Clinical Depression

How the Free Clinic went from hippie joint to civic icon, and somehow misplaced its soul.

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The funeral was over, so the old hands drifted off to mourn among themselves. One after another, they arrived at the small house in Euclid, with husbands and wives and children in tow -- to remember, to celebrate the woman who'd changed everything for them.

Thirty years before, Jeanne Sonville took a simple idea -- that health care should be available to everyone -- and did something extraordinary. She launched the Free Clinic.

Sonville stayed at the clinic for almost 20 years, finally retiring to Florida in 1989. But last spring, a doctor in Sarasota diagnosed her with acute leukemia. She came back to Cleveland to die.

So on this September night they gathered, a misfit mob of do-gooders Sonville had mothered, inspired, and employed over the years. The doctors, nurses, counselors, and volunteers who somehow made the clinic work. They looked at photos and told stories, like veterans of a war most people had forgotten.

And as the night dragged on, the conversation circled back to where it always did when they got together. Back to the Free Clinic. Not as it was, but what it had become: successful, important, an institution. More than a few couldn't help thinking that it wasn't only Jeanne Sonville who had passed away.

"There's this place that still has its name, and it's still doing some bits of good," says Jane Loisdaughter, who worked at the clinic for 27 years. "But what we knew as the Free Clinic, it's been dead awhile now."

If you grew up in Parma or Pepper Pike, you may never have heard of the Free Clinic. But if you're a doctor, a nurse, or one of the 165,000 people in Cuyahoga County with inadequate or nonexistent health care, the Free Clinic isn't just an institution; it's indispensable.

Over the last 33 years, the clinic has provided a spectrum of services -- medical, dental, mental health -- to hundreds of thousands of people. Today, with 400 volunteers, a staff of 45, and a $3 million annual budget, it deals with everything from tooth decay to AIDS, hypertension to hernia.

And it has never, not once, asked a patient to pay.

A product of the hippie golden age, the clinic has long since become a pillar of the city's medical establishment. A dozen years ago, it was named one of President Bush's "Thousand Points of Light." Former Surgeon General Jocelyn Elders spoke at its 20th anniversary celebration.

"The Free Clinic has an extraordinary reputation," says Amy Rohling, executive director of the Ohio Association of Free Clinics. "It's seen as a leader in the field."

It is also more important than ever. Since 1997, the clinic has gone from seeing 550 patients a month to more than several thousand. Last year, it logged 40,000 patient visits, a number that isn't expected to decline any time soon.

Amid a dismal economy, the Free Clinic has prospered. Last summer, it moved into a new $4.4 million building on Euclid Avenue. An endowment was recently established, and the clinic's finances are more stable than ever. "I think it's fair for me to say that this is about as good as it gets here," says recently retired Executive Director Martin Hiller.

Unlike its services, however, the clinic's transformation -- from hippie idealism to civic icon -- has come with a price.

Over the last several years, the clinic has overhauled not only its look and locale, but its organizational DNA. Administrators were hired. Veteran staffers were fired. A union drive was quashed. Dozens of workers and volunteers quit. Of the five supervisors who ran the clinic's various departments three years ago, not one is still on the job.

Defenders say the clinic needed to change -- that it needed to drag itself into the 21st century, however reluctantly. Its detractors say it sold its soul. Everyone agrees on one thing: Today, just like in 1970, the Free Clinic is still free. Almost nothing else is the same.

It's no exaggeration to say that Marty Hiller saved the Free Clinic. Even those who despise him admit it.

A former platoon sergeant in Vietnam, Hiller was hired in 1976 to run Safe Space Station, the Free Clinic's teen runaway shelter. In 1983, he was named executive director. "I don't think anyone else was dumb enough to want the position," he says.

He inherited a disaster. By the late 1970s, the Free Clinic had become more of a vast network of social services than a health care facility. It offered medical care, a mental health hotline, psychological counseling, a legal clinic, and the runaway shelter. But with the ascension of Ronald Reagan, federal money for social programs vanished. Conservatives rejoiced. Nonprofits tanked. Nationwide, two-thirds of the country's free clinics closed by the mid-'80s. Cleveland's was close to being among them.

