Speaking at a conference on Medicaid in June 2007, Florida's health care chief at the time, Dr. Andrew Agwunobi, bemoaned the "critical'' shortage of doctors willing to accept payment from Medicaid, the state's insurance program for the needy.
But two years later, under questioning from lawyers who sued seeking to reform the insurance program, Agwunobi repeatedly insisted he couldn't recall whether there were enough doctors who accept Medicaid reimbursement — or whether he ever made statements about the program's shortcomings.
Agwunobi's 2009 deposition, played on a video screen opposite the speech he made two years earlier, was included in the opening arguments of a federal trial that began Monday morning in Miami before U.S. District Judge Adalberto Jordan. Nine children are named as plaintiffs in the class-action lawsuit.
Jordan will decide in the no-jury trial whether Florida's Medicaid program pays doctors so little — and is so short of doctors, as a consequence — that it violates federal law.
The lawsuit, filed in 2005, accused three state agencies — the Agency for Health Care Administration, the Department of Children and Families, and the Department of Health — of running Medicaid so poorly and so miserly that children raised in poverty get inferior care to kids who have private insurance.
"A lot of what the plaintiffs say, agency officials agree with — outside the courtroom," argued Stuart Singer, one of several lawyers suing the state in an effort to improve the quality of care given to impoverished Florida children.
Plaintiffs in the lawsuit "fought all the way to the 11th Circuit'' — the federal appeals court in Atlanta — just to get Agwunobi's deposition, he said. When Agwunobi finally appeared, Singer said, there was little of importance he could remember.
Asked, for example, at his February 2009 deposition whether AHCA, the department he formerly led, had identified several specialties — such as orthopedics and neurology — as having the "greatest need'' for doctors willing to participate in Medicaid, Agwunobi replied, "I don't recall."
Later in his deposition, he insisted he didn't know why he couldn't remember any of the details of Florida's Medicaid program, the nation's fourth-largest by spending.
In the 2007 speech played on a video screen in court, Agwunobi said that "each year we should go to the Legislature to ask for more money." But in his deposition, he said he didn't recall making such a statement.
"In our system, we can't sue Florida legislators," Singer said. Instead, he added, agency heads "are forced to defend here what they have acknowledged in records is inadequate."
In his opening statement defending the state, former U.S. Attorney Marcos Jimenez insisted all nine of the children suing the state were given "excellent'' medical care on the state's dime. Jimenez is one of several attorneys — some with the state Attorney General's Office and some in private practice — defending the state.
One of the children, identified as T.G. in court records, saw 10 specialists and had 25 visits to an orthopedist to treat his severe scoliosis, Jimenez said. Taxpayers, Jimenez said, paid $1.2 million in doctors' bills to care for the boy.
Another child named in the suit "received 11 years of timely care in six specialized care areas," Jimenez said.
Jimenez strongly denied that children — both the nine named plaintiffs and the class as a whole — are forced to endure long delays in order to get medical care. He also denied claims that children have had trouble finding doctors or dentists who accept Medicaid reimbursement. "Every one of the children represented in this case has a pediatrician," he said.
Jimenez accused lawyers for the children of "exaggerating'' the failures of Florida's Medicaid program. He said the lawyers were simply "guessing'' when they said 30 percent of children on Medicaid had been "switched'' from one doctor or managed-care plan to another without notice.
And he suggested that, even if the insurance plan had failed some of its beneficiaries, it would be no different than virtually every insurance plan. Jimenez pointed out that both President Barack Obama and many members of Congress are pushing for an overhaul of the entire U.S. health system — not just the ones funded by taxpayers.
Jimenez also suggested the federal law requiring "reasonably prompt'' health care delivery was so vague as to be virtually unenforceable.
Even if some children could not get care quickly, he argued, they could go to any emergency room, where they could not be turned away.