Georgia to overhaul health and social service agencies

For years, Georgia’s health and social service agencies have lurched from crisis to crisis. People wait months, if not years, for something as simple as a copy of their birth certificate.

Georgia routinely ranks among the worst states for diabetes, obesity and infant mortality.

The state’s psychiatric hospitals are under federal scrutiny for the poor care of their patients.

On July 1, the tide of frustration and failure is set to turn, say state officials.

That’s when a massive restructuring of state health agencies begins. The changes involve agencies that will decide the state’s role should swine flu vaccine be distributed and the state’s response to a bioterrorism attack. They also handle issues surrounding foster care, Medicaid, child abuse, food stamps, alcoholism, the elderly and trauma care.

Proposed by Gov. Sonny Perdue last year, the sweeping changes would have three agencies split the work currently performed by two, the Department of Human Resources and Department of Community Health. A separate agency would be created to handle mental health issues, called the Department of Behavioral Health and Developmental Disabilities.

The head of the community health agency, which will

more than triple in size as it inherits DHR’s responsibility for public health and emergency preparedness, said the agency is already planning ways to raise the performance of those services and make them more accessible.

Many advocates have high hopes about the coming changes. But they also worry that the state may be simply creating new bureaucracies that, without the proper funding and leadership, may fail at fixing a poor mental health system, an unfocused public health system and other problems.

After all, the changes come at a time of severe budget constraints, as the economy struggles, the state budget tightens and more people seek government help.

“You can’t just get excited about moving squares around on an organizational chart,” said Alan Essig, executive director of the Georgia Budget and Policy Institute, a nonprofit analysis group that often concludes that state social and health services are underfunded. “In order to make sure this isn’t just rearranging chairs on the Titanic, there has to be the funding.”

State officials say Georgians should expect a seamless transition as the changes occur. People can still call the same phone numbers for service, type in the same e-mail addresses and go to the same offices where they received services. The reorganization is largely driven by problems at DHR, Essig said. It is the health services super-agency created by then-Gov. Jimmy Carter in 1972. Essig said the agency’s sheer size has overwhelmed its mission, and that services that should be priorities have been shifted to the back burner.

In the restructuring, DHR will remain — in stripped-down form — and continue to perform in areas where it has shown some improvement and success. The agency, reorganized into the Department of Human Services, will continue to operate the state family and children services, including the child welfare system. That system has improved under a federal court order to better protect and serve foster children in Fulton and DeKalb. The agency will also hold onto the division of aging and child support services.

DHR will lose nearly half its workers and remain at about 10,000 state employees, said B.J. Walker, who will remain the DHR commissioner.

Behind the scenes, officials are scrambling to unravel the fabric of a human resources agency that built up over 30 years. The three newly formed agencies will remain in the skyscraper on Peachtree Street in Atlanta, but thousands of federal grant and funding sources must be redirected, thousands of employee records must be transferred, and reams of budget plans must be reshuffled.

“It’s like brain surgery,” Walker said. “We’re going to be working on trans-ition for some months to come.”

Walker said the changes will allow her agency to focus better on its services.

About 8,000 of her workers will shift into the new Department of Behavioral Health and Developmental Disabilities. That agency, which will also include services for addictive diseases, will be led by Dr. Frank Shelp, who most recently served as clinical director at Georgia Regional Hospital in Savannah.

Criticism of mental health services has largely focused on the state psychiatric hospitals. Federal investigators found that the state hospitals have repeatedly violated patients’ constitutional rights by failing to keep them safe, providing incompetent medical care and conducting shoddy investigations into suicides and other deaths.

Perdue in January signed a pledge to settle a U.S. Justice Department inquiry that committed the state to a five-year plan of correcting deficiencies in the state’s mental health hospitals. With the new agency, advocates say the state also needs to provide more community-based services so people struggling with mental health issues can be served close to home.

“They focus too much on the crisis, and not enough on how to prevent the crisis,” said Ellyn Jeager of Mental Health America of Georgia, a nonprofit advocacy group.

Dr. Rhonda Medows, who will remain commissioner of the Department of Community Health, said she is already finding inefficiencies and ways to improve some services she will inherit from DHR.

Her agency will expand from 450 employees to 1,500. Medows said the acting public health director, Dr. Sandra Ford, will be replaced after July 1. The state’s preparedness for a major emergency, such as a bioterrorism event or natural disaster, needs improvement, she said. The swine flu outbreak was “a wake-up call,” Medows said. “Next time we may not be so lucky.”

She plans on using federal money from the Centers for Disease Control and Prevention to hire an additional 27 positions in the state lab, which performed swine flu testing. She said some of those positions have been vacant for years. The community health agency will also focus more on Georgia’s long-standing public health problems by improving infant mortality, providing more prenatal care and addressing obesity, she said.

Discussing the problems with the vital records department, Medows noted that the office she is inheriting had a “timeout room” for outraged customers to calm down. The vital records office also has of backlog of some 70,000 death records and 4,000 birth records, she said.

That program, she said, “needs an immense amount of work.”