County contracts with local doctor as search underway for new public health officer
Cascade County Commissioners interviewed two candidates for public health officer on Dec. 22.
They interviewed Mariah Messimer and David Rinderle. Jessica Kennedy didn’t log into Zoom at her scheduled interview time and county officials were unable to reach her, so she was not interviewed.
County Commissioner Joe Briggs said that now the city-county health board will need to make a recommendation on offering the position to one of the two candidates interviewed or to continue the process to get more applicants.
The health officer position has been vacant since Dec. 5, which was Abigail Hill’s last day after announcing her resignation from the position in November.
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The county has been operating without a health officer since and the interim administrator for the department quit the week after Hill.
Briggs told The Electric that the county can operate for up to 30 days without a designated public health officer, “although that is not our plan or desire. The county is currently in contract negotiations with an individual that is qualified to be the interim public health officer. We are hopeful of having that individual aboard shortly.”
State law includes a provision that if a local health board fails to appoint a health officer within 30 days, the Montana Department of Health and Human Services may step in and appoint a health officer.
During Jan. 2 meeting, commissioners voted to approve agreement with Gladys Young for her to serve as interim public health officer from Jan. 1 through June 30 at $500 monthly rate, plus time for Young’s services onsite or electronically at $150 per hour with the minimum incremental charge for services of 15 minutes.
The county will reimburse Young for six months of medical malpractice insurance coverage beginning Jan. 1.
Young is a licensed and certified medical doctor in Montana with previous public health officer experience in Liberty County during the pandemic, according to the county.
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Young is currently providing oversight for quick response units through the county’s disaster and emergency services.
Under the agreement, Young will handle tasks assigned to the public health officer by state law, and in a limited administrative capacity to include being in the CCHD office for weekly briefings, signing licenses and other items requiring execution by the health officer, and attending monthly health board and CCHD staff meetings.
Briggs told The Electric that since Hill’s resignation was announced, commissioners, county human resources and legal departments had been working with her on a transition plan for the City-County Health Department.
He said many items had been completed with some less time sensitive tasks remaining on Dec. 5, Hill’s last day.
Commissioners planned to meet with the CCHD team on Dec. 8, Briggs said.
Hill said that she’d asked commissioners throughout her final week for a response on who would be the acting administrator after her departure, and Jorey Garsjo, CCHD office manager, had been included as the backup interim if nothing had been decided before Hill’s last day.
Briggs said that Hill sent an email on her last day naming Garsjo as the interim administrator rather than waiting for commissioners to act, causing “significant confusion and did not establish a clear set of expectations or authority for the individual designated as the interim admin.”
Hill said that she’d emailed commissioners throughout her final week asking for an update on the plan and with no response, she said Commissioner Jim Larson gave her the okay to name Garsjo as interim on her last day.
On Dec. 8, commissioners issued a letter to Garsjo clarifying the scope of her duties, authorities and expectations.
Briggs said her response to the letter required further clarification and a meeting was scheduled for Dec. 11, during which commissioners addressed her questions to mitigate her concerns over the scope of her authority, “which was never intended to encompass duties of the [public health officer] or as a CCHD department head but rather serving in a limited liaison capacity.”
The meeting turned argumentative, Briggs said, regarding the role of the chief financial officer, Trista Besich, at CCHD.
He said that Garsjo told them Besich’s presence in the building even early in the morning before most staff arrive “created anxiety among the staff.”
Briggs said commissioners explained during the meeting that given CCHD’s financial situation, they had asked Besich weeks prior to become more actively engaged in CCHD operations and that Besich should be viewed as a resource rather than adversary.
Briggs said that Besich’s presence at CCHD had been arranged with Hill, but it seemed that staff were unaware of that arrangement and other CCHD operational and financial issues.
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He said commissioners were in the process of scheduling meetings with staff to communicate that information.
Briggs said that Garsjo pulled out a prewritten letter of resignation that she read to commissioners during the Dec. 11 meeting, with an effective date of 4 p.m. the following day.
“The commission regrets the outcome of the meeting and the resignation but ultimately, it is the board of county commissioners who are responsible for the operations and fiscal stability of the CCHD. The [chief financial officer] is an integral part of the path forward for the CCHD and having an interim admin who is hostile to the presence of CFO would not facilitate the stabilization of the CCHD,” Briggs told The Electric.
Requirements of a public health officer are specified in state law and Briggs said they’d received five applicants for the position that were distributed to the health board in early December.
The board members scored each of the applicants based on a specific set of questions to determine the top three candidates, who were scheduled for interviews with commissioners.
Briggs said that he was pleased with the pool of candidates and was hopeful to make a hire soon, but would also contract with a qualified health officer to fill the gap until the new health officer has started their employment.
The daily administrative duties, including routing emails and calls to the appropriate person, timecard management, meeting scheduling and liaising with the commission is being handled by Lenore Harries, Briggs said, in addition to her duties as immunization program manager.
Matt Kelley, director of the Montana Public Health Institute and former Gallatin city-county public health officer, said that Montana law states that counties shall have a board of health, which oversees the health officer.
The law allows for combined city-county health departments, rather than the cities within counties both having their own agencies and all of the big Montana cities have combined departments, he said.
Before the COVID-19 pandemic, Kelley said that the role of a health officer or the health board wasn’t top of mind.
The law states what health boards and public health officers “shall do” rather than mays or shoulds, Kelley said.
In Montana, it’s important to note, he said, that public health is decentralized and local governments have the responsibility and authority for public health.
“In every community, those public health threats are different, which is really the strength of that decentralized system,” Kelley said, in having local folks who know the community and can figure out what’s important, how to prepare and protect the community within public health.
As examples, he said Butte had a recent issue of contamination in the public water supply and their health officer and health board were able to assist in the response.
In Gallatin County, there was a foodborne outbreak, including fatalities, tied to morel mushrooms during which the health officer led the response to investigate and prevent more people from getting sick.
When there’s no health officer, it’s “effectively the absence of the authority that is there to protect the community in a time of crisis,” Kelley said.
In cases of a foodborne outbreak, only the health officer has the authority to shut down a restaurant and if there’s no health officer, a community doesn’t “have anybody with the authority to take that action,” he said.
It’s usually an action of last resort, he said, but in the Montana system, it’s done through the legal authority assigned by the Legislature to the health officer, health board and more recently, the governing body that oversees those entities.
In Cascade County, city and county officials disagreed about the makeup of the governing body under a 2021 legislative change in a dispute that went before the Montana Supreme Court.
The 2021 Legislature, in response to the COVID pandemic, made several changes impacting local health boards, one of which required a designated governing body over the health department and the health board. The makeup of the governing body was a point of contention between the city and county for years.
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 expired in June 2022 and in the absence of any new agreement, the 1975 agreement remains in effect.
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.
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.
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Cascade County appealed the district court’s ruling to the Montana Supreme Court that fall and in June 2024, the court affirmed Best’s ruling that the consolidated city-county health board as established in the 1975 agreement is the governing body and that the city mayor or representative is a full voting member of the health board.
No other county officer is authorized to make public health decisions in state law, Kelley said, so without a public health officer, a community would be dealing with a public health crisis with “a couple of arms tied behind your back.”
Most of public health is communicating, sharing information and collaborating, which happens daily, as well as preparing for any crisis and setting community priorities.
“Public health is about clean water, clean air, it’s about having a safe food supply,” Kelley said.
