County, State, Community Discuss Possible Changes
By Bonnie Davidson
For those in attendance it was a hot topic that was discussed with concern. With several changes in the healthcare industry, community members showed their concern with possible changes at the Valley County Health Department.
The public meeting took place on Wednesday, Jan. 29, at the Valley County Courthouse in the conference room. Over a dozen attended, including County Commissioners Bruce Peterson and David Reinhardt, and Jane Smilie, administrator for the state public health and safety division, along with Jim Murphy, the chief of communicable disease prevention and control in the Montana Department of Public Health and Human Services.
The meeting took place after discussion on possible changes at the county health department was brought up. The previous director of the health department, Vicky Bell, left her position after nearly three decades in service. When Peterson started to look into other counties on what they paid their employees, he found that the services provided and the way county health departments were set up varied. He began to look into other ways Valley County could run their health department.
Peterson explained that they were looking into the budget and they were trying to keep services while looking at how things could be done differently. Smilie and Murphy explained what the state code includes in guidelines for the health department. Smilie said that around seven years ago they had tried to get to every county in the state to provide the information presented at the meeting. She also explained how other counties were trying different approaches.
"You could have a more regional approach; we've seen that in two other areas," Smilie said.
She explained that Yellowstone County had organized its health department with several jurisdictions and that a central area in Montana grouped six counties together to provide services. Murphy added that Valley County has always been reliable to respond to illnesses and incidents and it has been easy to work with. The county has historically been proactive.
Peterson asked how successful other counties have been in combining services. Smilie and Murphy said that some services have worked well but that sometimes staff could be stretched if covering large areas. The sanitarian in particular was mentioned as spread a little thin with the travel. Peterson then went on to ask how counties who have partnered with their hospitals have been successful.
Murphy responded that the space and administrative costs were saved but that the hospital didn't take on services and tasks. Public health departments carry more power in some instances, such as ordering people to stay out of work or school due to illnesses that may spread. Murphy also said that they have seen Valley County already utilizing a close relationship with the hospital.
"It's a really strong system out here, and you don't want to weaken that system," Murphy said.
Smilie added that every year they have a county look at what is being done and might assess how they are currently conducting their health department. Murphy added that in the last few years they have seen several counties look at other options with the transitions in health care and the tightening of budgets.
David Irving, who had attended the meeting, asked if those transitions in Valley County were due to financial problems. Peterson answered that they were having trouble with the salary and when they started to research what they should be paying staff he had found different approaches. He added that they were also looking at the bottom line and budget issues.
Steve Bell added that he didn't want to see services lost to the people who have seen constant services over 40 years. He explained that they have provided important services to the county.
"I don't think the people in Valley County deserve to lose any of those services," Bell said.
The concern of those in attendance became more apparent as others stepped up to add services they had received in confidence and the environment being one that several county citizens have trusted over the years. Also, it has been a place where people have gone to ask a question or show up if they can't afford a hospital visit.
Steve Page asked if the facility was actually an issue or concern. Peterson explained that Commissioner Dave Pippin, who wasn't present, was adamant as that being an issue, with access for the handicapped and the conditions of the older building being a potential problem and focus for Pippin. Page then asked bluntly if the building, the personnel, or the budget was the actual issue that commissioners were looking at for a cause to change.
"Budget is an issue; if there is a more efficient way for us to provide the same amount of services with less money it would be better," Peterson said. "Details haven't been worked out and we're not sure how to work them out yet."
Page responded that he would hate to see the health department lose its identity today as it has represented essential services to the county. Peterson said that they have considered adding it to a ballot to see if they could gain support by raising a mill on the levy. With the school bond passing, a look at funding needed for the local library and adding a mill for the road department has been a tough decision.
Page argued that educating the public on space issues, competitive salary and other issues could bring enough support on the issue. Murphy said that other communities have been successful in raising their levy. Irving asked if it commissioners had been serious about adding the item to a ballot. Peterson said that they've brought it up several times but they've not thought seriously on adding the item.
Commissioners were asked what the percentage was of the county fund for the county health department. Peterson said that the budget was roughly $10 million and the county health department budget, including grants, added up to $400,000, which would be around 4 percent of the budget.
Page suggested that the commissioners establish a committee to research issues with the health department to find what could be the best option. He explained that the committee could help seek public support if raising the levy was needed and that a third party could help study all aspects of the decision.
"It'll help take the monkey off your back," Page said.
Reinhardt followed with a statement that he wouldn't add anyone in the room to the committee as they've all said what they thought about the health department and their choice would be obvious. He also added that money is a problem and should be a priority for the county. He added that the current staff at the health department was already putting in more hours than they were clocking in, which was a donation to the county. He explained that for more pay for employees the county would have the get more funding.
As the meeting came to a close no actions were decided. The state health officials simply added that gaining a mill on levies had been successful in other counties and that educating the community was important. Smilie added that there was a strategy involved when placing the item on a ballot, as it could be harmful if it wasn't the right time. She also said that the county should continue to look into gaining grants for further funding.