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Health Care Politics Shakes Up FL's West Coast

The Florida Department of Health wants Sarasota County to privatize its prenatal care in the next three years. And that has its southern neighbors worried – after all, when Charlotte County privatized health care, residents started leaving the county for care.

Charlotte County Commission Chairman Bill Truex walks through a small, squat building that houses a lot of the government functions for the small town of Englewood. He points into a darkened room.

Here, the Charlotte County Health Department used to have a health clinic until it closed in 2013. Volunteers staff it two days a week for a couple hours in the evenings.

“And then we have this facility,” Trues said. “It’s a small facility and they do need more space.”

Truex said the state forced Charlotte County to privatize health care services. And that isn’t necessarily a bad thing.

“If you have them in proximity to your population,” Truex said. “Our problem here is we have one in the southern portion of the county and this entire area over here is kind of left in flux as to where they’re going to get their health care.”

Where they get their care is an hour north in Sarasota County, and that includes pregnant women. Truex is worried because state officials want what happened in Charlotte County to happen in Sarasota County.

“I think what happens in Sarasota County when they go to our model, which is being forced on them by the state as it was forced on us, is we get a larger void,” Truex said.

Health News Florida is highlighting details of its Pregnant and Poor investigation all week. See the series here.

The grass is always greener in the other county

So what kind of public health system does Sarasota County have for pregnant women? In a word, robust.

Dr. Washington Hill helped build a clinic for high-risk pregnant women in Sarasota County. And now, the health department in Sarasota looks a lot like a private OB-GYN practice.

It has four doctors on staff, and treats pregnant women from conception to delivery. Seeing high-risk patients is a calling for Hill. He said some women see pregnancy as the reason to clean up their life.

“There are other patients we have to struggle with, to be honest,” Hill said. “They miss their appointments and when I go into the room I say, 'Where have you been?' They have this excuse and that excuse. And I tell them non-judgmentally that I need you to bring the baby in.”

The Sarasota County Health Department delivers one out of every five babies in the area. And it’s able to run the clinic on a $17 million budget. It’s a government partnership with the private sector, and the state puts in less than $100,000 per year.

Chuck Henry, director of the Sarasota County Health Department, said 40 years ago, health departments started employing doctors and taking care of patients directly because there wasn’t anyone else to do it.

“It’s also the reason you hear a lot of conversations going on today from a standpoint of reevaluating that model to see is there capacity in our community to begin to hand off some of these services to other entities that can provide them at just as high a quality as the health department, and maybe at a lower cost,” Henry said. “And I think that’s our responsibility as a taxpayer entity.”

State officials have put the county health department on notice that that the state wants obstetrics privatized in the next three years. And that scares Sarasota County Commissioner Christine Robinson.

Robinson and fellow commissioners have been challenging the shift since May.

“The thought of turning out 30,000 people or them not getting the proper care that they need in this county makes my knees shake,” Robinson said. “When I get the question of what’s the biggest issue that keeps you awake at night in Sarasota County, this is it.”

The Florida Department of Health in letters has said it will remain a partner in Sarasota County’s health care for now. But it also made clear it wants to change that, both in Sarasota County, and elsewhere in the state.

Statewide, only 28 of Florida’s 67 counties offer prenatal care. And it boils down to a philosophical question: Should government provide health care? State officials say the private sector can do better. Robinson disagrees.

“I just can’t imagine children and mothers and folks who can’t afford it not getting the health care they need because of a policy decision made in a vacuum,” Robinson said.

Robinson generally favors privatizing government functions – when it makes sense. Just this year, she worked to privatize Sarasota County’s transportation for disabled residents.

“I’ve been a lifelong Republican and been very active in my party, but you know what, you have to apply common sense to a situation and this just does not make sense,” Robinson said.

Abe Aboraya is a reporter with WMFE in Orlando. Health News Florida receives support from the Corporation for Public Broadcasting.

Health News Florida reporter Abe Aboraya works for WMFE in Orlando. He started writing for newspapers in high school. After graduating from the University of Central Florida in 2007, he spent a year traveling and working as a freelance reporter for the Seattle Times and the Seattle Weekly, and working for local news websites in the San Francisco Bay area. Most recently Abe worked as a reporter for the Orlando Business Journal. He comes from a family of health care workers.