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TALLAHASSEE — Gov. Ron DeSantis’ pick for surgeon general — a pediatrician by trade — has come under scrutiny for his lack of a public health background.
Surgeon General Scott Rivkees has gone before lawmakers and the public, where he was questioned about his qualifications for leading the state’s Department of Health despite a career spent in pediatrics, academia and research rather than epidemiology or public health.
As of Tuesday, there are two confirmed cases of COVID-19 in Florida so far, both on the west coast: in Manatee and Hillsborough counties. A second Hillsborough woman has also tested positively, making for three positive cases. As of its last update, the state said it was waiting on 16 pending testing results and monitoring more than 240 people.
Rivkees’ lack of experience has drawn the attention of lawmakers and the public alike.
The only mention of “public health” on his résumé is where he lists his position as chair of the CASE Public Health Board. CASE is the Connecticut Academy of Science and Engineering. Terri Clark, the academy’s executive director, confirmed Rivkees served on the board and told reporters that the board oversees issues brought to the academy and “offers guidance.”
The surgeon general, who was nominated last April, was the last of DeSantis’ major agency secretaries to be nominated.
As an appointee of the governor, Rivkees has had to go through the Senate confirmation process, which includes three committee votes and a full Senate vote. He received favorable votes for all three of his required confirmation hearings. His appointment has not yet gone before the full Senate.
During his questioning before lawmakers, his lack of public health experience came up more than once.
“I think I read that the surgeon general, by statute, has to have extensive public health experience in addition to being a medical doctor,” said Sen. Darryl Rouson, D-St. Petersburg.
Delray Beach Democrat Kevin Rader echoed the sentiment.
“I think there’s better picks in the state of Florida who have a breadth of experience when it comes to public health. You’re an expert when it comes to pediatrics,” he said. “It doesn’t mean you’re not a fine doctor. I think we need to find someone who is an expert in public health.”
Rivkees said he has “longstanding interests” in public health, which go back to his time as an undergraduate student at Rutgers University, where he worked in a lab testing blood samples for lead poisoning. He added that when he was a fellow at Massachusetts General Hospital in Boston, he was involved in newborn screening research that he eventually helped develop into a program in Indiana.
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Sen. Janet Cruz, a Tampa Democrat, said she’s been disappointed in Rivkees’ performance so far. She first heard about the coronavirus cases in her district through a text message, and it was only after she called the governor’s office that she was invited to the Tampa press conference Rivkees and DeSantis held to address the local cases.
“Rivkees is a real intellectual,” she said. “But we are in the midst of a health crisis here, and it’s not amateur hour.”
Pediatrics chair at UF
Rivkees, 64, was the chair of the Department of Pediatrics at the University of Florida College of Medicine and physician-in-chief at UF Health Shands Children’s Hospital. He is an international expert on pediatric endocrinology and developmental biology, and joined UF Health from Yale University in 2012.
Within three days of Rivkees being appointed, a Tampa doctor with a master’s degree in public health wrote to the governor’s appointments office to say he wasn’t qualified.
Dr. Tazia Stagg had never met Rivkees before, but immediately took issue with his lack of public health background. Stagg, 40, said Rivkees wasn’t right for the job.
She points to state statute, which says the state surgeon general needs to be a physician with advanced training or extensive experience in public health administration.
She said she tried contacting other legislators to no avail, emailed Rivkees at his University of Florida email address and attended a confirmation hearing to read into the record why she didn’t think he was qualified.
“The private care model is not, it just doesn’t have anything to do with caring for the public or messaging appropriately and anticipating what people are gonna need to know,” she said.
Stagg said she sees a failure in messaging from Rivkees. Before Rivkees and DeSantis gave a news conference on the state’s positive coronavirus cases, Rivkees refused to discuss the numbers of people being monitored or tested.
“When he was silent, not answering questions, it really did both things wrong,” she said. “It didn’t alleviate the worry, it caused worry, and it didn’t give people an action plan.”
At Monday’s news conference, Rivkees couldn’t answer some of the questions he was asked. For example, when he was asked if the state is expecting more people to test positive for COVID-19, DeSantis stepped in to answer. Watching from home, Stagg said she felt like he couldn’t answer the questions asked.
“I thought his shortcomings would be more subtle than they are,” Stagg said.
A Department of Health spokesman did not respond to multiple requests for comment on Monday and Tuesday.
