City, county discuss operation of joint health department

City and County Commissioners met July 28 to discuss the operation of the Cascade County City-County Health Department since law passed during the most recent Legislative session prompted the need for local action.

State law requires both cities and counties to have health departments, but allows for cities and counties to combine and operate jointly, as is the case for Cascade County.

CCHD has been operated as a joint city-county venture under a 1975 interlocal that has not been updated since and officials said there are many provisions of that agreement that haven’t been followed for years.

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Under that agreement, the department fell under the county and the employees were the county’s but the city contributed financially.

House Bill 121, passed in the last session, requires that there be a designated governing body for local health departments, instead of the Board of Health, which oversaw the health department and had the authority to implement health protocols during emergencies such as the COVID-19 pandemic.

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Several city commissioners asked if the elected bodies could designate the health board as the governing body and essentially maintain the status quo.

Cascade County Commissioner Joe Briggs said during the meeting that he believes the intent of the law was that it be an elected body as the governing body, in this case the city or county commission.

Briggs wrote that he believed the governing body should be the County Commission “as our area of authority is geographically larger than the city, the personnel operating the CCHD are county employees, Cascade County provides roughly 75 percent of the local tax funding and the county holds the liability for the actions of the CCHD,” in a June 2 letter to the city.

City and county commissioners agreed that the agreement needed to be updated but the immediate issue at hand was to determine a governing body in order to be in compliance with the new law. None of the officials said what repercussions existed for being out of compliance with the law, which went into effect in April.

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The group decided to draft an amendment to their existing agreement designating the county commission as the governing body temporarily and creating a working group to explore options and update the interlocal agreement.

During the July 28 meeting, Great Falls Mayor Bob Kelly said, “we have to figure out a way to reshape this agreement. I’m a little nervous about turning over health decisions to elected officials, being one myself.”

The 1975 agreement is “the only language that is in existence,” according to City Attorney Sara Sexe, that governs the operation of the joint city-county health department.

Briggs said, “I think it would be fair to say that this agreement has not been followed for some time,” and matters addressed such as approval on the budget and board members that weren’t appointed by the city or the county “have all been adrift for a long time. There are a lot of tuneups to be made.”

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Briggs said that currently, the county funds the health department about $750,000 through rural tax mills and the city contributes about $250,000. The 1975 agreement does not specify the amounts to be funded by either the county or the city.

The county’s rural mills are used for the health department, library and roads and he said that because the county funds more of the health department, it has less to contribute to the Great Falls Public Library, which is largely funded by the city to the tune of about $1 million annually compared to the county’s $177,000 contribution.

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City officials said they’d have concerns about contributing more funds to the health department without more representation or oversight, to which Briggs said that’s how the county felt about the operation of the 911 dispatch center, which is a joint operation lead by the city, leading to some tension among the officials in the room.

During the meeting, the role of the health board was discussed, as the Legislature stripped those boards and health officers of much of their authority.

Briggs said that he believed some of the legislation went to far regarding health officials and that “the role of the board of health has been diminished.”

He said though that the city-county should maintain the board though since they’re important to help guide health decisions.

County Commissioner Don Ryan said he believed health decisions should be left to the board of health, “not people worried about their next election. I thought what we had before was good,” but they had an obligation to comply with state law.

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City Commissioner Rick Tryon asked if the health board could be the governing body if elected officials sat on the board.

Briggs said that was being attempted in Lewis and Clark County and that the Montana Attorney General had said no, but he didn’t have formal documentation of such a decision.

The Electric has asked the AG’s office if a formal opinion has been issued and staff there said they were looking into it.

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County Commissioner Jim Larson said that the governing body wouldn’t take control of the health board and that county commissioners take the opinion of the health officer seriously, “but if something serious happens and we disagree, we then have a mechanism to override it.”

Larson said said that probably wouldn’t happen. City Commissioner Tracy Houck said it had happened in the Legislature in the last year.