"We got too big, and then the money for all these programs just evaporated," says longtime board member Gordon Friedman. "We were on the brink of extinction."

His first day on the job, Hiller discovered a filing cabinet in his office. Two drawers were crammed with unpaid bills. "We owed everybody, including the IRS. Nobody really knew the extent to which we were in this deep hole," he told Scene in 2000. "We survived because nobody wanted to be the one carrying the onus of closing the Free Clinic."

Hiller tightened the reins. Existing programs were cut back or axed. New ones were put on ice. Staff was laid off. "That was very painful, because most of us were very good friends," says Loisdaughter, who started working at the clinic in 1973. "But we needed to retrench. We were faced with losing everything."

The austerity measures worked. Within a few years, the clinic had retired its operating debt. By the late '80s, thanks in part to the flood of money to battle the onrushing AIDS epidemic, survival was no longer a matter of speculation. Hiller rightly got much of the credit.

"There's no question in my mind that Marty saved the Free Clinic," says Dr. Peter Cubberly, a former medical director at the clinic who still volunteers. "It was an absolutely horrible time. He kept it going and got it back on stable footing. We owe him a tremendous amount of gratitude for that."

But it wasn't just stability Hiller provided. Over the years, he has proved to be something of a fund-raising genius, a talented schmoozer with deep-pocketed donors. Testament can be seen outside the new building, where there is a walkway made of paving stones inscribed with donors' names. One reads: "The House That Marty Hiller Built."

"He could be extremely eloquent when talking about the plight of the Free Clinic," says one former employee.

Adds Charlie Clarke, a longtime board member: "He understands the nonprofit scene, the foundations and the agencies, the federal and the state government."

Inside the clinic's doors, however, the reception wasn't always so welcoming. Stoic, dark, and willfully enigmatic, Hiller came to be viewed with respect and repugnance by his staff, and the atmosphere was often rife with dysfunction. He and Loisdaughter -- who concedes she was hardly the model of workplace civility herself -- were famous for screaming at each other in staff meetings.

"It could be very ugly," she says. "Yelling, cursing, confronting people in a group setting, when doing so individually might have been less humiliating . . . a lot of people wouldn't come to staff meetings, because it would be painful."

Psychologist River Smith had an office across the hall from Hiller, where he would often hear Hiller screaming at employees. "That happened dozens of times," he says.

Others had more serious problems. Paul Dixie -- who is married to Loisdaughter -- was the head nurse in the early 1990s, when he began having problems with an employee in the medical lab. After several weeks, Dixie claims, he was given the OK to fire the employee.

The day after Dixie pulled the trigger, however, the worker showed up at the clinic anyway. Hiller, Dixie says, had overruled him. "My credibility with anyone who worked for me was zero after that," says Dixie. "When I went to Marty, he said, 'I never said you should fire him' "

Hiller has become accustomed to former employees bashing him. "My job was to move the clinic in a certain direction," he says. "Some people -- people who I had worked with and fought battles alongside -- didn't want to go in that direction. And because I had been there so long . . . they felt a sense of betrayal."

By the late 1990s, that direction became the source of increasing tension. The Free Clinic had become a multimillion-dollar operation and developed a bureaucracy to match. The front office became an orgy of titles like "assistant director of external activities." There were more rules, more paperwork, more demands from funders.

This wasn't all bad, of course; almost everyone realized the clinic had to evolve. "The culture at the Free Clinic from the beginning was essentially one of anarchism, that everybody basically did their own thing," says Cubberly. "As the clinic grew and became more complex, that style of administration didn't work much anymore."

Echoes Jim Young, a longtime staffer: "In order to serve such a huge number of patients . . . we had to evolve if we wanted to be here tomorrow. That meant more rigid adherence to foundation requirements for funding, to reporting on who we were seeing and what for. We had to do a lot more paperwork."

