Florida leads U.S. in new HIV cases after years of cuts in public health

[J.R.E.]

This was the front page of today's Tampa Bay Times

http://www.tampabay.com/news/politics/stateroundup/florida-leads-us-in-new-hiv-cases-after-years-of-cuts-in-public-health/2262471

TALLAHASSEE — Florida leads the nation in new HIV infections, but it's not being treated as a crisis by Gov. Rick Scott or the state's top health officer, Dr. John Armstrong.
 
   
As the virus has spread, Scott and Armstrong have imposed four years of personnel cuts in the Department of Health that have shrunk the size of county health departments.

State lawmakers are now asking whether the spending decisions have produced a sicker population in a state where HIV infections have risen each year since 2012 as they've declined across the country...

[BT65]

This is a sad state of affairs.  Sometimes things like this make you wonder how these people got voted in.  I remember Florida had a huge waiting list for adap not long ago, but that cleared didn't it?  I know it doesn't make a difference with getting people into treatment in the first place (let alone testing), was just wondering.  Thanks for posting this, Ray.

Betty

[leatherman]

I remember Florida had a huge waiting list for adap not long ago, but that cleared didn't it?

yes, but no thanks to Florida. A non-profit SC med delivery agency donated meds for nearly 6500 people for 4 months in 2011-12 until the next state budget began - and with a hefty Federal emergency measure that cleared all the states' waiting lists
http://forums.poz.com/index.php?topic=36414.msg453500#msg453500

pretty amazing that after receiving charity to keep people alive in the state, the FL government would continue to slash the budget. I guess they figured the nation would bail them out again.

[Wade]

Florida has large population of people in their late 70s and 80s
and a lot of rednecks, a perfect formula for Republicans. There is a large Democrat population in South Florida, the rest is mostly red. Florida has a long history of republican Governors.  I almost threw up when Rick Scott was elected , its ironic he was involved the health care industry before he was elected .

[Mightysure]

Florida... America's phallic shaped embarrassment.  The state responsible for President George W.  Bush,  Casey Anthony and George Zimmerman walking free,  and 90% of this country's weird news stories.  Do these ppl not realize that it will cost the state one way or another?
My sister the other day was watching some conspiracy theorists discussing how our state lines are becoming as meaningful as County lines within a state because the federal government is increasing in power.  Things like this make me wish that was true.

[Almost2late]

Thought I'd add this to J.R.E.s original story.. Something just doesn't seem right 


Health department number crunchers cure Florida’s HIV crisis
 
It was a miracle, sudden and wondrous. But like other medical miracles attributable to the Florida Department of Health, slightly suspect.

Only a few weeks ago, Florida was leading the nation in new HIV infections. For instance, last year the state reported 6,240 new HIV cases, up from 6,147 in 2014. In fact, Florida’s HIV infections had been increasing every year since 2012, even as the national numbers were declining.

Florida was facing a worrisome public health crisis. Well, worry no more. The Florida Department of Health knows how to beat down an epidemic. Send in the accountants.

Tampa Bay Times reporter Kathleen McGrory reported Saturday that the department has reconfigured the state’s embarrassing HIV stats from 2014 and managed to lop off a quarter of the new infections. The department was able to tamp down that year’s total to 4,613. Still bad, but low enough to allow Florida to shed its “worst in the nation” status.
 

The agency claimed it reached the new total by culling duplicated names from state records and by removing names of patients diagnosed with HIV in Florida clinics but with an official residence in some other state. Experts, however, found the reduction startling. And the timing suspicious.


THE SPIKE IN HIV CASES COINCIDES WITH REDUCTIONS IN STATE-PAID COUNTY HEALTH STAFFERS FROM 12,759 TO 10,519.

Earlier this month, the state Senate had refused to confirm John Armstrong, Rick Scott’s nominee for state surgeon general, in part because of concerns over the steady rise in HIV cases. Armstrong, who had been acting surgeon general since 2012, had also presided over cutbacks in health department staffing. The Herald reported in January that during Scott’s tenure, state-funded staff positions at Florida’s 67 county health departments had been reduced from 12,759 employees to 10,519. Critics in the Legislature suggested there was a relationship between the staff reductions and the increase in HIV cases.

