= I iiIII Fl kiI i.I.

] iti] [CP4iP4

[A F1

Ron DeSantis
Governor

Joseph A. Ladapo, MD, PhD

State Surgeon General

Michael J. Bennett, CIA, CGAP, CIG

Inspector General

I'.

r:rJ 9 Accredited since 201 1 by the Commission for Florida Law Enforcement Accreditation, Inc.
 FLORIDA DEPARTMENT OF HEALTH
OFFICE OF INSPECTOR GENERAL

INVESTIGATIVE REPORT

Case Number: OIG 21-117

Date of. Complaint: July 16, 2020

Subjects: Courtney Coppola, former Chief of Staff, Florida Department of Health

Shamarial Roberson, DrPH, former Deputy Secretary for Health, Florida

Department of Health

Carina Blackmore, DVM, PhD, Director of Medical and Health Services,

Division of Disease Control and Health Protection, Florida Department of
Health

Patrick "Scott" Pritchard, OPS Biological Administrator Ill, Bureau of

Communicable Diseases, Division of Disease Control and Health
Protection, Florida Department of Health

Complainant: Whistle-blower

Complaint: Violations of Laws, Rules and/or Agency Policy, including:

Code of Conduct, Conduct Unbecoming, Misconduct, and Falsification of
Records

Period Reviewed: March 16, 2020 through May 26, 2020

EXECUTIVE SUMMARY
ALLEGATIONS and CONCLUSIONS
On January 25, 2021, the Executive Office of the Governor, Office of the Chief Inspector General
(CIG), received a complaint, dated July 16, 2020, from the Florida Commission on Human
Relations (FCHR). On the same day, the ClG referred the complaint to the Department of Health
(Department, DOH), Office of Inspector General (OIG).

In the original written complaint to FCHR, the complainant alleged retaliation through termination
for opposing directions by DOH managers to falsify COVlD -192 data on the DOH COVlD -19 Data
and Surveillance Dashboard (dashboard) to support reopening efforts throughout Florida when
data indicated it was unsafe to do so, thus pulling Florida's citizens at harm due to the dangers

These dates will be referred to as the period under review' herein.

2
A disease caused by severe acute respiratory syndrome coronavirus 2 (SARS -CoV-2) first identified in 2019, thus the designation
COVID-1 9.

IR OIG 21-117
Page 1 of 27
 posed by the spread of COVID -19. The complainant identified the following DOH managers as
subjects of the allegations: Courtney Coppola, Dr. Shamarial Roberson; Dr. Carina Blackmore;
and Scott Pritchard.3 (Exhibit 1)

Based solely on the nature of the complainant's allegations as presented, the OIG notified the
complainant on May 28, 2021, of the approval of whistle-blower status, in accordance with
sections 112.3187 112.31895, Florida Statutes (F.S.), and initiated a whistle-blower
-

investigation.4'5

If found to be true, the subjects may have violated one or more of the directives listed in the
GOVERNING DIRECTIVES and DEFINITIONS6 section of this report.

Following a review of the original complaint documentation, subsequent documentation received,

and correspondence with the complainant, the specific allegations investigated, and conclusions
reached, are listed below:

Allegation 1: Dr. Roberson directed the complainant and other DOH staff to falsify COVID -

19 positivity rates. Unsubstantiated. Based upon an analysis of the available evidence, there
is insufficient evidence to clearly prove or disprove the alleged conduct, as described by the
complainant, occurred.

Allegation 2: Ms. Coppola pressured the complainant to falsify COVID -19 positivity rates
as directed by Dr. Roberson. Unsubstantiated. Based upon an analysis of the available
evidence, there is insufficient evidence to clearly prove or disprove the alleged conduct, as
described by the complainant, occurred.

Allegation 3: At the direction of Dr. Roberson and Dr. Blackmore, the calculation of new
case positivity was misrepresented on the DOH COVlD -19 Data and Surveillance
Dashboard. Unfounded. Based upon an analysis of the available evidence, the alleged conduct,
as described by the complainant, did not occur.

Allegation 4: Dr. Roberson, Dr. Blackmore, and Mr. Pritchard directed the complainant to
restrict access to underlying data that supported what appeared on the COVID -19 Data and
Surveillance Dashboard. Exonerated. Based upon an analysis of the available evidence, the
alleged conduct, as described by the complainant, occurred but was not found to be a violation of
any governing directive.

Details of the investigation and findings can be found in the INVESTIGATIVE DETAILS section
of this report.

The complainant identified additional allegations and subjects in their Florida Commission on Human Relations written complaint.
However, all other allegations, beyond those listed in this investigative report, were not within the jurisdiction of the Florida Department
of Health (DOH), Office of Inspector General (OIG) and are not addressed by this report.
The whistle-blower complainant will be referred to as "complainant" herein.
In accordance with 112.3188, Florida Statutes, granting of Whistle-blower status affords the complainant protection from their name
or identity being disclosed throughout the investigation and investigative report, unless specifically exempted in statute or in cases
where the disclosure is necessary to the investigation.
6
See page 13.

IR OlG 21-117
Page 2 of 27
 72
Jacob AIethnder, CIGI
i- -'fl-
Date
,

Senior Investigator

'r g,
Interim irettrofliivestigations

ti
_______________
Michael J. BennetttlA, CGAP, CIG Date
Inspector General

IR OIG 21-117
Page 3 of 27
 OIG 21-117
INVESTIGATIVE DETAILS

BACKGROUND7

On July 17, 2020, FCHR received a Whistle-blower Act Retaliation Charge of Discrimination
(Charge of Retaliation)8 from the complainant, alleging retaliation through termination for
opposing directions by DOH managers to falsify COVID-19 data on the DOH COVID-19
dashboard to support reopening Florida when data indicated it was unsafe to do so.

On January 25, 2021, the FCHR forwarded the Charge of Retaliation to the CIG in accordance
with requirements of sections 112.3187-112.31895, F.S., also known as the "Whistle-blower's
Act."9 That same day, the CIG referred the Charge of Retaliation to the DOH, 01G. (Exhibit 1)

On January 28, 2021, the OIG emailed the complainant's attorney to schedule a standard OIG
intake interview with the complainant. The complainant's attorney declined for the complainant to
participate in an interview with the OIG but agreed to receive and respond to the OIG's inquiries
in writing.

Beginning February 12, 2021, the OIG provided the complainant, through the complainant's
attorney, a series of questions to assist in clarifying and expanding upon the allegations made by
the complainant in the original Charge of Retaliation. The complainant responded in writing to the
OIG's questions on March 1, 2021, and to an OIG follow-up inquiry on April 4, 2021. In the written
responses to the OIG, the complainant clarified their allegations and affirmed Ms. Coppola, Dr.
Roberson, Dr. Blackmore, and Mr. Pritchard as the subjects of the complaint. (Exhibit 1)

Based upon a review of the original written complaint and the follow-up information received
through correspondence with the complainant's attorney, the OIG identified three1° specific
allegations that fell within the jurisdiction of the OlG to investigate pertaining to the early months
of the State of Florida's response to the CO VI D-19 pandemic (specifically March 16, 2020 through
May 26, 2020).

On April 19, 2021, the OIG received confirmation from the complainant (via the complainant's
attorney) of the specific allegations that would be investigated by the 01G. (Exhibit 2)

On May 28, 2021, the OlG notified the complainant of their designation as a whistle-blower and
initiated a whistle -blower investigation.11

The information discussed in this section is based upon research of DOH and Centers for Disease Control and Prevention (CDC)
websites, and testimonies of DOH staff, unless otherwise noted.
8
The complainant signed the Charge for Retaliation on July 16, 2020. The FCHR received the Charge of Retaliation on July 17,2020.
9112.31895(3) CORRECTIVE ACTION AND TERMINATION OF INVESTIGATION -

(a) The Florida Commission on Human Relations, in accordance with this act and for the sole purpose of this act, is empowered to:
5. Coordinate with the Chief Inspector General in the Executive Office of the Governor and the Florida Commission on Human
Relations to receive, review, and forward to appropriate agencies, legislative entities, or the Department of Law Enforcement
disclosures of a violation of any law, rule, or regulation, or disclosures of gross mismanagement, malfeasance, misfeasance,
nonfeasance, neglect of duty, or gross waste of public funds.
10 During
the investigation, the OIG separated one of the three original allegations established with the complainant at the onset of the
investigation into two distinct allegations for additional clarity, leading to four allegations overall addressed in this report.
On June 2, 2021, the complainant signed a Waiver of Whistle-blower Confidentiality. However, the identity of the complainant will
remain omitted from this report.

IR OIG 21-117
Page 4 of 27
Subject In formation

Courtney Coppola served as DOH Chief of Staff from October 8, 2019 to March 25, 2021.12 This
position is an executive leadership position within DOH and is a direct report to the State Surgeon
General, primarily overseeing all facets of the daily operations of the Office of the State Surgeon
General, providing coordination and oversight in the development of defined core initiatives for
the Office of the State Surgeon General, and serving as the State Surgeon General's primary
strategic liaison with DOH and community partners.13 Ms. Coppola was a direct report of State
Surgeon General Dr. Scott Rivkees during the period under review.

