Employees Say Howard Brown Health is Underserving South Side LGBTQ+ Communities

The non-nursing employees at Howard Brown, the largest LGBTQ+ health care provider in the U.S., voted to join the Illinois Nurses Association (INA) union at the end of last summer. Just three months later, the union learned that Howard Brown would be laying off sixty-one staff members, ranging from dishwashers to Behavioral Health Clinicians (therapists), due to what Howard Brown describes as a revenue shortfall. All of the sixty-one employees were members of the union’s current bargaining unit.

This decision didn’t surprise Louis Spraggins, a Howard Brown Partner Services Coordinator, who has long held reservations about the organization’s ability to adequately serve marginalized communities. Spraggins believes Howard Brown’s treatment of its South Side clients and staff before and during the unionization process reflects a racist tradition of underserving Black and Brown communities on the South and West Sides of Chicago.

Spraggins started doing HIV and AIDS peer-educator work when he was fifteen years old while still a student at Roseland’s Fenger High School. Spraggins got his first job on a stipend basis from the South Side Help Center, a community organization devoted to encouraging a “lifestyle of prevention” and healthy alternatives offered through various programs and services. This is where Spraggins was trained to teach health education to youth by providing courses, workshops, and outreach in high schools across the South Side. He compares it more to peer counseling than just outreach.

Spraggins would also talk to young people on the street, at nightclubs, and at schools. The work wasn’t limited to STI and HIV education; he helped connect pregnant and parenting teenagers to community programs and resources.

Spraggins found a second family at the South Side Help Center and was gratified by the work he was doing. In the process of developing his career in health care and education, Spraggins himself had a positive HIV diagnosis, the day before 9/11. “So yeah, they dropped that bomb,” Spraggins told the Weekly, laughing, his white cat Neema sitting in his lap.

“How the hell did you end up positive if you teachin’ all this information about it? And it hurt me; for a while, I was a little bit ashamed,” Spraggins admitted “But I had to also realize that a lot of the work that I was doing was peer work. And behavior change is a process.”

Spraggins, now forty-four, is a Black and same-gender loving man who continued working towards providing humanizing, impactful healthcare to marginalized communities his entire adult life. He helped develop and facilitate community programs with the Test Positive Aware Network and advocated with the AIDS Treatment Activists Coalition, a group that connects people living with HIV and AIDS to encourage their involvement in the national agenda to end HIV and AIDS. Given his work and lived experiences, Spraggins was an invaluable resource on these teams.

“We basically worked with pharmaceutical companies as peers who would review scientific information around the medications and ask the questions that no one was asking,” Spraggins said. “For example, have you had enough Black people in the study in order to understand whether or not this drug is going to be metabolized differently in our livers, as opposed to white mens’ livers?”

During the first twenty years of his career, Spraggins had crossed paths with Howard Brown several times. His initial impression was that they were a company that mostly served the white gay male population. Spraggins was outspoken about his skepticism that Howard Brown held the cultural competency necessary to serve a majority Black and Brown population and advocated against the opening of their South Side clinics.

“Lo and behold, years later, after Howard Brown had actually been on the South Side for some time…I’ve known some people who’ve been working here, and they were telling me that Howard Brown is actually trying their best to learn to do that and do that well. And so I needed work,” Spraggins said, laughing again.

For the past three years, Spraggins has been working as a Partner Services Coordinator at Howard Brown, doing disease intervention.

Spraggins says his initial impressions of Howard Brown were proven true within months of working there. “Howard Brown is still not able to live up to its vision of being rooted in LGBTQ liberation and wanting to fight disparities and inequities in communities of color, in particular, for LGBTQ+ people of color,” he said. “There are many, many great staff at Howard Brown. Our leadership, unfortunately, is making a number of decisions that seem very antiproductive to the head.”

Spraggins cites several inconsistencies between the North and South Side clinics to support his claim. All of the South Side locations rent space from external organizations or landlords: Thresholds South on 47th Street; a privately owned building on 55th; and a City-owned building on 63rd. Rather than create a new building owned by Howard Brown for its South Side patients, the organization is constructing a $53 million building on the North Side.

It is because of this setup that Howard Brown leadership says they are unable to perform immediate, necessary repairs on the buildings, where employees report rooms in disrepair, a lack of space for operations, brown sink water, bed bugs, and in one instance at 63rd street, a rodent running up the pant leg of a health provider.

