Black babies in Milwaukee are three times more likely to die before their first birthday than white infants here.
City officials on Friday cheered the return of a five-year, $5 million federal grant to combat the problem — a grant Milwaukee lost five years ago.
But friction quickly surfaced over who got the grant — and who didn’t.
Milwaukee Health Services, the second-largest community health center in the city, and three African American groups said its proposal to run the Healthy Start program was undercut by the city’s new health commissioner when she encouraged Children’s Hospital of Wisconsin to also apply for the grant.
But Health Commissioner Jeanette Kowalik said the group didn’t heed concerns that it planned to name former interim commissioner Patricia McManus to direct the program, five years after a group she leads lost its Healthy Start grant. Kowalik said state officials expressed similar concerns.
The group, known as the Milwaukee African American Perinatal Health Collaborative, eventually received a score of 96 out of 100 for its application, said Tito Izard, a physician who is president and chief executive officer of Milwaukee Health Services. Proposals with lower scores in other communities received grants, but the collaborative lost the grant to Children’s, which received a score of 100 for its application.
“We had a competitive grant,” Izard said, “and we were undermined.”
Kowalik said the city supported both proposals but contacted Children’s when she and her staff became worried the group would not make the deadline for the grant.
“My intention for all of this was about bringing Healthy Start back to Milwaukee to prevent black infant mortality. Period,” Kowalik said. “And at the end of the day, it’s back in the community.”
‘Everybody has to work together’
Izard saw the federal grant as a chance to help build leadership and organizations within the African American community, and he was frustrated to see the grant instead go to an established, well-funded health system.
The group put together to apply for the grant included the Zilber School of Public Health at the University of Wisconsin-Milwaukee and initially the Milwaukee Health Department.
“Everybody has to work together, and that’s what we were trying to develop — a true collaborative, but from the grassroots, not from the institutions,” he said. “The institutions cannot create the collaborative. The people have to create the collaborative. And that’s the same mistake that the city continues to do over and over again.”
Members of the collaborative held a news conference Monday to criticize Kowalik’s actions.
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“If it’s not implicit bias, then why is it?” Izard said.
If the collaborative’s application had not received a competitive score, Izard said, this would not be an issue.
“Clearly the collaborative did have the ability to produce a competitive grant application and it would have been funded,” said Izard, who was an assistant professor at the University of Wisconsin School of Medicine and Public Health before joining Milwaukee Health Services in 2006.
The news conference was uncharacteristic for Izard, who has never publicly criticized the city or the health systems in Milwaukee.
“I have never gone after anyone,” he said. “I always do things in private. I always try to give people a chance to correct, because, in the end, you have a partner now you can work with.”
Friction between city, McManus
But in the background of all this is friction between McManus and the city.
McManus was interim health commissioner from February through early September but was passed over for the permanent position in favor of Kowalik.
McManus was offered a $15,000 consulting contract with the Health Department days after she left office, according to records obtained by the Milwaukee Journal Sentinel through an open records request. The six-week contract was drafted to include work developing a Healthy Start proposal, the records show.
But McManus repeatedly raised concerns about the city’s requirement that she get insurance to work as a contractor.
“I cannot get the insurance that is being required unless MHD pays for an annual policy,” McManus wrote in a Sept. 17 email to Kowalik.
She instead urged Kowalik to again give her a temporary job in the Health Department, suggesting she temporarily name her health operations administrator, which is essentially the second most powerful job in the agency.
“I find this frustrating because I agreed to a contract arrangement and feel that it is the city’s responsibility to make it happen or put me back on the city payroll for six weeks,” McManus wrote in a Sept. 12 email.
‘The Milwaukee game’
Kowalik said Izard urged her to approve McManus’ contract, saying he told her it was “part of the ‘Milwaukee game,'” she wrote in one email.
But Izard disputes that characterization, pointing to an email from September he says made it clear he supported Kowalik’s decision either way.
“I understand that you feel you are bending over to ‘play nice.’ Only you can determine how much further you’re willing to go,” he wrote. “I wouldn’t get too frustrated b/c of it though as this is the Milwaukee game…unfortunately. I think you should just try to present the most reasonable conditions; she accepts or declines it.”
Kowalik responded in a later email that what mattered most to her was “not playing the ‘Milwaukee game’ but saving our babies’ lives.”
“The contract breakdown definitely muddied the Healthy Start process,” she said in an interview.
Milwaukee Health Services would be the fiscal agent — determining how the money would be allocated — for the federal grant but planned to hire McManus as project director.
Izard said the collaborative elected McManus.
“The group chose her because of her expertise in the area over the rest of us in the group,” he said.
The Black Health Coalition of Wisconsin, led by McManus, had received the federal grant for years but lost it in the last funding round five years ago. The grant was the organization’s main source of revenue.
Nearly 10 percent of babies born in the U.S. are born prematurely and the rates of preterm birth are going up, a new government report shows. Also more low birth weight babies were born last year than in previous years. Nearly 10 percent of babies born in the U.S. are born prematurely and the rates of preterm birth are going up, a new government report shows. Also, more low birth weight babies were born last year than in previous years. With half of all U.S. births covered by Medicaid, these rates would get even worse if Congress cuts back on the program. Medicaid covers 75 million people, including nearly 36 million children. The United States has much worse rates of infant mortality, preterm birth and low birth weight babies than other industrialized countries. Wochit
Losing the grant was a big loss for the city, which struggles with high mortality rates for African American babies. Milwaukee has gone without the grant money for five years.
