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Health Dept. shake-up draws slams, praise

The top Senate Democrat today blasted a reorganization proposal for the Florida Department of Health, saying it would harm dental health and other local programs that should remain priorities.

But the proposal got a much warmer reception in the House, where one of the department's leading critics described it as a "Herculean effort.''

"I think there's a lot of opportunities here for us to really put them in a good position for the future,'' said House Health Appropriations Chairman Matt Hudson, a Naples Republican who has spearheaded efforts to reorganize the department.

Senate Minority Leader Nan Rich, D-Weston, focused her criticism on a recommended end to funding for health programs that serve specific areas of the state – for example, at least eight dental programs in areas including Miami-Dade County, Southwest Florida, Jacksonville and Pensacola.

"This would decimate community health initiatives throughout the state that have been serving patients and community members for years,'' said Rich, a long-time leader on health and human-services issues.

The proposal, which DOH released last week, got its first public discussion today when agency Deputy Secretary Kim Berfield presented the recommendations to a House committee. In all, the proposal calls for cutting 1,608 department jobs, chopping $185.8 million from the agency's budget and consolidating divisions and bureaus.

Berfield described the process of making the recommendations as an "exciting opportunity.'' She said the department tried to clarify its purpose and goals, a response to legislative criticism last year that it had become unfocused.

"We approached this much like a business,'' Berfield said.

The 154-page report touches on numerous issues and calls for the state to cut funding for primary-care services that are provided through county health departments. That proposal has drawn questions, at least in part, because some counties -- particularly in rural areas -- rely heavily on their health departments for such care.

Some lawmakers and other state officials have urged greater reliance on federally qualified health centers instead of health departments. Berfield said the DOH envisions a phase-out of state funding for primary care, though county health departments could still offer the care if they have other sources of money.

As an example, she said 29 counties could handle the change with relative ease. On the other end of the spectrum, 13 counties rely only on health departments for primary-care services.

Rich's criticism was focused on a narrower set of local programs. Along with dental services, the report calls for eliminating money for programs such as arthritis control and education, asthma prevention and control, epilepsy case management and education and HIV-AIDS outreach.

In many cases, the DOH report says, funding should be eliminated because it is "not based on statewide prioritization of community needs" or that it is "not based on prioritization from a statewide perspective.''

At least some of the local programs have received money because of budget earmarks by lawmakers. Critics have long argued that such earmarks -- known as budget "turkeys" in Tallahassee -- don't prioritize state spending.

But after a meeting of the Senate Health and Human Services Appropriations Committee, Rich questioned the department's logic in targeting local programs.

"Everything can't be statewide programs,'' she said. "Dental health, in my opinion, should be a priority of this committee for funding.''

But another Democrat, Rep. Michelle Rehwinkel Vasilinda of Tallahassee, later lavishly praised the report when Berfield appeared before the House Select Committee on Government Reorganization.

"You have really, really hit the ball out of the park,'' Rehwinkel Vasilinda said.

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