But many came to believe the new administration didn't work much better than the old one. "Where we needed help -- finding more volunteers, running interference with funders, filling out reams of paperwork -- we wouldn't get that kind of help," says Loisdaughter. "But we'd have someone leaning over our shoulders, saying, 'You want to deal with patients that way?' These are people who know nothing about how to handle patients."

Not only were there more administrators, but they weren't sharing the wealth. While some administrators were being paid more than $50,000, licensed therapists with master's degrees were starting at $23,000 a year.

The new top-down style extended to the most pedestrian matters. For years, chairing staff meetings rotated among employees; now Hiller set the agenda and ran the meetings. Employee hiring committees would assemble to vet job applicants, only to learn the clinic was hiring someone they had never heard of.

"It came to the point where Marty or one of his minions would just come in and lay out a directive," says one former employee. "There was never any discussion."

Some refused to get with the program. In 1998, the divide between program staff -- those who actually worked with patients -- and administrators became so great that department heads began holding confidential meetings to discuss their beefs. By mid-1999, four of the directors drafted a lengthy memo detailing their problems with Hiller's chief lieutenant, Director of Operations Sarah Spengler.

Accusing her of everything from inappropriate eye-rolling to fudging data about the need to close the clinic's teen runaway shelter, the program directors asked that Spengler be removed from managing clinic programs and instead be shifted to oversee things such as fund-raising, public relations, and volunteer recruitment. "We do not take this process lightly," they wrote. "This summary is the result of months of thoughts and discussion."

Hiller refused to change Spengler's duties, and she eventually left the clinic. (Spengler did not respond to repeated interview requests for this story.)

But the lines had been drawn. "If Marty had a problem, it was not . . . changing his management style early enough," says Cubberly. "As a result, when it became obvious that things needed to be tightened up, there was a great deal of resentment toward him . . . He put up with behavior from people that was essentially anti-organization for just too long, and when it finally got unbearable, there was an explosion."

The explosion came in late 1999. And it came, perhaps fittingly, from the clinic's two biggest personalities: Hiller and Loisdaughter.

They were old pros at bickering with one another. Both had been there since the 1970s. Both had clear ideas about how things should be. And both weren't afraid to express themselves.

"Jane was the voice for a lot of people," says Mike Kutsick, who worked for the Free Clinic for four years. "She spoke up at meetings when other people didn't agree with things or didn't feel comfortable speaking up."

That November, Loisdaughter and Hiller had a disagreement about a personnel issue when they got into an argument. When Loisdaughter accused Hiller of lying, she says, he placed both hands on her back and tried to shove her out his office door. (Hiller wrote in a memo to Loisdaughter that he touched her shoulder to "guide" her to the door.)

Three weeks later, Loisdaughter filed a grievance. A four-month internal investigation followed. In March 2000, the board reprimanded both Loisdaughter and Hiller. Unhappy with the decision, Loisdaughter refused to keep quiet. She was fired three weeks later.

The board attempted to downplay the firing, arguing that it had been brought on by almost everything but her agitation about the shoving incident, such as her inability to adapt to a new management structure, her opposition to a new building. "Jane was a great friend," says Clarke. "[But] it was one of those situations where you have to choose between the institution and the people involved."

It is a popular line when it comes to Loisdaughter: She didn't play well with others. She wouldn't evolve with the times. "Jane basically fired herself," says Cubberly. "Jane's vision of the Free Clinic's role, as far as I could see, never really evolved past the hippie era. There was always Jane's way, and that was the only way of doing things, which Marty essentially put up with . . . So it ended up that it was quite clear that either she left or the board left."

Many staffers didn't see it that way. They considered Loisdaughter's departure a sign of how dramatically things had changed. As a token of protest, several employees wore tie-dyed purple ribbons. Others turned the front door of Loisdaughter's office into a shrine, as if she'd been an innocent victim in a drive-by shooting. Anonymous memos were circulated among board members, media, and funders, arguing that "the Free Clinic is dying."

