If Lubbockites need Title X-funded family planning services, the closest option is the South Plains Public Health District in Brownfield, a community — with a population of about 9,700 — approximately 40 miles southeast of here.

Despite Lubbock’s notoriously high sexually-transmitted disease and teenage pregnancy rate and population size of about 240,000, citizens do not see a single cent of Title X funding, and the answers from those behind the scenes are vague.

Fran Hagerty, the CEO of Women’s Health and Family Planning Association of Texas, said a falling out occurred with Generation Healthcare after its CEO, Merinda Condra, assumed the former Planned Parenthood of Lubbock. Condra said a dispute over Title X funds, which are solely distributed by WHFPT, have led her to repeatedly threaten legal action against Hagerty.

Condra sat at a long table with her mother and dog by her side for support. Tears filled her eyes as she recounted the timeline of the creation of Generation Healthcare and the beginning stages of its closure.

“The left torpedoed Title X funding because we disaffiliated from Planned Parenthood,” Condra said. “The right is going to because the entity used to be Planned Parenthood. In between are the women of this area who will be denied services.”

Title X funds are federal funds granted to clinics to make it possible to provide affordable sexual health care and family planning services to people who meet the requirements.

In Spring 2013, Women’s Health and Family Planning Association of Texas won the $13 million grant — originally $14.5 million — taking Title X away from the Texas Department of Health and procuring funds for Planned Parenthood and other clinics.

In Lubbock, though, preventive care for low-income women and men has been another casualty in this battle. Generation Healthcare, a family planning clinic that dissociated itself from Planned Parenthood after taking over what was formerly the only abortion provider in Lubbock, is going up for sale.

The clinic has struggled financially ever since it renamed itself and severed ties with Planned Parenthood programs across the state. Form 990s obtained from the organization show net assets plunged from 2012 to 2013 — from more than $800,000 to less than $500,000. The documents also reflect revenue has plummeted from over a million dollars to about $200,000 between those two years. In 2013, however, revenue has dropped to $131,000 with a deficit of about $104,000 after its operational costs.

The remodeled brown clinic in South Central Lubbock stood empty with a large blue and white “For Sale” sign on the street side of the property. The parking lot was empty, but that didn’t deter women from stopping by and asking if the clinic was open.

Condra pulled up in her personal vehicle and stepped out when a woman waiting in a small, black car asked about being seen; she said it was urgent. Condra held a brief conversation with her, and the woman got back into her car and drove away.

Fran Hagerty, the CEO of Women’s Health and Family Planning Association of Texas, said she has had a dispute with what used to be Planned Parenthood of Lubbock, which was renamed Generation Healthcare and is currently run by a new CEO, Merinda Condra. Since the takeover in October of 2013, a dispute over Title X funds solely distributed by WHFPT have even led Condra to repeatedly threaten legal action against Hagerty, she said.

The Emails

A month before the disaffiliation and the United States Court of Appeals for the Fifth Circuit’s decision to uphold tightened abortion clinic standards, Planned Parenthood of Lubbock began to solicit Hagerty for Title X funds. Two weeks after contacting them, an email transcript obtained by Hub@TTU reporters showed the clinic looked like it was going to become a provider in the state’s Title X network.

“Once you have looked them [policies and procedures] over and made the final determination to join us, we might want to hold a conference call with your staff and mine to answer questions and gather the information we will need to submit a ‘Change of Scope’ application to the Office of Population Affairs (OPA) to get approval to include you in our network”, said Hagerty to Tara Haskell, the then President-CEO of Planned Parenthood of Lubbock. “Together, I know we can make this happen!”

Hagerty got word from her chief financial officer that things were starting to change around the Lubbock clinic after the board of directors met. She said in the email she didn’t want to waste any time in submitting the change of scope approval and including them if OPA approved.

“We are so excited to have you, Tara,” Hagerty said in the email, “and want nothing more than to support you in the vital work you do for the community,”

“We are thinking of changing our name but still want to be involved with Title X, especially as there are no Title X providers in this neck of the woods,” Haskell replied.

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Haskell added that the tax ID number would remain the same, and Hagerty said that decision would have no affect on the clinic’s Title X status. When October came, the clinic’s name and ownership changed and so did WHFPT’s decisions.

