The Macon County Board of Commissioners is considering bringing the Health Department under its control.
The commissioners and the Board of Health held a joint meeting as part of the commissioners’ July 8 meeting. The Board of Health will hold a special called meeting on July 17 to discuss the issues brought up during the meeting with the commissioners.
The July 8 meeting began with each of the Board of Health members introducing themselves. State statute requires that the 11-member Board of Health include seven professionals, three members of the general public and a county commissioner. Serving in the professional positions are Courtney Patrick (pharmacist), Carlos Vargas (doctor), Garrett Higdon (engineer), Angie Stone (registered nurse), Matt Corbin (dentist), Roy Lenzo (veterinarian). The optometrist position is vacant. John Shearl and Barry Breeden are the county commissioners liaisons to the board. Representing the general public on the board are Don Feibelman, Steve Grissim and Jerry Hermanson, who serves as chair.
Commissioner Chair Josh Young said the issues to be discussed during the meeting were not the fault of the Board of Health. “By design there may be some flaws in the system, and I think we’re here asking for help.”
Young, Shearl and Breeden each went on to say that they get complaints about the Health Department. Young said he received at least 19 complaints in the past fiscal year.
“I think this is a time to just let the cat out of the bag, per se, and really have some good, healthy discussion on what we can do to help each other,” Young said. “I feel like we’ve had a lot of feedback with some interdepartmental conflicts. It’s really not our business to get into your business, but I feel like, it’s a little bit overwhelming.”
Shearl said the commissioners are elected by the people and that the appointed Board of Health should be an advisory board. (The commissioners appoint the health board members.) “The Board of Health was not elected by the people and should not have sole authority over this agency. The Board of Commissioners and the county manager should be in control of overseeing this agency.”
Shearl said his phone “rang off the hook with problems, internal problems” and that the calls come from people in the community as well as health department employees. He said he feared the county might lose some good, quality workers if the issues are not addressed.
“We have no authority and no control over what’s happening,” Shearl said.
Hermanson said he was concerned that the commissioners had been receiving complaints, but no one had brought those complaints to the Board of Health. He said he had received one call from someone that had been referred by the county manager’s office.
“If we don’t know there’s problems and we’re not communicated with, we can’t do our job to make sure things run well,” Hermanson said. “We have a confusing situation in my mind because we come under various regulatory limits.” He said state statute dictates what they are supposed to do. “We don’t ignore the county commission in any way.”
The Board of Health meetings include a public session when people can come in and talk about their concerns.
“If they ask us a question, we answer it. We try to engage them during their public comment because we don’t want them to go away saying, ‘Well, I talked and they didn’t listen.’”
Shearl referenced the backlog in permits over the past several years. “We talked about it several times, but nothing ever changed until this body, the elected body, made sure something happened.”
Hermanson said more than 20 years ago there was a discussion about getting septic and well permits. “It’s been an ongoing problem because of how it has to be done, because we can’t always get the people we need to do it. We appreciate you getting involved in helping get it to where it is now. It is still not where it needs to be. We’re aware of that and that’s a priority for us.
Shearl said it’s frustrating for people to wait 5-7 weeks for permits. “Whatever we need to do to bring in additional help, that’s what we need to do.” Shearl said the county is dependent on construction and second-home owners. “That’s what the driving force is, and if we can’t get this right, there’s a problem,” he said.
Public Health Director Kathy McGaha said the permit wait time is less than two weeks now.
“That’s a vast improvement over the last time we got involved in discussing this issue, but it’s still not where it needs to be,” Hermanson said.
Employee morale
Breeden said morale within the health department is “very low” and he had been told it is a toxic work environment.
“I don’t think it’s anything to do with the Board of Health or the commissioners. I don’t think there’s anyone to blame,” Breeden said. “But I do think that the structure of it is difficult because we are the funding arm of the Health Department, but we have no authority to make changes or requests.”
According to health department policy, complaints are to be directed to the health director (McGaha).
Hermanson said when the commissioners hear complaints, they could contact one of the board members or let the county manager know and he could pass the information along to the Board of Health.
Young said the county manager communicates with 22 or 23 department heads and the county has a human resources department. He said that they were offering to help with personnel issues and “iron out the wrinkles.”
Hermanson said the Health Department falls under different human resources rules because there are state rules they have to follow.
Young said, “We don’t have a problem taking complaints. I think the issue is we’re taking complaints and have nothing we can do about them.”
Shearl said, “Some of these people, especially employees, they’ll come to us in fear of retaliation; they know we will keep everything confidential.”
Board of Health response
Board member Steve Grissim said it sounds like most of the problem is communication. He asked if County Manager Warren Cabe could be the “mediator” or point of contact just as he is for the other county departments. “I think all of us are willing to take the call, but we’re just not getting them,” Grissim said referring to the complaints.
