Fewer than five states have a surgeon general. Arkansas has one. California's Gov. Gavin Newsom appointed the state's first surgeon general in 2019, but the doctor resigned earlier this month. In Pennsylvania, the title is physician general. Michigan has the position, but it hasn't been filled in years.
Since 2007, Florida governors have appointed a doctor for the role. The Florida Senate then votes to confirm that choice. The Senate is now in the process of confirming Gov. Ron DeSantis' latest pick.
However, critics of the governor's administration say the role has gotten too politicized to fulfill the original mission of serving as the top advocate for wellness and disease prevention.
Former Gov. Charlie Crist chose Florida’s first surgeon general back in 2007. He was still a Republican at the time — now he's running to win the Democratic nomination and compete against DeSantis in this year's gubernatorial election.
Dr. Ana Viamonte Ros, the state's first surgeon general, introduced herself in a video as the "leading advocate for health and wellness in our state." At the time, she upset critics by traveling home to South Florida from Tallahassee on weekends, using taxpayer dollars.
Dr. Scott Rivkees was the surgeon general when the pandemic began. He received criticism for his limited public health experience. Gov. DeSantis appointed this pediatrician, who then seemingly upset the governor himself.
About a month into the pandemic, in April 2020, Rivkees listed ways to stop the spread of the coronavirus that causes COVID-19.
"We don’t have a vaccine at the present time. So our mitigation measure is the social distancing," wearing masks and keeping gatherings to no more than 10 people, he added.
"This is a tough virus," Rivkees continued. "We’re going to have to practice these measures so that we are all protected."
Suddenly, a former DeSantis staffer led Rivkees out of the room, and he wasn’t heard from publicly for almost a year.
Then in January of 2021, Rivkees gave a cheery update to a panel of lawmakers in Tallahassee about the health department, via video.
He praised the state’s vaccine rollout, for instance. At the end of the presentation, lawmakers learned they could not ask Rivkees any questions, which frustrated Democratic State Rep. Carlos Guillermo Smith of Orlando.
"After over 25,000 Floridians have died from COVID, I don’t really understand what’s more important than our ability to ask questions of our state surgeon general," Smith said. "It just contributes to the perception that this process is a sham if we cannot be able to ask legitimate questions to the top public health officer in this state."
By last August, Rivkees resigned.
In September, DeSantis announced the state’s new surgeon general. He chose Dr. Joseph Ladapo. In his first press conference, Ladapo declared the end of fear in Florida.
"It’s over here," Ladapo said. "Expiration date: It’s done."
Senate Democrats disagree with his approach on how to handle the pandemic. Democratic State Sen. Lauren Book of Plantation made that clear during a confirmation hearing earlier this month.
"Do the vaccines work against preventing COVID-19? Yes or no?" she asked. "Yes or no questions are not that that easy to find in science," Ladapo replied.
The Centers for Disease Control and Prevention reports that during the Omicron variant surge, unvaccinated people were 97 times more likely to die compared to those who were boosted.
Ladapo also dodged a question about whether Florida should expand Medicaid eligibility to insure more people and bring down emergency department use. That expansion remains an option under Obamacare.
"The position of the governor is to not expand Medicaid in the state," Ladapo told one senator. "As the leader of the Department of Health, our job is basically to implement the bills that our lawmakers pass and our governor signs into law."
He declined to say whether he's received a booster shot of a COVID-19 vaccine. DeSantis also refuses to answer the question.
"The role of the surgeon general has now become the role of a political pawn to reflect the political exigencies of the governor and of the executive branch," said Dr. Jeffrey Goldhagen, chief of the University of Florida Division of Community and Societal Pediatrics in Jacksonville.
Goldhagen's opinions in this story do not reflect those of UF, which also employs Ladapo.
For 15 years, Goldhagen directed the Duval County Health Department. He said the local public health offices across Florida have lost autonomy over time. Each one is called the Florida Department of Health in a certain county rather than the county name first.
"And that’s more than a nuance," he said. Instead, they’ve become outposts of the state health department, he added.
"No one in the state of Florida should feel confident that the state has their best interests in mind as it relates to their health and well-being."
Goldhagen points to the case of Dr. Raul Pino, director of the health department in Orange County. Pino wrote to his employees in an email last month that their low vaccination and booster numbers are irresponsible.
He had learned that out of the 568 active staff at the department, 77 had received a COVID-19 booster, 219 had two doses of the vaccine and 34 had one dose, according to WFTV Channel 9 in Orlando, the ABC affiliate that broke the story.
"In the absence of reasonable and real reasons it is irresponsible not to be vaccinated," Pino wrote. "I have a hard time understanding how we can be in public health and not practice it."
Then, the Florida Department of Health in Tallahassee put Pino on administrative leave.
During his confirmation hearings with small Senate committees, Ladapo has declined to comment on Dr. Pino. The full Senate is expected to vote on his confirmation before the end of the session next month.
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