Commissioners heard options for building a consolidated Human Services Agency that would pair the Health Department with another county department, but the board agreed to put off a decision pending further research.
The Macon County Board of Commissioners’ Sept. 9 meeting was set to be a culmination of the commissioners’ push for greater control of Macon County Public Health which started at its July 8 meeting. A portion of the crowd was diverted into an overflow room where attendees could watch public comment on the proposal on a monitor.
Human Resources director Tammy Keezer outlined three options the county was considering. In all three options, Macon County Human Resources would take over the role of the Health Department’s human resources. Keezer stressed employee pay and benefits would not change as a result of any of the selected options.
The first option was the one first requested by commissioners at the July meeting: the Board of Commissioners take over the Health Department’s policy decisions, with the health board relegated to an advisory role.
The second option would consolidate the Health Department and one other county department (with Housing, Veterans Affairs, Senior Services and Animal Control listed as options) into a single Consolidated Human Services Agency (CHSA). The CHSA would be managed by a CHSA Board made up of members of the current Board of Health and four other “consumers of human services.” Commissioners had not decided on a department with which to consolidate the Health Department at the time of the Tuesday meeting.
The third option would establish a CHSA and impose commissioner control over the agency’s policies, creating a CHSA board to advise decisions.
The process would involve a public hearing and meetings with the current health board before combining the departments in December in time for the CHSA to begin administering services on Jan. 1, 2026.
Ahead of the public comment period, Commissioner Barry Breeden said, “I would like to say that the Board of Commissioners taking over the Board of Health and moving them to an advisory role is not an option. The options that we have are: leave the Board of Health as it is … or a consolidation which would be the Health Department and another human services department.”
“What that would allow us to do is to appoint the current Board of Health and we would have to add a few members to that as a consolidated health board and give them the authority,” Breeden said. “They would look at policy, at the budget … all of the decisions that we don’t need to be involved with.”
County attorney Eric Ridenour gave some background on a draft resolution presented to commissioners, which had been sent to the board at 3:45 p.m. that afternoon.
Under a CHSA, a Human Services director would be appointed to lead the department at the direction of County Manager Warren Cabe with the “advice and consent” of the Board of Commissioners.
Ridenour said the human services director would report to the county manager, but the county manager could not hire or fire the director without the consent of the CHSA Board. He said for people concerned that the board might put pressure on the county manager to fire the health director, that could not happen without the Board of Health’s approval.
“The health board, who’s making all decisions related to health … would still have to OK that … they’re going to have to come to a meeting of the minds before that can happen. So that gives a series of checks and balances that most people want to make sure is in place,” Ridenour said.
Once they are on the CHSA Board, the current health board members would nominate the four additional members of the CHSA Board.
Commissioner John Shearl asked if they could vote to build a CHSA and later determine which departments to add to it, but Ridenour said the board would have to choose at least one department to consolidate the Health Department with before moving forward.
Public comment
A mixed public comment period followed, with 11 people stepping forward to give their thoughts on the situation.
Constance Neely said, “I just want to underscore that we need to put science and patient care above anything that even sniffs of political decisions over the patient care of the residents of the county.”
“I do have some concerns about the process that got us here,” she said. “That process was flawed, and it seemed that meaningful solutions that the board could have raised were dismissed and there was a sense of ‘No, we have to take this over.’”
Neely was also concerned about how the proposed consolidated approach would work since it is not yet known what departments would be combined. “We would want another opportunity for the citizens to react,” she said.
Margaret Pickett said, “I am surprised. I’m very prepared to speak to the issue that is the non-issue now and I am not prepared to speak to the issue you’ve presented tonight. I feel like for you to vote on this issue tonight would be to push the public comment section away and out of the process … I would like for the public to have the opportunity to comment before you vote.”
“I am concerned about the timeline,” Mary Williams said. “That we would implement such a huge change in the way that things have been done by Jan. 1, is not really a smart idea … I encourage deliberation on it, I encourage consumer feedback, I encourage looking for individuals in the community who can add positivity to this and also professional knowledge.”
Jessica Jones of Macon County Public Health shared a statement “collectively written to represent the clinic and laboratory staff” at the department, reading, “We want to be clear that any action taken to address leadership and supervision shortfalls that led to this moment have never been motivated by personal vendetta … we have arrived at this decision tonight as a result of ineffective leadership over the years leading to the loss of valued staff or morale, toxic work environment and working conditions that have at times placed our licensure at risk … unfortunately it is apparent that without this level of attention to the issues at hand, change would not come.”