The DOH has issued a press release denying that the agency had manipulated its stats and instead accused the Tampa Bay Times of using “cherry-picked data to fit a predetermined conclusion.” What the department has not explained is why the revived stats weren’t used to rebut Armstrong’s critics when he was being skewered in the Legislature. Supposedly, the new numbers have been around since January.


Besides, the DOH has suffered a numbers credibility problem since last summer, when the Herald’s Carol Marbin Miller reported how the agency had come up with a clever new screening system designed to knock thousands of Florida’s frail and ailing children out of a state program providing crucial pediatric care.

At least 6,000 “medically complex and medically fragile” children were suddenly deemed no longer eligible for the Florida Children’s Medical Services program. Instead they were shunted — “transitioned” as the bureaucrats put it — into a clunky Medicaid program a federal judge had characterized as “a second-rate health care system.”

Children with serious and chronic conditions including severe vision and hearing impairments, facial deformities and metabolic disorders were reclassified without the bother of physician recommendations. When Florida needs a medical miracle, the Department of Health just calls out the accountants.

Read more here: http://www.miamiherald.com/news/local/news-columns-blogs/fred-grimm/article68680787.html#storylink=cpy

Think I remember this Governor used to work in the medical field and was indicted for wrong doing before being elected Governor.. Wtf

[leatherman]

The agency claimed it reached the new total by culling duplicated names from state records and by removing names of patients diagnosed with HIV in Florida clinics but with an official residence in some other state. Experts, however, found the reduction startling. And the timing suspicious.

while I certainly believe that FL has problems (I remember when (2010) their entire ADAP program ran out of money 4 months before the end of the fiscal year and had to receive assistance to continue supplying meds to PLWH), I wonder if FL is using the Data-to-Care program (D2C https://effectiveinterventions.cdc.gov/en/HighImpactPrevention/PublicHealthStrategies/DatatoCare.aspx)? While D2C is designed to use patient data to identify and engage those who have fallen out of care, a side benefit is that D2C helps a state to "clean up" it's HIV patient data.

For example, SC is in the final stages before implementing this intervention. We know that one of the first benefits of this program will be to "clean up" the data of several agencies that work across the borders into GA and NC. While one ASO just south of Charlotte NC also treats several patients from NC, they have also "lost" patients who crossed the line to receive treatment in NC. Two other agencies close to the GA border have also lost patients to that other state. Taken at face value, because neither NC or GA reports that it has taken on the care of these patients, it looks as if SC has simply lost over 2000 patients to care and treatment. Needless to say the state numbers for our continuum of care look especially bad with over 2000 patients who have dropped out of care. However, the new D2C program, using the entire state's database of HIV+ patients, is able to work with those other states to identify patients who are NOT lost to care but who are receiving care in neighboring states. Once our D2C program goes into effect, SC's continuum of care numbers will vastly improve as nearly 2500 patients are expected to be removed from the system (because they are living in those adjoining states and receiving care there)

As I said I don't know if FL is using D2C but that could be one explanation, as this article doesn't look for the underlying reason but simply blames the FL system based on what happened with a completely different patient set (medically complex child patients).

I also have some questions there about that piece of this story. Many patients with various afflictions are being shunted into Medicaid programs. That is what Medicaid Expansion is all about - giving people who are living with disparities and illnesses better access to healthcare. The Ryan White program is even doing something similar. Part D (supporting family-centered, comprehensive care to women, infants, children and youth living with HIV) is being phased out. Not because there are no more women, infants or children living with HIV; but because those people are just as easily treated through the other parts of Ryan White, ACA insurance plans, and Medicaid Expansion. Even states that didn't accept Medicaid Expansion are able to do better for these women and children by purchasing ACA insurance with ADAP funding - not only continuing to ensure that the patients have access to ARVs but, with the insurance, actually expanding access to complete healthcare not just the meds.

while the situation in FL, and for that matter most of the Southern states with their ever growing HIV epidemic and 3rd world survival numbers (17% of those diagnosed with HIV and 26% of those diagnosed with AIDS will be dead within 5 years!!!), is certainly terrible, this article (like most articles) doesn't go into enough details to find out if actual bad accounting "miracles" were happening, or whether patients were being "transitioned" into more complete programs or were removed from the rolls because they were being treated elsewhere in other states

If I were to guess (knowing what I know from SC), I would say that a little of all the above was actually happening. The state was skewing the numbers to look better, some patients were moving to different programs for health care, and other patients were removed from the accounting when it was verified that they had moved into the care of another state.