In March of 2022, the organization began construction on the new multimillion-dollar building in North Halsted, which would replace the at-capacity clinic that currently stands at 3245 N. Halsted Street. The new building will be five stories, with triple the clinical space than its previous iteration, and includes “expanded medical care, social services, and Howard Brown’s first North Side dental clinic.”

Many North and South Side employees presume its secondary use is to attract donors and solidify Howard Brown’s status as the exemplary health-care provider in Illinois. They also believe that its stated purpose to help accommodate an overflow of patients is superfluous when the layoffs happened later that fall due to an alleged lack of funds, and the conditions of Howard Brown’s South Side clinics remain in reportedly poor and cramped conditions.

This construction, while no doubt good for those who may directly benefit, informs Spraggins’s assessment that Howard Brown behaves contradictory to its mission to reduce health inequities across all identities.

In an email, a spokesperson for Howard Brown wrote, “As was done in all departments that underwent cuts, reductions in the behavioral health department were made strategically to ensure that no part of the city would be disproportionately affected by the changes.”

While the INA union representatives the Weekly spoke to confirmed that the South Side clinics did not see a greater number of layoffs to their behavioral health staff, the staff was smaller and understaffed to begin with. The layoffs then have a greater per person impact on a staff that says they are already overwhelmed.

Howard Brown’s oft-referenced genesis story (on their website) is touted as evidence of their commitment to the advancement of LGBTQ+ rights and enrichment. The organization’s humble beginnings started in 1974 as a post med–school project assembled by members of the Chicago Gay Medical Students Association, who sought to provide safe and nonjudgmental sexual health services to Chicago’s gay community. The students met and provided care on a walk-in basis in a one-room apartment above a grocery store in Lincoln Park.

The organization thus christened itself Howard Brown after the pioneering Illinois-born doctor, who publicly identified as gay in 1973 and helped to create the National Gay Task Force (now the National LGBTQ Task Force). Howard Brown Health established itself as an early researcher of Hepatitis B and contributor to the vaccine and an early tester and researcher of HIV and AIDS, providing free testing and resources to patients living with the disease.

As white gay men gained mainstream acceptance and class mobility, so did Howard Brown. While early funding came from the Brown Elephant, its vintage clothing and furniture stores, and grassroots fundraising, the clinics were able to acquire transformative funding by way of large private donations and million-dollar grants. This evolved into Howard Brown being the primary healthcare provider for LGBTQ+ Chicagoans, Illinoisians, and out-of-state patients who relied on Howard Brown for affirming and affordable care.

It is this progressive history that attracted people like Jessica Vazquez, twenty, to work for Howard Brown. Vazquez, a queer Latinx person who was born and raised in Humboldt Park and Logan Square, is currently in school for registered nursing and began an externship at the Howard Brown off-site clinic in La Casa Norte, conveniently located near their home.

Vazquez was elated when she was offered the position as a full-time bilingual medical assistant on her second day at Howard Brown. However, Vazquez would have to commute to 47th and Halsted for this job.

Every Chicagoan has a CTA story. Vazquez’s involved taking a train to a bus for their commute to Howard Brown on the South Side. Without the common delays and disruptions that plague the CTA, their commute was about an hour long. But the pandemic-era setbacks coupled with their knee pain contributed to Vazquez being late to work on several occasions. Vazquez maintains that this lateness was not excessive in time or occurrence. Additionally, they say they were easily able to catch up on what they missed by consulting with their lead or peers if they missed that morning’s huddle. Two of their co-workers seconded this with the Weekly.

Vazquez and coworkers said that most employees are accommodated for schedule changes due to school and childcare conflicts. Vazquez required these accommodations so that she could make her 6pm Thursday class and a daytime class on Saturdays. At this point, Vazquez was working five days a week at Howard Brown in addition to a shift every third Saturday of the month. But when they requested to leave work early on Thursdays or change her Saturday shift, Vazquez was told she couldn’t be accommodated.

After several warnings about their lateness, Vazquez was fired at the end of February. In her dismissal paperwork, Vazquez’s manager referenced a complaint from the health care provider, stating that the provider felt Vazquez’s lateness was a disruption to service. The provider told the Weekly that this is a lie, and she not only denies ever making these complaints but also feels that Vazquez was an outstanding employee whose presence the team misses.

