toward creating a system that is responsive and fully accountable for quality services.”
“[MRDDA] has been stabilized,” Graham reiterated in a recent interview. “It’s not perfect yet, but we know what’s going on with it.”
The Post won a Pulitzer prize for its stories. Graham’s stated completion of a goal earned a check mark on her colorful cardboard scorecard in the lobby of One Judiciary Square and helped ensure her a bonus check of $8,288 for the year. And, after all the hoopla, D.C. residents who rely on MRDDA appear to have gotten—so far at least—not very much.
Graham’s upbeat assessment of MRDDA contradicts the most recent information filed in U.S. District Court by the court monitor for Evans vs. Williams. The January- March 2001 report cites case management ratios of 35 to 1 even in January 2001, two months after Graham announced that the 30-to-1 goal had been met.
Only by April 11—the report was filed in May—had the city reduced the case-management ratio to 29 to 1.
But even these reduced outcomes fail to fulfill the compliance plan’s intent. The city agreed to establish not merely an average ratio but an absolute ceiling of 30 clients per case manager. The quarterly report notes that during one week in January, nearly half of the agency’s 46 case managers were juggling more than 30 clients—and that 17 of those case managers were dealing with more than 41 clients at a time.
“Case management is the front-line defense to ensure people get what they need,” says Evans plaintiff counsel Kelly Bagby, a lawyer with University Legal Services. “If case managers are not supported, both through training and manageable caseloads, they can’t possibly protect their clients.”
The problems don’t end there. The city has hired additional case managers, as Graham has noted, but retention and training remain major problems. “In one of our houses, we’ve had the same case manager for two or three months. In our other house, we’ve had four since the beginning of the year,” reports Don Kelly, service coordinator for L’Arche, which has a contract with MRDDA to run group homes in Adams Morgan. “A couple we’ve never seen at all.”
With the revolving door of case managers, the agency has found another way to keep ratios near the court-mandated goal, sources within the DHS acknowledge: slowing down the client-intake process. In other words, leaving mentally retarded and developmentally disabled residents off the rolls and on the streets.
“[Intake] is in a holding pattern,” admits one senior DHS official.
Case management isn’t the only area where Graham has fallen short of her pronouncements. According to the compliance plan, the city agreed to investigate and review all deaths within the MRDDA system. In fact, Graham assured councilmembers in her testimony in May and again in September 2000 that the investigations would indeed occur. But according to advocates, not one review has been completed since Williams swore in the Serious Incident and Fatality Review Committee, on May 31, 2000.
That assertion seems to be backed up by the court monitor’s report. “While no formal reports of Fatality Review Committee activities or reviews have been received by the Monitoring Office, the committee reportedly conducted preliminary reviews of fourteen [patient] deaths that occurred in 2000. There have been no meetings of the committee since January of 2001,” the quarterly report notes. In the first quarter of 2001, MRDDA reported eight deaths.
Shortly after the second Post series hit the newsstands, DHS Director Jearline Williams resigned. Graham assumed leadership of the entire department until a permanent director could be hired.
Before her abrupt departure, Jearline Williams hired Beverly Doherty, an experienced specialist in mental retardation from Wisconsin, to head the District’s troubled agency. But Doherty left after only six months following clashes with Graham, say sources within the department.
And whom did Graham replace her with? Essie Page, a longtime city bureaucrat with no experience in the field, who had previously worked in D.C. Public Schools and the DHS’s Income Maintenance Administration.
In new-government terminology, Graham labeled Page a “change agent” for the MRDDA. Graham’s critics charge that the move was far more old school: They say Page is a Graham acolyte rather than a technical expert. Colvin reassigned Page soon after assuming control and reportedly will hire a new agency director soon.
That Graham is personally and deeply committed to children and families can scarcely be doubted. You can glimpse that commitment in her own front yard. Parked in the grass between her modest red-brick row house and the sidewalk is a bright-red plastic toy car, a one-seater for the 4-and-under set. Graham, 54, lives in the Brookland house with the owner of that car—her granddaughter—and her son and daughter-in-law. A wooden “Welcome Friends” sign greets visitors at the front door.
