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DOH-shrinking bill marches on

By Jim Saunders
3/23/2010 © Health News Florida

Public-health leaders say they are all about preventing disease, not just mopping up after it strikes. So a House proposal that could strip the Florida Department of Health of its health-education mission has unleashed opposition from DOH, led by Surgeon General Ana Viamonte Ros. 

On Monday, the department's secretary told a House committee that the proposal would jeopardize disease-prevention programs and make it harder to attract federal money. And it could limit a wide range of public-health programs, including diabetes prevention and control, stroke prevention and breast and cervical cancer detection.

Nevertheless, the House Health Care Regulation Policy Committee voted 11-2 to approve the measure, part of a broader push by House Republican leaders to rein in the size of government.

Rep. Matt Hudson, a Naples Republican who is spearheading efforts to pass the bill, said supporters want the department to be more focused. The bill proposes seven main areas of responsibility for the agency, including communicable diseases, public-health emergencies, vital statistics and regulation of health-care professions.

"We're talking about creating a high-performance, laser-focused mission,'' Hudson said.

But Democrat Michelle Rehwinkel Vasilinda, one of the dissenting votes on the committee, said it appeared the bill had been "rushed through.''

"This seems like a very complex bill (that) also has the potential for sweeping changes in a front-line agency,'' the Tallahassee representative said.

House leaders signaled early this month that they would try to reorganize the Department of Health, but the release of the bill sent public-health officials scrambling to oppose the idea. Florida's Public Health Association sent out an alert last weekend asking members to tell lawmakers how much damage this proposal could do.

Viamonte Ros said she was disappointed that Hudson had not talked with department officials about his concerns. Hudson expressed a similar pique.

"No one from the Department of Health has reached out to me to discuss a single provision in this bill,'' Hudson said.

Even if the full House passes the bill, it is unclear whether senators will go along. Senate Health and Human Services Appropriations Chairman Durell Peaden, R-Crestview, said last week he doesn't think the department should undergo changes.

But the bill comes as lawmakers struggle with severe budget problems that are expected to continue for the next couple of years. The DOH-shrinking bill has that aim.

The bill would require leaders of the 17,000-employee department to propose a plan by Nov. 1 to reduce the number of agency's divisions and bureaus and limit executive positions. The initial version of the bill set a Dec. 1 deadline for that proposal, but the date was moved up Monday.

Also, the bill calls for eliminating 11 divisions unless they are reviewed and re-enacted by the Legislature before July 1, 2011.

Tallahassee lawyer Tim Cerio, a former general counsel and chief of staff for the department, said the bill would make significant changes. But Cerio said he is not surprised that in tough economic times lawmakers would look at the operations of DOH or any other agency.

Viamonte Ros said she doesn't know how many jobs, divisions and bureaus would be eliminated if the bill passes. She said those numbers would not be known until the department put together a plan to meet the proposed Nov. 1 deadline.

Much of the discussion during Monday's meeting centered on whether the bill would limit programs aimed at preventing or treating chronic diseases. Viamonte Ros said part of the bill appears to focus the department on dealing with communicable diseases, rather than on illnesses like diabetes.

Miami Democrat Yolly Roberson, who cast the other dissenting vote on the committee, said the department recently received a grant for obesity-prevention efforts. She questioned whether the department could be involved in such efforts if the bill passes.

But Hudson pointed to part of the bill that would allow the department to provide services for "targeted populations,'' which he said could allow such programs.

Another part of the bill would eliminate the department's ability to spend state or federal money on such things as conducting health-education campaigns. Also, the bill would redefine the surgeon general's role, eliminating a description of the job as the "leading voice on wellness and disease-prevention efforts, including the promotion of healthy lifestyles, immunization practices, health literacy and the assessment and promotion of the physician and health-care workforce.''

Viamonte Ros said she also is concerned that the bill could make it harder for the department to compete for federal grants. The bill would require the department to get legislative approval before it could start new programs or change programs.

"We need, as an agency, to be able to move quickly,'' Viamonte Ros said. "We need to be flexible.''

But Hudson argues that the department in the past has sought federal grants for programs without legislative approval --- and that the programs have later required state funding.

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at