Breeden said the Board of Health could not immediately address issues because they meet every other month instead of monthly as the commissioners do.
Garrett Higdon said a subcommittee that included him, Hermanson and Grissim met to talk about a complaint process and how the Board of Health could take complaints.
“I’d hate for us to have to reinvent the wheel here if it’s something that can be as simple as us reevaluating our complaint process and going forward with something that we can do as a board and function the same way that we have been,” he said. It was suggested that the board members could post their phone numbers so that people can easily contact them if they have issues.
Breeden said, “The complaints are one thing. It’s the action after the complaints. How are we going to solve some of these problems?”
Addressing Shearl, who serves as liaison to the board, Angie Stone said, “I’ve been at the last three meetings with you, and if you were fielding concerns and problems from the people who are contacting you, why have those not been brought to us at the board meeting?”
Shearl said he thought some of the issues might be settled but that he didn’t bring it up because there is “nothing I can do about it.” He then asked Stone how the issues would have been dealt with had he said anything.
She said they would have discussed it as a board and then discussed it with the director.
Courtney Patrick is the newest appointed member and said she was surprised to hear the issues being discussed. “I could see how a partnership could make sense. I also am hearing that there’s concern for retaliation, and I would say to make sure that we’re upholding the integrity of the department, we need to fix that now. There has to be a way that people can anonymously let us know what their concerns are.”
She said if the board switched to an advisory function that she hoped they would still be able to share their expertise.
“I don’t feel like any of you guys would want to be making big decisions if there’s a measles outbreak in Macon County, right? And so we need to think about maybe those really kind of high-level pictures of who’s going to be stepping in and who’s going to have ultimate control there.”
Dr. Carlos Vargas said he appreciated the opportunity to meet face-to-face but he was trying to decipher what was going on.
“I’m a physician, and my job is to understand the truth, kind of like a lawyer. But I’m stuck. I don’t understand what’s going on here,” he said. “I don’t understand your truth right now. I don’t get it. I don’t understand it. It sounds like you want hiring and firing authority. That’s what it sounds like. But I’m not sure.”
He referenced McGaha’s performance reviews saying her record is “impeccable” and asked if the commissioners had talked to any of her employees other than the ones complaining.
“You’re blessed to have Cathy as your director of the Health Department. To imply that she’s not doing a good job to me is ludicrous. Why do people have poor morale in any workplace? They’re not paid enough. Somebody here said that you have the financial part of our authority. There’s the answer. Pay them more. You said that the wait’s too long. Hire more people. It doesn’t seem that complicated to me.”
Like Grissim, Vargas also said the issue is communication. “It’s problem-solving in a mature, adult way instead of just talking about problems that we haven’t heard yet,” he said. “There’s something else going on here, with respect, and I don’t see there is a problem.”
He said there is no need to make changes and create an extra process. “We’ve got an excellent director. If you have personal friends who work there who are calling you disgruntled, that needs to be handled appropriately, not by changing the structure and firing people.”
Vargas said the commissioners have more authority than they were implying since they appoint the Board of Health members. “Painting yourselves as these kind of helpless people . . . I don’t buy that,” he said. “I wish you guys would speak more clearly, more honestly, so I could understand what’s going on.”
Options
There are 21 counties in North Carolina that have health departments governed by the county commissioners, according to data from the UNC School of Government. (humanservices.sog.unc.edu)
If the County Commissioners took over the Health Department, they would still be required to appoint an advisory committee with the same makeup as the current Board of Health – seven professionals, a county commissioner and three members from the general public.
There are other departments within Macon County government that have boards – Parks and Recreation, Social Services, and Planning and Permitting. Attorney Eric Ridenour said the Planning Board would be a similar example because it operates as an advisory board.
Matt Corbin said he appreciated the commissioners bringing the issues to the board’s attention and that they needed to have a chance to discuss how they would address them.
Patrick asked if before moving to the next step that the commissioners could attend the Board of Health’s next meeting to talk in detail about the complaints. “At this point, we still don’t know the issues,” she said.
It was suggested that the boards meet in closed session to address personnel issues, however county attorney Eric Ridenour said since the Health Department employees are not technically county employees it would not be appropriate for them to meet to discuss personnel.
However, he said, the Board of Health could meet in closed session and invite one or two of the commissioners to join them to discuss the issues. (Three or more commissioners would create a quorum, which would not be allowed under the Open Meetings laws.)
The joint meeting ended with the commissioners voting to hold a public hearing at the Sept. 9 meeting to get input on the county taking over the Health Department as a county department.
The public hearing will be held as part of the commissioners’ regular meeting beginning at 6 p.m. in the board room on the third floor of the Macon County Courthouse.