State audit: Ga. HIV unit had history of policy violations

In an interview last week with GA Voice, McKinley-Beach defended her actions, saying the unit was one of total dysfunction when she came on board and the state is using her as a “scapegoat.” She resigned after only 16 months on the job in the midst of the internal investigation prompted by an anonymous complaint. Before she joined the HIV Unit, the position was open for two years.

Dr. Brenda Fitzgerald was appointed commissioner of the Georgia Department Public Health by Gov. Nathan Deal in February 2011 and oversees the HIV/AIDS unit.

A spokesperson for Fitzgerald said the department has carefully addressed all concerns raised in the investigation, specifically the timely distribution of much-needed federal funds to agencies contracted to provide HIV prevention and other AIDS services such as case management.

“DPH discovered early on substantially uneven reimbursement rates around the state. With those and similar concerns in mind, DPH re-examined our relationships with community-based organizations (CBOs) and the contracts CBOs had been awarded in the past and during the audit period,” said spokesperson Ryan Deal.

“DPH formulated a more standardized reimbursement system. Essential to any reform in this area was DPH’s ability to award contracts more rapidly. And there is success in that area as well. In 2011, DPH substantially expedited the system to award and transmit funding to CBOs, changing it from a grant process-driven system to a contract awards process,” Deal added.

Larry Lehman, executive director of the Ric Crawford Clinic/AID Gwinnett, said his organization has had no issues in the past two years with receiving funding from the DPH in a timely manner for HIV prevention programs as well as federal Ryan White funding.

But some activists say the department must continue to deal with a history of losing federal funding because it was not being spent by deadlines set by agencies including the Centers for Disease Control and Prevention.

Jeff Graham, executive director of Georgia Equality and a longtime HIV/AIDS activist, said that was one issue he did not see addressed in the state audit of the unit.

“The one thing I though that was not clearly addressed is what would have happened if we had lost federal funds?” he said.

“That’s what I took from the report — shortcuts were made because deadlines were to be met. I don’t know what happened internally within the department, but it seems to be a greater breakdown in leadership. I’m more concerned these sorts of things don’t happen again,” Graham added.

Problems with competitive bidding

Several examples of McKinley-Beach circumventing the correct bidding process were cited in the state audit, which noted that under her leadership, more funds were given out through direct awards than competitive bids:

• The chance to purchase more advertising from the Kaiser Foundation for the “Greater Than AIDS” campaign: McKinley-Beach explained she could not spend more than $4,999 without having to conduct a competitive bid process. The transaction ended up being split between two vendors for $4,999 each.

• In February 2011, McKinley-Beach sought to implement the “Sistas Organizing to Survive” initiative that she and others founded first in Florida to conduct HIV testing on black women, a demographic hard hit by new HIV infections. McKinley-Beach played a role in stating how the Georgia logo should be designed and noted to vendors she would not have to bid the process out if the bid comes in under $4,000.

McKinley-Beach told the GA Voice the Sistas Organizing to Survive was a national initiative to test black women and said she felt there was no reason to reinvent the wheel with a new logo but rather give it a “facelift” to make it unique to Georgia.

“In a program that had $12 million, I’m looking at a correct practice that was under $4,000 … the department should be more focused on why there is 80 percent of HIV cases in black women,” she said. “You have to wonder was if it was one person as portrayed as the problem or a failed system from top leadership down.”
Granting bids in timely manner

The state audit noted it appeared the leadership “fostered a culture that was focused on expediting the acquisition and distribution of federal funds with limited oversight” as a way to eliminate bureaucracy. The audit states much money went to inexperienced and under-qualified organizations which did not meet grant requirements.

“Furthermore, a common theme expressed from the HIV Prevention Program staff was that the main objective was to ‘spend down’ the federal funds,” the audit states.

The inspector general noted a similar issue: “When [McKinley-Beach] was hired by DPH she knew Georgia had a reputation for not meeting deadlines and giving money back. …Her main objective was to get the money out and not have to send it back [to the CDC].”

McKinley-Beach said she sees Georgia as the “perfect storm” of an area heavily hit by new HIV infection rates, especially among gay men, while surrounded by institutions such as the CDC as well as numerous leading activists and researchers in HIV/AIDS. But she believes there continues to be a history of neglect when it comes to addressing HIV/AIDS in the state.

“The department has had a history of delayed contracts, not executed on time. And regardless of name changes [for the department], the system still continues,” McKinley-Beach said. “I think that [the audit] is unfair. Again, the report is very focused on one individual that is part of a broken system. It’s not like I went out intentionally to deceptive.” She also maintained she had approval from her supervisors.

However, DPH spokesperson Ryan Deal said many improvements have been made since the Inspector General’s report was completed in March 2011.

“I feel it important to underscore that, during our challenging economic times, DPH is scrutinizing each dollar we spend while we constantly look for additional funding. One critical area of examination and change, as noted in the audit, centers on contracts and the awards process, and your question on ensuring ‘contracts are awarded in the proper and ethical manner,’” he said.

“In conjunction with the new award process, the agency promulgated and implemented policies for the agency’s purchasing, procurement, and contracts processes which effectively addressed any previously existing deficiencies while ensuring strict adherence to the highest ethical standards. A structured, mandatory training program for staff was also implemented,” Deal added.

Last year, the Office of HIV/AIDS instituted an evidence-based mathematical formula for fair and equitable distribution of HIV prevention funding in all but two of Georgia’s counties — DeKalb and Fulton counties are funded directly by the CDC as of January 2012, he explained.

“And this April, patient care funding will also be distributed via an evidence-based mathematical formula. To date, and as a result of our improved efficiencies, no funding has been returned to the CDC,” Deal said.

But McKinley-Beach still stings from the audit.

“Do I feel the Department of Community Health used me as a scapegoat for a broken system? Yes. Do I forgive them? Absolutely. Will I ever help the department? I’ve never stopped. And I won’t until the epidemic is over,” she said.


Top photo: Brenda Fitzgerald, commissioner of the Department of Public Health, says new policies related to grants mean HIV organizations will receive federal funds in a timely manner. (Courtesy photo)