Earlier this year, a prominent state legislator called Georgia’s Public Health division “a mess.’’
And to clean up that mess, legislation was passed to move Public Health out of a larger state agency. On July 1, it was launched as an independent department.
The health challenges facing the new agency are enormous. Georgia ranks 36th among states on a prominent public health measure, and it lags far behind on important measures such as infectious disease (47th), infant mortality (41st), cardiovascular deaths (40th) and rate of uninsured residents (44th). Georgia has the second-highest rate of childhood obesity.
Yet Public Health’s challenges are not confined to improving health statistics. The commissioner of the new agency, Dr. Brenda Fitzgerald, has her work cut out for her in confronting several major administrative problems — some of which may involve past improprieties or mismanagement.
The Public Health problems “have been buried so deep for so long,’’ says Russ Toal, a professor of health policy and management at Georgia Southern University, and a former president of the Georgia Public Health Association. “They’re going to have to do some serious digging.’’
The latest problem surfaced this past weekend when the Atlanta Journal-Constitution reported that state officials are investigating a series of suspicious contracts awarded by the Department of Public Health’s HIV unit. It is “an office that for years has been plagued with a stifling bureaucracy, massive turnover and questionable management of federal money,’’ the AJC’s Chris Joyner reported in the article.
The internal investigation centers on about $5 million in contracts. Fitzgerald, appointed to lead Public Health five months ago, said there appeared to be a wide variation in the costs of the contracts, some of which went to former state employees without competitive bidding, the AJC reported.
That investigation coincides with the agency’s work on ridding a nutrition program of fraud. The anti-fraud initiative in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has led to a handful of arrests, state officials told Georgia Health News recently.
“WIC fraud is certainly not confined to the state of Georgia, but we’re sending a clear message to taxpayers and would-be criminals: Fraud will not be tolerated,” an agency spokesman told Georgia Health News.
And there is a continuing question about the billing of three managed care companies for vaccines. Georgia Health News reported in November that a state spreadsheet showed that three managed-care companies owed a combined $12 million to Public Health for children’s vaccines. That situation still has not been resolved, though the Department of Community Health, which spun off the Public Health unit in July, says it should be finalized soon.
Another recent example of Public Health problems could be seen in a breakdown in the state’s system for tracking data on infant mortality, which the AJC reported on earlier this year. The state Office of Vital Records’ medical files on infants under age 1 year were only 7.2 percent complete for 2009, the Centers for Disease Control and Prevention found. Community Health told the newspaper that it had worked to eliminate the data backlog.
And a December letter from auditors to Community Health listed flaws in the financial oversight of bank statements, checks, cash receipts, expenditures and invoices at Public Health, GHN reported in January.
The Public Health unit, with its $600 million budget and more than 1,000 employees, moved from another agency to Community Health in July 2009. That switch itself led to financial documentation problems, noted the audit. The agency said at the time that it was fixing those flaws.
Much of these problems stem from the days when Public Health was part of what was the Department of Human Resources.
The unit was mired in what Rep. Mickey Channell (R-Greensboro) called a mammoth state agency, where it endured years of budget cuts. Channell spearheaded the legislative fight to end “the mess’’ and create a separate agency.
Both Toal and Kathryn Martin, the vice president of the Georgia Public Health Association, applaud Fitzgerald for addressing the problems head-on.
“Dr. Fitzgerald is coming in with fresh eyes,’’ Martin says. “She’s working on stopping the bleeding. She’s looking at contracts, looking at money being left on the table.’’
Toal says Public Health, as its own department, will now have increased visibility. “It’s essential for [Fitzgerald] to establish the integrity of the department,’’ he says. “They’ve got to get these issues resolved.’’