Dr. Shamarial Roberson served as the DOH Deputy Secretary for Health from November 29,
2019 to October 14, 2021.14 This position oversees the Division of Disease Control and Health
Protection (DDCHP); the Division of Public Health Statistics and Performance Management; the
Division of Emergency Preparedness and Community Support; and the Division of Community
Health Promotion, along with the Office of Minority Health and Health Equity and the Office of
Medical Marijuana Use.15 Dr. Roberson was a direct report of State Surgeon General Dr. Scott
Rivkees during the period under review.

Dr. Carina Blackmore is designated as the State Epidemiologist and has served as the Director
of Medical and Health Services for the DDCHP since April 21, 2017.16 This position supports the
Department's mission through public health services that includes disease prevention and
intervention, surveillance and reporting, epidemiology, laboratory testing, disease investigations,
HIV client services, and protecting Florida's environment through water quality, onsite sewage
and toxicology programs statewide. This position oversees four Bureaus, including Bureau of
Communicable Diseases (BCD), Bureau of Epidemiology (BOE), Bureau of Public Health
Laboratories and Bureau of Environmental Health.17 Dr. Blackmore was a direct report of Dr.
Roberson's during the period under review.

Scott Pritchard served as Biological Administrator II within the BOE from September 27, 2013
to July 16, 2020. During the period reviewed, Mr. Pritchard was the BOE's Investigation Section
Administrator. Following a brief voluntary separation, Mr. Pritchard returned to employment with
the DOH in 2021 and currently holds the position of Other Personal Services (OPS) Biological
Administrator II within the BCD.18 Mr. Pritchard was a second -level report of Dr. Blackmore's
during the period under review.

Bureau of Epidemiology and Geographic Information Systems unit

According to information provided in the written complaint, the complainant's allegations centered
around operations within the BOE and the Geographic Information Systems unit (GIS unit), both
of which are within the DDCHP.

The BOE is comprised of five sections: Immunization, Infectious Disease Prevention and
Investigation, Operations and Training, Refugee Health, and Surveillance Systems. The pertinent

12
According to People First (PF) records
13
Florida DOH Resource Manual, State Fiscal Year 2019-2020
14
According to PF records
15
DON lntranet SharePoint site
16
According to PF records
17
DOH Intranet SharePoint site
According to PF records

IR OlG 21-117
Page 5 of 27
BOE sections for this investigation are Surveillance Systems (Surveillance Section) and Infectious
Disease Prevention and Investigation (Investigation Section).

The primary functions of the Surveillance Section are to:

¯ Support the county health departments (CHD) in identifying and reporting cases of
infectious disease through our surveillance systems;
¯ Develop and maintain the Merlin19 and the ESSENCE -FL (ESSENCE)2° surveillance
systems and provide technical assistance to system users;
¯ Provide training and technical assistance to CHDs on infectious disease protocols,
epidemiological investigations, and timely public health topics;
¯ Describe patterns of disease that can be assessed over time, compared with trends from
other states, and act as an aid in directing future disease prevention and control efforts;
e Conduct innovative research to broaden the knowledge of infectious agents and reduce
morbidity and mortality; and,
¯ Collect and maintain laboratory results for reportable diseases and conditions in the state
of Florida.21
The primary functions of the Investigation Section are to provide consultation, guidance, surge
capacity, and training on infectious disease case and outbreak investigations and utilization of
surveillance systems during investigations. Team members serve as laboratory liaisons, with
offices at each public health laboratory. (Exhibit 3)22
The GIS unit is housed within the office of the DDCHP Director and is part of the DOH's distributed
information technology services. According to sworn testimony provided by the complainant's
former supervisor, Craig Curry, Systems Programming Administrator, DOH, DDCHP, the primary
function of the GlS unit is to develop visualizations of data analysis performed by entities
throughout the DOH, including the BOE. In this role, the GIS unit developed and maintained the
dashboard. During the period under review, the complainant managed the GIS unit and was the
primary point of contact for the design and operation of the dashboard. (Exhibit 4)23

COVID-19 Data and Methods of Reporting24

The BOE collects data for most reportable diseases in the state of Florida, which includes CO VI D-
19. As previously mentioned, Merlin and ESSENCE are the systems used by the BOE's
Surveillance Section to gather, analyze, and report data on reportable diseases.
Merlin serves as the state's repository of reportable disease case reports. ESSENCE serves as
a biosurveillance system that provides state and local epidemiologists access to data, analytic

19
Merlin refers to the Merlin Communicable Disease Reporting Application.
20
ESSENCE-FL (ESSENCE) refers to the Electronic Surveillance System for the Early Notification of Community-based Epidemics
21
The Bureau of Epidemiology (BOE) does not collect data for the human immunodeficiency virus, sexually transmitted diseases,
tuberculosis, or cancer, and data for these diseases and conditions is not stored in Merlin.
In approximately June 2021, the OlG obtained screenshots from the BOE, Surveillance Section's and Investigation Section's DON
Intranet webpages.
23
Electronic recordings of sworn subject and witness interviews.
24
The primary source of the information disclosed in this section was Thomas Troelstrup, Operations and Management Consultant
Manager, DOH, Division of Disease Control and Health Protection, BOE. During the period reviewed and at present, Mr. Troelstrup
served as the Surveillance Section Administrator within the BOE. In this capacity, Mr. Troelstrup was/is the DON's data custodian for
all reportable diseases and conditions and oversees the Merlin and the ESSENCE surveillance systems.

IR OIG 21-117
Page 6 of 27
tools, and data visualizations that enhance their ability to detect outbreaks of disease in a timely
manner, conduct routine descriptive epidemiologic analysis, and monitor morbidity and mortality
trends over time and space and across multiple data sources. (Exhibit 5)25
Based on sworn testimonial evidence obtained by the OIG during the period under review, when
a person received a COVID-19 antigen or polymerase chain reaction (PCR) laboratory (lab) test,
the result of their test, whether positive or negative, was reported in Merlin via electronic laboratory
reporting.26 For any positive antigen or PCR lab result entered into Merlin, the system
automatically created a profile and a case the same day the DOH received the positive test result.
Profiles were not created in Merlin for negative results. If a person already had a Merlin profile
created from a previous positive lab result for a reportable disease (COVlD -19 or otherwise), the
new positive COVID-19 case was added under the person's existing profile.

Once a new COVlD-19 case was created in Merlin, the BOE's Investigation Section worked
through the jurisdictional CHD to contact the person to provide general health information about
COVID -19 and gather additional information, which was included in the person's Merlin case file.

Simultaneous to the CHD's and Investigation Section's activity, the Surveillance Section analyzed
lab results and positive case information in Merlin and syndromic data27 in ESSENCE, producing
daily reports based on the data. These reports, which contained only aggregate, non -personally
identifiable information, were distributed each morning to the CHDs for review and approval. Once
the daily reports were verified as accurate by the CHDs, a final daily report was published and
distributed. A copy of the most recent final daily report was published on the publicly-available
DOH COVID -19 website.

Following the distribution of a final daily report, a copy of the aggregate dataset used to produce
the report was provided by the BOE to the GIS unit manager, who would run the pre-calculated
data through GIS code and upload it to the dashboard, which was also available on the DOH
COVlD-19 website and served to summarize the same data found on the final daily reports in an
easy-to -understand, graphical format.

COVID-19 individual case and lab data, as well as syndromic data, were not made available to
the GIS unit and were not available on the DOH COVlD -19 website or the dashboard. As
previously stated, Merlin and ESSENCE were the State's only repositories for reportable disease
case reports and syndromic data, respectively.

The first COVID-19 surveillance data daily report was published on March 16, 2020. The
dashboard, which went live on or around March 16, 2020 as well, was accessible both online and
via a mobile application.28 As such, the dashboard data had to match the daily reports. To
accomplish this, routine quality control steps were conducted by BOE staff. (Exhibit 6)29 Any
deviation (intentional or unintentional) from the BOE's data analysis made by the GIS unit when

25
In approximately June 2021, the OIG obtained screenshots from the BOE Surveillance Section's DOH Intranet webpage regarding
the Merlin and ESSENCE systems.
26
According to Mr. Troelstrup, during the period reviewed, 98% of COVID -19 test results were reported to the DOH via electronic
laboratory reporting. The remaining 2% of test results were reported via fax or mail and manually entered in Merlin by BOE staff.
27
Syndromic data consisted of statewide Emergency Department (ED) chief complaint and admission data. The Surveillance Section
used this data to monitor and report the daily percent of ED visits presenting symptoms of Influenza and/or COVI D-like illnesses such
as cough, fever, or shortness of breath.
28
The dashboard was no longer updated when the DOH moved to weekly reports effective June 4, 2021.
29
On July 15, 2021, the OlG obtained from Mr. Troelstrup, via the DOH OneDrive," a copy of the DOll's first COVID-19 daily report
published March 16, 2020, and copies of one daily report for each subsequent month, through May 2021. For June 2021 and July
2021, Mr. Troelstrup provided copies of COVID-1 9 Weekly Situation Reports, as the DON had by that time transitioned from daily to
weekly reporting.

