TALLAHASSEE — Despite a contentious first hearing — characterized by one senator’s assertion that hers was “one of the worst confirmations of someone I could imagine in the United States” — Florida’s new healthcare chief, Mary Mayhew, cleared her first confirmation hurdle Thursday as a Senate committee advanced her nomination largely on party lines.

The Senate Health Care Appropriations Committee voted 6-3 to recommend the former Trump Medicaid official, despite harsh questions from multiple Democratic senators about a federal audit that skewered Maine over the deaths of 133 people with developmental disabilities during her tenure as the state’s healthcare chief and her vigorous opposition to expanding Medicaid.

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Mayhew had largely stayed quiet since her nomination by Gov. Ron DeSantis in January, save for appearances at the occasional legislative committee meeting. During a roundtable at the Governor’s Mansion, she had sketched out some early priorities like improving communication with other healthcare agencies such as the Department of Children and Families and increasing mental health services.

She stood with DeSantis when he announced he would call on the Legislature to allow importing prescription drugs from Canada and when he supported a measure before the House and Senate that would encourage shopping for cheaper care by allowing insurers to share savings with patients.

On Thursday, she told lawmakers that she wanted to focus on data-driven improvements to the agency and move beyond what she termed a transactional focus on resources.

Perhaps anticipating the questioning on her past record, she told the committee “government’s not perfect, I’m not perfect,” but that as a leader, she would be “continually focused on who we serve, how we serve them and whether we are serving them effectively.”

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For much of the nearly hour-long hearing, some senators focused on Mayhew’s long track record in Maine as the commissioner for health and human services. Under former Republican Gov. Paul LePage, Mayhew had helped push substantial restrictions on eligibility standards for Medicaid and food stamp and welfare programs. Proponents including LePage had praised her for controlling the state’s health spending, but critics charged she slashed needed safety-net programs and was sluggish in responding to the state’s opioid epidemic.

Mayhew repeatedly said her focus in Maine had been to stop the state from “hemorrhaging red ink” and that her priorities there were different from what they might be in Florida, “certainly in terms of the financial challenges that were affecting that state.”

“We had to make difficult decisions,” she said.

Sen. Kevin Rader, D-Delray Beach, grilled Mayhew on an August 2017 federal audit issued after she stepped down to unsuccessfully run for governor in Maine, that skewered the state for failing to investigate more than a hundred deaths of people with developmental disabilities in state care.

The Office of the Inspector General for the U.S. Department of Health and Human Services, which conducted the audit, had charged that the state had not complied with its federal agreement to provide home and community-based services under Medicaid or meet state requirements to “inform” district attorneys’ offices of suspected neglect or abuse during a two-year period in Mayhew’s tenure.

“There were systems that absolutely needed to be improved,” she acknowledged, though she said the audit emerged after she stepped down from her job to run for governor. She also faulted what she said were overly broad regulations in Maine that too widely defined terms like critical incidents, she said.

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Rader also asked Mayhew about her long-time opposition to Medicaid expansion and push in Maine to restrict eligibility for the program. He pressed her on whether she would enact expansion if a citizen initiative to the ballot passed. LePage, before he left office, had resisted a voter referendum to expand the Medicaid population until he left office last year.

Mayhew acknowledged she was personally against expansion but implied she would support the voters’ decision: “I am responsible for implementing the laws that are passed.”

Multiple senators also raised a proposed rule that would have dramatically slashed reimbursement rates for thousands of behavioral analysis providers that serve developmentally disabled children — Mayhew said that proposed rule had been yanked a few days prior for further review in the summer and fall.

Some senators, including Sens. Anitere Flores, R-Miami, and Lauren Book, D-Plantation, who eventually voted to recommend her, thanked Mayhew for being particularly responsive on that and other issues.

But that was not sufficient for Rader or most of the other Democrats on the committee — Rader in particular, compared Mayhew’s management record to that of disgraced financiers Bernie Madoff, Michael Milken and Ivan Boesky.

“There’s absolutely no way the board of directors. which is what we are in this case, or the shareholders would put up (with this),” he said, equating Mayhew to “an uninsurable risk.”

“There’s just no way that those banks’ board of directors would allow someone who has had past problems and issues and broke and didn’t comply with federal and state requirements,” he added. “This is really one of the worst confirmations of someone I could imagine in the United States.”

Republican Sen. Ed Hooper contended that Rader’s criticisms were too harsh: “Is there a perfect person anywhere in this country?… I believe this lady needs to have a chance.”

After the hearing, Mayhew briefly addressed reporters and said she expected the grilling: “This is expected, as a public servant, to be held accountable… Audits are part of the overview of state agencies. I take very seriously any audit that identifies weaknesses and concerns.”

She sidestepped when asked if she supported proposals to institute Medicaid work requirements in Florida, saying she and the governor had not specifically discussed current legislation.

Mayhew’s second of three confirmation hearings is expected Monday. Despite Democrats’ concerns, she is likely to be confirmed by the Republican-controlled Senate.