Dismantled or Reorganized, It May Be the End of the Department of Health As We Know It

Jim Saunders
Health News Florida

With the Florida Department of Health under fire in the Legislature, longtime public-health leaders are trying to help craft plans to avert what they fear will be a dismantling of the agency.

But a huge unknown is Gov.-elect Rick Scott, who could seek significant changes in the department after he takes office in January. Scott’s health-care transition chairman, Alan Levine, said Tuesday it is critical to set priorities and focus on the department’s “core mission.”

“If a department tries to be all things to all people, it will end up failing miserably at its core mission,” said Levine, a former secretary of the Agency for Health Care Administration and now a hospital-company executive.

The Department of Health faces a March 1 deadline for releasing a wide-ranging report that includes justifying its divisions and recommending ways to reduce and restructure parts of the agency. Lawmakers required the report this spring, after a tumultuous legislative session in which House leaders targeted the department for revamping — and shrinking.

The department hosted a meeting in late November of about two-dozen agency officials, public-health advocates and legislative staff members to discuss the possible reorganization.

Meanwhile, a group of longtime public-health leaders, including former top officials in Florida and other states, has met quietly in recent months to come up with big-picture recommendations for the agency. The group has presented the recommendations to Surgeon General Ana Viamonte Ros, the department secretary.

The group’s recommendations don’t go into the nitty-gritty details of running the department. Instead, for example, one of the recommendations calls for any reorganization to be “seamless” for county health departments to ensure that services will not be interrupted.

“Any reorganization of DOH should first do no harm to the state’s county health departments and the important services they provide in partnership with county governments,” the recommendation says.

Dr. Leslie Beitsch, a group member and associate dean for health affairs at the Florida State University Medical School, described the 2010 legislative session as a “clear wake-up call” to the group members. He said the department plays critical roles, such as helping prevent and control disease outbreaks — particularly important in a state that draws tourists from throughout the world.

Beitsch, who also is a former DOH deputy state health officer and former Oklahoma health commissioner, said a reorganization “shouldn’t be about spanking anyone. It should be about making Florida healthier.”

Former lawmaker Sam Bell, another group member who has long been involved in health issues, said advocates are trying to tell the Legislature the “story about what public health is really about.”

Assuming that works, it “really is going to turn into a reorganization rather than a dismantling,” Bell said. “I hope that’s true, and I think there will be a greater emphasis on the county public health units and their importance.”

But House leaders have argued that the department has taken on too many duties and become unwieldy — with one top lawmaker describing the agency as a “dumping ground.” Supporters of reorganizing say the agency should focus on core areas of responsibilities such as communicable diseases and public-health emergencies.

Levine, in a telephone interview and e-mails Tuesday, also said he thinks the agency needs to focus on priorities such as ensuring water quality and being ready to respond to hurricanes, terrorist attacks or other emergencies. With the state facing a budget shortfall next year, Levine said it is important to prioritize instead of making across-the-board cuts to programs.

“The governor-elect wants agencies to focus on core mission,” Levine said in an e-mail. “It is the ultimate cop-out to make the presumption that every program is operated as efficiently as it can be, and every dollar of cost is necessary.”

Levine said he thinks the next DOH secretary should review each county’s health department. He said some areas have other types of entities, such as federally qualified health centers, that provide similar services as county health departments.

The arrival of the new governor creates additional uncertainty about the reorganization of the department. Scott likely will name a new DOH secretary and possibly replace other top-level administrators, which could substantially affect the agency’s plans for the future and priorities.

Scott also will bring years of health-care experience to the governor’s office. His background includes serving as chief executive of the Columbia/HCA hospital chain and later as a founder of a company that runs urgent-care clinics.

During the spring legislative session, public-health advocates particularly worried that a DOH reorganization would endanger disease-prevention and health-education programs.

Along with its recommendations, the group of long-time public health leaders included a list of 10 “essential” services based on findings of the Institutes of Medicine. Beitsch said some of those services — such as to “inform, educate and empower people about health issues” — are threatened by the legislative direction.

But Levine, who also served as secretary of the Louisiana Department of Health & Hospitals, said setting priorities also can involve such things as disease prevention. As an example, he said Louisiana moved from near the bottom in the country in child immunizations to second — while also cutting the number of jobs in his department.

In addition to Beitsch and Bell, the group that wrote the recommendations included Dr. Claude Earl Fox, executive director of the Florida Public Health Insitute and former state health officer in Alabama; Richard Hunter, a former deputy state health officer at DOH; Dr. James Howell, former secretary and state health officer at DOH; Sandra Magyar, executive director of the Florida Public Health Association; and Dr. Charles Mahan, former state health officer at the old Department of Health and Rehabilitative Services.

The group made 10 recommendations, with five focused on the leadership or organizational structure of the department. Beitsch said the group did not offer an opinion on the performance of Viamonte Ros.

But the recommendations make clear that the group thinks the department needs a strong secretary who is a physician and has experience as a public-health leader.

“This individual (the DOH secretary) needs to be well versed in the management of large, complex organizations and must understand how to work with high-level public and private-sector entities and individuals,” one of the recommendations says.

Another recommendation even calls for doing away with the “surgeon general” title, which Gov. Charlie Crist bestowed on the position, and replacing it with “state health officer” or “secretary and state health officer.”

Beitsch said those are the titles recognized in states across the country. The federal government has a surgeon general, but that position serves more as spokesman and advocate than as someone who needs to run the day-to-day operations of a large state health department.

The recommendations also suggest a few ways to streamline the agency, including ridding it of the Correctional Medical Authority, which oversees prison health services, and the Division of Disability Determination. The group said such entities are “not a good public-health fit.”

The group, however, did not recommend changes in the Division of Medical Quality Assurance, which includes the Board of Medicine and other professional boards. Lawmakers have considered proposals in the past to move such boards to the Department of Business and Professional Regulation — but the idea has been adamantly opposed by physicians.

“Having the boards in the department, to us, makes perfect sense,” Beitsch said.

Rob Hayes, a Department of Health spokesman, said an agency working group is gathering information and doing evaluations in advance of drawing up the report for the Legislature.

But Hayes said Tuesday that coming up with a reorganization plan isn’t simple. He said the department’s duties range from “prenatal to post-mortem” and also include factors such as the tens of millions of tourists who visit the state.

“When you think of the scope and the complexities of all of those different things, it isn’t easy,” Hayes said. “It doesn’t mean it can’t be done. It just isn’t easy.”