She agrees with the Tallahassee evaluators' judgment that the number of full-time STD doctors in the program is too high. By her reckoning, the high number of physicians is a holdover from the elevated levels of syphilis and gonorrhea Dade County experienced in the Eighties, and the relative glut of medical doctors countywide.
She also accepts the reports' stinging assessments of the subpar care those physicians provide. "There is no excuse for the quality of those services," she concedes. "Certainly we recognized that we needed individuals who were completely trained in those particular services. They were not particularly up-to-date on particular standards." She would not elaborate on which of the physicians' clinical shortcomings she found most disturbing, adding only that some of them have undergone additional training.
The main issues, Neasman insists, have been budgetary, and for that reason this past September, the two STD doctors with the shortest time of service at the DOH found themselves in the downsizing crosshairs: Dr. Rusquin Duany and Dr. Luis Arrue.
These two men were among the doctors who, as a group, were criticized for giving substandard care. They also were among the signatories of the letters that led to the political heat. If Neasman took umbrage at her subordinates overtly trying to exert pressure, she's not admitting it. And firing them for bad performance (as opposed to financial reasons), she notes, would have required going "the disciplinary route."
Neasman agrees with Sfakianaki that none of what was described in the reports warranted disciplinary action. She also seems to accept their intransigence and complaints to politicians as par for the course. "They are not any different from any employee we have in state government," she says. "They don't like change. When you make a change, you're going to have resistance."
As it happened the department did not pull the trigger on either Arrue or Duany. Arrue accepted a demotion. The death of another STD doctor and the retirement of a doctor from another program obviated the need for further physician layoffs this year, Sfakianaki says.
Neasman points out that a new and more comprehensive system of keeping medical records, designed by Brewer, has been instituted, thus addressing a complaint common in both the Tallahassee and Holmes reports.
The fact that the harshly criticized doctors are still working comes as no surprise to former DOH staffer Dr. Kunjana Mavunda. "People at the Department of Health are not doing their jobs, and they're getting away with it," Mavunda laments. "Some of those [STD] physicians are among the most incompetent and uncaring people there are. But the main problem we have is the administration, and Tallahassee knows that. They know, but they're not willing to act.
Published:Owing to a reporting error in Ted B. Kissell's story about the state Department of Health ("The Doctor Is Out," December 10), both the name of Dr. Bill Skeen's organization and his title were misidentified. The group is called the Florida AIDS Action Council. His title is director of public policy. New Times regrets the error.