Miami Herald - June 7, 2007
Andrea Robinson, arobinson@MiamiHerald.com and Marc Caputo

But now, because of a change in a state contract that pays for his care, the 47-year-old Miami man says he has something new to fear: the loss of his longtime nurse, who's more "like my guardian angel."

Davis' nurse, Tricia Rodney, works for the nonprofit AIDS Healthcare Foundation, which lost its longtime Medicaid contract with the state last month to a new for-profit firm that will now offer the services -- for half the price.

Davis and HIV/AIDS activists are so worried they will get a lower quality of care -- and fewer nurses -- that they plan to protest today at Gov. Charlie Crist's Miami office. The protest, like others arranged around the state, has been organized by the foundation, which has filed a bid protest with the state's Agency for Healthcare Administration, or AHCA.

Donna Stidham, a registered nurse and the chief of managed care with the AIDS Healthcare Foundation, said the new plan is not workable with AIDS patients because they require more hands-on monitoring.

"If you have diabetes and don't take care of yourself, you will end up in the emergency room and then go see your doctor," Stidham said. "With HIV, you don't get sick quickly. The medicines are not easy to take. You need someone to monitor you and make sure the right regimen is in place."

AWARDED FAIRLY

Both AHCA and the new firm, Specialty Disease Management, say the contract was awarded fairly.

Agency spokesman Doc Kokol said the state reduced the contract from $9 million to $4.5 million because many of the 8,000 clients statewide are getting care through other contractors in Broward and Duval counties, where the state is testing changes to a Medicaid program that serves the medical needs of more than 2.2 million poor, sick and elderly Floridians.

Kokol, noting the bid protest prevents him from commenting in depth, said other savings are based on better data that more accurately reflect the cost of caring for AIDS patients.

"We are confident that recipients will receive the care and quality of care that they expect and they deserve," he said. "The services are the same, but I can't get into how those are provided."

And that's a big point of contention.

AIDS Healthcare Foundation, based in Fort Lauderdale, currently provides 70 disease-management nurses statewide. For the revised contract, the foundation proposed using 35 field nurses and at least 15 nurses at a call center.

Steve Gutos, a spokesman for Jacksonville-based Specialty Disease Management, declined to say how many nurses his agency plans to use.

However, The Miami Herald obtained a copy of Specialty Disease's proposal to the state. That document shows the agency plans to use up to 24 registered nurses and licensed practical nurses. Seven of those would be based at a Jacksonville call center.

Gutos said the comparison was not accurate.

"It's not the same program in terms of what the state requested. They selected us after a very thorough selection process," Gutos said.

WON'T BE ENOUGH

Rodney, the Miami-based nurse, said the math does not add up. She currently has about 120 clients, all of whom live in Miami-Dade County. On average, she figures she visits at least four clients a day.

"I don't know how they're going to make it work," she said, referring to the reduced number of nurses.

Also, Rodney said, personal interaction is key to caring for patients who are in denial about the advancement of their disease.

Rodney makes sure her clients take their medications, follows up with them after doctor's visits, reviews their charts and sometimes takes them to pick up groceries if they're too weak to do it.

"I'm close to my patients. Sure, I can call them," Rodney said, "but the face-to-face meetings are good for the clients."

Davis said he's grateful for his "angel" and hates the idea that she may not be there for him any longer.

"When I got the news that I might not have her anymore, I was devastated," he said. "Once you get attached to someone, they almost become your mother. This is like snatching your heart out."

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