[J.R.E.]

Just to follow up on this,  Here's another article from the Tampa Bay Times from the other day:

http://www.tampabay.com/news/politics/rick-scotts-misleading-talking-point-about-record-funding-for-hivaids/2271769

Rick Scott's misleading talking point about 'record' funding for HIV/AIDS


Asked to explain a discrepancy in the state's number of new HIV cases, Florida Gov. Rick Scott only crowed about how much is being spent on prevention programs.

    Florida had the dubious distinction of leading the nation in new HIV cases a few months ago, even as the country's overall trend was declining. Then the state Department of Health's division of disease control revised the numbers, which is a routine practice.

But the Tampa Bay Times found that the adjusted total showed only a slight increase in the number of new cases reported since Scott took office in 2011, putting Florida behind California and Texas. The revisions erased one in four cases in 2014, an unprecedented drop that led experts to question the extent of the changes.

When the Times asked Scott's office why the figures were revised so drastically, spokesman John Tupps said only that Scott is "proud that Florida is investing record amounts of funding for HIV/AIDS prevention."

For this fact-check, we are putting Scott to the Truth-O-Meter, and not his spokesman, because this has become a talking point of his administration. Scott made a similar claim in a news release after he signed the 2016-17 budget, saying that "last year, Florida invested a record $34 million in HIV/AIDS prevention."

Leaving alone the health department's self-editing for a moment, could it be that the state has spent a record amount combatting HIV/AIDS?

Well, the state health department did get more funding for prevention programs in 2015 than ever before. But almost all of that money came from the federal government, not Florida.

Scott's office directed us to the health department, which cited the same amount of $34 million.

The word choice is interesting because "investing" makes it sound like the state of Florida is spending tens of millions of its own dollars to address a public health crisis. That $34 million, however, is from the Centers for Disease Control and Prevention, not state coffers.

The money is part of an awards process that gives cash to state health departments and some cities that apply for help with curbing HIV/AIDS cases. The CDC awards are for programs like HIV testing, services for HIV-positive patients and their partners, condom distribution and more.

It's not unusual for Florida to receive money from the federal government for this purpose. The CDC provides most of this funding because the agency is in charge of monitoring and fighting infectious diseases, according to Emily McCloskey, senior manager for policy and legislative affairs at the National Alliance of State and Territorial AIDS Directors. The CDC is the primary source of money to deal with HIV and AIDS, but also other STDs and conditions such as hepatitis, tuberculosis, diabetes, arthritis and obesity.

Technically, the pot of money at issue is split between prevention programs and testing. But as you can see, the amount Scott is touting has indeed gone up:

[bmancanfly]

And on an adjacent issue.  Great video.  Watch him skulk out when confronted with the reality of what he has done.

http://www.huffingtonpost.com/entry/rick-scott-medicaid_us_570476a1e4b0a506064d8dba

[GoForIt]

What a creaton of a character.  That grin on his face at all times is like...what are you smiling about...no one is happy with you.  Look at the comments on that article.  It's like all of Florida wants this guy to hear that no one likes what they are seeing.

[RobbyR]

Anyone see the video of the woman who called his ass out for cutting Medicaid? I enjoyed that. And seeing him run away like a little bitch instead of conversing with her. How predictable.

[J.R.E.]

And on an adjacent issue.  Great video.  Watch him skulk out when confronted with the reality of what he has done.

Just caught that about an hour ago !! 

Here's a direct you tube link :

https://www.youtube.com/watch?v=mXYzgTLoQjY

[RobbyR]

Good for her! He thought he'd come get a cheap photo op but got more than he bargained for!

[J.R.E.]

