Department of Health Pinellas County Director Dr. Claude M. Dharamraj explains challenges of fulfilling her three-prong mission to commissioners during an April 24 budget information session.
CLEARWATER – Six entities that receive funding from Pinellas County government presented their budgets for fiscal year 2014-15 April 24 during the first information session of the season.
Presentations were made from representatives of the Office of Human Rights, Feather Sound Community Services District, Construction Licensing Board, medical examiner, health department and human resources.
Interim County Administrator Mark Woodard began the meeting by announcing that interim Director of the Office of Management & Budget Bill Berger had lost his interim designation and is now the director.
“We’re growing our talent from within,” Woodard said.
Paul Valenti, director of the Office of Human Rights, was the first to present. He said his department is not requesting an increase from the current year’s budget for costs it can control.
“We’re trying very hard to be strong stewards of the public’s purse,” he said.
Human Rights also is applying for a HUD grant to help pay staffing costs.
Rich Pettit, treasurer of Feather Sound Community District, reported, “All is well” in Feathersound. He talked about a future capital improvement project to build a fitness zone at a cost of $50,000. He said the area would be equipped with exercise equipment to provide a space for adults to work out and socialize adjacent to the children’s playground.
“This will allow them to exercise in sight of their kid’s playing,” he said.
Feathersound is not requesting a change in the millage rate. However, Pettit said an increase would be necessary in the future, as the budget is being balanced using reserve money.
Rob Fischer, executive director of the Construction Licensing Board, said projections showed a “slight deficit” coming in FY 2015. He said an ordinance was in the works to increase the allowable fines to increase to $2,000. Currently the board is holding $685,000 in unpaid liens from fines not paid. He said the board could pull licenses from contractors who don’t pay their fines.
“But, we’re hesitant to put someone out of business,” he said.
Jon R. Thogmartin, M.D., chief medical examiner for District Six, which serves Pinellas and Pasco counties, told commissioners that the local crackdown on pain clinics had reduced his workload; however, more people seemed to be dying of “odd other things.”
“We’ve got more weird stuff and violent death,” he said.
He also said grant money, which he has used in past years to pay for lab equipment and other needs, seems to be “drying up.” For FY 2014-15, Thogmartin is asking for money to pay for capital projects. He also plans to give his staff a 3 percent pay raise.
He talked about advances in DNA matching that is making a difference in solving “old murders.”
“DNA is so powerful. It is helping solve crimes going back many years,” he said.
He explained that while Pinellas County provides a portion of funding for the medical examiner’s office, control of operations is “all on me.” Thogmartin hires and is responsible for his staff, takes full risks for operations, providing indemnity for county government.
“If I lose or release a wrong body, that’s on me, not you,” he said.
He also talked about the problems related to synthetic drugs as it relates to cause of death.
“There are so many varieties, we can’t test for them all,” he said. “We have to put undetermined on the death certificate and hold their blood and wait until we can test.”
He said Pinellas County had more analogs (variations) of synthetics than any other county in the state.
Thogmartin said the effect of legalizing medical marijuana on DUI testing remains to be seen, as it is more difficult to do a quantitative analysis based on percent of THC. He said it might require additional equipment and staff.
The future is uncertain for the county’s department of health, which also receives funding from the state. DOH Pinellas County Director Dr. Claude M. Dharamraj told commissioners that the mission had changed over the years, making the department more dependent on community partners.
“It is an impossible mission to fulfill by myself,” she said.
She is requesting that the commission continue to levy the maximum millage allowed by state law. The money will help Dharamraj fulfill her mission of providing primary care, communicable disease control and management of the county’s environmental health.
She said she divides the money between the three areas, reminding commissioners that primary care did not just include the indigent population. Pinellas County has the third largest health department in the state.
She is concerned about the continuing increase in need coupled with rising costs. She also is concerned about the affect changes in Medicaid funding and billing will have on her ability to meet her obligations.
“My mission is to make sure everyone has access to care,” she said.
She refuses to join in to the idea that there is competition for Medicaid money among providers.
“I don’t care where you (patients) go,” she said. “We (health department) are the last resort.”
Still, she has to ensure everyone has access and only sees patients when no one else will.
She said a problem area was health care for illegal immigrants living in Clearwater, who are now served by a health department clinic because no one else was willing to take them as patients. Another problem is ongoing issues with local clinics who are willing to take Medicaid patients, but not those who are uninsured.
She said a reduction in state Medicaid funding left her in a position where she needed to seek a larger reimbursement from the federal program; however, at least one local clinic is objecting to that change and accusing the county of competing for available Medicaid money.
Dharamraj said competition does not exist and that there are still Medicaid patients who need access to health care. She said she had supported opening of additional non-government sponsored clinics in the county. She said all those clinics had the capacity to serve more.
“You are the closest to being the board of health,” Dharamraj said. “Florida has no board of health. It is a difficult situation when the community partners have the perception that (county government) favors health department.”
Dharamraj said she could close health department clinics and let someone else provide care, but she would prefer it is county government would apply for a different Medicaid status allowing for higher billing rates, so she can keep clinics open.
As of September, state Medicaid reimbursements will decrease due to lawmakers declining the increases made possible by the Affordable Care Act, leaving uninsured residents will fewer options for care.
The commission agreed to look into the issue of Medicaid funding.
“People in the community don’t care about politics,” said Commissioner Ken Welch. “They just care when they can’t go to the clinic right down the street.”
The final presentation came from Peggy Rowe, director of Human Resources, who told commissioners that her department had met the budget target. She said changes made to how the county recruits and selects new employees was working.
“It is a well-received enhancement,” she said.
Results of the health plan show that it is working, although Rowe said it was still too early to say it is “a trend.” Workforce analysis and planning are also proving to be successful, as is an expansion of volunteer services.
A revamped program to reward employees for exceptional work also is popular. She said team-building activities were getting good results.
Human Resources staff has been training to be able to take over training and leadership development services offered by a consultant. Woodard reported that due to staff’s abilities, he had canceled the consultant’s contract.
“I believe we can do this work ourselves,” he said.
The remainder of time was spent discussing the budget as a whole.
Commissioner Chair Karen Seel reminded everyone that improvements in the economy didn’t mean more money was available for spending.
“We’re still in recovery mode,” she said.
Berger said staff was working on a “reset” of the budget forecast to reflect a larger increase in taxable property values – 5 percent as opposed to 3 percent. The new forecast shows a balanced budget for the next four years, followed by a period with budget gaps.
“We’re in a better position than we were previously,” he said.