State officials are investigating a series of suspicious contracts awarded by the Georgia Department of Public Health’s HIV unit, an office that for years has been plagued with a stifling bureaucracy, massive turnover and questionable management of federal money.
The internal investigation focuses on about $5 million in contracts issued to nonprofits that perform much of the HIV testing in Georgia. New State Health Officer Brenda Fitzgerald said there appears to be a wide variation in the costs of the contracts, some of which went to former state employees without competitive bidding.
The HIV prevention program manager resigned last month as investigators probed how she doled out millions in federal funds during her 16-month tenure.
Officials will not talk in detail about the investigation. Department spokesman Ryan Deal said Friday that Fitzgerald is reviewing the investigative report and may refer the matter to Attorney General Sam Olens “to see whether there is any criminal involvement.”
In addition, an Atlanta Journal-Constitution review of internal documents and interviews with top officials in the Department of Health found deep-seated problems with the HIV unit:
● For years, it has been slow to pass along federal prevention grants to nonprofits to conduct HIV tests.
● Those delays have resulted in nonprofits rushing to spend grant money or risk losing it.
● The state’s tangled bureaucracy has given back more than $2 million in unspent money to the federal government since 2006. That’s money advocates say is badly needed for HIV testing and prevention.
Georgia is sixth in the nation in total AIDS cases, and the state office is responsible for overseeing the state’s prevention and treatment plans for HIV and AIDS. Fitzgerald, who was appointed to the job five months ago, said she is conducting a top-down review and all of the contracts awarded by the unit are being inspected.
“I’m looking at every single part of that, because we have to do better in the state of Georgia,” she said.
Widely disparate costs
Fitzgerald said the investigation by the Department of Community Health inspector general centers around the “uncertainty” of how the contracts to nonprofits were awarded, including widely disparate per-person costs to the state for HIV tests.
“Some are like $75 a person; some are $40 a person,” she said. “It may be there are wonderful programs out in that $75 [range that] we want to emulate, or it may be that they are not very efficient partners.”
The state receives about $8 million a year from the Centers for Disease Control and Prevention for HIV prevention, about $5 million of which is handed out to nonprofit organizations in contracts ranging from $30,000 to $150,000. Some of those contracts went to a nonprofit affiliated with two men who recently had left the state health department, the AJC has learned.
In a June 16 email announcing her resignation, former HIV Prevention Program Director Leisha McKinley-Beach made no mention of the investigation. Instead, she thanked a long list of people, including her former boss Jevon Gibson, who had left the health department a year earlier.
Gibson is a contractor for Atlanta-based nonprofit Comprehensive Men’s Health Initiative, which was awarded three HIV prevention contracts during McKinley-Beach’s tenure. CMHI’s chief executive officer, Gregory Bolden, also is a former health department official who left the state just as the CMHI was awarded the money.
Fitzgerald would not comment on the contracts except to say that they were “another part” of the investigation. Both Gibson and Bolden said the inspector general interviewed them about the contracts.
Gibson, who had been director of the state office of infectious diseases until he left last year, said one of the contracts was to develop a comprehensive HIV prevention plan for the metro area on a short timeline so the state could tap into $6 million to $10 million in federal funding.
Officials with the Department of Public Health would not comment on the contracts, citing the ongoing investigation.
Gibson acknowledged the contract was not competitively bid. Acting State Epidemiologist Dr. Anil Mangla said such contracts are supposed to be awarded competitively, but he acknowledged that does not always happen.
Contracts can be awarded without competition when there is a legitimate reason, such as when an area is served by a single nonprofit. Officials said they are looking into whether noncompetitive contracts awarded by the unit met those requirements.
Gibson said McKinley-Beach — who could not be reached for comment — approached him last fall to do the work. He agreed because he knew the state could not do it alone, in part because of constant turnover of staff in the health department.
“The total institutional knowledge of the HIV unit was less than a year,” he said.
Gibson said no one said at the time that his prior service with the state was a problem. Now the state has refused to pay the $120,000 contract, he said.
“This is not about money. It’s about integrity,” he said. “I know what the appearance of it is. I’m not crazy. It looks like some sort of insider trading.”
