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.
"I can withstand this flak, that's my profession," says Smith, who hears housing discrimination cases involving people with HIV and AIDS for the City of Miami. "But people on Medicaid are in an economically disadvantaged position and not as likely to speak up for themselves because they are afraid of retribution. If they treated me that way, how do they treat the people who need the services?" he asks.
Neither AAA nor Byrnes ever got back to Smith with the result of his complaint. Byrnes says the general policy is not to notify complainants of the outcome. But AAA did provide New Times with the results. The company determined that the complaint was "not valid" because no call for a pickup was received and recorded on its call log. But if AAA staffers had checked with the counseling clinic, as New Times did, they could have talked to two clerks who swear that they heard Zapata make the phone reservation on September 13.
Caputo also explains that her agency was swamped with emergency calls on September 13, the stormy Monday when everyone was fleeing Hurricane Floyd. Even on normal weekdays, she adds, there's nothing she can do about longer waits in the early afternoon, when demand peaks. She claims that Smith's complaint was an attempt to get special treatment for Zapata. "Graham Smith is a very nervous person with unrealistic expectations about service," she says.
Nervous or not, Smith's grievances are echoed by the staff at the East Las Olas Psychological Group, the Broward House, CenterOne, and KRU Medical Ventures, many of whose patients use AAA Medicaid vans. Clinicians and clerical staff at those agencies say that long waits for pickups are frequent, particularly for return trips home. These waits can be debilitating for people who are sick or on medication regimes that require them to take their pills with food. Zapata, for instance, sometimes gets auras, which are warning signals of impending seizures, when he is worried about whether the van will arrive on time or when he has to wait outside in the hot sun.
"Some patients have quit coming for therapy," says Elizabeth Brochu, an East Las Olas psychotherapist who recalls problems going back at least five years. "They just give up because they say it's more hassle than it's worth. It often takes a big part of the session just to calm them down from the transportation problems." Two weeks ago a client who had been waiting for an AAA pickup for more than an hour started yelling in frustration, disrupting other client's sessions.
Staff at the various clinics say that just getting through on the phone to arrange pickups from appointments is usually a long, trying process. "When I call [AAA] to make an appointment, I am constantly on hold," says a receptionist at Broward House who has worked there for four years but didn't want her name used. "You'll be holding for 30 to 45 minutes. Once, the line was busy for two hours." She says patients sometimes miss their medical appointments and have to reschedule because the AAA van was late or didn't show up at all.
Caputo says she personally reads every complaint on the day it comes in. "When we are wrong, we apologize," she says. "We don't try to blow smoke up anyone's ass for any reason." But she remains confident that most of her clients are satisfied. "They know what to expect from the service, and they know that sometimes they have to wait a little longer, and that's acceptable," she says.
Smith, however, finds that attitude toward people who are poor and sick completely unacceptable. "A lot of people think, 'You're lucky to have any transportation, so just shut up.'" he says. "These providers do what they damn well please, without consideration to individuals. I'm not interested in special handling for Bobby. I want all the patients treated right."
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