Public health leadership
Though Rivkees doesn’t have a public health background, he leads about 15,000 employees who are the state’s first line of defense in a public health emergency like the one declared Sunday night by the governor when the first two cases of coronavirus in Florida were announced.
Shoou-Yih Daniel Lee, a professor and chair at the University of Michigan School of Public Health, said someone doesn’t have to have a public health degree to be a public health leader if they’ve worked in the field before.
But according to Rivkee’s résumé, he hasn’t had that experience. For almost his entire career he has worked in and taught pediatric care at different hospitals.
Lee said a surgeon general having no public health experience would concern him, but it would be all right if the team around that person was knowledgeable and experienced in the area.
“The person may know public health is important and therefore intentionally build a team with public health experts to help him or her understand health problems, health challenges and propose solutions incorporating public health perspectives,” Lee said.
Some lawmakers agree, noting that Rivkees is just one person. It’s the team that counts, says Sen. José Javier Rodríguez.
“I think our state Department of Health, local departments ... are really well prepared. I’m confident in them. I trust his agency and I trust their ability to prepare us,” he said. “He comes from a [medical school] background so I think he does have the resources and ability to address this sort of thing. “
In practice, however, top brass at the department is similarly under-qualified. The chief of staff, Courtney Coppola, is a holdover from former Gov. Rick Scott’s administration, with no background in healthcare. She most recently served as the director of the Office of Medical Marijuana Use. Before that, she was a policy analyst in the Executive Office of the Governor under Scott.
The new Deputy Secretary for Health, Shamarial Roberson, was promoted into the role from within the department in November after a year-long vacancy. She has less experience than her predecessor.
Roberson has a bachelor’s degree in Family and Child Science and a Master’s of Public Health from Florida State University. She also has a Doctor of Public Health degree in epidemiology from Florida A&M University.
She started as the Department of Health’s chronic disease director in 2016 and later became an administrator, according to her LinkedIn profile.
The deputy secretary position that is tasked with organizing the 67 county health departments is still vacant. The director of that office, Beth Paterniti, worked as a policy analyst under governors Scott and Charlie Crist but doesn’t have a background in community health.
There are two other deputy positions within the department — deputy secretary for children’s medical services, which is vacant, and the deputy secretary for operations, Michele Tallent.
Tallent, who oversees the budget, quality assurance and IT for the department, used to serve as the director of the department’s budget office, according to the agency’s website. Prior to joining DOH, she was a budget staffer for the Governor’s Office of Policy and Budget. Before that, she served as the budget director for the Agency for Health Care Administration.
Too little transparency?
The state has also faced heat for not disclosing how many people were initially being tested for the virus and for delaying in announcing the first two presumptive cases of COVID-19 in Florida.
At the news conferences in Tampa and Miami Monday, Rivkees revealed there was a 24-hour delay between state officials discovering the test results and then informing the public. He said the Centers for Disease Control and Prevention expanded its testing criteria Thursday, making eligible for testing more people who were not included under the initial, more limited guidelines.
The state health department updated its own practices and collected samples on Friday, and it learned of the “presumptive positive” results on Saturday. The department issued a news release on Sunday night, about 24 hours later, announcing its preliminary findings.
Last week DeSantis and Rivkees held a news conference reassuring Floridians the state is prepared for an outbreak. But they declined then to say how many people are being tested or monitored, prompting Senate Democrats to call for more transparency.
DeSantis and Rivkees cited a rule in Florida Administrative Code, which says information about epidemiological investigations will only be released “if determined as necessary by the State Surgeon General” based on certain criteria, such as whether the disease is highly infectious, there is a potential for future outbreaks and there would be an inability to identify specific people based on that information.
Following a meeting with Vice President Mike Pence, who is overseeing the federal response, DeSantis reversed course and disclosed that state health officials had tested 15 people for coronavirus
Sen. Tom Lee, R-Thonotosassa, said he “was kind of surprised” to see Rivkees reference the code provision that allowed them to conceal test results until they determine there “was a public health necessity.”
“My attitude has been, if you’ve got infectious disease in the state … you got a public health necessity,” he said. “This is not the People’s Republic of China. This is the Sunshine State.”
Times/Herald staff writer Lawrence Mower and Tampa Bay Times reporter Steve Contorno contributed to this report.
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