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A long-running series of skirmishes between Dr. Shahnaz Nikpay, head of the nonprofit San Francisco Health Plan, and an advisory committee made up of beneficiaries of the plan has erupted into an all-out war.
In what is, to say the least, a very strongly worded letter, the Health Plan's Public Policy Committee has requested that Nikpay be fired from her $190,000-a-year job, claiming she has refused to share information with the committee, diminished its right to be heard, "maliciously impugned" the honor and dignity of its members, and "acted as if we were her servants and the health plan her personal property."
The letter, approved unanimously at the committee's July meeting and sent to the Health Plan's Governing Board, provides a rare glimpse into the seldom-exciting world of powerless, advisory citizen bodies. The call for Nikpay's ouster is somewhat unorthodox in that it does not stem from Nikpay's performance as an administrator. Those favoring her removal say that, for the most part, Nikpay has done an admirable job of running the Health Plan.
Rather, they are upset with Nikpay herself, and the way she has treated the citizen committee that is supposed to advise her on how best to meet the needs of the plan's low-income beneficiaries.
The Health Plan, which was formed by the Board of Supervisors in 1993 and commenced operation 2 1/2 years ago, oversees health care services for Medi-Cal recipients, low-income children, home-care workers, and small businesses. The Public Policy Committee was created in 1994 to advise the plan's Governing Board, which has the actual power to set plan policy and hire and fire the plan's top administrator.
The committee chooses its own members, who must be confirmed by the Governing Board. The committee meets monthly, and members serve without pay. At present, the committee has 13 members, though it can hold up to 25. The committee is also allowed to nominate two members to sit on the Governing Board.
Nikpay, a Ph.D. in public administration who has been CEO of the 27,000-member managed care plan for the past four years, says there is no conflict between her and the committee. "I really don't have any insight, information about their intention," Nikpay says. "Their perspective is extremely important to us. It's important to our board, it's important to us, and we take many of their suggestions into consideration."
But if Nikpay -- described by most as a hard-charging, aggressive leader -- doesn't see any conflict, a handful of current and former committee members tell a vastly different story, one of ongoing discord between Nikpay and the mostly low-income committee members, who feel their well-meant efforts have been routinely treated with contempt.
The grievances are many. Committee members say Nikpay was responsible for suspending their child-care stipends (which allow single parents to attend meetings), has denied them access to public documents, and engineered a six-month delay blocking the committee's nominations for two seats on the Governing Board in 1996.
They say Nikpay has failed to place items recommended by the committee on the board's agenda, and that the Health Plan staff has done the same with the committee's agenda. Also, they say the staff has attempted to appoint committee members of their own initiative, and called individual members at home to sway their votes on who should be nominated to the board.
One of the most recent flare-ups occurred last December, when Nikpay temporarily suspended staff support to the committee, citing "offensive and abusive remarks" made by co-chair Frederick Hobson to the staff liaison. In response, Hobson wrote a letter calling the move a part of Nikpay's "subtle campaign to discredit and dishonor me."
"This is not a strategy that builds relationships," Hobson wrote.
"She's done some good stuff from the financial aspect, I think, but the way she treats people is not acceptable," says Hobson, who is leading the charge against Nikpay, and is one of the two committee members who also hold seats on the Governing Board. Hobson's relationship with the CEO may well have taken a turn for the worse four years ago, when, in a discussion with a former committee co-chair, Nikpay allegedly questioned Hobson's mental health because of medication he is taking for HIV.
Hobson isn't alone in describing a rancorous relationship between the committee and Health Plan management. Co-chair Maria Torre, who likewise sits on the Governing Board, also feels Nikpay is not consumer-oriented, saying, "The way she is treating the Public Policy Committee, our recommendations are belittled."
"I think the CEO saw the committee as a thorn in her side, an obstacle to be overcome," says Tony Leone, a former member and co-chair who left the committee two years ago. "She continually rubbed the committee the wrong way, over and over again, and I think the committee's just tired of it."
Sandra Stewart, another former member and co-chair -- who claims to have heard the 1995 comment about Hobson's mental health -- gives a similar account of struggles between the committee and management, saying, "I think what they wanted was a very quiet, rubber-stamp committee, and that's not what they got."
