Wednesday, July 18, 2018
Politics

Florida leads U.S. in new HIV cases after years of cuts in public health

TALLAHASSEE — Florida leads the nation in new HIV infections, but it's not being treated as a crisis by Gov. Rick Scott or the state's top health officer, Dr. John Armstrong.

As the virus has spread, Scott and Armstrong have imposed four years of personnel cuts in the Department of Health that have shrunk the size of county health departments.

State lawmakers are now asking whether the spending decisions have produced a sicker population in a state where HIV infections have risen each year since 2012 as they've declined across the country.

Miami-Dade and Broward counties were Nos. 1 and 2 in the United States in new HIV infections in 2014 per 100,000 residents, according to state and federal data.

Armstrong said Florida is spending a record $34 million on HIV and AIDS prevention this year, thanks to a federal grant. He did not dispute the rise in infections.

"Staff reductions did not impact the surveillance, education, prevention, counseling, testing, care and treatment of HIV/AIDS patients," he said in a statement.

But some advocates say Armstrong is part of the problem because he rarely talks about HIV or AIDS and instead places greater emphasis on fighting childhood obesity.

"Without leadership at the head of the agency speaking about this, it creates a hurdle," said David Poole, director of legislative affairs for the AIDS Healthcare Foundation, which offers treatment and prevention throughout Florida.

Poole worked in the Department of Health's HIV program for 12 years. He said staff reductions have hampered prevention, and that has led to a rise in cases.

"Silence equals death," said Ron Ford, 53, of Clearwater, a former HIV caseworker who has the virus. "This does not have to happen. But people have to start talking about it for it not to happen."

Armstrong is under new scrutiny about rising HIV rates and budget cuts as he faces a Senate confirmation hearing Tuesday in an effort to keep his job.

A former Army trauma surgeon, he was a top medical officer at the USF Health Center, earning $405,000 a year, when Scott appointed him surgeon general and health secretary in 2012.

In his first year, the state saw 4,512 new cases of HIV infections. The number has increased every year since then.

New cases last year totaled 6,240, the highest since 2002. Miami-Dade and Broward together account for 38 percent of that total.

Although Florida is among the nation's fastest-growing states, Scott has pushed every year to trim the state workforce, and nearly one quarter of those reductions have been in the Department of Health.

The 67 county health departments, largely funded by the state health agency, have declined to 10,519 positions, compared with 12,759 when Scott took office in 2011.

"It's indicative of the neglect of this administration across the board in social services," said Sen. Oscar Braynon, D-Miami Gardens. "We have a rise in AIDS, and we have a reduction in public health spending. We're now cutting just to be cutting."

Braynon is a member of the Senate Health Policy Committee that will scrutinize Armstrong's record starting Tuesday.

The panel has six Republicans and three Democrats. All three Democrats have been critical of Armstrong, and one Republican is voicing doubts.

Sen. Don Gaetz, R-Niceville, is troubled that under Armstrong, the agency's mission has shifted away from direct patient care to messaging about health.

"We've seen a reduction in services provided by county health departments," Gaetz said. "Health conditions exacerbate, and folks wind up in emergency rooms. That's a cycle that doesn't end well for patients or taxpayers."

Gaetz said he respects Armstrong's work as a doctor and veteran but wants the agency's mission to return to treating more people at county clinics. He said he was undecided on whether to confirm Armstrong.

If Armstrong loses Gaetz's vote and can't win support from all five other Republicans on the panel, he'll be in jeopardy of losing his $141,000-a-year job.

Armstrong has clashed with senators twice in the past year. He dodged questions about whether the Senate's failed effort to expand Medicaid would have led to better health outcomes. His agency's changes to the Children's Medical Services program last year ended coverage for about 9,000 children.

Sen. Denise Grimsley, R-Sebring, supports Armstrong but said past budget cuts may have cut too deeply.

"I'm not sure that we haven't over-reduced," she said. "It's time for us to go back and look at the funding we give to them, especially in rural counties."

Others say money is not the problem.

"We have found that Tallahassee is supportive and is doing whatever they can, within their ability, to address the uptick in HIV," said Priya Rajkumar, vice president of Metro Wellness and Community Centers in Tampa Bay.

Rajkumar said the state has launched programs to address HIV and AIDS in minority communities, including efforts to reach two separate high-risk groups: black women, and men who have sex with men.

Dr. Claude Dharamraj, retired director of the Pinellas County Health Department, said much of the state's money for HIV comes from the federal government.

Most is for people infected with the virus or those who have AIDS.

William Harper, executive director of the AIDS Service Association of Pinellas, said more state money would mean more education and prevention. He doubted budget cuts are tied to higher infection rates and suggested another possible reason.

"I think it's because there's more testing going on around the state," Harper said. "We're finding people who have been HIV positive for a while and didn't know it."

Armstrong declined requests to be interviewed.

The agency has a budget this year of $2.9 billion, mostly from fees and federal grants, with 14,358 budgeted positions, down from 17,367 five years ago.

Scott wants the Legislature to make more staff cuts next year. In his budget recommendations, Scott called for eliminating 718 more Department of Health jobs, of which 507 are in county health departments. Those cuts would save $13 million.

"Nearly two-thirds of the proposed staff reductions are vacant and therefore will not impact daily DOH operations or result in any interruption in services," Scott's office said.