Representatives from Howard Brown say that they cannot comment on these allegations due to employee confidentiality law but also said their code of conduct handbook clearly outlines prohibited behaviors, and any person who feels they are being treated unfairly is encouraged to file a claim with their internal incident reporting system. Representatives also said there is a team “dedicated to actively investigating all claims and will take appropriate action.”

While her employment would have been much more secure had a union contract already been in place, Vazquez still found relief and support from the union after her termination, even though a contract has not been established.

Showing up to work late and receiving formal warnings on these instances can result in a fair termination. However, the union can file a claim with the National Labor Relations Board (NLRB) on Vazquez’s behalf because the conditions involved disparate treatment between Vazquez and their peers since Vazquez observed other coworkers’ scheduling needs accommodated

A previous NLRB case, referred to as Total Security Management, established this precedent. When employees are terminated based on discretionary discipline, wherein personal discretion is used for when and how discipline is given, the employer is required to bargain with the union over the termination, regardless of whether a contract is being established or not.

This precedent was overturned during the Trump administration, but the INA union is considering using similar cases to return to this standard in their support of cases like Vazquez’s. In addition, the fabrication of a provider’s complaint can serve as evidence that Vazquez was being singled out by her manager.

The INA considers all sixty-one of the layoffs in January as part of several unfair labor practices, or ULPs, that Howard Brown has allegedly committed. So far, the INA has successfully reinstated two employees that were terminated last fall due to violations of the National Labor Relations Act.

According to Vazquez, one of the Howard Brown nurses said to them, “‘You know, you have this glow on you; you have this amazing personality you bring to the team.’ I was just there to help. I was just trying to come in every day with a smile, just trying to get through the day,” said Vazquez.

Vazquez has since struggled to find new employment, even as she is one of the sole providers for her family. She remains passionate about healthcare and her planned career in nursing but feels the blowback of broken trust when the security that she initially found at Howard Brown was compromised by the actions of a single leader. Vazquez says she has been asked about “drama” at Howard Brown during job interviews

Tiffany Foster-Mitchell started her career as a medical assistant in 2013, at Roseland Hospital’s emergency room, a job where she says she worked with her community: “minorities, period.” From there, she worked in cardiology at Northwestern for four and a half years, and then she did dermatology at Rush for one year. And while she enjoyed this work, it was not making the impact she imagined herself making.

Foster-Michell, thirty-three, was hired as the lead Medical Assistant at Howard Brown’s 47th Street clinic within Thresholds South, the housing nonprofit, in February 2022. She looked forward to working for Howard Brown because it put her in closer proximity to working-class Black and Brown people like herself.

“I feel like I went and got all this awesome training. And I was like, I’m gonna bring it back to my community and show them that you can get the same care and passion that the patients at Northwestern and Rush are getting,” Foster-Mitchell said.

“Especially in this particular area between 63rd and 55th and 47th, there’s a lot of queer individuals, a lot of sex workers, things of that nature. That’s our reality over here. But if we can get them the care that they need, they can do what they’re doing safely.”

Foster-Mitchell started work with expectations of being a leader. She assumed she’d work with a team and a manager with similar goals and sought to meet those goals by doing things “by the book…like our medical system should.” But Foster-Mitchell says she wasn’t provided the resources or management support to do so.

Her staff was short and overworked; at the 47th Street location, there are only three doctor rooms and four exam rooms, one of which is allegedly not fully functioning, that providers have to rotate between.

Discussion of unionizing at Howard Brown began before Foster-Mitchell started, and although she wanted to join, the prospect of still being within her ninety-day probationary period concerned her. Within this period, an employee can be terminated without specific reason; in this case, an employer could terminate a potential union member because the organization perceives the union as a threat.

Once she passed this period, Foster-Mitchell was all in. “I was just pushing, ‘Vote for the union.’ I was nominated as a bargaining committee member, and I didn’t even know people had nominated me! I didn’t know that people knew who I was. It made me proud that people trusted me enough to represent them.”

During the process of voting for the union, Foster-Mitchell experienced turmoil at 47th Street. She says her manager, who was also manager to Jessica Vazquez, often pitted coworkers against each other through favoritism and by sharing confidential information. When Foster-Mitchell would email her manager about an issue, the message would be ignored or not properly addressed. At one point, she was put on a performance improvement plan, a move most consider the courtesy warning shot before termination.

Despite these thorns, Foster-Mitchell shared plenty of roses from this period, many of which were about the ecstatic joy her team felt when the union passed.