Severed Ties

A little over a week later, the name change was implemented, and Generation Healthcare severed all connections with Planned Parenthood of Lubbock. Some of the original board members remained, including Haskell, and when the application was making precarious progress, Condra called Fran to ask her about its status.

“When I asked if every organization that changed its name was required to reapply as a new entity, you asked if I thought that was our situation,” Condra said in a follow-up letter to Hagerty, “When I stated that it was, you responded, ‘So, you are still a Planned Parenthood affiliate?’ To which I responded ‘no.’ You stated, our organization ‘agreed to work with a Planned Parenthood affiliate.’ When I asked if every organization that disaffiliated with Planned Parenthood was going to be denied funding and forced to reapply as a new organization, you stated ‘yes.’”

A clinic representative in Hidalgo County, in Texas’ Rio Grande Valley, had a different story to tell.

“As far as the Title X funds, we didn’t have to reapply whatsoever,” said Kathryn Hern, the community services director of Access Esperanza’s Hidalgo County clinics, formerly known as a Planned Parenthood affiliate. “We just had to let them know of the name change.”

The only difference between Hern’s situation and Condra’s, is that  Access Esperanza’s Hidalgo County clinics were already Title X clinics when the organization operated as a Planned Parenthood affiliate, unlike Planned Parenthood of Lubbock.

The letter showed Hagerty told Condra she did not know Generation Healthcare, even though Condra maintained it is the same legal entity: same services, same Medicaid number, same charter number and same tax ID number. Hub@TTU reporters obtained records verifying Condra’s statement.

For Condra, she said she felt the deal breaker was the decision to not associate itself with Planned Parenthood, the most widely known recipient of WHFPT’s Title X funds.

The letter also shows Condra pressed for specifications of recipient qualifications for clinics after Hagerty had stated WHFPT doesn’t have to give funds to anyone short of their standards.

According to her letter, Hagerty admitted there were none.

Condra had said that was odd for an organization with an instrumental role in Texans’ sexual health.

“We are simply trying to provide desperately needed services to the women of this area,” she said. “We have no interest in playing politics with women’s lives. Any attempts by your organization to withhold Title X funds to dissuade entities from disaffiliating or to punish organizations which have disaffiliated from Planned Parenthood is wholly improper and a violation of both state and federal law.”

On top of the setback that occurred after the takeover, Condra said she had also been denied funds because she was not referring patients to abortion clinics but providing counseling and adoption information as an alternative. She said this compelled Planned Parenthood to cancel them by delaying her clinic’s application process.

Truth Be Told

Carolena Cogdill, Title X recipient and CEO of Haven Health Clinic, said her clinic provides patients with several options, including adoption, but abortion referrals are barred from Title X funded clinics.

“We don’t refer anybody anywhere,” she said, “and neither does any other Title X clinic.”

Bell County Public Health District in Temple, Texas, second Cogdill’s statements. However, South Plains Public Health District does things differently.

Soronya Shafer, director of nurses at the South Plains Public Health District, said she does give abortion referrals to clinics with patients in need. Under federal law, a clinic may issue a referral if the patient’s life is in danger either due to a form of violence or illness.

A contract with WHFPT does reflect an unbiased approach to counseling pregnant patients, which would include abortion information, but the contract was signed by Tara Haskell, former CEO of Planned Parenthood of Lubbock. Whether or not Generation Healthcare assumes this responsibility, which Condra said she doesn’t, was not explicitly stated in the contract.

The contract was presented to Condra, and she said she had never seen it before.

Hagerty said it was inaccurate to say the setback happened because there was a disagreement over Generation Healthcare as a new entity. The reason the entity was denied funding, she said, was because she didn’t see an increase in Title X funding. Furthermore, she said, the paucity of Title X funds in the first place doesn’t give her the flexibility to divide the money even more.

Condra said $150,000 was already reserved for Planned Parenthood of Lubbock prior to the name change, when Hagerty knew the board of directors.

She said this has led her to believe funding was denied because of her dissenting views.
When asked to elaborate on the fight with Condra, Hagerty said she could not disregard her lawyer’s advice by talking about it. Condra said she does not plan on bringing any legal action against Hagerty and plans to focus on her latest project — turning the abortion clinic into an educational center for children dealing with learning differences.

