Patrick Johnson, the Flagler County Health Department Administrator for the past 11 years, announced this morning that he’d be retiring at the end of the month—or at least leaving his post in the county for a job at a public health department in North Carolina.
In March, Bonnie Sorensen retired as the director of the Department of Health in Volusia County after a decade and a half at the agency. Both departments, like all departments across the state, have been hard hot by changes in the state’s administration of public health as state dollars diminish and medical responsibilities are shifted away from county health departments. The budget Gov. Rick Scott is proposing this year would eliminate 758 health department positions in the state, though this year’s budget projects no layoffs in Flagler. The county’s health department has maintained staffing at around 52 for the past seven years, on a budget of $3.6 million (just $250,000 of it from county taxes), though last year it went into its reserves, drawing down $193,000, to maintain its level of service.
“That’s a sign of an organization that’s having some financial difficulties,” Johnson said.
The department actually peaked at 60 people at one point, but has reduced its staffing through attrition, Johnson said. More cuts are coming. “Obviously we’ve talked about it, we’ve been upfront about it,” Johnson said. “Our business has decreased, so folks know here, we’ve let them know, except for the very specifics about it, and we’ll have to make those difficult decisions relatively soon.” He said the cuts will amount to fewer than 10 people.
In another significant change, the department will end primary care services at the end of June. “The Florida Medicaid managed care has decreased our patients in primary care from 2700 to, we have just a little over 1,000 right now, and we just cannot sustain that program,” Johnson said. The state’s new managed-care system requires Medicaid recipients to seek care in the private sectopr, through one of four private-sector providers. It’s a reflection of the governor’s antipathy for government-provided care, even though that care has generally been provided efficiently and effectively—and even though the governor has no issue channeling government dollars to private providers.
Azalea Health Care opens in Palm Coast on Palm Coast Parkway and Florida Park Drive at the end of August, providing some of that care locally. “So the majority of patients will be going there,” Johnson said. “People don’t realize the majority of our patients come from Palm Coast to begin with. About 75 percent of pour patients are Palm Coast residents.”
Azalea Health is a non-profit provider based in Putnam County that started operating in 1977. It’s a federally designated qualified health center (a designation the Flagler Health Department sought and failed to secure a few years ago). Azalea operates nine primary-care health centers in Alachua, Clay, Putnam and St. Johns. The Palm Coast location will be its 10th.
“Overall people like to choose where they want to go, and they’re going to places where they ddin’t have an opportunity to go to before,” Johnson said of the choice system under Medicaid.
In yet other changes that underscore the changing and diminishing role of the health department, Johnson said the Flagler department lost its tobacco-prevention grant to a competitor this year. “We were very disappointed in this,” Johnson said, referring to Lake Worth-based Civic Communications. “But they underbid us, and they got one letter of support. We had letters of support from many, many folks. So that’s going to be handed over to another organization beginning July 1.” This even though the department successfully lobbied local governments in Palm Coast, Bunnell and Flagler Beach to pass resolutions discouraging the sale of flavored tobacco, and the department led four beach clean-ups of cigarette butts, a bane of local beaches. “Every time we do it, it’s amazing to see how much cigarette butts are picked up on the beach and on the boardwalk,” Johnson said.
Johnson made his retirement announcement at the end of a brief presentation to the Flagler County Commission, an annual ritual when he sums up the year’s achievements and challenges.
Among the department’s continuing successes: the federal WIC program—Women, Infants and Children—which provides nutrition assistance to young mothers and their children. It’s the department’s busiest program, with Flagler ranking first in the state with “breast-feeding initiation.” Local residents who receive WIC vouchers spent $1.3 million in local grocery stores.
“I would like to see WIC expanded, it’s our biggest department, it brings money into the county,” Johnson said, but the program’s personnel is cramped. He asked the county commission for help in that regard.
The department cared for 236 pregnant women last year, and provided family planning for 1,900 people. Many health departments are dropping pre-natal care from their responsibilities, as did Volusia, St. Johns and Putnam counties. Not so in Flagler, at least not yet. “We consider pre-natal care still our core public health because it’s a safety net,” Johnson said. “We’re going to continue as long as we can.” Why is it being dropped? “It’s a money loser in many regards. We don’t get a lot of money for it. You end up seeing a lot of unfunded women, meaning they don’t have Medicaid and they have no insurance, and we still take care of some of those women.”
“I’m just curious further why they would stop treating,” Commissioner Nate McLaughlin said. “At some point it’s going to be—even if you look at it financially—the medical liability to the county you could either catch it up front or catch it at the end. You’d think it would be less expensive to catch it up front from a financial standpoint.”
“In a way they’ve just moved their patients to the private sector for them to take care of it,” Johnson said. “And then they have to work with Healthy Start Coalition to try to find some providers who’ll take the unfunded women. But we do that right here, and we are going to continue to do that.”
The governor has refused to sign on to the Affordable Care Act’s Medicaid expansion, which would have provided the state with $50 billion over 10 years and broadened health care coverage for upwards of 1 million Floridians.
The department t conducted 640 disease investigations last year and reported 276 “reportable diseases” for the year. There were 29 food illness reports to the department with 17 investigated outbreaks that exposed almost 3,000 people. The department also had 223 animal bite reports. It had no tuberculosis patients last year. It has one this year. The department treated 921 people for sexually transmitted diseases last year. The department’s dental pediatric program also has 2,500 patients.
Johnson wanted to stress: the department is ready to staff a special needs shelter during weather or other emergencies.
In the near future, the department will be promoting healthy-weight initiatives so people get more involved in caring for their own health. The department is also starting HIV medical and dental care for adults, which will keep patients from going to Volusia or St. Johns County.
Finally, Johnson said, “I will be retiring at the end of the month after 11 years.”
Johnson will be joining the Haywood County Health Department in Waynesville, N.C., near where he and his wife, Kathie, decided to retire. He will be the department’s nursing director, the position he held at the Volusia County Health Department before he took the top post in Flagler. He was previously the chief nurse in an Air Force Reserve unit at Patrick Air Force Base in Brevard County. His wife will retire at month’s end from Halifax hospital, where she’s worked 28 years.
“Kathie and I have been going up to that part of North Carolina for many, many years, way back,” Johnson, 61, said, “and we started looking at where we might want to retire to in the mid 2000s. Kathie is quite a researcher type, and she found some property up there which looked very nice. We bought property up there in 2006, quite a while ago, and started talking to a potential builder probably five years before he started building the house. We decided to start building a house up there a little over a year or so.”
He added: “Yeah, I’m too young to retire retire. I just looked at a web site and there was a job.” He wanted to work in the community where he’ll be living. So he will.
“I’d like to thank Patrick for his service, not only to our country but to our county,” Commissioner George Hanns said.
“This hasn’t been easy because I’ve really enjoyed this job, I’ve enjoyed working with people in this building,” Johnson said.