The DOH's internal brawl, with its allegations of substandard care, political infighting, and a brain drain of talented recruits, has taken place mostly out of public view. During the past two years, however, the Miami-Dade DOH has taken very public criticism over its attempts to shut down a single clinic: the Prevention, Education, and Treatment (PET) Center in Miami Beach. Throughout the PET Center controversy, members of the public have been doing what many inside the DOH have been doing: second-guessing the department's upper management.
Much of this can be traced to the affected patients. The poor and indigent clients of DOH's other STD clinics have little political voice; sufferers of chlamydia or bacterial vaginosis have yet to form lobbying groups. But with the PET Center, the DOH was threatening the care of some 600 HIV patients, most living in South Beach.
There was an outpouring of public protest, mostly because the center's combination of HIV primary care and STD/TB treatment is the kind of unified approach HIV experts recommend nationwide.
The center itself is a tiny, boxy pink structure at 615 Collins Ave. When Miami-Dade DOH executive administrator Annie Neasman announced its closure in June 1997, the reaction from the HIV/AIDS community in Miami Beach was one of incredulity. Gary Knight, a member of the AIDS Prevention Task Force, remembers hearing about it on the night he was delivering a speech at the Miami Beach Women's Club, where many in the HIV-care community had gathered to celebrate the department's unveiling of a new AIDS awareness poster. "I got up there and said, 'Imagine my disgust when I picked up the paper and read that the Department of Health is closing the PET Center.' I couldn't believe you could work this closely with people and they would not talk to you about such a significant issue, or give an opportunity for the community to have input."
Neasman says the planned closure in 1997 was dictated strictly by finances (her department's $43 million budget was in the red last year), and by the fact that two other nearby facilities, South Shore Hospital and the Stanley C. Myers Community Health Center, also offer HIV primary care in South Beach.
Even so, Dr. Bill Skeen, executive director of the Florida AIDS Action Committee, was baffled by Neasman's decision. "Florida is the third-most heavily impacted state in the union in terms of numbers of AIDS cases," Skeen points out. "Miami is now the third-most impacted city in the nation. South Beach in particular is one area that's also highly impacted. It's sort of an epicenter within an epicenter."
Some poor clients prefer the PET Center to the other clinics in the area. "They get more things done here, in less time, with less problems, and you don't leave frustrated," says David Schwartz, an HIV patient who has been coming to the PET Center for more than a year. "You come to this place, at least you know you're going to walk out feeling a lot better."
After Neasman's announcement Skeen, Knight, and several other HIV/AIDS activists, including much of the PET Center staff, formed an ad hoc group called the PET Center Action Committee and began meeting with administrators from both the DOH and the county's Public Health Trust.
Within three months of the announced closure, the committee managed to broker a deal: Miami-Dade's Public Health Trust would fund the HIV primary-care portion of the PET Center while the STD/TB services would continue to operate with Department of Health funds. As far as Skeen, Knight, and others were concerned, this meant that disaster had been averted. The Public Health Trust had agreed with them that the PET Center was worth saving.
As it turns out, the 1997 deal only deferred the crisis. This past September Neasman announced that the STD/TB portion of the PET Center's services would be eliminated. As before, she cited declining numbers of patients and a redundancy of services in the neighborhood.
"Stanley Myers [Community Health Center] has always treated a certain level of HIV patients, but they cannot absorb 600 indigent HIV patients," opines Rita Volpitta, a former AIDS coordinator at the PET Center who now works for a private pharmaceutical company.
Neasman maintains that the PET Center controversy was unavoidable. In 1998, with more cuts in funding from the legislature, she had to find money somewhere, and the PET Center's STD/TB operation seemed the logical victim. "I told the [PET Center Action Committee] myself, 'I'm glad you love us,'" Neasman recalls. "We don't often hear that. But the services there do not warrant full-time, 40-hour-a-week providers. They just do not. It was not an easy decision, and it was not one that was made in haste. It was not that the site was being targeted as far as STD services were concerned. I mean, targeted without reason."
She points out that another STD clinic, the Quail Roost facility in South Miami-Dade, also was scaled back (though not closed). In the last two months of 1997, Quail Roost, with its half-time doctor, one registered nurse, and five other employees, averaged 7.64 STD patients daily. In that same time frame, the PET Center, with one full-time doctor, no nurses, two half-time employees, and one full-time clerk, averaged 8.51 patients. Yet it was the more efficient PET Center that faced extinction. Neasman's explanation: the redundancy of STD services in the area from other providers.
Shortly after the September shutdown, the Public Health Trust found some grant money to keep the STD/TB operation running on a part-time basis, at least until February. The Department of Health, the Public Health Trust, and the PET Center Action Committee met on November 23 to discuss the long-term fate of the operation. "We don't want to eliminate the STD and TB programs on South Beach, wait till the infection rate skyrockets, and say, 'Oh, now there's a need,'" Bill Skeen says. "That's not good public-health planning."
-- Ted B. Kissell
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