Comprehensive Group Health Serv. Bd. of Dir. v. TEMPLE UNIVERSITY OF COMMONWEALTH SYSTEM OF HIGHER EDUCATION

• Decision Date: 08 August 1973
• Docket Number: Civ. No. 71-2157.
• Citation: 363 F. Supp. 1069
• Parties: COMPREHENSIVE GROUP HEALTH SERVICES BOARD OF DIRECTORS, an Unincorporated Association, by Oscar Shambourger, Trustee Ad Litem and Health Oriented Consumers, Inc., a Pennsylvania Non-Profit Corporation v. TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION, a Pennsylvania Non-Profit Corporation and City of Philadelphia and Philadelphia Anti-Poverty Action Commission and Samuel L. Evans, Individually and as Chairman of the Philadelphia Anti-Poverty Action Commission and Melvin L. Hardy, Individually and as Executive Director of the Philadelphia Anti-Poverty Action Commission.
• Court: U.S. District Court — Eastern District of Pennsylvania

363 F. Supp. 1069

COMPREHENSIVE GROUP HEALTH SERVICES BOARD OF DIRECTORS, an Unincorporated Association, by Oscar Shambourger, Trustee Ad Litem

and

Health Oriented Consumers, Inc., a Pennsylvania Non-Profit Corporation v. TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION, a Pennsylvania Non-Profit Corporation and City of Philadelphia

and

Philadelphia Anti-Poverty Action Commission

and

Samuel L. Evans, Individually and as Chairman of the Philadelphia Anti-Poverty Action Commission

and

Melvin L. Hardy, Individually and as Executive Director of the Philadelphia Anti-Poverty Action Commission.

Civ. No. 71-2157.

United States District Court, E. D. Pennsylvania.

August 8, 1973.

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Elliot B. Platt, Community Legal Services, Inc., Philadelphia, Pa. (Theodore Clattenburg, Jr., David L. Hill, Jonathan M. Stein, Laurence M. Lavin, Philadelphia, Pa., on the brief), for plaintiffs.

Peter Platten, Richard Z. Freemann, Jr., Ballard, Spahr, Andrews & Ingersoll, Philadelphia, Pa., for defendant Temple University.

Ronald M. McCaskill, Philadelphia, Pa., for defendant City of Philadelphia.

Isaiah W. Crippins, Philadelphia, Pa., for defendants Philadelphia Anti-Proverty Action Commission, Evans, and Hardy.

OPINION AND ORDER

EDWARD R. BECKER, District Judge.

I. Preliminary Statement

A. Legal Background

The Economic Opportunity Act of 1964 (Act)¹ authorizes federal grants for the operation of Community Action Programs,² including Comprehensive Health Services programs.³ This case involves one of these Community Action Programs. In 1967, a Philadelphia city ordinance created the Philadelphia Anti-Poverty Action Commission (PAAC) to administer and coordinate community action programs within the city.⁴ PAAC is a "community action agency" (CAA) within the definition of the Act. The same year, funded by a grant from the federal Office of Economic Opportunity, OEO, PAAC, and Temple University of the Commonwealth System of Higher Education (Temple) established the Comprehensive Group Health Services Center at 2539 Germantown Avenue, Philadelphia, and the West Nicetown-Tioga Neighborhood Family Health Center at 3450 N. 17th Street, Philadelphia, to provide comprehensive health services to inhabitants of the Hartranft, West Nicetown, and Tioga sections of the city. PAAC is the recipient of the grant for the funding of the centers and distributes the funds to Temple, which, as the so-called "delegate agency," administers the program and provides the bulk of the necessary technical resources.

Noting that the causes of proverty include lack of education, poor health, absence of a marketable skill, and unstable family life, the Act sets in motion a comprehensive effort to attack the causes of poverty by coordinating the antipoverty efforts of federal, state, and local governmental agencies and private non-profit agencies, by using innovative techniques in the development and implementation of programs, and by requiring the active involvement of the people to be served. Central to the structure of the Act is the notion of "community action," the belief that local citizens understand their communities best and that they will provide leadership by developing and implementing local programs.⁵

The concept of active involvement of the people to be served is one of the most important, as well as innovative, features of the Act. The purpose of the Congressional requirement of citizen participation is explained in the first section of Title II⁶ of the Act:

To promote . . . (4) the development and implementation of all programs and projects designed to serve the poor or low-income areas with the maximum feasible participation of residents of the areas and members of the groups served, so as to best stimulate and take full advantage of capabilities for self-advancement and assure that those programs and projects are otherwise meaningful to and widely utilized by their intended beneficiaries . . . ."

