County Commissioners voted to make an appointment to the City-County Health Board during their March 26 meeting.

The county seat on the board has been vacant since April 2021.

Two people applied for the seat, Ray Geyer and Charlotte Mehmke.

Geyer has been on the board as the physician member since about 2012.

He retired from Great Falls Clinic as an infectious disease specialist in January 2023 and his medical license will expire March 31, so he will no longer be eligible to serve as the physician member on the board.

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Geyer applied to fill the county’s citizen position on the board instead.

Mehmke applied for the seat with a background as a dietitian and nutritionist.

The appointment is through Dec. 21, 2025.

The health board is primarily responsible for the management and oversight of the local public health systems through the City-County Health Department.

During their March 26 meeting, Commissioner Rae Grulkowski moved to appoint Mehmke.

“I see this as offering someone new to serve,” she said. “She will bring new ideas.”

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Commissioner Briggs said he appreciated Mehmke, her background and willingness to serve, but preferred to keep Geyer on the board with his experience and expertise as an infectious disease physician.

Commissioner Jim Larson said he wished there were two opening, but with some of the issues of the recent past regarding public health, “I would rather stay with Geyer at this point. We just need the experience on that board.”

Calling for the vote, no one voted in favor so it failed.

Grulkowski said she did that wrong and wanted to vote to appoint Mehmke, but then when they redid the vote, again voted no.

Staff and the other commissioners said that they were voting on her motion to appoint Mehmke and on a third try, she voted in favor of the motion, that still failed with Briggs and Larson opposed.

Briggs then moved to appoint Geyer, which passed 2-1, with Grulkowski opposed.

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In 2021, Briggs told The Electric that the county wasn’t filling their vacancy on the health board as the county and city were discussing a governing body for the health department due to changes in state law following the COVID pandemic.

The legislature made several changes that year impacting local health boards, one of which requiring a designated governing body over the health department and the health board. The makeup of that governing body has been a point of contention between the city and county for several months and is part of their ongoing discussions.

The city and county have an agreement governing the operation of the Cascade County City-County Health Department that has not been modified since 1975.

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In the fall of 2021, the city and county approved a temporary agreement to make the county commission, with one city commissioner as a nonvoting member, the designated governing body.

That agreement is in place through June 2022 while the city and county continued working on a new agreement for operation of CCHD.

The city and county continued to disagree over the makeup of the governing body and the matter went before a district court judge in 2022.

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District Court Judge Elizabeth Best issued an opinion on Aug. 29, 2022 that state law does not prohibit a city commissioner from serving on the governing body of the City-County Health Department.

Cascade County appealed the district court’s ruling to the Montana Supreme Court that fall and the case is still pending before the higher court.

During the Dec. 6, 2023 health board meeting, Board Chair Matt Martin, a dentist, asked if they just had to wait for the Supreme Court decision.

Briggs said that they could ask the court, but they do things at their own pace and that he didn’t think this case rated very high among their priorities.

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Martin asked during that meeting if there would be a point that the county would consider appointing someone to the board while awaiting a court decision since it could drag on.

He said he felt there were a lot of changes coming as Great Falls Public Schools Superintendent Tom Moore and Mayor Bob Kelly were retiring and they both served on the health board.

Briggs said during that meeting that he’d visit with the other commissioners to gauge their interest in filling the seat.

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During their Jan. 3 health board meeting, Briggs said he had asked the other two commissioners to open the position the day of their December meeting.

He said he’d had no response from the other commissioners at that point and would follow up.

During their March 6 health board meeting, they discussed their bylaws, which required a licensed physician.

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Since Geyer had retired, he was planning to let his medical license expire and they discussed the option for him to apply for the citizen position that didn’t have specific requirements.

Briggs said the bylaws were developed by the city and county and need to be updated.

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He said the concept was good in the 1970s, but they no longer work.

Briggs said during that meeting that he wasn’t “holding his breath on the Supreme Court ever dealing with the issue before them,” so he was hoping to sit down with City Commissioner Shannon Wilson, the city’s current representative to the health board, to start working on a master agreement to see f they could iron out the differences between the city and county.

Moore, GFPS superintendent, said that would be great, but also that it had been helpful having having a licensed physician on the board, as well as other health professionals.

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Briggs said recent changes to state laws regarding the authority of local health boards “have lessened the time sensitivity to fill the position and more importantly depending on the outcome of the discussions between the city and county commissions, the make up or even the existence of the Board of Health is in question.”

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The city has indicated a plan to file in District Court asking a judge to make the determination on the law whether the governing body can be the existing health board or if it must be an elected body such as the county commission.

Briggs said that those discussions could potentially result in the city and county each having their own health departments and then each entity would need to define their own board membership requirements.

“An appointment made based on the current BOH structure may or may not be a good fit for the new structure of a county health department should that occur,” Briggs told The Electric in an email.

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The operation may continue as a joint agency, but there could be other changes to the membership requirement for the board, as the 1975 agreement requires a doctor, dentist and the superintendent of Great Falls Public Schools, as well a city and county commissioner, and one person appointed by the city and one appointed by the county.

Briggs said that could remain the same, but there could be changes to the appointment process. He said that the appointment of one city commissioner, one county commissioner and another person appointed by each body “is no longer inherent in the law.”

If the governing body for the local health board includes a county commissioner, it may not be appropriate to have one on the health board, he said.

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Another possibility is that the combined health department could be expanded to include other incorporated communities in the county, which are Belt, Cascade and Neihart, Briggs said. If that were to happen, then they would also get an appointment to the health board and possibly reduce the number of appointments for the county and city.

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“Until some fundamental structural decisions are made by the city and county commissions regarding the City County Health Department, any appointment made to the current board of health would be a conditional appointment that may or may not exist at the end of fiscal year. Given the lack of a clear direction and description of the role that a new appointee would fill, it does not seem prudent to fill the position until we have some clarity,” Briggs said.