James A. Buford has worked hard at maintaining a low profile J since he became director of the District's massive Department of Human Services (DHS) in April 1980. A highly recommended administrator, Buford came to Washington to harness a system for the unfortunate and the poor that was fraught was problems in the good times, and faces even greater headaches at a time when finances for public programs are dwindling.
The city's largest department, DHS oversees the administration of welfare payments, food stamps, child protective services, Medicaid, alcohol and drug abuse, mental health, preventive health, care for the elderly, the handicapped and the mentally retarded, and more. The department employs about 7,000 people with a $471 million budget for fiscal 1982.
Buford's quiet and cautious stewardship of that empire contrasts sharply with the fire and charisma associated with his most recent predecessors, Joseph P. Yeldell and Albert P. Russo.
District building observers say this lack of pizzazz appears to have cooled the relationship between Buford and top city officials. In recent weeks, when asked by a reporter for their appraisals of various department heads, Mayor Marion Barry and City Administrator Elijah Rogers both failed to give Buford the ringing endorsements they gave to others.
By Buford's own admission, he and the explosive Rogers are opposites. "The fact that we have a different style of management does cause situations for both of us that are stressful, but most of the time it's productive," Buford said. Rogers declined to comment on the matter.
What the reticent Buford lacks in flamboyance, he has compensated for with administrative know-how, many of his DHS colleagues believe. His methodical administrative approach, punctuated by meetings and memos to managers, is credited with shortening the time spent filling out forms and getting clients' questions answered.
"People in bureaucracies often don't feel as great a sense of urgency to get things moving as efficiently as they should," Buford complained.
Deborah Maiese, a special assistant for mental health, views Buford as a no-nonsense executive. "He really demands competence in his employes," said Maiese. "Jim's goal is to give managers everything they need so they have no excuse."
Social Services Commissioner Audrey Rowe credits Buford's push for employe accountability with helping to reduce the welfare error rate from 22 percent to 11 percent. But Rowe cautions that recent changes in the federal law that will require welfare applications to be reviewed monthly instead of twice a year may overload her small staff and push the error rate up again.
Polly Shackleton, a City Council member who chairs the committee on human services, said she has known Buford for some years and is "very impressed with his ability to pull things together." She applauded his untangling of the Medicaid accounting system, enabling the agency to determine where its money is being spent.
Barry was asked recently, through his press secretary, for his view of Buford's work. In his comment, relayed to the reporter, Barry credited Buford with "streamlining" the department by cutting out unnecessary staff and by improving the administration of welfare and medicaid programs. Running DHS, Barry acknowledged, "is one of the toughest jobs in the city. . . . The task to turn this agency around is enormous since DHS has such a long-standing history of administrative problems."
During the past year, Buford and Barry have come under fire from people in the city with a special interest in health for failing to appoint a permanent commissioner of public health. The post has been vacant since 1979. Currently, the job is being held by an acting commissioner, Dr. Martin Levy. Although several candidates have been considered and recommended by Buford, he said, city officials have not been able to agree on the type of person to choose.
In addition, only two of 10 top DHS administrative slots have permanent appointees. Buford says this is because he is still "very actively recuiting . . . for the best people we can find." Shackleton suggested that the air of tentativeness felt by the acting administrators is a major barrier to efficient operation of department programs.
Problems with DHS programs abound.
Early this year, D.C. Village, the city's home for the elderly, voluntarily withdrew from the Medicaid and Medicare programs because of overcrowding, understaffing and chronic supply shortages. Forest Haven, an institution for retarded children, lost its federal funding for similar reasons. Next month, for the first time since 1974, D.C. Village will have all of its 600 beds approved to participate in the federal health programs.
However, progress at Forest Haven has been painfully slow, to the reported consternation of the mayor. Staffing the institution continues to be a problem. City Personnel Office official Frank Crawley, who is in charge of personnel for DHS, said the difficulty is in finding people who are willing to work with retarded children and travel to the distant location in Laurel, Md.
There have been other embarrassments. When the mayor's highly touted war on infant mortality was undermined by a reported increase in infant deaths recently, Buford personally took charge of the public relations effort to explain why the increase occurred and to assure the public that earlier recommendations to reduce the death rate were being put into action.
Buford, 47, a former football coach and teacher from Kansas City, Mo., changed careers about 10 years ago. He completed graduate school in health administration and in 1972 was appointed health and welfare director in Newark, N.J., where, he said, he learned about the complicated issues that urban areas face.