The board didn't exactly snap to attention. River Smith recalls sending five letters to every member after Loisdaughter was fired, asking them to reconsider. He got but one form letter in response. Even board member Friedman admits, "We could have done much better at communicating."

Yet instead of quelling the anger, the board's stance stoked it. The gripes about pay and management had culminated in a union drive. Loisdaughter's firing only made the cause seem more righteous. "It was like, if they can do this to Jane, they can do this to anybody," says Kutsick. "People were afraid for their jobs."

Administrators sought to crush the drive. Staffers were required to attend anti-union "informational" meetings. Administrators expanded the definition of who was management -- thus who couldn't join a union -- so that fewer pro-union staff could vote. Workers were told that if a union were approved, their entire compensation package would be open for negotiation.

The clinic eventually repelled the effort, but a sense of paranoia remained. In the months to follow, people left "in droves," says Kutsick. He recalls being told several times that someone had quit, "even though you knew they were fired. A person isn't just walking down the hall bursting into tears, running into their office for no reason."

When Kutsick decided to leave, he had already packed up his office. "When I handed in my letter of resignation, I didn't have anything in my office anymore that was mine, because I didn't know if I was going to be escorted out right then."

The repercussions were felt even by those who sought reconciliation. Like several mental health volunteers, Kathy Lynn left after Loisdaughter's firing. A year later, she began to miss the place. "I figured maybe I can get past the political stuff and at least help some people," she says. She called, and got a new assignment in the pharmacy. She lasted three nights. An administrator told her that "people were uncomfortable with you here."

"When you start firing volunteers," says Lynn, "you are really scraping."

In September, Hiller announced his retirement. The man most responsible for the clinic's new building wasn't staying around to enjoy it.

He's leaving behind an organization vastly different from the one he took over 20 years ago. In the last three years, dozens of staffers and volunteers have left. Many quit because of the treatment Loisdaughter received. Some were fired. Others simply tired of working at a place where the headaches outnumbered the rewards. Two, Dan Chambers and Louise Foresman, have filed suit against Hiller and the clinic, claiming wrongful termination.

To Hiller, the departures have actually improved the clinic. "It made it a better place to work," he says. "It made it the kind of place you felt more comfortable coming to . . . It felt healthier."

Not everyone has such a positive take on it. For River Smith, the end came that fall. At the time, Smith had a cable access show that covered psychological issues. He often talked about what was happening at the clinic. "Unless I agree to take the show off and stopped publicizing the problems at the Free Clinic, then I would not be able to consult there any longer," he was told. He left soon after.

"I want to say that people were demoralized," says Kutsick, who left in 2001. "But morale was so low even before that, it's hard to say people were demoralized. I think people were going through the motions. So many people left during that period that it was clear the place I thought it was, or the place I wanted to work -- this was no longer that place."

Kutsick remembers hearing a rumor that an assistant program director had hurled an ashtray at an administrator. "My only reaction was 'Too bad he missed.'"

With all the controversy surrounding Hiller, it's little surprise that there were rumors he was pushed into retirement. Board members deny this; they say they're sad to see him go. "We're going to miss him, frankly," says Friedman. "He's remarkably talented."

Others don't sound so sure: "No, the board didn't ask him to leave," says Clarke. "The board put the situation up to him, and he decided to leave."

Either way, no one disputes that Hiller has left a sizable legacy. Even his most contentious decisions have been recast amid the soft-focus of retirement. "The fact that people left and new people came in, in my mind, is not a bad thing," says Friedman.

Hiller, not surprisingly, echoes that appraisal. "In the bottom line, the clinic is in a better position than it ever has been. I think that speaks for itself. People who didn't want to go the direction the clinic was going left. I still maintain that was good for the clinic."

In the victory lap of Hiller's final months as director, few have publicly quibbled with that assessment. It may be because he's right. It may be that there are so few people left to argue.

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