A.G. Holley patients would go to local hospitals in state planby John Kennedy | June 1st, 2012
The Florida Department of Health released a four-page outline Friday of steps it plans to take leading to the January 1 closing of the state’s last tuberculosis treatment center, Lantana’s A.G. Holley Hospital.
But the document, ordered by the Florida Legislature, basically is a logical how-to when it comes to shuttering the 62-year-old facility. The practical difficulties of relocating 37 severely ill patients and what the state plans to do with Holley’s 144-acre campus are reduced mostly to aspirational goals.
Eleven of the patients at Holley have been hospitalized there under court-order, DOH acknowledges.
DOH, however, states in the transition plan that there are “ongoing discussions with several licensed hospitals” for accepting Holley patients who need continued in-patient care. “The anticipated contracts for hospitalization remain in a stage of active negotiation,” DOH said.
“Our Department of Health continues to demonstrate our commitment to meeting the needs of Floridians with tuberculosis as we work to reduce the risk of tuberculosis across our state,” said State Surgeon General Dr. John Armstrong. “We remain focused as well on facilitating the transition of our AG Holley employees to new opportunities.”
The town of Lantana has long talked about acquiring the hospital site and using it to lure industry to the area.
The state has talked about closing Holley for years but has been stymied by a host of problems related to the facility’s population of patients difficult to treat.
In 2008, the Legislature directed DOH to find a new way to treat tuberculosis patients, while also outsourcing their management to a private vendor, records show. When no qualified vendors came forward, the Legislature in 2010 ordered DOH to develop a plan to find community hospitals willing to isolate and care for patients.
That seems to be where DOH has been returned to, following the Legislature’s action.
The Legislature moved ahead with the proposal as part of a larger DOH reorganization, which advanced over opposition from several health advocates. Some said closing the Lantana hospital would threaten care for a few dozen seriously ill patients who also pose a public health risk.
“It’s a unique institution,” Dr. Paul Arons, former director of the state’s HIV-AIDs program, told a House committee in February. ”It treats the hardest of the hard patients.”
Arons said 40 percent of Holley’s tuberculosis patients also have HIV, making them particularly frail and complicated to treat. He labeled the legislation “puzzling and troubling.”
Rep. Matt Hudson, R-Naples, the House health care budget chairman, spearheaded the move. Hudson has said Holley sometimes serves as few as 29 patients on average, some from out-of-state, but costs taxpayers $10 million annually to operate.
The DOH document sheds some light on the prevalence of tuberculosis in Florida and the clients Holley serves. Last year, there were 753 TB cases reported in the state, a 10 percent reduction from 2010. The disease has been in steady decline since 1994 when 1,764 cases were found in Florida, DOH said.
Health officials also said that 14 Florida counties account for 80 percent of the state’s TB incidents.
DOH’s transition plan for Holley also cites plans for notifying county health care officials and patient families about the closure, and working with alternative, community facilities that could help care for patients who may not need acute-care hospitalization.
Once the Holley campus is closed, DOH envisions providing minimum groundskeeping and security while awaiting the facility’s sale or transfer to another agency, the report concluded.
The document also hints that DOH is looking to help hospitals skirt Medicaid restrictions if they are willing to accept Holley patients.
Hospitals usually receive a maximum 45-days of Medicaid payments for inpatient services. But since many tuberculosis patients demand months of hospital care, DOH said it is requesting that the state’s Agency for Health Care Administration (ACHA) lift this restriction for community hospitals that accept Holley patients.