“When we got that phone call, it seemed like everything was working. I knew how my manager was, I knew how things was,” Foster-Mitchell said, referring to her manager’s actions that seemed to undermine the passing of the union. “But I felt like I just took such a beating and pushed through. And once I became on the bargaining committee, I was, like, untouchable, as far as I had support from my union.”

Since assuming her position on the bargaining committee, Foster-Mitchell has seen personal improvements. She’s received private and public praise from leadership for her work applying the PCMH (patient-centered medical home) model, a philosophy of client-centered care, and Epic, a platform to organize client treatment, in 47th Street’s clinic.

But she fears these positives are negated by the overall response from Howard Brown since the union started contract negotiations. Continued layoffs and firings, specifically surrounding the behavioral health staff at 47th Street, put increased pressure on Foster-Mitchell and others. A mandatory attendance policy and in-person care, rather than telehealth visits, impacts not only the employees but also those patients who come from outside of Chicago or even out-of-state.

“You hear [leadership and management] talking about empowerment and all of this, and they don’t know the programs they dismantled when they did those layoffs. Now we [the medical assistants] have to perform as health educators, changing people’s job titles when your union contract is under negotiation,” Foster-Mitchell told the Weekly. “Changing the attendance policy—that’s the first way to get rid of people. The things they did, the moves that they were pulling, had me like, ‘wow.’”

Foster-Mitchell says the response to claims about mismanagement, buildings in disrepair, and overall union busting have been dismissed by Howard Brown’s team at the bargaining table. Their response is sterile and often references the employee handbook or the company’s stated values as reasoning that the claims are unfounded or as grounds for defense.

An INA union representative, Sarah Hurd, told the Weekly that she finds Howard Brown’s actions before and at the bargaining table to be egregious. Hurd said the bargaining location at Howard Brown’s headquarters in Uptown symbolizes the way the company allegedly treats its South Side employees and clients as an afterthought, citing evenings when Howard Brown employees from all over Chicago commuted after work for bargaining meetings that sometimes lasted hours. Additionally, Hurd says workers from one side of the city, many of whom use public transit to get to work, have since been relocated across town.

“The sheer amount of anecdotal evidence that we have points to some amount of bad-faith bargaining on the side of management,” said Hurd. “We have a group chat that is all the workers in their non-work group, and not a day goes by that somebody doesn’t post in that saying, ‘You know, can somebody find me a union rep? I feel like my manager is targeting me for X, Y, or Z.’ It’s basically like a nonstop onslaught of what we feel is like union-busting behavior.”

In an email, a spokesperson for Howard Brown wrote, “Howard Brown Health and the Illinois Nurses Association (INA) have been engaged in contract negotiations for five months now. In that time, we have had nineteen direct bargaining sessions and have reached sixteen different tentative agreements on contract proposals. We will continue to bargain in good faith so that we can reach a contract agreement that is satisfactory to all parties involved.”

The INA’s Executive Director, Julia Bartmes, agrees that the current length of the bargaining process is standard, but that this is irrelevant to the overall claims that Howard Brown staff are making about alleged union-busting behavior.

“That just feels like a superfluous defense,” Bartmes says.

The wave of unionization across the country and healthcare industry includes several organizations and companies whose otherwise progressive values are demonstrably malleable once their staffs unionize. Howard Brown’s union has experienced nothing different, but the power dynamic between staff and leadership is magnified by the fact that the union is diverse across race, class, and sexual orientation, while executive leadership remains mostly white, cis people.

Despite this, the union members remain determined. The two employees whose terminations were found to be in violation of the National Labor Relations Act and whose jobs were reinstated have also received back pay covering the period they were out of work.

For people like Louis Spraggins and Tiffany Foster-Wallace, the purpose they found in organizing the union is itself a win.

“A lot of the people within the Howard Brown union, they are therapists,” Hurd noted, referring to when a union member noticed a change in Hurd’s mood after a frustrating bargaining meeting. “And like, ten different workers came up to me throughout the day, and they were like, ‘Hey, are you okay? Like, do you need to talk about things? You need to take some space? Are you taking care of yourself?’”

“And I was like, ‘No, no, no, I’m supposed to be here supporting you,’” Hurd said. “Don’t you dare do unpaid emotional labor on my behalf. But this is a special group.”

Annabelle Dowd is a contributor to the Weekly. When she’s not dancing across Chicago with friends, Annabelle is cuddling with her cat, Francoise. She last wrote about the City Council race in the 15th Ward.