County revising health officer job in hopes of finding person to reorganize

The future of the Cascade City-County Health Department is uncertain.

Since the county split with what is now Alluvion Health, a private nonprofit that took many county staffers with it including the health officer and prevention services division manager, the county has struggled to figure out next steps.

By the end of a meeting on Sept. 18 between the County Commission and the city-county Board of Health, the consensus was to revise the health officer job description to include a core responsibility of reorganizing CCHD with a focus on prevention services and infectious disease.

Alluvion withdraws from consideration of contracting for county health services

In February, the commission approved a contract with Alluvion for interim health officer services. Essentially, former health officer Tanya Houston continued the duties of the county health officer through Aug. 31.

Alluvion has not continued that contract and the Board of Health has been wanting to move forward with hiring a replacement.

County votes to move forward with negotiations to outsource health department functions to Alluvion

Over the summer, county officials met with city officials to discuss the possibility of outsourcing a number of county health services to Alluvion. But the new health agency pushed back when Commissioner Jane Weber requested additional financial data.

The day after that joint meeting, Alluvion submitted a letter to the county withdrawing from consideration for that contract, she said.

County considering outsourcing public health functions to Alluvion

Weber and the Board of Health wanted to move forward with hiring at least an interim public health officer, but Commissioner Joe Briggs had reservations and the BOH requested a meeting with the county commission for discussion of the issue.

On Sept. 18, the two bodies met to discuss the future of CCHD.

Morale at CCHD is low, the officials said, and some suggested it was due to the lack of leadership and direction resulting in uncertainty.

County, Alluvion partnering for health officer services temporarily

Weber and BOH members said they wanted to hire a new health officer to fill that void and provide direction and leadership on what they view as important community services.

Briggs said he wanted discussion on outsourcing or reorganizing CCHD since “it’s not financially sustainable in my opinion.”

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Briggs created charts showing financial breakdowns with revenues and losses for CCHD since 2015. This budget year, he said the county had to move $200,000 that would normally be used to purchase graders for the roads division as well as $35,000 from another account, but still has a loss of $260,476, according to Briggs’ figures.

One set of numbers was based on the budget approved by commissioners earlier this month, but in the meantime, county auditors discovered a significant issue in billing revenues.

Alluvion has been handling billing for CCHD and the auditors discovered $287,000 that hadn’t been booked to the county, Briggs said.

Auditors from both agencies have agreed on the amount that was incorrectly accounted for and they’re now working on a plan for Alluvion to pay it back to to the county.

Even with that additional revenue, CCHD would still be $55,476 in the red this budget year, Briggs said.

CCHD gets the majority of its funding from county taxes, but the city has contributed $250,000 since at least 2015.

Briggs said “we need to look at a different model.”

Community Health Care Center continuing split from county, move to Rocky Mountain Building

Weber said there are some services the county is legally obligated to provide and the county is required under state law to have a health officer, though it doesn’t have to be a full-time person who serves as the department head at CCHD.

In a special meeting earlier on Sept. 18, commissioners approved an agreement with a local physician to provide professional services so that the CCHD can operate the flu clinics this month. Such services hadn’t been necessary yet this year and the service was previously provided through Alluvion.

CCHD hosting flu shot clinics this month

She said she felt that the county was taking too long to make a decision on one of the four potential options for CCHD: to keep the agency with some changes; remove immunizations since Alluvion is offering that service; remove immunization and family health services; or outsource to a private entity.

Weber was initially supportive of outsourcing to Alluvion, but not lately because the agency withdrew from consideration after she requested additional information.

Commissioner Jim Larson said that he was also supportive of outsourcing initially, but “kind of had a change of heart with the financial situation that showed up” with the billing error.

“I feel like we are self imploding the health department,” by not filling the health officer and prevention services manager positions, Weber said.

Weber has been working with Carey Ann Haight, chief of the civil division in the county attorney’s office, to develop a contract for an interim health officer. The contract was set to go on commission agendas, but there were more details to be worked out for the county’s insurance provider.

The position has been vacant since Tanya Houston moved to Alluvion in the spring and as of May, when the county was having discussions about the potential to outsource services, no applications had yet been received.

City Commissioner Owen Robinson is a BOH member and said during the Sept. 18 meeting that it would make sense to hire a health officer and let that person restructure the department.

Briggs said he had concerns about hiring someone for the year and then not having funding for the position in the next budget, or not knowing what components of CCHD would remain in the county.

Amanda Ball, BOH member, said she thought without leadership, the department would likely continue losing employees.

Weber said CCHD was fully funded in the current budget, which runs through June 30, 2020.

Several BOH members asked why not hire a health officer if it was a funded position.

“What about 2021,” Briggs said. “Am I the only person in this room” thinking about long term plans, he asked.

Weber responded that if that was going to be the approach, then the county should look at other departments that aren’t self-sustaining, starting with Montana Expo Park.

She said she considers CCHD a public health and public safety issue and “we subsidize other departments way more.”

Briggs said there are services at CCHD now being replicated by Alluvion, “so should we be spending tax dollars to compete with Alluvion?”