IR OIG 21-117
Page 7 of 27
visualizing the data would have resulted in discrepancies between information on the dashboard
and in the corresponding, already distributed daily reports. Such discrepancies would have been
detectable, not only to BOE staff running routine quality control, but to anyone who compared the
two publicly -available data sources, including but not limited to: CHDs, local governments,
researchers, the press/media, and the general public. (Exhibit 4)

White House Gating Criteria

On March 11, 2020, the World Health Organization officially declared the COVID -19 outbreak to
be a global pandemic and suggested countries take aggressive actions to contain the spread of
the virus. Soon after, many countries, including the Unites States, enacted measures to shut down
businesses and events and encouraged people to stay at home and avoid gatherings to prevent
the spread of the disease.

To establish a consistent and measured methodology for states and local jurisdictions to use, the
United States federal government enlisted the assistance of leaders from a variety of business
and health sectors to put a plan together for the "reopening" of America in a safe and controlled
manner, while still dealing with the effects of the global pandemic.

On April 16, 2020, the White House, in conjunction with the Centers for Disease Control and
Prevention (CDC), released a document entitled, "Guidelines Opening up America Again" (WH-

reopening plan) (Exhibit 7)30 which included the following "Proposed State or Regional Gating
Criteria" (WH gating criteria) for states and other jurisdictions to consider when determining when
and how to begin reopening from COVID-19 shutdowns:

The OIG created this table based on WH gating criteria, as presented on page 2 of the WH reopening pan.

The document also included a key caveat that "State and local officials may need to tailor the
application of these criteria to local circumstances (e.g., metropolitan areas that have suffered
severe COVID outbreaks, rural and suburban areas where outbreaks have not occurred or have
been mild). Additionally, where appropriate, Governors should work on a regional basis to satisfy
these criteria...."

The document does not state that decisions for reopening must be made on a city by city, county
by county, or metropolitan versus rural basis. Furthermore, the criteria put forth in the WH
reopening plan were guidelines and not mandates. States and other jurisdictional authorities had

°
In approximately April 2021, the OIG obtained a copy of the WH reopening plan from GuideIines-for-Opening -U -America -Again.pdf
(archives .pov)
31
The Florida Agency for Health Care Administration collected and reported data pertaining to the "Hospitals" criteria.
32
This metric is commonly referred to as positivity or percent positive cases.

IR OIG 21-117
Page 8 of 27
the discretion to alter or use forms of the guidelines to develop their own, more specific criteria
that could be adopted to best suit the needs of the local jurisdictions making the decisions.

The DOH Dashboard's Florida Health Metrics tab

Prompted by the announcement of the WH gating criteria, the BOE Surveillance Section
developed methods of analyzing and calculating data pertaining to the Symptoms and Cases
criteria. To visualize the BOE's new data analysis, on April 24, 2020, the GIS unit was directed
by Dr. Blackmore to develop an additional tab for the dashboard; eventually titled "Health Metrics"
(Health Metrics tab).

The purpose of the Health Metrics tab was to provide information, both on a statewide and county -

by-county basis, to interested parties on cumulative CO VI D-related case data being received by
DOH, in an easier-to-understand graphical format.

The Health Metrics tab was implemented on or around April 26, 2020 and graphed the data on
both a county and statewide level, for the following health metrics: 1) Emergency Department
(ED) Visits with Influenza -Like Illnesses (ILl); 2) ED Visits with COVID-like Illnesses (CLI); 3)
Documented New Cases; and 4) Percent Positive for Laboratory Testing (see example below).

Screenshot of one statewide data page of the DOH Health Metrics tab, showing data points over several weeks'
time.

Using a drop -down menu in the upper right corner or the Health Metrics tab, users could view
data for the entire state or individual counties. Reporting data in the Health Metrics tab on both a
statewide and county level was consistent with how the DOH analyzed and reported data from
the onset of the COVID -19 response, prior to the WH reopening plan and development of the
Health Metrics tab. Furthermore, reporting data on a county level was consistent with how health
services are delivered via the DOH Office of County Health Systems, which assists DOH
leadership and core public health operations of CHDs located in all 67 Florida counties.

Florida DOH Resource Manual, State Fiscal Year 2019-2020

IR OIG 21-117
Page 9 of 27
Safe. Smart. Step -by-Step. Plan for Florida's Recovery

On April 29, 2020, Florida Governor Ron DeSantis announced the Safe. Smart. Step -by-Step.
Plan for Florida's Recovety (Florida reopening plan); which was created by the Governor -

appointed Re -Open Florida Task Force (taskforce).34 (Exhibit 8) The "Benchmarks for Re -

Opening" (Florida benchmarks), included as part of the Florida reopening plan, were as follows:

SYNDROMIC EPIDEMIOLOGY AND HEALTH CARE

SURVEILLANCE OUTBREAK DECLINE CAPABILITY
Downward trajectory of influenza- Downward trajectory of documented Capability to treat all patients
like illnesses COVID-19 cases without triggering surge capacity
AND OR AND

Downward trajectory of COVID-19- Downward trajectory of positive tests Robust testing program in place for
like illnesses (fever, cough, as a percent of total tests (flat or at-risk healthcare workers, including
shortness of breath) increasing volume of tests) emerging antibody testing

The OlG created this table based on the Florida benchmarks, as presented on page 9 of the Florida reopening plan.

As was the case with the WH gating criteria document, the Florida reopening plan document did
not state that decisions for reopening would be made on a city by city, county by county, or
metropolitan versus rural basis. Additionally, there was no defined data threshold that needed to
be met for reopening to occur. The only criteria included was the criteria noted in the chart above.

The Florida reopening plan document included the names of many individuals across a wide
spectrum of industries as participating on the taskforce that developed the criteria for reopening.
However, no DOH officials were listed as members of the taskforce, even though it appears some
DOH officials were consulted by the taskforce during the plan's development.

Executive Orders Issued for Re-opening Florida

Between April 29, 2020 and September 25, 2020, Governor DeSantis signed a series of Executive
Orders (EO) that initiated a phased reopening of Florida's businesses and economy.36 (Exhibit
9)37

The EOs followed the guidelines established in the Florida reopening plan for Phases I & II. For
Phase III, reopening was based upon a declaration that "the State of Florida has suffered
economic harm as a result of COVID -19-related closures, exacerbating the impacts of the State
of Emergency, and Floridians should not be prohibited by local governments from working or
operating a business."

Because DOH officials were not tasked with establishing the criteria for reopening or granting
authority for reopening, the DOH Health Metrics tab was never used, or intended to be used, to
identify when local governments would be authorized to reopen.

Information regarding the development and implementation of the Florida reopening plan are outside the OlG's jurisdiction.
In approximately April 2021, the OIG obtained a copy of the Florida reopening plan from Guidelines for Openinp Up Florida -

COMBINED 4 -29--20.cdr (f1ov.com).

36
Executive Orders (EO) 20-112, 20-139, and 20-244 initiated reopening phases I, II, and Ill (respectively) as described in the Florida
reopening plan.
In approximately April 2020, the OIG obtained a copy of the EOs from 2020 Executive Orders (flpov.com).

IR OlG 21-117
Page 10 of 27
Calculating Positivity Rate38
Key criteria for reopening stated in both the WH gating criteria and the Florida benchmarks was
downward trajectory of positive tests as a percentage of total tests (positivity). This calculation is
the data analysis used to show the number of people with positive COVID -19 test results as a
percentage of the total number of people with CO VI D-19 test results (positive and negative). No
law, rule, or policy exists which states how positivity must be calculated. However, for positivity to
be a useful epidemiological surveillance tool, the same method of calculating positivity must be
used consistently over time. (Exhibit 1O) Additionally, the higher the percentage of a population
that has been tested, the more accurate the calculated positivity rate's assessment of risk for that
population will be. When a low percentage of a population has been tested, the positivity
calculation is more likely to produce a skewed percentage (either higher or lower than reality),
thus producing a calculation that has less confidence it accurately reflects the true risk for that
population.

According to sworn testimony and the DOH data definition sheet, the DOH used two methods of
calculating positivity:

Overall positivity is the percent of cumulative people in Florida who had a positive
antigen or PCR lab test out of the cumulative number of people in Florida tested. Each
person only counts once for their first positive test, regardless of any future test results
(positive or negative).

