When the pandemic arrived in Florida last year, the state had a position ready made for a public health crisis like the one on its doorstep: The Deputy Secretary for County Health Systems.
On paper, it’s the third-highest ranking position in the state’s health agency because of its key role in coordinating with health offices in all 67 counties. “Preventing epidemics and spread of disease” is in the job description.
But the job was vacant when Gov. Ron DeSantis took office in January of 2019. It was still empty last March when Florida recorded its first two COVID-19 cases. And it remained unfilled in the ensuing months as the virus spread to every corner of the state. An interim hire was made in early December, after 1 million Floridians had become infected and more than 19,000 people had died.
In January, the Tampa Bay Times filed a public records request with the Department of Health for documents related to the vacancy. After a five-month search, the department said there were no records responsive to the request. This means that, from the start of 2019 through the first nine months of the pandemic, the department had not advertised that it had an opening for this senior-level position. It had not posted internal notices to encourage employees in Tallahassee or at the state’s 67 county offices to consider applying. It hadn’t sought or received applications or resumes.
One position would not have prevented the state’s death toll from climbing during a worldwide pandemic. But Dr. Leslie Beitsch, a top-ranking official in the state Department of Health until 2018, said the confusion and tension that was a hallmark of the state’s response to the crisis was likely made worse by this missing link in the chain.
It is the job of the Deputy Secretary for County Health Systems to not only explain emergency directives from Tallahassee to the county offices, but also get feedback from the local level on what strategies are working and what are not, said Beitsch, who served in the role under former governors Lawton Chiles and Jeb Bush.
“What we’ve been seeing for two years is a communication channel that only goes in one direction,” said Beitsch. “That works well in an emergency setting for a while. Now into month 14, that’s straining all aspects of the system beyond repair.”
Marc Yacht, the former director of the Pasco County Department of Health, agreed.
“Not filling that position is just creating another weakness in the flow of information,” Yacht said.
The department filled the position with an interim hire late last year. Courtney Coppola, then-chief of staff to Surgeon General Scott Rivkees, offered the position to Mark Lander, the director of the Marion County office of the Department of Health, in a letter dated Dec. 3, which listed an annual salary of $126,000. There was not an application from Lander on file with the department.
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The department would not make Lander available for an interview. In a statement, Department of Health spokesman Jason Mahon declined to explain the prolonged opening in its senior leadership team, but he said the agency “has always ensured there is close coordination and communication across all 67 counties.”
“The department used multi-layered communication, including having regular calls with county health officers, providing continuous guidance to county health officers from experts in pandemic response and epidemiology, and having county health officers come to the (emergency operations center) to ensure a local perspective was taken into consideration as statewide decisions were made,” said Mahon, who left the department shortly after making this statement.
DeSantis inherited a state health department in 2019 that had undergone a decade of cuts by his predecessors. About 3,700 public health jobs were eliminated by then-Gov. Rick Scott during his eight years in office. The state was so short-staffed at the start of the coronavirus outbreak that DeSantis had to hire 100 students and professors in a matter of days to assist with the response.
But Scott left a Deputy Secretary for County Health Systems in place when he exited the governor’s mansion: Paul Myers, the longtime head of the Alachua County Department of Health office. Myers first ascended to the job in 2014 and stayed through Scott’s second term.
When DeSantis took office, the position was vacant. It’s not clear why Myers left that role.
“To be announced,” the department’s website said at the time on a page reserved for the deputy secretary, according to an Internet archive.
Myers did not respond to an email and multiple messages left on his office answering machine at his Alachua office.
Throughout the pandemic, the Tallahassee office of the Florida Department of Health has tightly controlled communications coming from its 67 county satellites around the state, many staffed by career public employees with decades of experience and expertise. Questions sent to local health departments by reporters are often forwarded to a state communications team for response. (When the Times asked the Pinellas County health department office about its experience operating with and without a Deputy Secretary for County Health Systems, the questions were redirected to Mahon.)
The South Florida Sun-Sentinel reported last year that an employee in the state office ordered county staff in September not to issue press releases or post on social media about the pandemic until the election was over.
Health directors were also instructed not to provide local school boards or colleges with advice on when it was safe to reopen, the Palm Beach Post found. Indeed, at a key Hillsborough County School Board meeting to address school closures last August, Hillsborough Health Department Director Dr. Douglas Holt wouldn’t weigh in.
“I represent the health department here,” Holt said. “I’m providing technical assistance and advice. I do not have a position.”
Multiple calls and emails to a spokesperson in Holt’s office were not returned.
The approach ensured few dissenters from local health officials as DeSantis eschewed national public health warnings and took an aggressive stance to reopening Florida’s theme parks, businesses and schools. But it also created confusion among cities and counties as DeSantis made sweeping announcements at press conferences that took hours to clarify in writing. Sometimes, those decrees stood at odds with the executive orders he signed, and local leaders could not get answers about what to do.
“Our county staff and legal department worked overtime to understand what was being said publicly and what was coming down in actual orders,” Hillsborough County Commissioner Kimberly Overman said. “That (deputy director) probably would’ve made a big difference. It wouldn’t have been a guessing game on where we go from here. But obviously it wasn’t their priority.”
On paper, the Deputy Secretary for County Health Systems was created to fill the void. The person in that job “ensures that county health offices support Department priorities” and “promotes collaboration with external stakeholders,” according to a job description provided by the state.
Yacht said when he was at the Pasco health department, directors often coordinated with top secretaries in Tallahassee, who in turn encouraged him and his colleagues to meet with elected officials and talk in open forums about public health concerns.
Leaving a critical job vacant for two years is part of a years-long fight by governors to shift public health policy to a handful of decision makers who aren’t in the community and won’t act out of line, Yacht said.
“In the bigger picture,” Yacht said, “it’s just another example of undermining what should be a coordinated communication among the counties to develop strategies that look at threats.”