By Michael E. Miller
By Allie Conti
By Keegan Hamilton and Francisco Alvarado
By Jake Rossen
By Allie Conti
By Kyle Swenson
By Chris Joseph
By Michael E. Miller
For the past six years, Bobby Zapata has suffered from frequent seizures, possibly due to a childhood head injury, and can't work or drive. Even walking around the block is chancy. Depressed about his condition and inability to work, the stocky, wiry-haired 37-year-old recently started going for weekly counseling. Zapata, who has Medicaid health insurance because of his disability, depends on a Medicaid-funded van service, AAA Wheelchair Wagon Service of Hollywood, to transport him to his medical appointments. The last time he tried to take a city bus, he suffered a seizure at the bus stop and woke up to find his wallet and shoes missing.
Two days prior to a July 26 counseling appointment, Zapata called AAA and scheduled a pickup from his home in west Fort Lauderdale. But the white Ford van arrived only ten minutes before his 1 p.m. appointment downtown, and he ended up missing half of his therapy session. Then he called the service to take him home. The van took several hours to arrive, zigzagged around the county dropping off other riders, and didn't deliver Zapata home until almost 7 p.m. His personal caregiver, Graham Smith, with whom Zapata lives, called to complain. AAA apologized for the problem that day and promised it wouldn't happen again.
But less than two months later, it apparently did. On September 13 Zapata says he waited three hours for the van to pick him up after his noon psychotherapy session. He finally gave up and called Smith for a ride home. Smith, a health care consultant who works in Miami, hit the roof. He called AAA as well as the state Agency For Health Care Administration (AHCA), which runs the Medicaid program, to file another complaint.
Zapata and Smith aren't the only ones who have beefs with AAA, which has transported Broward County's poor and disabled Medicaid recipients to clinical appointments since 1983 and which has been hired by the state as the county's exclusive provider since 1990. Pat Walden, a social services counselor at the county-run Northwest Clinic, says that two weeks ago, a sick patient waited three and a half hours for an AAA van, so she offered to take the woman home herself. "That's one among many cases," says Walden, who notes that it's not uncommon for patients still to be waiting for a ride at the end of the day when the staff leaves.
But state officials and AAA's president, Karen Caputo, insist that these criticisms are grossly exaggerated. While there are inevitable travel delays in a huge county with congested roads and frequent bad weather, they say, AAA provides high-quality, timely service for the vast majority of Medicaid clients. The written provider agreement between the state and AAA, however, contains no specific requirement for punctuality or quality of service.
With its 95 vans, AAA delivered 171,878 rides to Broward Medicaid recipients in the past year, according to AHCA. It is paid $13.54 per ride for those who can walk and $18.39 for those in wheelchairs, which translates to about $2 million a year in total revenue for AAA. The per-ride rates will soon rise 46 percent when Medicaid transportation is folded into a more costly transportation system for disabled and elderly people, run by Broward County Transit. AAA will then have to split the Medicaid business with three other companies, though it will still provide almost half the rides. These providers were selected by county transit officials on the basis of competitive bids.
Caputo says her company picks up more than 85 percent of its Medicaid clients on time, which she defines as within a one-hour window. Deborah Byrnes, an AHCA program specialist who oversees Medicaid transportation in Broward, says that the state does not keep systematic records of on-time performance or client satisfaction. But she says there were only 166 "valid" complaints about AAA service in the past year, and another 100 found "invalid." For example, there are 21 valid complaints about vans not showing up, 53 about lateness, 2 about busy phone lines, and 18 about rude employees. AHCA, however, relies on AAA to investigate complaints, with no independent check done by the state. "We've been consistently satisfied with [AAA's] performance," Byrnes says.
As proof of her company's excellent service, Caputo, a generous contributor to Broward politicians' election campaigns, waves a stack of testimonials from state, county, and nonprofit agency officials. "[AAA's] expertise in routing, scheduling, and training of employees has made the Broward [Medicaid] system almost complaint-free," gushed Sen. Howard Forman (D-Cooper City), in a 1997 letter of recommendation to Palm Beach County officials. Her political support helped her land a new contract to run Medicaid van service in that county, starting this month.
But Caputo's service in Broward looks a lot less peachy to those who are sitting in one of her vans rather than in a politician's easy chair. After Smith had to pick up the stranded Zapata on September 13, he called to complain and left a message for Caputo. An AAA staffer, he says, called him back and verbally attacked him, claiming that Zapata never called for a ride home that day. Smith tried to explain that several staffers at the East Las Olas Psychological Group heard Zapata make the phone reservation. But the AAA staffer hung up on him. So Smith called Byrnes, who assured him she never gets complaints about AAA's services.