A federally funded program that screens low-income District women for breast and cervical cancer stopped providing exams for six months because the D.C. Health Department failed to spend grant money, according to several cancer doctors who provide the services.
More than 400 needy women could not get mammograms and about 450 could not get Pap smears because of problems with the Project WISH (Women Into Staying Healthy) program, said Jeanne Mandelblatt of Georgetown University's Lombardi Comprehensive Cancer Center.
Physicians consider the tests valuable in the early detection of cancer -- especially in the District, which has the nation's highest breast cancer death rates and worst overall cancer mortality when compared with the 50 states. In the District, the tests are performed by private physicians, who are then reimbursed.
Of the $1 million that the federal Centers for Disease Control and Prevention provided to Project WISH in July, the first $350,000 was not released until December, Mandelblatt said.
The remaining $650,000 remains in limbo, said Donald Henson, co-director of George Washington University's office of cancer prevention and control.
The CDC granted $1.46 million to the Health Department for Project WISH and other cancer programs, including $150,000 to help a committee of cancer experts write a plan to coordinate cancer prevention.
However, none of the $150,000 has been spent, and city officials stopped participating several months ago without explanation, said the committee's co-chairmen, Mandelblatt and Henson. The plan cannot be completed on time and will take at least until next year, Henson said. "This is ludicrous," he said.
CDC officials said that they have been aware of unspecified "problems" since October and that they are monitoring the Health Department's use of the grant. They said some of the delays might be related to the release of the money by the D.C. Council.
Francisco Semiao, who worked with the grant before leaving the Health Department last year, said paperwork had to be resubmitted repeatedly before it would reach the appropriate officials at the council or on the city finance staff.
The medical committee suggested that the department assign control over the grant to an outside agency for the good of the public.
The city official who oversees the grant, Stephanie Harper, stopped attending meetings or responding to phone calls, letters or e-mails, Henson said. She did not respond to an e-mail yesterday, and Health Department officials declined to arrange an interview with her.
Henson and Mandelblatt complained about Harper in a June 9 letter to Herbert R. Tillery, deputy mayor for operations. "Her consistent lack of leadership, performance, cooperation and accountability puts the Department of Health in jeopardy of fulfilling its mission and in meeting its contractual agreement with CDC," they wrote.
The Health Department director, James A. Buford, was removed in March, and Mayor Anthony A. Williams (D) temporarily replaced him with Tillery. After hearing about the grant problems yesterday, Tillery said he called a department staff meeting for today to unravel the details.
Since last year, Kathy Wall, an American Cancer Society health planner, has traveled from Delaware to volunteer about one day a week as the planning committee's staff person because the Health Department never provided anyone, she said.
"It's just unconscionable," she said. "The District has the highest [cancer] mortality in the nation, and we're sitting back on money to screen women, and we're not screening them because of bureaucratic incompetence."
John J. Lynch, a volunteer committee member and associate medical director of the cancer institute at Washington Hospital Center, said this episode fits a pattern he has seen often in more than 30 years of dealing with District health officials.
"It's just massive, dysfunctional bureaucracy," he said. "Everybody blames everybody else. They blame procurement and the hiring and firing. It's just a mess, and nobody's ever had the time or patience or wherewithal to get in there and just root it all out. . . . I think there are so many individual fiefdoms within the Health Department that it's very difficult to know who's doing what to whom."