...While People are Dying
Last week in the LA Times, I read that Los Angeles County was shaking up its sexually transmitted diseases program. What the story didn't say was that the Director of the County Department of Public Health, Dr. Jonathan Fielding, was only playing politics while people are dying.
Dr. Fielding says he believes this move would shake up the "management" of the county's sexually transmitted disease program, which was investigating the spread of HIV among porn performers. What would make Dr. Fielding do something so incredibly irresponsible? Los Angeles County, with some of the highest HIV and STD infection rates in the country and Dr. Fielding feels we no longer need a disease expert overseeing the management of the county's sexually transmitted disease program.
Mr. Mario Perez, who is currently working as the director of the Office of AIDS Programs and Policy, whose main duties are to distribute grant money for AIDS programs throughout Los Angeles County has been proposed to lead the new division. What is Dr. Fielding thinking? Why would you take something as important as overseeing the management of a sexually transmitted disease program in an industry where HIV infection is a tremendous risk and hand it over to someone so grossly under qualified? A man that has never seen an HIV/AIDS patient, never headed up an investigation on HIV/AIDS and he has never been a principle investigator over an HIV project. Mr. Perez is probably a decent fellow, but clearly he's not skilled for that job.
Dr. Fielding said the reorganization is solely intended to increase the program's efficiency and effectiveness, a deal he feels will give him more bang for the buck. Talking about penny wise and pound foolish; Dr. Fielding, you win the prize! Some say Dr. Fielding is doing this because he and some of the supervisors are uncomfortable addressing the folks in the porn industry. Or could it be because it's a $12 billion industry and we all know money is the mother's mike of politics? Or is it because Dr. Fielding knows that Mario Perez will report directly to him and nothing will really get done? Fielding said that he's very concerned about the lack of adequate protection of performers in the adult industry. So, why would he put a mall cop over something so serious?
"So why do you think he's dong this, Tony?" I'm so glad you asked. The Office of AIDS Programs and Policy (OAPP) is primarily an administrative office that manages contracts to medical providers for HIV medical care or community based organizations for HIV testing. OAPP has limited direct programs and very limited research. The STD Program conducts surveillance for STD, case management and has an active and extensive program research agenda. It is a medical centered disease control and prevention program that creates and implements interventions through innovative and comprehensive approaches.
Some recent examples include the development of an online home STD test kit that has been made available to young women in Los Angeles County and a control plan for gonorrhea in the 2nd Supervisorial District. By the way, the 2nd district has the highest STD rates in the state, if not the country. "So why do you think Dr. Fielding has come up with this good idea?" I'm so glad you asked.
Most of OAPP's current Ryan White funded contracts for HIV medical care with providers will be eliminated under Health Care Reform and will require OAPP to eliminate much of its' fiscal, administrative and contract monitoring staff. OAPP and DPH don't have the HIV expertise that is present in the Department of Health Services (DHS) to oversee its current contracts. HIV infected patients would be better served if the HIV medical care contracts were managed in DHS where the HIV medical care experts for HIV/AIDS already exists.
There are effective, formal and informal collaborations that already exist between STDP and OAPP. Merger is not required to have effective program collaboration. A merger in this case will be disruptive to existing departmental and community collaborations and partnerships and will result in the loss of the STD program identity in the community and loss of accountability for STD control in the community. Different approaches are needed in the diagnosis, prevention, and treatment of STDs vs. HIV. There are major differences in the population specific disease distribution. Chlamydia and gonorrhea effect young women and cause infertility. The decision to merge and name an administrator without experience or training in epidemiology, or STD control to lead, appears rash, abrupt, ill-conceived and taken without any consultation with stakeholders, the affected communities or discussions within the affected programs nor done with an appropriate posting and open internal or national search for the a new division director position.
Thank God Dr. Fielding's proposal has to be approved by the county's Chief Executive Officer, William T Fujioka; we better let him know this is not a very good idea.