The Generation Healthcare Facebook page shows its profile picture as a white square with bold red letters displaying the words, “CLOSING DOWN.”

Condra sat at a rustic-style wooden table as her mother sat looking on while petting their small dog. At times, a pause would give her a chance to compose herself as tears continued to fill her eyes.

After the dust has settled over this, Condra said she remains optimistic of the future but laments her cause being subverted by political polarization. She said while everyone involved should be more concerned with taking care of women, that is not what she has experienced.

She said this has been a trying year as they have spent the better part of it fighting to keep their doors open to help serve women in the Lubbock area.

“There are women hurting and their children hurting,” she said, her mother staring at her as her words slowed and softened, “and we have people playing politics back and forth.

The clinic was approved for funds under the Texas Women’s Health program which provides the clinic with about $5,000 a month. She said they were awaiting to hear about their request for expanded primary health care, which is more broadly based by providing services for women who are not necessarily of reproductive age. She said funds are crucial because most of the women who go to her clinic do not qualify for Medicaid.

She called the actions of the OPA and WHFPT impermissible, abusive, and possibly actionable under Texas law.

“Do we want to spend our time fight or do we want to spend our time helping?” A visibly upset Condra asked. “We all have a limited number of years on this Earth, and we have limited hours in each day. And, for me and my organization, a successful life is one that makes this world better. We have to measure how we’re going to spend those hours, how we’re gonna spend those years to make the world a better place.”

 

 

 

Previous: All-in-All: My Own Words                                                                                                                                                                                   Next: An About-Face with Title X Funds

When Merinda Condra was denied Title X funding for her reproductive health clinic, she was told there were existing clinics in this region receiving these funds. Although this is true, conflicting reports cloud the truth.

Condra, CEO of Generation Healthcare, said after a long messy battle over funding, she is closing the doors to her clinic. Unfortunately, women in this area are going to feel the effects of another casualty in the state’s reproductive health care war.

 

 

 

 

 

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She said as she was delivering adoption literature in 2012 when the Planned Parenthood staff approached her. In discussion, she said, she was told they were looking to change; she wanted to help. In the Fall 2013, Planned Parenthood of Lubbock became Generation Healthcare with Condra holding the reigns.

“The intent was to take the whole Planned Parenthood abortion debate and politics out of that clinic,” Condra said, “and make it just about helping women.”

Condra said the denial of funds came as a shock to her because she felt confident about the change — including the Title X application. The distribution of funds is the sole responsibility of Women’s Health and Family Planning Association of Texas and CEO Fran Hagerty.

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WHFPT was neglecting her communication efforts after steady correspondence between the agencies, she said. Once denied, Condra sought answers, and in a final effort, she wrote a letter to Senator John Cornyn.

The letter justified Hagerty’s decision by stating there are five existing Title X clinics in public health region 1. The WHFPT website shows four, and a representative for the United States Department of Health and Human Services said there are only three within this region.

When asked about the clinics and the funding, a representative with Cornyn’s office said that was a figure given to them from HHS. Office of the Assistant Secretary for Health representative Diane Gianelli said her records indicated three clinics, none of which are located in Lubbock County.

When asked for a further explanation, Gianelli said she would contact the Office of Population Affairs. Their response never came.

Carolena Cogdill, CEO of Title X-funded Haven Health Clinic in Amarillo, Texas, said she is surprised clinics in Lubbock are not receiving funds.

“It’s absolutely critical for women in the state of Texas to get complete care,” she said as she explained the strict requirements women need to meet in order to receive care under the Texas Women’s Health program.

Texas Women’s Health program, Cogdill said, covers women of reproductive age, and to apply, women need to provide proof of Texas residency.

About 40 minutes away, citizens of Brownfield can drive to the South Plains Public Health District clinic. As a Title X provider, this clinic can see both men and women, but funds are limited as they are distributed based on the clinical needs of the county.

Based on information received through various Title X websites, Lubbock residents are limited when it comes to reproductive health care. The drive to the smaller community seems to be encouraged and may be essential in dire cases.