Kowalik acknowledged that she had concerns about Milwaukee Health Services’ plan to hire McManus as project director if it won the grant. The health commissioner said that the state Department of Health Services also had concerns because the Black Health Coalition previously had lost the grant.
Kowalik also questioned McManus’ ability to meet the stricter requirements of the grant. She said she told Izard multiple times that the plan to hire McManus as project director was a mistake.
“He dismissed me,” Kowalik said. “He said that’s what you think, but we still are going to go this way.”
In December, Izard met with Mayor Tom Barrett and Milwaukee Common Council President Ashanti Hamilton and presented them with a list of four recommendations for reconciliation.
“I didn’t want to make this a public thing,” Izard said.
The recommendations included that Kowalik receive “cultural competency training, with focus on implicit bias” and that she work with a “community mentor.”
“When I saw this I laughed,” said Kowalik, who is biracial and grew up in Sherman Park. “I’ve actually given the training.”
The request struck Kowalik — who worked full-time while earning a master’s degree in public health and a doctorate in health sciences — as condescending.
“My family still lives here for crying out loud,” she said.
Izard also demanded that Kowalik apologize for encouraging Children’s to apply for the federal grant. Kowalik refused.
“I don’t respond to threats,” she said. “I’m not the kind of person who gives fake apologies.”
She said she did apologize for not contacting Izard before reaching out to Children’s.
The timing of that call particularly angered Izard.
Kowalik spoke to him Oct. 31 about her concerns about the progress on the grant, which was due at the end of November.
He said he told Kowalik that he was not worried but would take note of the health commissioner’s concerns.
The next day, on Nov. 1, Kowalik contacted Bob Duncan, executive vice president of community services at Children’s, to ask if the health system would reconsider applying for the grant.
“Through her own implicit bias, at best, she assumed that we couldn’t get it done, but assumed Children’s could get the whole thing done in 30 days,” Izard said.
Izard remains frustrated.
“The only way the City of Milwaukee is going to be able to solve its historical problems and distrust of each other is for a true collaborative to be established,” he said.
Kowalik said that Children’s will have to work with community groups for the grant to be successful. And she is unapologetic.
“As much energy is going into dragging me, we need to be put energy into the implementation of the grant,” Kowalik said.
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How does being an American Descendant of Slavery affect your pregnancy, birth outcome and first year of your child’s life? That is the question asked by the Milwaukee African American Perinatal Health Collaborative (M.A.A.P.H.C.). Dr. Patricia McManus, President & CEO of the Black Health Coalition of Wisconsin and physician, Tito Izard, M.D., President and CEO for Milwaukee Health Services, Inc. have studied and evaluated this critical issue for decades.
According to Dr. McManus, “over the last 3 years reporting period, Milwaukee has seen a worsening of African American infant mortality despite hospitals and universities working downstream to save mothers and babies. We wanted to work upstream, in the community with the families, to prevent poor birth outcomes before they happen.”
So, when Dr. McManus became aware that a federal grant notice of funding opportunity was announced to address this topic, she thought that this would be a great opportunity to collaborate. “Not just any collaboration but one that would incorporate and be led by the population most impacted, those organizations primarily focused on caring for African American families.” Joy Tapper, Executive Director for the Milwaukee Health Care Partnership, inquired and reiterated public support from the healthcare consortium. After discussions, Children’s Hospital of Wisconsin, who was originally considering applying for the grant, agreed to withdraw their consideration and lend their support for this “unified one Milwaukee application” approach. Everyone publicly agreed when the notice was released, so the collaborative work began.
“MHSI was asked to be the fiscal agent for the collaborative because of our expertise with managing federal grants, our ‘One Stop shop’ comprehensive primary care services and our close connectivity to the community”, said Dr. Izard. Other core members of the collaborative included: the African-American Breastfeeding Network, Zilber School of Public Health, the city of Milwaukee Health Department and subsequently, My Father’s House, Inc. “This was going to be great, this was a dream come true,” said Dr Izard. Many of us have worked together in different committees around the city but this would be the first Children’s decided to compete against this African American collaborative? We asked Children’s to come to the table with us, but their administration declined. “These are our dying babies, mourning mothers and fathers who need to be supported that we’re talking about,” said Albert Holmes President & CEO for My Father’s House, Inc.-a local agency dedicated to building strong and responsible fathers that better the lives of children and families. “This is not how you collaborate. We deserve the right to be heard and we deserve the right to know what the mayor’s office said to change Children’s position from supporter to competitor.”
We want a community meeting with Mayor Barrett, Commissioner Kowalik, Common Council President Hamilton and Peggy Troy, President & CEO of Children’s Hospital of Wisconsin.
- We want to know what happened that led to CHW competing against the M.A.A.P.H.C.?
- We want to know who are CHW’s grassroots community partners written into the grant?
- We want to know how CHW and the Mayor plan to fund components of the Milwaukee African American Perinatal Health Collaborative?
- If the mayor is going to tip the scale towards majority institutions competing against grassroots, then what’s his plan for the A.D.O.S community and other under-represented minority groups?