New case positivity, based on the condition that once a person tests positive for CO VI D-
19 they will not be re-infected40 and excludes duplicate test results, is the number of newly
positive Florida residents divided by the total number of people with test results within a
defined timeframe, excluding persons who previously tested positive within the same
defined timeframe. Thus, a person's first positive test result is the last test result for that
person that will ever be included when calculating new case positivity. (Exhibit 11)

GOVERNING DIRECTIVES and DEFINITIONS

If substantiated, the allegations may violate one or more of the following governing directives:

I. Florida Statute (F.S.)

Chapter 112, Part Ill, F.S. Code of Ethics for Public Officers and Employees
-

112.311, F.S. Legislative intent and declaration of policy -

(6) It is declared to be the policy of the state that public officers and employees, state and
local, are agents of the people and hold their positions for the benefit of the public. They are
bound to uphold the Constitution of the United States and the State Constitution and to
perform efficiently and faithfully their duties under the laws of the federal, state, and local
governments. Such officers and employees are bound to observe, in their official acts, the
highest standards of ethics consistent with this code and the advisory opinions rendered with
respect hereto regardless of personal considerations, recognizing that promoting the public

38
Percent positive, positivity, and positivity rate are interchangeable terms.
Per guidance on the CDC website, dated September 3, 2020, and obtained by the OIG approximately April 2021.
°
During the period under review, COVlD -19 re -infections had not yet occurred and thus were not accounted for in the calculation of
new case positivity.

IR OIG 21-117
Page 11 of27
 interest and maintaining the respect of the people in their government must be of foremost
concern.
Chapter 839, ES. Offenses by Public Officers and Employees
-

839.13, F.S. Falsifying records -

(I) Except as provided in subsection (2), if any judge, justice, mayor, alderman, clerk, sheriff,
coroner, or other public officer, or employee or agent of or contractor with a public agency, or
any person whatsoever, shall steal, embezzle, alter, corruptly withdraw, falsify or avoid any
record, process, charter, gift, grant, conveyance, or contract, or any paper filed in any judicial
proceeding in any court of this state, or shall knowingly and willfully take off, discharge or
conceal any issue, forfeited recognizance, or other forfeiture, or other paper above mentioned,
or shall forge, deface, or falsify any document or instrument recorded, or filed in any court, or
any registry, acknowledgment, or certificate, or shall fraudulently alter, deface, or falsify any
minutes, documents, books, or any proceedings whatever of or belonging to any public office
within this state; or if any person shall cause or procure any of the offenses aforesaid to be
committed, or be in anywise concerned therein, the person so offending shall be guilty of a
misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083.

II. DOH Policies (DOHP) and DOH Internal Operating Procedures (lOP)41

DOHP 30-2-13 Code of Ethics

I. Policy
The Florida Department of Health's (Department) mission is to protect, promote and improve
the health of all people in Florida through integrated state, county, and community efforts....
All department employees shall comply with Chapter 112, Part Ill, Florida Statutes and the
requirements of this policy, which, in some circumstances, requires conduct beyond what is
provided by law. All employees are expected to use the powers and resources of the
department to further the public interest and maintain the respect and trust of the people of
the government. Employees shall avoid any conduct, regardless of whether in the context of
business financial, or social relationships, which might undermine the public trust, regardless
of whether that conduct is unethical or merely has the appearance of unethical behavior.

Employees are expected to safeguard their ability to make objective, fair, and impartial
decisions. By embracing a strong code of ethics, we will further our department vision: "To be
the healthiest state in the Nation."

DOHP 60-8-16 Personnel and Human Resource Management Discipline

VII. D. 6. Permanent career service employees may be suspended or dismissed only for
-

cause that shall include, but is not limited to, the following:42

e. Violation of Law or Agency Rules:

(8) Misuse of Computer Facilities or Equipment: The intentional introduction of

fraudulent data into a computer system, the unauthorized use of computer facilities
or equipment, the intentional alteration or destruction of computerized information or

41
The listed policies were in effect at the time of the events under investigation. Some policies may have been superseded by more
current versions.
42
For the purposes of an OIG investigation, Section Vll.D.6. applies to both career service and non -career service employees per
Section Vll.D.3 which states, "Non -career service employees may be disciplined, up to and including dismissal, at will. Supervisors
may want to review the considerations for discipline discussed in Section Vll.D.6 of this policy before taking disciplinary action against
a non -permanent career service employee."

IROIG 21-117
Page 12 of 27
 files, or the unauthorized removal of data from a computer. This includes, but is not
limited to, the use of the Internet or e-mail for purposes or at times not authorized by
Department policy. With respect to computer use, see DOHP 50-10, Information
Security and Privacy Policy, that may be accessed from the Department's intranet
from the "Policies and Publications" link.

(13) Rules, Regulations, Policies, or Laws Violated: An act that results in an unintentional
violation of law, regulation, policy, or law.

(14) Rules, Regulations, Policies, or Laws Violated: An act that results in an intentional
violation of law, regulation, policy, or law.

f. Conduct Unbecoming a Public Employee: Employees should conduct themselves, on and

off the job, in a manner that will not bring discredit or embarrassment to the state.

(2) Employee shall maintain high standards of honesty, integrity, and impartiality.

(4) Examples of conduct unbecoming a public employee are:

(d) Falsification of Records or Statements: An intentional act of misrepresentation,

falsification, or omission of any fact, whether verbal or written, on such records and
statements as, but not limited to, time and attendance (leave); employment status;
employment application; licenses; records relating to child abuse or vulnerable adult
investigation or protective services or foster care and related services; client records,
including falsifying client records and accounts, establishing false client accounts,
misrepresenting worker performance in client records, repeatedly failing to make
timely changes or updates in client case files that result or may result in inappropriate
services or benefits to clients; travel vouchers; work and production; or knowingly
filing a false complaint, or providing a false or untrue statement related to a claim of
discrimination or sexual harassment, or in connection with an internal investigation.

g. Misconduct: Employees shall refrain from conduct which, though not illegal or
inappropriate for a state employee generally, is inappropriate for a person in the
employee's particular position.

IV. Definitions43

Substantiated: case materials support the alleged conduct likely occurred and may
have been a violation of one or more governing directives.

Unsubstantiated: case materials were unable to prove or disprove the alleged conduct
occurred.

Exonerated: case materials support the alleged conduct likely occurred but was not found to
be a violation of any governing directive.

Unfounded: case materials support the alleged conduct did not occur.

The list of definitions describes the various potential conclusions the OlG may reach on each allegation investigated. This does not
infer that all conclusions listed were used in this report.

lR OIG 21-117
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 Additional Findings: case materials support a finding that an act, not part of the original
allegations, likely occurred and may have been a violation of one or more governing directives.

Policy Failure: case materials support the alleged conduct likely occurred but was not
adequately addressed by any governing directive.

INTERVIEWS

The OIG contacted and/or conducted sworn recorded interviews with the following:

COMPLAINANT

Whistle -blower44

WITNESSES

Current and former DOH employees and/or contractors:

¯ Dr. Scott Rivkees, former State Surgeon General45

¯ Leah Eisenstein, Senior Surveillance Epidemiologist, Wired People, Inc.46
¯ Megan Gumke, Biological Administrator II, DOH
¯ Lin Yue, System Project Consultant, Effervo Technologies, Inc.48
¯ Thomas Troelstrup, Operations and Management Consultant Manager, D0H49
¯ Craig Curry, Systems Programming Administrator, DOH5°
¯ Jessica Joiner, former Environmental Consultant, D0H51
¯ Dr. Andrea Morrison, Biological Scientist IV, D0H52

"
On January 28, 2021, the OlG contacted the complainant by email via their attorney to schedule an interview. The complainant's
attorney responded on January 29, 2021 and stated the complainant would not participate in an OlG interview. On March 1, 2021 and
April 4, 2021, the complainant through the complainant's attorney, responded in writing to the OIG's written intake questionnaires.
A sworn, recorded, video interview was conducted with Dr. Rivkees on November 30, 2021. According to information provided by
Dr. Rivkees during his OIG interview, Dr. Rivkees' tenure as State Surgeon General was from June 2019 through September 20,
2021, via a contract with the University of Florida, where he served as Chairman of Pediatrics and Physician -in -Chief at University of
Florida Shands Hospital, Gainesville, Florida.
46
A sworn, recorded, video interview was conducted with Ms. Eisenstein on July 1, 2021. According to PF records and information
provided by Ms. Eisenstein during her OlG interview and in follow-up emails, Ms. Eisenstein began her employment with the DOH
effective June 16, 2006 and held the position of Biological Administrator II on February 15, 2018, when her position was transferred
to a DOH contractor; Wired People, Inc. Ms. Eisenstein stated during her OIG interview that she currently works for Wired People as
a Senior Epidemiologist within the DOH.
A sworn, recorded interview was conducted with Ms. Gumke on July 12, 2021. According to PF records, Ms. Gumke began her
employment with the DOH effective August 19, 2011 and started her current position of Biological Administrator II on September 29,
2020. Ms. Gumke held the position of Biological Scientist IV dunng the period reviewed.
48
A sworn, recorded interview was conducted with Ms. Yue on July 12, 2021. According to PF records and information provided by
Ms. Yue during her OlG interview and in follow-up emails, Ms. Yue began her employment with the DOH effective November 13, 1998
and held the position of System Project Consultant on October 22, 2010, when she voluntarily separated employment with the DOH.
Ms. Vue explained during her OIG interview she currently works for a DOH contractor name Workfiow Technologies, Inc. (Effervo),
as a System and Database Administrator within the DOH.
A sworn, recorded interview was conducted with Mr. Troelstrup on July 13, 2021. According to PF records, Mr. Troelstrup began
his employment with the DOH effective January 5, 2018 and started his current position of Operations and Management Consultant
Manager on June 16, 2020. Mr. Troelstrup held the position of Biological Administrator II during the period reviewed.
°
A sworn, recorded interview was conducted with Mr. Curry on July 15, 2021. According to PF records, Mr. Curry began his
employment with the DOH effective September 7, 2018 in his current position of Systems Programming Administrator.
51
A swom, recorded, video interview was conducted with Ms. Joiner on July 27, 2021. According to PF records, Ms. Joiner began her
employment with the DOH effective February 24, 2017 and voluntarily separated as an Environmental Consultant on October 22,
2021.
52
A sworn, recorded, video interview was conducted with Dr. Morrison on August 17, 2021. According to PF records, Dr. Morrison
began her employment with the DOH effective October 24, 2014, in her current position of Biological Scientist IV.