However, Stewart also speculates that the dispute isn't entirely one-sided, in that committee members could be a contentious group who battled not only with Nikpay, but among themselves.
"It's not just Shahnaz who is the problem," she says. "It kind of takes two to cultivate a relationship."
Wading through this river of bad blood has proved vexing. Many of the allegations rest on hearsay and the general feeling among committee members that they are not being respected. Others stem from legal hairsplitting -- the committee's Governing Board nominations were supposedly delayed because the committee didn't have enough qualified members when it nominated them, and the nominees were eventually approved -- and accusations of subtle influence of the board by the CEO.
Nikpay, clearly, has a different view of her relationship with the committee, describing it not as a four-year marathon of rancor and antagonism, but rather as helpful, cooperative, and cordial.
"As far as I know, there hasn't been a unique incidence," says Nikpay, who answered many of the accusations against her -- that staff interfered with committee business, that she herself terminated the committee's child-care stipend -- with a curt, though polite, "No." As for whether she questioned Hobson's sanity four years ago, Nikpay says, "Who knows who said what to whom? I do not recall ... I don't really have any comments about this kind of stuff."
"Like any other member, I respect [Hobson's] views, I listen to his ideas," Nikpay says. "Everyone has their own perspective, everyone has their own feelings. ... If that's how they feel, that's how they feel, and there are others who feel differently."
But the problems are real enough that Dr. Mitchell Katz, head of the city's Health Department and chair of the Governing Board, has stepped in to try to arbitrate the dispute. Speculating that "there is obviously a misunderstanding between the committee and Dr. Nikpay," Katz dropped by the committee's August meeting, hoping to resolve the conflict.
At the meeting, four longtime committee members, including Torre and Hobson, detailed for Katz their dissatisfaction with Nikpay, saying they don't feel their recommendations are taken seriously and, in one case, expressing fear of retribution. A half-dozen or so others, many of whom are new to the committee and have never dealt with Nikpay, said nothing, while another, who was absent when the unanimous vote asking for the CEO's job was tallied, asked that her name be expunged from any public account of the dispute.
"What she has done is egregious and outrageous, and she deserves to be reprimanded," argued Hobson, adding that he took great offense at Nikpay's supposed statement that his HIV medication made him act in a "crazy, bizarre" fashion.
Looking thoughtful as he scribbled the occasional note on a yellow legal pad, Katz pointed out that, while there have indeed been quarrels between Nikpay and the committee, most have been resolved in the committee's favor, often by Katz himself. Torre and Hobson, however, expressed frustration at having to go to Katz again and again, and asked that, if nothing else, Nikpay be prohibited from interfering with committee business.
"Imagine if you could all be in the same room and you could really talk about these issues," said Larry Brinkin of the San Francisco Human Rights Commission, who was attending at Hobson's request and suggested mediation as a possible solution. "Not because we want Shahnaz to say, 'Oh, I'm bad, I'm horrible and I did all these terrible things' ... but what we do maybe want to hear is, how can we resolve this so we can all get along?"
After agreeing to mediation, in which committee representatives and Nikpay will attempt to lay a groundwork for future relations, Hobson said he was cautiously optimistic the situation would improve, although, "Two things are for sure -- I will be watching, and I won't be holding my breath."
Torre said she felt the meeting was "a good start."
Whatever happens, Nikpay probably won't lose her job. The handful of Governing Board members -- most of whom are directors and CEOs of various nonprofits and medical agencies -- who offered comment unanimously supported Nikpay, and seemed surprised to learn of the allegations against her.
Anthony Wagner, executive administrator of the Community Health Network, referred questions to Katz, who said Nikpay's last review was favorable, and resulted in a bonus because of the millions of dollars she won for the Health Plan in recent legal actions against the state.
Steve Fields, executive director of the Progress Foundation, said the case against Nikpay would have to be overwhelming before he would even consider ousting her. "I haven't always agreed with Shahnaz, but I think she's done a great job bringing the Health Plan to where it is today," Fields said.
"There's no question in my mind that Shahnaz has done an outstanding job for us and for the program," Fries said. "I see no reason to take such an extreme position. I think it's crazy.