Clare McGuire, senior counsel for government watchdog group Georgia Watch, said competitive bidding for government contracts ensures better use of taxpayer money.
“In this case contracts were awarded noncompetitively to state employees who had just recently left their state government posts,” she said. “The appearance of impropriety or favoritism created by such a process would have been substantially alleviated had the contracts been awarded competitively.”
A critical moment
The internal investigation comes at a critical moment for the state’s approach to public health. Legislation approved this year created Public Health as a standalone department as of July 1. Already the HIV unit has been criticized over its list of about 1,600 patients waiting for access to a government-funded program for HIV and AIDS drugs.
Fitzgerald and other top officials acknowledged the department has been hampered by an inefficient and overly bureaucratic culture that slowed the spending of federal HIV prevention dollars while Georgia’s HIV problem got worse.
A list of contracts obtained by the AJC shows that dozens of nonprofits waited weeks or months to receive money for HIV prevention that had already been awarded to them.
Positive Response, a Carrollton-based volunteer group, waited more than six months for the state to relinquish $40,000 in federal money for HIV testing in West Georgia. Now officials there have less than six months to test 1,000 high-risk patients, and they are worried they will not be able to finish.
“It’s not that we can’t do the work. We just don’t have the time,” said Will Lavender, a volunteer at the organization. “We were told the funding was coming, it’s coming. There were just delays.”
Larry Lehman, executive director of AID Gwinnett, said working with the state is “challenging.”
The nonprofit was three months late getting its federal grant of $91,600 to counsel female inmates on safe-sex practices. Working with inmates is one way activists hope to stop the spread of the disease.
“They have already made some bad decisions in their life, and when it comes to relationships they may not be making the best choices,” Lehman said. “Anything you can do to reduce infection rates is incredible.”
But this year the money was so late Lehman said he was preparing to lay off staff because he could not pay them.
It is a familiar tale to Mark Douglas, founder of Savannah-based HIV and AIDS outreach organization My Brothaz HOME.
My Brothaz HOME was awarded $140,000 in two federal grants for HIV testing. According to documents obtained by the AJC, the state was 41 and 77 days late handing the money over.
Fitzgerald said those long delays in awarding contracts are something she is trying to change. At her first meeting of senior staff, Fitzgerald said she was presented with an 8-month-old requisition for laboratory chemicals.
“This was a [chemical] that we use every single day consistently. We knew about it, it was in the budget and we use it every day, and it was eight months [in the process] and I was signing off on it,” she said. “That obviously is not an efficient process.”
She said part of the problem was the department was a division under the Department of Community Health, which has a much wider scope of responsibility and more layers of management. Contracts, grant applications and other documents routinely stalled as they made their way up and down the long organizational ladder.
Now that Public Health is its own department, Fitzgerald has since instituted a rule that paperwork cannot stay on anyone’s desk for more than two days.
Money wasted, returned
Not only is the department months late in sending prevention money to the nonprofits, but state officials are also slow spending their own money.
Douglas, who is co-chair of an advisory panel set up to work with the state on HIV prevention, said the state is so disorganized that millions more in grant funding has been returned to the feds unspent over the past several years or wasted on nonessential expenses at the end of the year.
“That’s what they did last year,” he said. “They find other, creative ways to spend the money — conferences, condoms and things like that — instead of it going out to the prevention community.”
Public Health spokesman Ryan Deal said the department is “looking closely” at spending in the unit. He said he could not comment on specifics because the investigation is open.
Mangla confirmed that the state has returned large sums of unspent grant money to the CDC in past years, but he said new budgetary controls have reduced the amount considerably. Last year, the state returned about $148,000 in unspent grants compared to $1.4 million returned in 2006, according to figures provided by the department.
Now the nonprofits are dealing with more turmoil. Despite the investigation, many of them had a high opinion of McKinley-Beach.
In her 16 months heading HIV prevention, McKinley-Beach gained a reputation for cutting through some of the red tape. “It was a very big blow to all of us. She brought so much hope and vision to the HIV unit,” said Jeffrey McDowell, executive director of the Atlanta Harm Reduction Coalition, a nonprofit that does HIV outreach to at-risk groups in metro Atlanta.
Her sudden resignation “left a lot of questions for a lot of us,” he said.
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