On Florida Roundup, with WLRN's Tom Hudson and WJCT's Melissa Ross, how the pendulum of public health power has swung from local governments to the state. Also, why have childhood vaccination rates dropped? And a big settlement over pain pills?.
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The pandemic brought a spotlight to the push and pull in Florida over power, policy and public health, but it didn't start with COVID-19.
In Florida, the decisions about infectious disease and all kinds of issues related to public health come from the state capital. Tallahassee calls the shots on things like masking vaccines and quarantine. For decades, though, individual counties actually had a lot of say over public health.
Public health in Florida began in the 19th century with yellow fever. For a long time, big decisions that affected the health of Floridians came from county-run health departments. Aiming for more equity, Democrats funneled that power to the state, and somewhere along the way, Republicans have embraced the transformation of public health to big government.
Most states do not have a surgeon general, but Florida is one of them. The position is the state’s top public health official. It has been a lightning rod for controversy throughout the pandemic and helped shift the decision-making for public health in Florida away from county-run health departments to the state government.
First, Surgeon General Scott Rivkees was out of the public spotlight throughout most of the public health emergency and wasn’t allowed to answer questions from the public or lawmakers. He eventually resigned.
The new surgeon general — Dr. Joseph Ladapo — has not shied away from controversy and giving voice to Gov. Ron DeSantis’ opposition to vaccine and mask mandates, among other policies.
WLRN’s Danny Rivero and Verónica Zaragovia explored the balance of power with public health in the podcast “Tallahassee Takeover.”
HEAR MORE: Tallahassee Takeover Podcast for iPhones
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'I just stopped counting'
The COVID-19 pandemic is now in its third year and continues to affect the lives of health care workers.
Darleen Gruver lives in Brooksville, a small town north of Tampa. She has been a hospice nurse providing end-of-life care for almost 20 years. She says she’s seen a lot of people die, but COVID-19 made things worse. During the first year of the virus, Gruver kept a grim count of the people she helped comfort during their final hours or days as they died from the virus.
"I think when I got up to 40, I just stopped counting on my own. I just didn't want to know anymore. And that was the first year. That was 2020," she told WUSF.
Adding to her worries after more than two years is a shortage of colleagues. Her teams of staff members are less than a third of the size they were before COVID-19. Instead of teams of 20 to 22 people, they're down to six.
A drop in routine vaccinations
The Centers for Disease Control and Prevention reports that fewer children are getting routine vaccinations required to enter school.
Jill Roberts, professor of public health at the University of South Florida, pointed to several reasons for the national decline beginning the first year of the pandemic. Initially, parents may have been worried about taking a child to a doctor's office, and school was largely online during the first three months of the pandemic. Health record requirements, at the time, were not enforced.
"So then, unfortunately, the other factor is probably vaccine hesitancy," she told WUSF. "What's different about COVID is people put it in a different category. They see children after getting COVID and recovering and seemingly fine," she said.
"So in their minds, COVID does not equal polio and all these other diseases that we vaccinated for. So this hesitancy really kind of grew up to say, 'Well, maybe we don't need this, maybe this is a mild disease, maybe I'm putting my child at risk.' If you put that little amount of doubt in there, people who push anti-vaccination campaigns will jump on it in a heartbeat," said Roberts.
According to CDC data, Florida kindergartens are in better shape than others. During the 2020-2021 school year, only one out of every 500 Florida kindergarteners did not have their full schedule of recommended vaccines. Nationally, it was 17 out of every 500 who didn't get their full vaccine coverage for diseases such as measles, mumps and diphtheria.
Opioid battles across Florida
More people die in Florida from drug overdoses than in almost any other state. Only California has more, according to national statistics.
Almost 8,000 Floridians died from drug overdoses in 2021. That was up 4% from the year earlier. The most common culprit is opioids like prescription painkillers and synthetic opioids such as fentanyl, which can be up to 50 times stronger than heroin.
Deaths from fentanyl stretch from large urban counties to smaller, more rural areas across the state. Escambia County in the Panhandle saw fentanyl deaths jump more than 350% last year.
"We are not doing well in the Panhandle," Dr. David Josephs, clinical director at Pensacola's Lakeview Center, told WUWF. "For many years, there’s been a push that we take pain medications, primarily opiates, to manage your pain. And of course, these medications are extremely addictive," he said.
"It’s bad everywhere," Dr. Kenneth Palestrant told WQCS. He is a leading member of the Treasure Coast Opioid Task Force. Almost three out of four deaths he's seen recently involve fentanyl.
"Because the laws in the different states have cracked down on opioid prescribing, what ends up happening is that a lot of these people who are addicted to the prescription opioids, and they’re not getting it from their doctors anymore, they go out on the street, and unfortunately the stuff in the street is contaminated with fentanyl," he said.
A new wave of opioid deaths, often mixed with psychostimulants, is raising old fears in Palm Beach County, so now families are urging the sheriff's office to carry Narcan. Drug overdose deaths were up almost 30% in the first two months of the year compared to the same time last year, according to the Palm Beach County Medical Examiner's Office. That surge has brought new scrutiny to the Palm Beach County Sheriff's Office policy against deputies carrying the emergency medicine to reverse opioid overdoses.
Southeast Florida Recovery Advocates organized a rally in January outside a sheriff's executive office. Organizer Maureen Kielian and others sent a letter asking for PBSO deputies to carry the overdose treatment. Palm Beach County Sheriff Ric Bradshaw did not accept an invitation for an interview with WLRN. A spokesperson said the policy was based on concerns over liability.
The Sheriff's Office also said paramedics arrive first to suspected drug overdoses. That claim was based on a 10-year-old study that is no longer available.
Most Florida sheriff's offices train deputies on how to administer naloxone and have them carry it, according to the Florida Department of Law Enforcement.
Breaking baseball's glass ceiling
Florida is where baseball’s glass ceiling is being broken. A year ago, the Miami Marlins became the first Major League Baseball team to be led by a woman. Kim Ng is the general manager of the Marlins.
And this spring, Rachel Balkovec became the first woman to coach a major league affiliated minor league team when the Tampa Tarpons took the field.
Balkovec is used to firsts. In 2019, she was the first woman to become a hitting coach in the minor leagues when she held the job for a minor league affiliate of the New York Yankees.
She is a former softball catcher who learned Spanish to improve communications with players.
"If I can walk in front of a room, speak confidently know what I'm talking about, oh, and then I can say in Spanish too, it's like, OK, all right, this woman is about business and this is a job, she's a professional," she told WUSF. "I really think it doesn't take too long for them to figure out, you know, that I'm just a coach. And eventually, they just kind of forget and be themselves around me."
She led her Tarpons to a 9-6 win against the Lakeland Flying Tigers in the season opener in April.
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