Mismanagement and bureaucratic hassles cost Fulton County millions of dollars in federal money to fight HIV, an internal audit shows.

Insufficient oversight, cumbersome hiring and purchasing rules and a lack of centralized grant management all contributed to the loss of the federal money, according to an internal audit report completed last week. It's the latest in a series of grant and contracting investigations that have revealed mismanagement in Fulton County government over the last year.

County Manager Dick Anderson already has taken several steps to address the HIV grant foul-up, including replacing the county health director.

Jeff Graham, executive director of the gay rights group Georgia Equality and a member of a board that advises the county on the grant program, called the problems outlined in the audit “bureaucracies at their worst.” But he praised the county’s recent response.

“What we’ve seen in the last four months is bureaucracy at its best,” Graham said.

From 2012 to 2014 the county received $21.5 million for HIV prevention and testing from the federal Centers for Disease Control and Prevention. The money is used to increase HIV testing at hospitals, health fairs and other settings. It also expands educational efforts such as support groups and condom distribution.

But the county had to return $8.8 million because it failed to meet spending deadlines.

The county has been able to recover about $3.4 million of that money and is on track to spend all of its grant money this year. But the county’s internal auditor reviewed the program to determine how the mishap occurred.

The audit report cites several contributing factors. Among them:

• The county Health and Wellness Department did not provide sufficient oversight, communication and planning for the grant.

• The county’s “tedious” hiring process for grant-funded employees delayed filling vacant positions.

• Cumbersome purchasing rules delayed contracts with outside agencies to perform some of the work.

• The county lacked a centralized system to provide proper oversight of grants.

The CDC is conducting its own review of Fulton County’s problems. In the meantime, Anderson has taken several steps to address issues raised in the audit.

Health Director Dr. Patrice Harris resigned last week. Anderson replaced her with Dr. David Sarnow, the interim health director.

Anderson also has consolidated management of the HIV grant with another HIV program and consolidated cash management functions in the county finance department.

Graham said he likes what he’s seen from the health department’s new management.

“They’ve come into a very difficult situation, but they have come in with a sense of urgency and a real dedication to making sure the problems are identified and corrected quickly,” he said.