Nurse Jamie Waldroop, who also spoke at the July special called Board of Health meeting, said, “We are surprised at the inadequacy of the leadership, particularly in clinical services … currently, we are surprised that more actions to correct the situation have not been done … whatever the decision may be, we simply want accountability of leadership, of quality, and expect fair and appropriate solutions to problems.”
Mike McKee asked Shearl, who currently serves as a commissioner liaison to the health board, what has been done about issues the board is facing.
“If you listen to whatever my stance was on this entire thing,” Shearl said, “which was the protection of all of our county employees, or the Health Department employees that feel that they have been mistreated, abused, been berated, everything else. All of these people need protection, and you cannot protect all of these people when there is one person that is overseeing these people.”
“That’s where you were talking about cutting off the head of the snake?” McKee said.
“That’s correct, and so that’s where we’re headed, I hope,” Shearl said.
“Mr. Breeden, you can cast this any way you want, you’re still taking over the Health Department,” McKee said. “It’s still putting the ultimate authority of the board over the direction of hiring and firing … that is the end result.”
Richard Edfeldt said, “I do appreciate the proposed resolution that’s in your hands now and I believe it has a lot of positive merits. I would encourage you not to rush into deciding tonight and use the days ahead to hash out the many potential issues that it could face.”
“Public health should only be under the leadership of those who are in the medical profession and have the training and expertise to make sound medical decisions based on science and research. Putting our Health Department under the control of any other governing body leads to the chance of medical decisions being based on politics and public opinion,” he continued.
Richard Brady said, “I think the change might be a better approach, a better offering for a win-win situation … I researched this quite a bit, spoke with some of you commissioners quite a bit when it was the first option that we talked about and then, now that this other approach has been considered, I think it probably will be a better outcome for everyone.”
Betsy Baste said, “What’s critical in this whole conversation is that employees needed to be heard, needed to be believed and needed to be treated with respect and professionalism. That was a simple fix, a simple solution. Now we have a huge, complex problem that we are trying to make really, really difficult.”
“We, tonight, saw a pretty rushed presentation … to give us some knowledge and information but none of us can digest it that fast and I don’t know how you can … my ask would be not to rush into a foolhardy decision, to take your time,” she said.
Comments from public officials
The Board of Health’s new chair, Garrett Higdon said, “I would like to express our gratitude first for this board highlighting the ongoing issues at the Health Department … At our joint meeting in July and special called health board meeting in the following week we learned of these issues and have taken measures to address them with our commissioner liaisons.”
In the previous two months of work, Higdon said the board has been working on several changes, including restructuring certain departments, increased focus on key areas and restructuring the complaint policy, with a draft to be presented at the meeting.
“Subcommittees have been formed with subject matter healthcare experts to examine various departments’ efficiency and structure,” he said. “County emails have now been made to ensure an open line of communication between board members for a situation that exists outside of the normal complaint process. We have requested that both our county emails and our phone numbers be published and given to the public to access. We have worked diligently to make ourselves successful and if you’re continuing to receive concerns, we ask that you inform us that we can continue to work together to address them. Although we have a lot of new board members, we want to make it clear that we are a dedicated board.”
As chair Josh Young opened the floor for comment, Shearl said, “If you go into that agency every day to work and you’re feeling that toxic environment and you feel berated and everything else, this is not rushing anything … I have no desire to oversee the day-to-day operations of public health. The biggest issue is not the Board of Health or the Health Department, the biggest issues are personnel matters and the environment in which they work … Some of these problems are decades old.”
“What we’re trying to do is continue on with exactly what we’re doing now,” Breeden said. “The Board of Health can continue to be the governing board to handle all of the medical things, the medical decisions, the policy, they approve the budget, they can approve the health director. But what it allows us to do is when there are issues … go in and handle those issues appropriately.”
“I’m going … to not take action on this matter immediately following the close of this public hearing,” Commissioner Gary Shields said. “This is going to take consumption of information … let’s not get in a hurry. Let’s do it right the first time.”
Commissioner Danny Antoine said, “Personally, I’m not up to making any decisions tonight. I’ve had an opportunity to talk to several board members the last couple of days, … it was a very productive conversation … I’m very much concerned for the employees as well, because I feel like they present a real legitimate concern.”
“In good faith, I say give the current board right now some time to be able to implement this, give them an opportunity to help these employees and get rid of these issues. While they’re doing that we can explore the options [presented] tonight,” he said.
“I do think the consolidation would work,” Young said, “I do think it needs to be looked at in a more comprehensive manner … to Mr. Shields’ point, I think we look at the whole county … I don’t think it’s a bad thing, I do think it needs a little more time.”
The commissioners did not vote on a consolidation option at the Tuesday meeting. The Board of Health will next meet on Sept. 23, at 6:15 p.m. at the Macon County Health and Human Services building.