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Changes in store for DOH

By Jim Saunders
3/26/2010 © Health News Florida
Speaker Larry Cretul and other House leaders put a bulls-eye on the Florida Department of Health during the first day of this year's legislative session.

Just hours after the session opened, Cretul met with reporters to announce a push for "high-performance'' government. And among all state agencies, House leaders singled out the Department of Health for major changes.

That announcement led last week to the release of a bill that has sent public-health advocates into a frenzy. They worry that the push for a smaller, "high performance'' department will translate into gutting critical disease-prevention programs.

Even more fundamentally, they question why the House is targeting the Department of Health.

A House committee added to the controversy this morning by changing  the bill to move regulation of medical professions from the Department of Health to the Department of Business and Professional Regulation. Doctors' groups, who lobbied in the past to have medical regulation under the Department of Health, immediately said they were opposed to such a move.

Claude Earl Fox, a physician and founding director of the Florida Public Health Institute, said the bill probably reflects what he considers an "anti-government, small-government attitude'' of many Florida politicians. But he said prevention programs that address chronic diseases, such as diabetes, are vital.

"I think the Legislature should be extremely cautious about making any changes in the public-health department,'' said Fox, who served as Alabama's state health officer from 1986 to 1992 and later held health posts in the Clinton administration.

The proposed reorganization originated in Cretul's office and is now being spearheaded by Naples Republican Matt Hudson, vice-chairman of the House Health & Family Services Policy Council. Cretul, R-Ocala, has the power to push his priorities through the House and also enjoys considerable leverage to help get them approved in the Senate.

Other House Republican leaders have used descriptions like "dumping ground'' and "mission creep'' when talking about the Department of Health. Bottom line, they argue that the department has taken on duties that go beyond what was originally intended --- which drives up costs for the state --- and should be more focused.

House Majority Leader Adam Hasner, a Boca Raton Republican who is one of Cretul's top lieutenants, said the department is doing "a lot of things that (weren't) set out when they were created.''

"Every day, you have to challenge the status quo and you have to ask the right questions about whether government is working effectively for the people of Florida,'' Hasner said.

With the state facing an overall shortfall of as much as $3 billion next year, Hudson said the House looked at the Department of Health because of concerns about health-related budgets. At the same time, both the House and Senate are trying to find ways to curb costs in the Medicaid program, which is run by the Agency for Health Care Administration.

"The problem is, we just don't have enough money,'' said Republican Rep. Ed Homan, a Tampa orthopedic surgeon who voted against the bill during a committee meeting today. "That's the underlying problem.''

But Chris Nuland, a lobbyist for the Florida Public Health Association, said the state likely would receive only short-term savings if lawmakers reduce disease-prevention efforts. As an example, he said spending money to prevent obesity can help avoid more costly problems later with diabetes or high blood pressure.

"It's cheaper to prevent disease than to treat it,'' Nuland said.

Revamping the Department of Health is not a new idea. For example, Gov. Charlie Crist last year floated the possibility of merging the department and the Agency for Health Care Administration, though the idea went nowhere.

The House Health Care Appropriations Committee voted 7-4 to approve the proposed bill today, following passage by another health committee earlier in the week. But even if the full House ultimately approves the bill, it will be a moot point if the Senate does not go along.

Senate Health Regulation Chairman Don Gaetz, R-Niceville, said this week he doesn't think the issue is "alive'' in the Senate. With the 60-day legislative session nearing its mid-point, Gaetz said the Senate doesn't even have a version of the House bill.

Procedurally, it remains possible for the Senate to take up the proposed reorganization. But Gaetz likely would have to be involved in such a move, and he said nobody from the House had talked with him about it.

"It would be hard (for the Senate to approve the House proposal),'' he said. "There is no bill.''

Even if the Senate doesn't go along, the House could be setting the stage for trying to pass a reorganization in 2011 --- a possibility that Homan likened to a "shot across the bow'' this year. House leaders have indicated their efforts to create a overhaul state government could take years.

"We are not going to accomplish all of our high-performance government goals in one year,'' Hasner said. "It's going to take multiple sessions and multiple years.''

The House proposal would make wide-ranging changes in the 17,000-employee department. In part, it would require department leaders to propose a plan by Nov. 1 to reduce the number of divisions and bureaus and limit executive positions.

Much of the controversy focuses on parts of the bill that department officials and other public-health advocates interpret as limiting their ability to provide disease-prevention and health-education services. Also, they worry that requirements in the bill would make it harder for the department to compete for federal grants.

Hudson said he wants the department "laser-focused" on seven main areas of responsibility, including communicable diseases, public-health emergencies, vital statistics and regulation of health-care professions. But he also said the bill would leave room for the department to conduct prevention programs so long as it can show tangible results.

It appears, however, that House leaders sought little --- or no --- input from the department or public-health advocates before releasing the bill. Hudson and Cretul both work in the real-estate industry and are not health professionals.

Even Homan, who is chairman of the House Health & Family Services Policy Council, said he didn't know about the bill until after it was released.

Homan said he doesn't object to trying to rein in the department's costs, but he would have handled the issue differently. He said he would have told department officials the state doesn't have enough money and then worked with them to try to come up with a plan to focus on providing core services.

But Hudson blamed department officials for not stepping up to work with House leaders. He said Cretul's comments on the first day of the legislative session made it apparent that the House was looking to make changes, but agency officials never met with him.

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