IR OIG 21-117
Page 14 of 27
 ¯ Ryan Slapikas, OPS Systems Programming Consultant, D0H53
¯ Surenderreddy Konatham, GlS Analyst, Workflow Technologies, Inc.54
¯ Shelby Fawaz, Electronic Case Reporting Surveillance lnformatician, Wired People, Inc.55
¯ Amy Bogucki, former Respiratory Disease Surveillance Epidemiologist, Wired People,
Inc.56
¯ David Atrubin, Biological Scientist IV, D0H57

SUBJECTS

¯ Courtney Coppola58
¯ Dr. Shamarial Roberson59
¯ Dr. Carina BIackmore6°
¯ Scott Pritchard61

Electronic copies of the sworn recorded interviews are maintained as Exhibit 4.

FINDINGS and CONCLUSIONS

The specific allegations addressed by this report, and the conclusions reached, are as follows:

Allegation 1: Dr. Roberson directed the complainant and other DOH staff to falsify COVID -

19 positivity rates.

Allegation 2: Ms. Coppola pressured the complainant to falsify COVID -19 positivity rates
as directed by Dr. Roberson.

In response to Dr. Blackmore's April 24, 2020 request to develop the new Health Metrics tab on
the dashboard, the complainant prepared a mockup (draft) of the tab for review prior to its
implementation.

A sworn, recorded, video interview was conducted with Mr. Slapikas on August 25, 2021. According to PF records, Mr. Slapikas
was hired by the DOH effective February 22, 2019, to his current position of OPS Systems Programming Consultant.
A sworn, recorded, video interview was conducted with Mr. Konatham on August 25, 2021. According to information provided by
Mr. Konatham during his OIG interview and in follow-up emails, Mr. Konatham stated he currently works for a DOH contractor named
Workflow Technologies, Inc. as a Geographic Information Systems Developer within the DOH.
A sworn, recorded, video interview was conducted with Ms. Fawaz on August 27, 2021. According to PF records and information
provided by Ms. Fawaz during her OIG interview and in follow-up emails, Ms. Fawaz began her employment with the DOH on July 7,
2017 and held the position of Other Personal Services Data Processing Control Specialist on April 9, 2018 when she voluntarily
separated employment with the DOH, and began working for Wired People, Inc. as a DOH contract employee. Ms. Fawaz currently
works for Wired People, Inc. as an Electronic Case Reporting Surveillance Informatician (DOH) and held the position of Opioid
Surveillance Informatician (DOH) during the period reviewed.
56
A sworn, recorded, video interview was conducted with Ms. Bogucki on August 26, 2021. According to information provided by Ms.
Bogucki during her OlG interview and in follow-up emails, she worked for Wired People as a DOH contract employee and held the
position of Respiratory Disease Surveillance Epidemiologist from May 1, 2020 until December 3, 2021. From November 1, 2017 until
April 30, 2020, Ms. Bogucki held the position of Vaccine-Preventable Disease Surveillance Epidemiologist.
A sworn, recorded, video interview was conducted with Mr. Atrubin on August 30, 2021. According to PF records, Mr. Atrubin began
his employment with the DOH effective April 8, 2002 and started his current position of Biological Scientist IV on January 4, 2013.
A sworn, recorded interview was conducted with Ms. Coppola on September 27, 2021.
A sworn, recorded interview was conducted with Dr. Roberson on September 15, 2021.
65
A sworn, recorded interview was conducted with Dr. Blackmore on September 14, 2021.
61
A sworn, recorded interview was conducted with Mr. Pritchard on September 13, 2021.

lR OIG 21-117
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According to the complainant, on April 26, 2020, a mockup of the tab was presented to Dr.
Roberson, Ms. Coppola, and an unknown individual from the Office of the Governor,62 which
included real data. The complainant further stated Dr. Roberson verbally expressed her
displeasure with how high the COVID-19 positivity rates were for several counties, many of which
were rural with relatively low populations, and directed the complainant to falsify county positivity
rates that were higher than 10%.

In the FCHR Charge of Retaliation, the complainant remarked, "When I pulled up the data behind
the scorecard, showing that some counties had 15% or 20% positive persons of all persons tested
(the threshold each county had to meet to be eligible for reopening, as defined by the State and
our Epi team, was below 10%), Roberson suggested I "just change" the numbers to 10% to meet
the criteria for those counties."

The complainant further explained in their response to an OIG follow-up inquiry that, at the time,
many rural, low-population counties had not tested significant enough portions of their populations
for the DOH to calculate positivity rates that could be relied upon as accurate assessments of
risk. Therefore, as indicated in the statement above, Dr. Roberson directed the complainant to
"just change" positivity rates to 10% to make such counties eligible to reopen when the data did
not support reopening the counties at issue.

The complainant alleged being astounded at being asked by Dr. Roberson to falsify data that
could mean life or death for people in those counties and refused to do so. To this, Dr. Roberson
allegedly replied, "I once had a data person tell me, 'you tell me what you want the numbers to
be, and I'll make it happen." The complainant stated they again refused to falsify data or otherwise
intentionally mislead the public during a health crisis.

The complainant further stated that during the same April 26, 2020 meeting, Ms. Coppola shared
Dr. Roberson's displeasure with certain county-level data, and allegedly pressured the
complainant to falsify COVID -19 positivity rates as Dr. Roberson had directed, stating, "We can't
tell Jackson and Franklin counties they can't open, but Miami-Dade and Broward that they can,"
adding that it would be a 'political nightmare."

The complainant affirmed never falsifying COVlD -19 data and is unaware of anyone else ever
falsifying COVID-19 data. The complainant's allegation only concerned Ms. Coppola's and Dr.
Roberson's pressure and direction to do so. (Exhibit 1)

Findings (Allegations I and 2): The following information was obtained from subject and witness
testimonies (Exhibit 4), Merlin and ESSENCE authorized user search results (Exhibit 11),63 and
a copy of the complainant's DOH position description (Exhibit 12):64

¯ According to sworn testimony, Dr. Roberson denied ever directing the complainant or
anyone else to falsify COVID-19 data or any other kind of information, and specifically
denied making any of the statements alleged by the complainant. Additionally, Dr.

62
The complainant mentioned the presence of an individual at the April 26, 2020 meeting representing the Office of the Governor, but
could not provide a name. During their sworn interviews, Ms. Coppola and Dr. Roberson did not recall the presence of an individual
representing the Office of the Governor at this meeting.
63
On October 19, 2021, the OIG obtained from Mr. Troelstrup, via email, documentation of the authorized user histories for Merlin
and ESSENCE.
64
On June 17, 2021,the OlG obtained from Amy Graham, Chief of General Operations, DOH, Division of Administration, Bureau of
Personnel and Human Resource Management, via email, a copy of the complainant's position description.

lR OIG 21-117
Page 16 of 27
 Roberson denied ever discussing anything with the complainant other than the
appearance of the dashboard.

According to sworn testimony, Ms. Coppola denied ever pressuring the complainant or
anyone else to falsify COVID-19 data, and specifically denied ever making the comments
alleged by the complainant. Ms. Coppola stated in her interview that during the period
reviewed there were many "open discussions" about COVID-19 data. Ms. Coppola
affirmed to the OIG that such discussions were always held with the sole intent to achieve
the most accurate methods of analysis and reporting.

¯ According to sworn testimonies, all witnesses (which included Dr. Rivkees, Dr. Blackmore
and Mr. Pritchard) denied ever being asked by anyone to falsify or otherwise alter COVID -

19 data or witnessing someone else being directed to falsify or otherwise alter COVID-19
data.