He left Newark in 1977 to come to Washington as a special assistant for the U.S. Department of Health Education and Welfare to plan the still-pending reorganization of St. Elizabeths Hospital. Just prior to returning to the District, Buford spent a year in Dallas, where he was regional health administrator for HEW. He and his wife Ramona now live in Southwest. Their son Dwann attends the University of Maryland.
When Buford returned to D.C. from Dallas last year, he said that he was unprepared for "the magnitude of the financial troubles of the city." Those problems, he continued, have "required me to spend 90 percent of my time, for almost a year, dealing with budget-related activity."
"The biggest bureaucratic problem we have is the inability to get the system to work to meet our personnel needs," Buford said, adding that he found the city's personnel office to be a constant source of frustration. Staff shortages were heightened by last year's reduction in force and early retirement options throughout the city, which reduced the size of DHS by 1,500 positions, of which more than 50 percent were vacant.
Meanwhile, normal staff turnover has left the department with some 500 other vacancies for direct service employes such as nurses and social workers. Social service and health program managers, in interviews, grumbled that staff shortages are hampering services to clients at D.C. Village, Forest Haven, and various health clinics.
Buford blamed the city's personnel department for dragging its feet in announcing and filling those openings. That system "needed some greasing, and that grease has been applied," he said, explaining that announcements for 350 job vacancies were posted recently.
The most painful personnel issue continues to be the appointment of a public health commissioner. Members of the medical community have said they believe Buford made a mistake in failing to appoint Dr. Roselyn Epps, who was acting in that position last year. Buford said she, among others, had been under consideration. Epps said "the job continued to be advertised after I applied," so when the opportunity arose for early retirement, she took it.
Buford contends the $50,000 salary the District is offering health commissioner applicants is not enough to entice qualified physicians to take on the many responsibilities of that job.
Nevertheless, some members of the medical community give Buford fairly high marks. Dr. Arthur Hoyte, a Georgetown physician who chairs the city's Maternal and Infant Health Advisory Board, said he has been impressed by Buford's leadership. "I would be highly intimidated by the task of the job."
Dr. Lewis Biben, president of the Medical Society of the D.C., said that while Buford is responsive to concerns of the city's physicians, the overwhelming size of the department is almost more than one person can handle.
Many agree that Buford's is a thankless job. "If he leaves, I think it would be very difficult to find anyone else willing to take it (DHS) on," said Nancy Smith, director of the Child Advocacy Center, an organization that monitors welfare programs for children. "He's been a breath of fresh air."
If Buford has sought to avoid the limelight, he may have hidden himself too well. A few months ago when the director accompanied the mayor and Rogers on a visit to the city's tuberculosis and VD clinics in Southeast, many of the employes did not know who he was.
But Buford maintains that keeping a low profile has given him "time to fix deficiencies and not be forced to work in reaction to the press." Unlike Russo before him, he does not hold regular press conferences.
But events have not always cooperated. When it was reported that the DHS warehouse was empty, causing supply and medicine shortages for D.C. Village, and the VD and TB programs, Buford had to press the city government to make emergency funds available.
Recently, Buford had to explain to angry employes why 93 mental health administration positions (of which 61 are actually filled) were being abolished. He promised that every employe would be reassigned elsewhere in DHS. In his quiet, halting way, he said, "I'm well aware of the anxiety that is caused by this." Though the employes seemed to appreciate their boss's attempt to explain the situation, they remained unconvinced that the transition would be smooth and that they would end up with jobs to their liking.
At the moment, Buford is spending much of his time worrying about the 1982 budget, and planning for 1983. He said he is concerned that congressional reductions in Medicaid fundings will force the city to make drastic cuts. The District's Medicaid program now pays for health care for about 125,000 residents, but Buford said a tightening of eligibility requirements could cut off benefits to as many as 10,000 recipients.
Buford and his staff will also have to make unpopular decisions about which local services to Medicaid recipients will have to be sacrificed. He said some services might be saved and would be less costly to the city if the department were to contract with private agencies to provide some health care for patients instead of trying to fund full-service city programs.
A recent move to increase Medicaid payments to doctors was designed to encourage patients to seek private care instead of the ubiquitous and expensive hospital emergency room. Local hospitals however, are not happy about this, because while private doctors will benefit from this decision, the hospitals are still being paid at 1979 rates.
Despite the many headaches that have greeted Buford at his office on North Capitol street, he said, "If I had to do it all over again, I would accept the appointment."