 Here's another follow up article in today's Tampa Bay Times, Regarding the HIV numbers here in Florida:

http://www.tampabay.com/news/health/members-of-congress-demand-answers-from-gov-rick-scott-on-revised-hiv/2275204


Members of Congress demand answers from Gov. Rick Scott on revised HIV numbers

Eleven members of Florida's Congressional Delegation are pressing Gov. Rick Scott to explain how the state changed its count of new HIV cases amid a controversy over the numbers.


The members, a mix of Democrats and Republicans representing districts from North Florida to the Keys, sent Scott a letter Thursday demanding to know why the state health department revised the number of new infections reported in 2014 from 6,147 to 4,613.

A Tampa Bay Times analysis found the 25 percent adjustment was much larger than any adjustment made in recent years. That report also noted that the numbers were revised as the state faced heavy scrutiny over a spike in HIV cases that year.

"The large data revision combined with these vague and imprecise explanations has created uncertainty regarding the true status of new HIV infections in Florida, as well as questions regarding (the Florida Department of Health's) competency and transparency," the members of Congress wrote.

Statistical integrity, they added, has "vital ramifications for Florida and our nation."

PREVIOUS COVERAGE:  Criticized for HIV spike, Florida takes hundreds of cases off the books

RELATED:  U.S. Rep. Kathy Castor calls for federal review of Florida's shifting HIV statistics

"The (Centers for Disease Control and Prevention), in particular, uses the data collected by each state to compile national statistics, and this data influences resource allocation and grant funding, as well as response actions," they wrote.

Earlier in the day, state health officials released some more detailed information about a process known as "de-duplication," which they say helps explain the changes.

Health Department spokeswoman Mara Gambineri said the CDC had recently changed the criteria for identifying cases that may have been counted twice or in two different states, causing Florida to have to sift through more records.

The process takes months, she added. Data from 2014 won't be finalized until June 30 of this year.

Despite the new details, the health department has failed explain how each infection was either reclassified or removed from the rolls. What's more, the department has declined to make interim state Surgeon General Celeste Philip or anybody in the HIV/AIDS department available for an interview.

Florida's HIV statistics have been in the public eye since January, when a spike in the number of new cases diagnosed in 2014 cost then-Surgeon General John Armstrong his job.

The new, lower figures were published around the same time.

Last month, a Times analysis found the adjustment was twice as large as any adjustment made in the past decade. The Times also found Florida had recently changed the annual counts dating back more than a decade, removing more than 7,300 cases from the rolls.

The analysis prompted U.S. Rep. Kathy Castor, D-Tampa, to call for a federal investigation. Castor cited "widespread questions over the accuracy of the HIV/AIDS numbers in Florida" in her letter to U.S. Health and Human Services Secretary Sylvia Burwell.

Castor was among the 11 members of Congress who signed the letter to Scott on Thursday. She was joined by Democratic Reps. Debbie Wasserman Schultz, Ted Deutch, Alcee Hastings, Patrick Murphy, Lois Frankel and Frederica Wilson, and Republican representatives Ileana Ros-Lehtinen, Mario Diaz-Balart, Carlos Curbelo and Ted Yoho.

The members asked Scott for specific information on what evidence had been used to justify the revisions. They also wanted to know how many cases had been shifted to other states or reporting years.

"We hope that you will conduct a thorough examination of Florida's new HIV infection rate data and make it publicly available, to ensure that this critical information has been accurately and transparently recorded, reported and revised," they wrote.

They pointed out that Florida continues to be a national leader in terms of new infections.

"Floridians deserve clarification on how (the Florida Department of Health) records, reports, and revises public health data, especially with respect to new HIV infections in our state," they wrote.

[leatherman]

Earlier in the day, state health officials released some more detailed information about a process known as "de-duplication," which they say helps explain the changes.

Health Department spokeswoman Mara Gambineri said the CDC had recently changed the criteria for identifying cases that may have been counted twice or in two different states, causing Florida to have to sift through more records.

The process takes months, she added. Data from 2014 won't be finalized until June 30 of this year.

aha! sounds like Data-to-Care was part of the issue.

I wonder, does Florida have an HPC (HIV planning council) - an oversight/planning committee of Ryan white, health dpt, and consumers? I ask, because when SC suddenly finds they have a whole different number of PLWH, PLWH here won't be surprised because we have been kept apprised of (and even assisted with) our D2C program and the possible outcome