According to sworn testimony, Ms. Eisenstein recalled the complainant "venting" to her in
or around late April or early May 2020 about a meeting that occurred earlier in the day.
Ms. Eisenstein did not know who was in the meeting with the complainant but stated the
complainant was upset about a discussion that took place during the meeting about a
proposed county scorecard for the Health Metrics tab.65 Ms. Eisenstein disclosed to the
OIG that the only thing she specifically remembered the complainant saying was, "I
shouldn't have been the one doing it and I felt very uncomfortable." Ms. Eisenstein
remarked to the OIG that discussions regarding epidemiological surveillance data analysis
are typically driven by epidemiologists, which the complainant was not.

¯ According to sworn testimonies, Ms. Gumke and Dr. Morrison both disclosed that in late
April 2020, the complainant approached them during a lunch break and remarked that
they (the complainant) had been asked to falsify COVID-19 data during a recent meeting
concerning the COVlD -19 reopening criteria.

o Dr. Morrison testified during her OIG interview that the complainant disclosed being
asked by Dr. Roberson to "change some of the underlying values on the dashboard."

o Both Ms. Gumke and Dr. Morrison explained they did not know the complainant very
welt at the time and were skeptical due to the casual way the complainant disclosed
such a serious allegation. Both noted in their interviews that the complainant was not
an epidemiologist and did not have system access to underlying COVlD-19 data in
Merlin and ESSENCE.

o Dr. Morrison stated in her OIG interview that she tried to explain to the complainant
that sometimes people get confused because they assume, "...the CDC guidance is
X-Y-Z so you should do it this way, and not realize that we don't have to do exactly
what the CDC says we do what works best for Florida..." Dr. Morrison added that
...

her remarks to the complainant were based on her experience with the DOH's
response to the 2016 Zika virus outbreak. Despite her comments, Dr. Morrison stated
the complainant remained adamant that they had been asked to change data on the
dashboard.

65
The proposed county score cards are discussed in the Additional Information section of this report.

IR OIG 21-117
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 o Dr. Morrison stated during her OIG interview that the complainant's allegation did not
make sense to her because the underlying data does not go directly from Merlin and
ESSENCE to the dashboard (it is first published and distributed in the COVID-19 daily
reports).66

o Following the lunch break, Ms. Gumke escalated the matter directly to Mr. Pritchard,
who was her direct supervisor at the time. Mr. Pritchard responded that he thought the
complainant misunderstood the discussion at issue, which was about how to best
analyze data germane to the reopening criteria. Mr. Pritchard added that the
complainant was included in the meeting because they were responsible for the
dashboard's visualization of the data analyses being discussed.67

¯ During his OIG interview, Mr. Pritchard testified that no one ever reported to him that they
or anyone else had been asked to falsify data and, when asked, stated he did not
remember Ms. Gumke coming to him about the complainant's claim that they were asked
to falsify COVID -19 data.

The complainant was never an authorized Merlin or ESSENCE user and did not have
access to either system.68

¯ According to the OIG's review of the complainant's position description, no duties

pertaining to either epidemiological surveillance or investigations were listed.

Conclusion (Allegations I and 2): Unsubstantiated. Based upon an analysis of the available
evidence, there is insufficient evidence to clearly support a violation of a law, rule, or policy, as
described by the complainant, due to conflicting testimonial evidence and the lack of witnesses
to the April 26, 2020 meeting between the complainant, Dr. Roberson, and Ms. Coppola.

In addition, the totality of the information obtained by the OIG indicates no reasonable cause for
Dr. Roberson or Ms. Coppola to have directed and/or pressured the complainant or other DOH
staff to falsify or otherwise alter COVlD -19 data as alleged, because achieving ~10% positivity
was not a criterion for reopening according to the WH and Florida reopening plans.

Moreover, without system access to COVlD-19 surveillance data in Merlin and ESSENCE, the
complainant only had the ability to change or otherwise alter the dashboard's visualization of the
COVlD -19 data analysis that had already been published and distributed in final daily reports by
the time the complainant received the dataset from the BOE. Therefore, if the complainant or
other DOH staff were to have falsified COVID-19 data on the dashboard, the dashboard would
then not have matched the data in the corresponding final daily report. Such a discrepancy would
have been detectable by BOE staff conducting data quality assurance, as well as other parties,
both within and outside the DOH, including but not limited to CHDs, local governments,
researchers, the press/media, and the general public.

Further supporting information for this conclusion can be found in the Additional Information
section of this report.

66
This testimony is consistent with information presented in the Background section of this report.
In their complaint, the complainant did not list Mr. Pritchard as present during the April26, 2020 meeting in which they were allegedly
directed by Dr. Roberson to falsify COVlD -19 data.
68
On October 19, 2021, Mr. Troelstrup explained to the OIG via email, that both Merlin and ESSENCE retain records of all individuals
who have ever had system access; regardless of whether an individual is currently an authorized user.

IR OIG 21-117
Page 18 of 27
Allegation 3: At the direction of Dr. Roberson and Dr. Blackmore, the calculation of new
case positivity was misrepresented on the DOH COVID-19 Data and Surveillance
Dashboard.

In the Technical Appendix attached to the Charge of Retaliation, the complainant alleged "Epi"69
changed how positivity was calculated in the following way: "Percent positivity in this context was
changed from the total number of positive people divided by the number of people tested to total
new cases by day over total negative tests. This resulted in the percentage being calculated
...

based on new positive people, over negative lab tests (not people). As most people who are
tested submitted a minimum of two specimens for labs to analyze, and negative people could be
repeatedly tested over time, this dramatically inflated the denominator to make the percent
positivity seem lower, making many counties with population above 75,000 eligible to reopen
when they had previously not been."

The complainant claimed this change was not defined as the method of calculating new case
positivity and conflicted with the definition that existed on the dashboard, which resulted in a
misrepresentation to the public.

Findings: The following information was obtained from subject and witness testimonies (Exhibit
4), copies of the DOH's COVID-19 Data Definitions sheet and Health Metrics Overview (Exhibit
13),° a sample copy of the code used by BOE to calculate positivity (Exhibit 14),71 email records
between BOE staff and the complainant dated April 29-30, 2020 (Exhibit 15)72 and DOH COVID -

19 daily reports from March 16, 2020 -July 8, 2021 (Exhibit 6):

¯ According to sworn testimony, Dr. Roberson denied ever directing the complainant or
anyone else to manipulate how COVID-19 surveillance data was formulated to produce
artificially low positivity rates or misrepresenting how COVID-19 positivity was calculated,
for determining whether counties were eligible to reopen on the dashboard.

¯ Dr. Roberson stated her only interactions with the complainant concerned the appearance
and visual display of the dashboard. Dr. Roberson affirmed she never discussed data with
the complainant as epidemiological surveillance data analysis was not part of the
complainant's job duties.

¯ According to sworn testimony, Dr. Blackmore denied ever directing the complainant or
anyone else to manipulate how COVID-19 surveillance data was formulated to produce
artificially low positivity rates or misrepresenting how COVID-19 positivity was calculated,
for determining whether counties were eligible to reopen on the dashboard.

¯ Dr. Blackmore stated epidemiological data analysis is discussed among and performed
by epidemiologists within the BOE, and stated the complainant was not an epidemiologist.

¯ According to sworn testimony, Mr. Troelstrup explained the following:

69
"Epi" refers to the BOE.
70
In approximately June 2021, the OIG obtained the Health Metrics Overview directly from the dashboard. On July 27, 2021, the OlG
obtained from Ms. Joiner, via email, a copy of the Data Definitions sheet.
71
On July 1, 2021, the OIG obtained from Ms. Eisenstein, via email, a copy of the code/logic used by the BOE to calculate new case
positivity.
72
In approximately July 2021, the OIG obtained the referenced email correspondence through its access to all DOH email
correspondence.

IR OIG 21-117
Page 19 of 27
 o Regarding positivity in general, there are several different methods of calculating
rates of positivity that exist in the field of epidemiology, but no "gold standard."

o The complainant's allegation and related claims made in the Technical Appendix
of their Charge of Retaliation (referenced above) are not accurate. First, the DOH
did not change the way positivity was calculated. The DOH, BOE, developed a
new method of calculating positivity (new case positivity) and began reporting that
metric in addition to overall positivity. Second, the DOH never calculated rates of
positivity in the manner alleged by the complainant. Overall positivity was positive
test results over total number of test results. New case positivity was the number
of newly positive Florida residents divided by the total number of people with test
results, excluding persons who previously tested positive.

o Because a person's first positive test result is the last result for the person ever
included in the calculation for new case positivity (this excludes all subsequent
positive and/or negative test results for that person), the denominator in the new
case positivity calculation is reduced. This tends to increase the positivity rate.
Therefore, the complainant's claim that the denominator in the DOH's positivity
calculation was "dramatically inflated to make the percent positive seem lower..."
is not accurate.