Soronya Shafer, director of nurses for the South Plains Public Health District, said their Title X funds cover four different locations, but only one is located in public health region 1.

“The Title X is a little more inclusive as far as eligibility guidelines for clients, so it’s valuable to us because of that,” she said as she stressed the importance of Title X funding for the four locations she oversees.

She said Title X differs from state reproductive health funds because it covers teenagers as well as men.

Why not Lubbock?

With Title X playing such a vital role in the state’s reproductive health care, Lubbock County, an area notorious for high rates of sexuallly transmitted diseases and unplanned pregnancies, is without Title X-funded clinics.

Fran Hagerty, CEO of WHFPT, refused to comment on the situation between her and Generation Healthcare and the number of applicants out of the Lubbock region. However, she said Title X funds are coming into Lubbock.

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Documents obtained by Hub@TTU reporters showed Title X funding was indeed distributed to this area. When asked, Hagerty confirmed the Texas Tech University Health Sciences Center as the only agency in Lubbock that receives funding through her organization.

“To give you a sense of that in comparison to other places in the state,” she said, “our office is located in Austin, which is a much bigger community than Lubbock, and we only have one Title X provider in Austin as well.”

Hagerty said her organization has an established set of providers who receive funding, but documents showed she was ready to provide funds to Planned Parenthood before Condra took over.

Condra was not the only one denied Title X funds. Hagerty said WHFPT was unable to bring on new providers until the association is granted more money by the federal government.

“We are not going to take money away from them (existing providers) and from the wonderful work that they have,” she said, “to bring new providers on.”

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State of Confusion

Representatives for the Texas Tech University Health Sciences Center-Permian Basin campus in Odessa, Texas, said the regional campus receives funding through WHFPT. Several government websites show the Permian Basin campus as an active provider, unlike the Lubbock campus.

Hilary Majors, a representative for the Health Sciences Center-Permian Basin, said the Department of Obstetrics and Gynecology received more than $36,000 during the 2013 cycle and more than $208,000 in 2014.

According to a budgetary document received from a representative of the Health Sciences Center in Lubbock, they receive more than $158,000 in Title X funds. Mike Crowder, the vice president of business affairs at the Health Sciences Center, said the Lubbock location sees none of that money.

Lubbock representatives, including Crowder, claim the funds are distributed to the Permian Basin campus, but none of the documents delivered from Odessa reflect this statement.

In a last effort to obtain more information, a request was sent out to view the same type of financial documents the Permain Basin campus released, but the Health Sciences Center-Lubbock representative Kevin Williams said no such documents exist.

Executive Director of Communications and Marketing Mary Croyle said when it comes to the situation at hand, she could not speak for Fran Hagerty. She also said their obstetrics and gynecology department serves people regardless of the circumstance. However, when asked about their knowledge of Title X funds, the response was the same all across the board: no one knew about the grant.

The Hub reporters were told by various Health Sciences Center officials that the Texas Women’s Health Program was used in Lubbock. According to the program’s guidelines, the program is predominately for women of reproductive age. Condra states Title X funds serve both men and women.

 

The Health Sciences Center’s Mike Crowder said he contacted WHFPT after being interviewed and was told the Health Sciences Center’s Lubbock campus does not receive Title X grant funds.

WHFPT CEO Hagerty’s response claims otherwise.

Condra sat behind her desk and accessed the Office of Population website. As she explained Lubbock’s lack of funding, she typed in “Lubbock” in the Title X clinic search field.

“Look,” she said as she pointed to the screen. “There are none in this area. Now watch this.”

She expanded the search radius to 10 miles, and being unsuccessful, she moved up to 25 miles; nothing showed up. She finally broadened the search to a 50-mile radius, and Brownfield appeared on the map.

Condra said she knew the Health Sciences Center-Odessa received funds, but she wasn’t sure where the five clinics within public health region 1 are located, even though Senator Cornyn’s office representatives claimed they exist.

Although the clinic was something Condra had her sights set on, she said political biases are everywhere and it does not make sense to her

“Go ahead and fight about the other things,” she said, “but let’s get together and help these women,” she said. “Surely, we can agree on that.”

 

 

 

 

 

 

 

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