Graham shares child-rearing responsibilities with her son and daughter-in-law. Some weeknights, when they are working or studying, she takes her granddaughter along to official meetings and appointments.
Graham, too, was reared by two generations—her mother and her grandmother—on a three-acre farm in rural southern Mississippi. “I was raised in a home that embraced strong Christian principles,” she says. “I learned that you must always be conscious of those who have less.”
As a young girl, Graham had a powerful vision in which she saw people “suffering in a city with flashing lights,” she told Fort Lauderdale’s Sun-Sentinel in a 1994 profile. After her mother remarried and moved the family to Baltimore, when Graham was in her teens, she witnessed poverty in an urban setting and interpreted her earlier vision as God’s call to service.
For most of her career, Graham has fulfilled that call in the secular realm. But in 1992, Graham was ordained by the Gethsemane Baptist Church. While serving in Broward County government, Graham also ministered at Fort Lauderdale’s Mount Bethel Baptist Church. She received a master’s of divinity degree from the New York Theological Seminary in 1998.
Graham says she works seven days a week on behalf of the District—Monday through Friday as deputy mayor, and Saturday and Sunday, as well as a weeknight or two, as a minister. Her next career move, Graham says, will most likely be into full-time ministering. “We’ve been busy building the church but not restoring people,” Graham says, “and that’s what the gospel tells us to do.”
At Israel Baptist Church, Graham runs a women’s ministry. The women in her congregation were interested in community outreach, and given her interactions with the Child and Family Services Agency (CFSA), Graham suggested working with teenage parents.
A group home where some of those young women lived turned out to be only a block or two from the church. “That was really quite a revelation,” the deputy mayor says with a smile. “That was truly divine providence.”
The mission became clearer after Graham heard a sermon delivered by Israel Baptist’s senior pastor, the Rev. Morris L. Shearin. “As we approached Christmas, our pastor preached a sermon about the relationship between Mary and Elizabeth,” recalls Graham, referring to the mother of Jesus and her older cousin Elizabeth, the mother of John the Baptist. The pregnant Mary came to Elizabeth, also then pregnant, for advice.
“As a woman, we can only imagine what their time together was like….Mary didn’t know what she was doing,” Graham says. “I decided that’s what this is going to be: This will be the Elizabeth ministry. We will be what Elizabeth was to Mary—we will nurture them, support them, nurture them into motherhood.”
Graham herself was in her preacherly element on Good Friday evening. Dressed in a white-skirted suit, Graham smiled and shook a few hands as she approached the pulpit of the Isle of Patmos Baptist Church off Rhode Island Avenue NE. She had taken the day off from her deputy-mayor responsibilities to prepare her sermon, one of seven that would be given by various guest women ministers assigned to preach about the last utterances of Jesus Christ during his crucifixion.
The service, conducted for an audience of mostly African-American women and children, felt a little like a poetry slam. The first segment, “Father Forgive Them, for They Know Not What They Do,” fell to Angela Simmons, a minister with Mount Sinai Baptist Church. She urged the congregation to forgive. “Even when your boss is talking about you!” thundered Simmons at one point. “Because who is your real boss?”
Hands shot into the air in affirmation. Sitting in her chair behind the pulpit, Graham nodded her head and clapped with enthusiasm.
About an hour—and four utterances—later, it was Graham’s turn. “God, this is your desk that you have permitted me to stand behind,” Graham began in a low voice as she patroled the pulpit, microphone in hand. The other ministers had stood still, but Graham walked around, preaching to both the congregation and her fellow clergy.
“Do you want to be healed today?” Graham asked, her voice building to a crescendo of call-and-response frenzy. “Does anyone know my Jesus today? I invite you to know my Jesus tonight! My Jesus, if you don’t know, will take away all your pain, will take away all your hurts, will take away all your disappointments. He is a Jesus that can make all things new!”
The audience members rose to their feet.
If only Graham were so convincing in her day job.