According to sworn testimony, Ms. Eisenstein explained the following:

o There are two key concepts used when analyzing epidemiological surveillance
data: prevalence and incidence. Prevalence is the number of people who are
positive within the community at present, regardless of when they tested positive
and for how long they have been infected. The concept of incidence narrows a
community down to an "eligible pooi," which is the number of people within the
community who are not currently positive but could still become positive, and then
calculates the number of new positive cases as a percentage of that eligible pool.74

o The DOH never used total number of negative tests as the denominator in any
positivity calculation as alleged by the complainant. Furthermore, positivity
calculations were always "people based," meaning the calculation was always
people/people not people/tests or tests/tests. Tests were not used as the basis of
positivity calculations because people could receive multiple tests within a given
time frame and, for numerous reasons, duplicate test results were sometimes
being reported by medical laboratories to the DOH.

o When calculating any type of positivity, terms and time resolutions for numerators
and denominators always matched (Ex: number of people with positive test results
over total number of people with test results and daily/daily or weekly/weekly). This
contrasted with the complainant's assertion that DOH changed the calculation to
daily new cases (people) over total negative tests (cumulative).

o The GIS team did not calculate positivity or any other reported COVID -19 health
metric. The BOE ran the calculations for the DOH's daily COVID-19 reports and
then provided the pre -determined numerators and denominators for each metric's

Overall and new case positivity are discussed and defined in the Background section of this report.
Overall positivity is based on the concept of prevalence. New case positivity is based on the concept of incidence.

lR OIG 21-117
Page 20 of 27
 calculation to the GIS team, who then ran the figures through GIS code/logic to
visualize BOE's data analysis on the dashboard.

¯ The OIG's review of DOH COVID -19 daily reports75 showed new case positivity did not
replace overall positivity. Both metrics were included in COVI D-19 daily reports as well as
the dashboard from April 2020 onward.

According to the Data Definitions sheet and Health Metrics Overview, new case positivity,
which was the only positivity type included on the dashboard's Health Metrics tab, was
defined as: "The number of newly positive Florida residents divided by the total number of
people with test results, excluding persons who previously tested positive... Only PCR and
antigen testing are included in these figures." This again contrasted with the complainant's
assertion that DOH changed the calculation to daily new cases (people) over total negative
tests (cumulative).

Based on the OIG's review, the code/logic used by the BOE to calculate new case
positivity was consistent with the definition for new case positivity provided on the Data
Definition sheet and Health Metrics Overview.

The OIG reviewed emails between BOE staff and the complainant that took place on April
29, 2020 and April 30, 2020, which documented the drafting of the definition for new case
positivity. The emails show the definition, as alleged by the complainant, was not provided
to the complainant but was developed by the complainant and submitted to DOH
management for review. Once reviewed by Mr. Troelstrup and Ms. Eisenstein, an email
was sent back to the complainant, correcting the actual definition that was to be used. This
final definition was published on April 30, 2020, and was included on the dashboard's Data
Definitions sheet the same day.

¯ The final definition for new case positivity cited in the April 30, 2020 email is also identical
to the definition found on the Health Metrics Overview.

Conclusion: Unfounded. Based upon an analysis of the available evidence, the alleged conduct,
as described by the complainant, did not occur.

Prior to April 30, 2020, DOH only reported COVlD-19 positivity based on "overall positivity."
Beginning on April 30, 2020, the BOE developed a second calculation, "new case positivity,"
which was reported in addition to overall positivity on subsequent daily reports and the dashboard.
This second calculation was added to show current trends of positive cases in Florida separate
from the overall positivity occurring since the beginning of the pandemic.

The OIG found no evidence that the DOH misrepresented or otherwise misled the public
regarding how positivity rates were calculated. The definitions for overall and new case positivity
were provided on the Data Definition sheet and Health Metrics Overview, which were both linked
to the dashboard, and were consistent with testimonial evidence obtained by the 01G.
Furthermore, the definition for new case positivity provided on the Data Definitions sheet and
Health Metrics Overview matches the code/logic used by the BOE to calculate new case positivity.

Further supporting information for this conclusion can be found in the Additional Information
section of this report.

See Footnote 27, page 8

IR OlG 21-117
Page 21 of 27
Allegation 4: Dr. Roberson, Dr. Blackmore, and Mr. Pritchard directed the complainant to
restrict access to underlying data that supported what appeared on the COVID -19 Data and
Surveillance Dashboard.

In the Charge of Retaliation, the complainant alleged being directed to delete the dashboard's
"data hub,"76 thus restricting access to the underlying COVID-19 surveillance data that supported
what appeared on the dashboard. In subsequent communication with the OIG, the complainant
clarified that their allegation concerned the removal/restriction of access to data (i.e., the "data
hub"), not the actual deletion of data itself.

Specifically, the complainant claimed being directed by Dr. Roberson, Dr. Blackmore, and Mr.
Pritchard to remove the "data hub" from the dashboard on May 4, 2020, before being asked to
reactivate the "data hub" within 24 hours. The complainant informed the OIG no changes were
made to the data available via the "data hub" once it was reactivated.

Findings: The following information was obtained from subject and witness testimonies (Exhibit
4):

Dr. Roberson, Dr. Blackmore, and Mr. Pritchard each testified during their sworn OIG
interviews that they were unaware the dashboard contained an open "data hub" when the
dashboard was first activated. All said the "data hub" was discovered in or around the first
week of May 2020 when the DOH was responding to a press inquiry, and there was
concern that personally identifiable information (P11) associated with positive COVlD-19
cases may have been released through the "data hub."
¯ Dr. Roberson, Dr. Blackmore, and Mr. Pritchard each confirmed during their OIG
interviews that the complainant was directed to remove the "data hub" so the BOE could
review what data had been released. Once the BOE determined no P11 or other information
prohibited from public disclosure had been released, the "data hub" was reactivated.

Dr. Blackmore and Mr. Troelstrup each explained in their sworn testimonies to the OIG
that in the field of epidemiology, preliminary data (data that is subject to change) is typically
not made available until it has been thoroughly reviewed for accuracy. Nevertheless,
following the BOE's review, the DOH chose to reactivate the "data hub" due to the
precedent that had been set regarding access to dashboard's underlying, provisional
data.

¯ Mr. Curry explained in his sworn OIG interview that he was aware the dashboard
contained an open "data hub" as it is a standard practice in the GIS field to make all
underlying data for GlS models available in real-time. However, Mr. Curry stated he
understood the DO H's specific concerns regarding P11 and supported the decision to have
the complainant temporarily remove the "data hub" until it could be reviewed.

Based on the OIG's review of the complaint information, if true, the alleged conduct does not
appear to violate law, rule, or policy since the "data hub" was not required to be made available.

76
The 'data hub" housed underlying, provisional COVID -19 data that supported the DOH dashboard's visualizations and allowed the
data to be publicly downloaded for independent analysis, research, and to support other entities' COVID-19 dashboards.
Initial data that is later reviewed by the BOE Investigation Section, after contacting individuals who were reported as receiving a
positive test result, leading to the possibility of corrections and updates to the initial data received by the DOH.

IR OIG 21-117
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The complainant confirmed data was not deleted and access to the data via the dashboard's "data
hub" was only temporarily removed and then restored with no change to the available data.

Conclusion: Exonerated. Based upon an analysis of the available evidence, the alleged
conduct, as described by the complainant, occurred but was not found to be a violation of any
governing directive.

The complainant confirmed to the OlG that COVID-19 data was not deleted; rather, access to the
dashboard's underlying data was temporarily removed and then restored. Sworn subject and
witness testimonies confirmed the complainant was directed to temporarily remove the "data hub"
from the dashboard so the BOE could review what data had been made public and determine
whether PIt had been released. Once the BOE completed its review and confirmed no P11 had
been released, the complainant was directed to restore the "data hub" less than 24 hours later.

ADDITIONAL INFORMATION

In the initial complaint (Charge of Retaliation) filed with FCHR on July 16, 2020, the complainant
included other statements, in addition to the allegations themselves, which as listed, conflict with
the totality of the information obtained during the OlG investigation:

1) "Florida needed DOH to develop criteria and a plan for reopening non -essential
business and government."

¯ As established in the Background section of this report: 1) the taskforce, not the DOH,
developed the Florida reopening plan which contained benchmarks patterned after the
WH gating criteria; and 2) the DOH collected, analyzed, and reported data germane to the
benchmarks, but did not determine or report reopening eligibility or status.

2) "On April 24, 2020, Dr. Carina Blackmore, Director for the Division of Disease Control
and Health Protection, directed me to develop new data for a reopening plan and to
mockup the dashboard design for the new page/tab and have it live by the end of the
weekend, with a composite 'score card' for each county based on its readiness to
reopen."