State agencies often keep long-dormant "phantom jobs" on the books so that they can get credit from the Legislature when they eliminate those jobs to comply with demands to cut spending.

"Now that I see some of the consequences, I need to know what positions were cut that weren't phantom positions," Gaetz said.

Armstrong's own data shows that since fiscal year 2010, the year before Scott took office, the amount of state money spent on county health departments has fallen 26 percent, from $173 million that year to $128 million in the budget year that ended last June.

Miami-Dade lost a quarter of its county health revenue from the state during that period. Broward saw a reduction of 27 percent, Pinellas 27 percent and Hillsborough 31 percent. Hillsborough County health director Doug Holt did not respond to a request for comment.

During the same period, Scott also has vetoed millions of dollars for local health care programs.

When Scott signed the current budget last June, he vetoed $9.5 million for the Florida Association of Free and Charitable Clinics, a network of 100 clinics that provide primary care to people lacking insurance.

Scott said liability laws blocked use of the money for salaries, and as a result, the program was "not a statewide priority for improved cost, quality and access to health care."

The clinics' director called Scott's statement misleading because the money could have been spent on equipment, support staff and medicines.

In the current budget, Scott also vetoed $3 million for residency slots for rural primary care doctors, $500,000 for local health centers in the Suncoast region north of Tampa Bay and $350,000 for an HIV/AIDS outpatient program at Broward's public hospitals.

Times staff writer Kathleen McGrory contributed to this report. Contact Steve Bousquet at [email protected] or (850) 224-7263. Follow @stevebousquet.

   
Comments
Meet the man who might have brought on the age of ‘downloadable guns’

Meet the man who might have brought on the age of ‘downloadable guns’

During the summer of 2012, Cody Wilson hung around J&J, a car-repair shop run by two "goofy" guys in their late 20s. The Austin warehouse was crowded with engine blocks, car parts and Pelican boxes that never seemed to have been opened, but the 24-ye...
Updated: 7 hours ago
‘She was like a novelty’: How alleged Russian agent Maria Butina gained access to elite conservative circles

‘She was like a novelty’: How alleged Russian agent Maria Butina gained access to elite conservative circles

WASHINGTON - For nearly five years, the young Russian political-science student was an unusual fixture at the most important events of the U.S. conservative movement.Maria Butina, who was indicted this week on charges of being a covert Russian agent,...
Updated: 9 hours ago
PolitiFact: Fact-checking the Donald Trump-Vladimir Putin summit

PolitiFact: Fact-checking the Donald Trump-Vladimir Putin summit

President Donald Trump and President Vladimir Putin made inaccurate statements to the media following their one-on-one talks in Helsinki about election meddling, global terrorism and nuclear nonproliferation.Here’s a rundown of our fact-checks.Trump:...
Published: 07/17/18
Obama gives Trump sharp rebuke in Mandela address on values

Obama gives Trump sharp rebuke in Mandela address on values

JOHANNESBURG — Former U.S. President Barack Obama on Tuesday took aim at "strongman politics" in his highest-profile speech since leaving office, urging people around the world to respect human rights and other values now under threat in an imp...
Published: 07/17/18
Romano: Excuse me Gov. Scott, but you’re a hypocrite

Romano: Excuse me Gov. Scott, but you’re a hypocrite

Hypocrisy, thy name is Rick Scott.And, yes, I owe Shakespeare an apology.But I think Florida’s governor owes all of us an apology.This isn’t about one man’s opinion, and it isn’t about philosophical differences. This is about a politician who is publ...
Published: 07/17/18
Trump questions US intel, not Putin, on Russia 2016 meddling

Trump questions US intel, not Putin, on Russia 2016 meddling

HELSINKI — Standing next to Russia’s Vladimir Putin, President Donald Trump openly questioned his own intelligence agencies’ conclusions that Moscow was to blame for meddling in the 2016 U.S. election to Trump’s benefit and seemed to accept Putin’s i...
Published: 07/16/18

Pasco Political Notebook

Hunter, Murphy speak to Democratic ClubThe Trinity Democratic Club will host candidates Chris Hunter (running for U.S. Congress in District 12) and Amanda Murphy (running for state Senate in District 16) as guest speakers at its meeting at 6:30 p.m. ...
Published: 07/16/18
Giant pork pile awaits Americans as trade wars risk exports

Giant pork pile awaits Americans as trade wars risk exports

Donald Trump’s trade wars are making pork a bargain.American production is poised to reach an all-time high this year, and output is forecast to surge again in 2019. The supply boom comes as tariffs from China and Mexico threaten to curb export deman...
Published: 07/16/18
Sacha Baron Cohen still knows how to punk America, but his new show erodes what little trust we have left

Sacha Baron Cohen still knows how to punk America, but his new show erodes what little trust we have left

Sacha Baron Cohen’s return to incognito trickery is, in current conditions, a little like pouring rubbing alcohol into the nation’s open wounds.Employing the same ingenious commitment and subterfuge that made him famous in the guise of Ali G., Borat ...
Published: 07/15/18
Trump tweets, hits links before high-stakes Putin meeting

Trump tweets, hits links before high-stakes Putin meeting

TURNBERRY, Scotland — Two days before a high-stakes summit with Russian President Vladimir Putin, President Donald Trump played golf and tweeted Saturday from one of his namesake resorts, blaming his predecessor for Russian election meddling and lash...
Published: 07/14/18