42 U.S.C. § 2781(a)(4) (emphasis added). With respect to Comprehensive Health Services programs specifically, the Act provides that they shall include programs "designed . . . (ii) to assure that . . . services . . . are furnished in a manner most responsive to the needs of low income residents of the target areas and with their participation . . . ." 42 U. S.C. § 2809(a)(4)(A) (emphasis added).⁷ As will be seen, the notion of maximum feasible community participation is the touchstone of this case, which raises questions of the role of a community participation component of a comprehensive health services program and of the manner in which such a component may legally be altered.

The Act itself does not amplify the community participation concept. The meaning of that concept is, however, fleshed out in the OEO Regulations on community action programs in general, 45 C.F.R. § 1060 et seq. (Regulations), and in the OEO Guidelines (Guidelines) governing comprehensive health services programs.⁸ We will review the statutory and quasi-statutory law before setting forth our findings of fact (this is a nonjury case) to aid in framing the issues and viewing them in an appropriate perspective.

The Regulations place a gloss upon the maximum feasible community participation language of the statute by requiring "meaningful" participation in all programs (see note 3) funded with community action moneys. The Regulations require, inter alia, that: (1) all funding applications explicitly indicate a course of action which will lead to improvement in the involvement of poor people in the community action programs; (2) all community action programs provide guidance, training, and technical assistance to poor people so that their involvement may be effective; (3) the poor be provided employment in all phases of community action programs; (4) delegate agencies involve poor people in the planning, operation, and evaluation of delegated programs, by establishing a program advisory committee at least half of whose members are democratically selected representatives of the poor served by the program.⁹ The program advisory committees, in addition to their program responsibilities, must have a strong voice in the development of personnel policies.

The Guidelines also deal directly with the effectuation of the community involvement concept. The Guidelines mandate that "neighborhood residents must share with the operating organization the responsibility for policy making" so as to maximize responsiveness to the community's needs. The specific means of giving a policymaking voice to neighborhood residents are detailed in the Guidelines:

The Neighborhood Health Council shall participate in such activities as the development and review of applications for OEO assistance, selection of the project director, the location and hours of the Center's services, the development of employment policies and selection of staff personnel, the establishment of program priorities, the establishment of eligibility criteria and fee schedules, the selection of neighborhood residents as trainees, the evaluation of suggestions and complaints from neighborhood residents, the development of methods for increasing neighborhood participation, the recruitment of volunteers, the strengthening of relationships with other community groups, and other matters relating to project implementation and improvement.

B. The Dispute in This Case

The plaintiffs, Comprehensive Group Health Services Board of Directors (CGHS)¹⁰ and Health Oriented Consumers, Inc. (HOC), successor to the West Nicetown-Tioga Neighborhood Family Health Center Board of Directors (WNT) (collectively "plaintiff Boards"), are the community action program advisory boards that were established to provide the required community participation in the comprehensive health services programs involved in this case. CGHS was the advisory board for the Hartranft center at 2539 Germantown Avenue, and HOC was the advisory board for the West Nicetown-Tioga center at 3450 N. 17th Street.

In the spring of 1970, after the plaintiff Boards had been in operation for several years, PAAC and Temple determined that the two health centers should merge and accordingly be served by a single program advisory board. When the plaintiff Boards failed to work out a merger, they were removed by the defendants and replaced by a single newly created program advisory board, which plaintiffs consider a mere rubber stamp for the program decisions of PAAC and Temple.

After being displaced, plaintiff Boards brought this lawsuit for declaratory and injunctive relief. They ask that we permanently enjoin defendants from operating the centers without recognizing plaintiffs as the community participation components thereof and from maintaining a new board without plaintiffs' participation therein, and that we declare that defendants acted illegally in purporting to dissolve and replace plaintiff Boards. The complaint also alleges that the defendants seized plaintiffs' files and denied them access to the centers, and seeks appropriate relief. Plaintiffs also ask that we declare that defendants have violated the Act, the Regulations, and the Guidelines by unduly narrowing the scope of plaintiffs' participation in program planning to exclude them from the preparation of the budget, the decision to undertake a health maintenance program,¹¹ and the selection and removal of the project director. The complaint includes a general allegation that defendants have refused "to permit plaintiffs to participate in policy decisions concerning the centers." Samuel L. Evans (Evans), PAAC's Chairman, and Melvin L. Hardy (Hardy), PAAC's Executive Director, are named as defendants because they played major roles in the events giving rise to the lawsuit. This litigation does not involve issues of any details of the actual operation of the health centers, and the delivery of health care to the community...