Last summer, in response to community concerns about adequate shelters, Graham announced that the city would open a “homeless assistance center” at D.C. Village, the city’s former public nursing home, to house and serve some of the homeless.
Located near the bottom of D.C.’s diamond, near the Blue Plains Wastewater Treatment Plant, D.C. Village is in one of the most remote areas of the city. Homeless advocates quickly labeled the center a “gulag” and a “concentration camp.” They believed the homeless were being shunted to a distant location—away from the central city services.
Graham countered that a similar homeless center has done well in Broward County. She didn’t mention, however, that during her tenure there, the county had practiced a distinctly different approach to the homeless: In Broward’s largest city, Fort Lauderdale, a parking lot filled with tents served as its primary shelter.
“Tent City was a festering sore in the center of Broward’s largest city. As many as 350 homeless at a time lived in the stinking, crime-ridden encampment, while dozens more hovered nearby awaiting handouts of food,” wrote Governing magazine in December 1999. “It was a civic embarrassment of the highest order, not only because it showed in the clearest possible terms just how bad the homeless problem had become, but also because it symbolized the lack of political will to do something about it.”
The Governing article made another point about the homeless assistance center, which D.C. homeless advocates voiced, too: It addressed only the easiest-to-serve of the homeless population—those willing to accept help and enter the mainstream. The Broward homeless assistance center, the article noted, had strict rules and regulations, which many of the county’s homeless simply decided not to adopt.
The warnings proved prophetic. Last winter, five homeless D.C. residents froze to death in Columbia Heights and Mount Pleasant—some of them, advocates allege, after being refused entry into city-funded shelters.
Even after the headlines, Graham has been sluggish on the issue. After advocates pushed, Graham did open the Frank D. Reeves Center for Municipal Affairs as an emergency hypothermia shelter this past winter. But activists say that Graham rarely attends homeless working-group meetings, often sending in staffers who are unprepared to discuss the issues. “It shows that there’s a real serious lack of commitment to homelessness and poor people in this city,” says Brian Anders of Neighbors’ Consejo, which works with the homeless in Mount Pleasant and Columbia Heights.
Such distance has put a chill on the deputy mayor’s relationship with advocates interested in combating the same issues. “When [Graham] came in, I was really thrilled,” says one advocate who works on welfare. “Then the door was slammed.”
Graham has been able to avert a Three Mile Island on welfare, so far. In March 2002, 2,600 D.C. residents are scheduled to face their federal five-year ceiling on benefits. But the DHS’s Income Maintenance Administration found an innovative way around that, by switching federal money to local funds and circumventing the time limit.
They did that without much help from Graham or her staff, who have little expertise or knowledge about the subject, say advocates.
Another nuclear chain reaction may now be silently accelerating out of control—at the CFSA. Exhausted and overburdened caseworkers, inadequate foster homes, nonexistent monitoring, and actual deaths of abused children have been the dismal toll. The January 2000 beating death of toddler Brianna Blackmond, a foster child in the agency’s care who had been returned to her birth mother despite a record of neglect and abuse, was so shocking that even Congress was motivated to act, setting in motion an overhaul of the family court system.
The CFSA is now in the process of being restored from court receivership to District government control. That means the troubled agency will soon be back on Graham’s plate.
The issue gets to the heart of the Williams administration: The mayor is a foster child himself. “[W]e must not turn away from foster children like Brianna Blackmond or from persons with mental retardation and developmental disabilities who are entrusted in our care,” said Williams at his 2000 State of the District address. “No one is more outraged than me. I was a foster child myself, and my mother adopted me when they said I was retarded. I’ll never forget the lesson she taught me: There are no disposable people.”
What really worries Williams’ inner circle is another potential Post bombshell. Sources indicate that reporters for the newspaper have been investigating CFSA records for nearly a year.
But if Graham herself is worried about the CFSA—or indeed about any aspect of her vast human-services portfolio—she doesn’t show it. “When you view it out of context, you may see it as overwhelming,” Graham says. “But it’s very doable….We can fix this. This is not rocket science.” CP
Art accompanying story in the printed newspaper is not available in this archive: Photographs by Darrow Montgomery.