¯ According to sworn testimony, Dr. Blackmore stated she never directed the complainant
to "develop data" of any kind because the complainant is/was not an epidemiologist.
During the period in question, BOE staff developed the data analyses for the daily reports,
which were visualized on the dashboard. (Exhibit 4)

According to sworn testimony, Dr. Blackmore stated the inclusion of a scorecard (a

composite score combining the four health metrics described on page 9) for each county
was discussed early in the development of the Health Metrics tab. However, county
scorecards were never implemented because Dr. Blackmore and Dr. Roberson were
concerned that including them would have signaled prematurely that it was safe for a given
county's population to cease social distancing, wearing masks, etc. and may have resulted
in a surge of positive cases. Dr. Blackmore remarked, "Dr. Roberson was not a fan of [the
score cards]," and later added, "We didn't want to provide black and white guidance [score
cards] so that people would completely ignore being careful." (Exhibit 4)

IR OIG 21-117
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 During the period in which the Health Metrics tab was being initially developed
(approximately April 24-28, 2020), the WH reopening plan had been published but the
Florida reopening plan had not yet been announced. Because of this, the proposed
scorecards may have implied DOH was setting criteria for reopening; however, based on
the OIG's findings, the DOH never had the authority to do so.78

According to sworn testimony, Dr. Roberson stated the DOH does not have "the ability to
open or close anything in Florida, nor have we ever had that capability. In the state statute,
we control outbreaks, and in this case COVID-19 outbreaks at the Florida Department
...

of Health, we don't open and close businesses, we don't open and close schools, we
simply look at data from epidemiological standpoint, we tell people when they should be
excluded from different things, and then we make sure that we understand, and we explain
how the disease is transmitted. Any opening/closing type things that we've done in this
state, that has been done through executive orders, through things of that nature, but we
never had that authority." (Exhibit 4)

¯ Dr. Roberson further stated, "I am aware of what the White House proposed as gating
...

criteria, however, at no time did anybody state in the state of Florida that that was the
criteria that would be used. It has been clearly stated, over and over, that whatever we
[the state of Florida] were to do [regarding reopening], that would be done through
executive orders, not the Department of Health." (Exhibit 4)

3) "...the threshold each county had to meet to be eligible for reopening, as defined by
the State and our (Epidemiological] team, was below 10%...."

As established in the Background section of this report: 1) the taskforce, not the DOH,
developed reopening criteria as presented in the Florida reopening plan, which was
patterned from the WH gating criteria; 2) the WH gating criteria and the Florida
benchmarks both listed "downward trajectory" in positivity as the recommended metric for
reopening, not a positivity rate of ~10%; and 3) Florida's phased reopening was
implemented by Executive Order on a statewide, not county-by-county, basis.

According to sworn testimony, Dr. Blackmore stated 10% was an "artificial arbitrary ...

boundary" first used by the federal government, which the DOH adopted as a reference
point on the Health Metric tab's Percent Positive for Laboratory Testing graph. Dr.
Blackmore clarified that the "magic positivity threshold" for when CO VI D-19 will no longer
spread is not yet known and has likely changed with the emergence of new COVlD-19
variants. (Exhibit 4)

¯ DOH COVlD -19 daily reports never included reopening eligibility/status (for either the state
or counties) and never referenced a 10% positivity threshold. (Exhibit 6)

¯ Furthermore, as described by the complainant, this would not have been a complete
metric because no time -period was included over which the state or a county would have
needed to reach and maintain ~10% positivity.

78
The DOH never added a county scorecard to the dashboard, even after the Florida reopening plan was announced on April 29,
2020.

IR OIG 21-117
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4) "Roberson returned later and said the state was going to exempt all rural counties from
the (reopening] criteria all counties with fewer than 75,000 residents would be
...

completely exempt from the [reopening] criteria."

The complainant further stated in their complaint that during the period reviewed, the positivity
rates for many rural counties with low populations were very high due to low testing rates in
those counties.79

¯ The OIG obtained no evidence to support this action occurred; though doing so would not
appear to have violated any law, rule, or policy, provided it was publicly disclosed.

¯ The JDOH, through both daily reports and the dashboard, continued to report COVlD -19
data for all counties in Florida. (Exhibit 6)

¯ EQs 20-112, 20-139, and 20-244, which initiated Phases I, II, and Ill of the Florida
reopening plan respectively, applied to the entire state and did not exempt any county
from the reopening criteria (i.e., benchmarks). (Exhibit 9) Other EQs did address delays
for certain counties with exceptionally high ILl, CLI and new case positivity prior to fully
implementing Phases I and II of the Florida reopening plan.

¯ According to sworn testimony, Mr. Troelstrup explained population was never a factor
when calculating positivity. Mr. Troelstrup further explained population and population
density are considerations when determining public health policy for different areas, and
remarked, ". you have to think through these things in epidemiology. If you're not an
. .

epidemiologist, you're not going to think about that stuff Does [population] come into
...

play in your calculation? No [Population] comes into play in your public health practice
...

at the county health department level." (Exhibit 4)

5) "In the end, an outside vendor was hired to do calculations and determine eligibility by
county without consultation with myself or the other DOH data managers beyond
executive leadership."

In the complainant's written response to an OIG intake inquiry, they further stated:

"The task was given to a private vendor (I do not know the vendor's name) who
requested the raw data from Leah Eisenstein the day after I refused to manually
manipulate the data myself. Leah told me on Tuesday morning, April 28, 2020, that she
received a call late the previous night in which the vendor asked her for the raw data.
She sent them the data, but had not walked them through how it was collected, what
the object/field names were and what they meant, or the appropriate use of the data.
The vendor had never worked with the data before and could not have possibly made
any meaningful analysis from the data provided."

¯ As established above and within the Background section of this report, the DOH did not
determine or report reopening eligibility. Therefore, DOH executive leadership would not
have had the authority to outsource the task of calculating and determining eligibility, as
described by the complainant.

This dynamic is noted and explained in the Background section of this report.

IR OIG 21-117
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 According to sworn testimony, Ms. Eisenstein did not recall the specific interaction with
the complainant that allegedly occurred on Aprit 28, 2020 (Exhibit 4). However, she did
find in her email records, correspondence dated April 27, 2020, in which she provided a
COVlD-19 dataset to the Florida Chamber of Commerce Foundation, Inc. (FCCF). Prior
to releasing the requested dataset, the FCCF completed the requisite Application and
Agreement for Access and Use of Florida Reportable Disease Surveillance Data. (Exhibit
16)80

¯ Ms. Eisenstein disclosed to the OIG that she does not know how or if the FCCF used the
dataset that was provided.

AUTHORITY and METHODOLOGY

Authority to conduct this investigation resides in the following: Section 20.055, F.S., which creates
in each state agency an OlG and authorizes it to initiate, conduct, supervise, and coordinate
investigations that detect, deter, prevent, and eradicate fraud, waste, mismanagement,
misconduct, and other abuses in state government. The authority of the OIG is limited to
conducting administrative investigations of wrongdoing by employees of the DOH or DOH
contractors and the contractor's employees.

The OIG conducted this investigation in accordance with the policies and procedures of this office
and the Association of Inspectors General Principles and Standards for Offices of Inspector
-

General. The methods used in completing this investigation included conducting sworn recorded
interviews, and review of email correspondence, personnel records, documents pertaining to the
State's and DOH's response to the COVID -19 pandemic, as well as applicable DOH guidelines,
policies, and procedures, and F.S.

EXHIBITS

1. Copy of the July 16, 2020 Charge of Retaliation and additional complaint information
(redacted)

2. Copy of April 19, 2021 email from complainant's attorney confirming complaint allegations

3. Screenshots of DOH Intranet BOE, Surveillance Section and Investigation Section

4. Seventeen (17) recorded sworn interviews in electronic format

5. Screenshots from the DOH Intranet BOE Surveillance Section regarding the Merlin and
ESSENCE systems

6. Excerpts from one DOH Daily CO VI D-19 Report per month from March 2020 through May
2021, with copies of one DOH COVlD -19 Weekly Situation Report from June and July
2021

7. Copy of "Guidelines -
Opening up America Again," published April 16, 2020

°
On July 1, 2021, via email from Ms. Eisenstein, the OIG obtained copies of the referenced email correspondence.

IR OIG 21-117
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 8. Copy of "Safe. Smart. Step -by-Step. Plan for Florida's Recovery," published April 29, 2020

9. Copies of Executive Orders 20-112, 20-139, and 20-244

10. General guidance about calculating positivity from the Center for Disease Control's
website

11. Copy of Merlin and ESSENCE Authorized User Search Results (redacted)

12. Copy of complainant's DOH Position Description (redacted)

13. Copies of the DOH's Data Definitions sheet and Florida Health Metrics -
Overview

14. Copy of code/logic sample used by BOE to calculate new case positivity

15. Copy of email records between BOE staff and the complainant (redacted), dated April 29-
30, 2020

16. Copy of emails between Ms. Eisenstein and the Florida Chamber of Commerce
Foundation, Inc. with copy of the attached Application and Agreement for Access and Use
of Florida Reportable Disease Surveillance Data, dated April 27, 2020

FILES

The complete report and all relevant case supporting materials will be maintained in the OIG
investigative case file and available for review upon request, subject to the provisions of Chapter
119, F.S.

IR OlG 21-117
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