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Concerns arise over health department management

Editor`s note: After an article outlining Gov. Haley Barbour`s healthcare plan was published in the Mississippi Business Journal`s Jan. 12, 2004 issue, an unprecedented response from readers representing a cross-section of the business community led to this story examining the management of the Mississippi State Department of Health. Considering the sensitive position a number of the sources used for this story are in, names have been withheld. A majority of people contacted for this story, including former and current employees who declined to comment for fear of losing their jobs or endangering the jobs of current employees, shared information with the MBJ, and an unmistakable theme emerged. This story explores that theme.

Healthcare advocates are calling for an investigation into numerous personnel and operational matters relating to the Mississippi State Department of Health (MSDH), while they are waiting for Lt. Gov. Amy Tuck to make new PEER Committee appointments.

Priority issues include addressing the current composition of the Mississippi State Board of Health, organizational charts that show a top-heavy department with increased administrative costs coupled with a significant loss of field service employees, an investigation into the background of current executive director Brian Amy, the status of the PEER Committee investigation and the lack of adequate healthcare services for Mississippians.

State health board composition

Allegations of conflicts of interest have swirled around the current composition of the governor-appointed 13-member state board of health. Serving staggered six-year terms, the board includes chairman R.A. Foxworth, a chiropractor from Jackson; vice chairman Larry Calver, a physician from Gulfport; Ruth Greer, a registered nurse from Holly Springs; Shelby C. Reid, a physician from Corinth; Waltor C. Gough, a physician from Drew; Duane F. Hurt, a dentist from Greenwood; Mary Kim Smith, a registered nurse from Brandon; William Briggs Hopson Jr., a physician from Vicksburg; Norman Marshall Price from McComb; Ted Cain, a nursing home owner from Diamondhead; Alfred McNair Jr., a physician from Ocean Springs; Janice K. Conerly from Collins; and H. Allen Gersh, a physician from Hattiesburg.

Then Attorney General Mike Moore warned state health board members about possible conflicts in a January 2002 letter, which stated: “The law allows the board to be comprised of persons who know and understand the healthcare industry. However, this does not allow individual members to use their board position to enhance their personal financial situation or that of their clients, either by working through department staff or attempting to influence the entire board to take official action.”

The Mississippi division of the AARP, the nation`s largest senior citizen organization, has also advocated changes in the composition of the state board of health. “I really don`t think we have any true consumer representation,” said state director Mattie Stevens. (Conerly, considered the only consumer representative on the board, has said she was in favor of revising the board.)

“There are definite conflicts of interest on the board,” said state senator Debbie Dawkins (D-Pass Christian). “It was never the legislative intent to have it as a political plum that would allow someone to line their pockets or favor their industry. The legislative intent was to have the board of health oversee issues that concerned the public health and welfare of the citizens of Mississippi. Since I have been in the Legislature, this board has not been operating in that manner.”

Dawkins introduced Senate Bill 2138, with seven co-authors, an act to amend appointments to the state health board. At press time, the bill was stuck in the Senate public health and welfare committee.

Soaring administrative costs

In a state personnel board report, central office salaries increased by $1.15 million while salaries for field services employees decreased by $1.7 million from September 2002 to November 2003. During that time, the state lost 41 nurses and 16 health inspectors while the central office gained 19 high-level administrative positions, for a total of 35 directors. A Performance Evaluation and Expenditure Review (PEER) Committee report noted that the department had a 30% vacancy rate for environmentalists as of Nov. 17, 2003. Of 102 public health environmentalist positions, 31 were vacant.

“I am one of many, many people who lost their enthusiasm for my job while watching Brian Amy ‘update’ our agency from one that served the public and had a ‘family’ attitude amongst employees to a place from which to exercise his personal agenda,” wrote a retired public health environmentalist.

Adding padding?

In the last 10 years, agency expenses for salaries and fringe benefits have climbed from $82.5 million for 3,140 positions in fiscal year 1995 to $100.1 million for 2,768 positions appropriated for FY2004. In a memorandum dated Nov. 14, 2002, Amy, who was appointed by Musgrove a month earlier, assumed total control of “the appointment of all positions branch director level and above.” Soon after, the state personnel board approved a massive restructuring of the department. As of Aug. 31, 2002, administrative salaries totaled $1.9 million. Within a year, that figure had jumped to $3.2 million, for an overall increase of $1.3 million.

Questions have surfaced about Amy, and speculation about him has been fueled by his inaccessibility, for the most part, to the media. The Mississippi Business Journal was told that Amy would not be available for this story. All questions were referred to Danny Miller, a MSDH deputy director.

“If Dr. Amy cannot face the press and talk to the public in the state of Mississippi, then he needs to return to the swamps from which he came, because he is not serving the public health interest of this state,” said retired state health department public relations director NancyKay Wessman, citing a study by the Washington, D.C.-based Association of State and Territorial Health Officials that identified communication as the top trait of an effective public health administrator. Ed Thompson and Alton Cobb served as presidents of the national non-profit association during their tenure as state health officers.

Last spring, Amy asked Margaret Morrison, a district health officer for the East Central Mississippi headquarters in Meridian, to take over another district in addition to her own.

“There was no offer of a salary increase even though I understand the remaining health officers have gotten salary increases,” she said.

Instead of doubling her workload for no additional pay, Morrison decided to retire.

“I’m sure Dr. Amy was not sad that I left, but I can`t say that was his motive for asking me,” she said. “When he first came to the agency, he presented to those of us in the management arena a plan to do away with the district system completely and to replace it with congressional district organizations. This obviously took us all aback because we’d worked under a district system for many years. When word got out into the counties, there was weeping and wailing. It was an unnecessary exercise. Looking back, I think Dr. Amy decided if he couldn`t do that, then he’d be more resourceful and combine districts so it wouldn`t cost as much. From a money standpoint, and from someone who came from out of state and who was not familiar with the way our system worked, that probably made sense to him.”

Morrison said she was frustrated because she had difficulty communicating with Amy.

“He didn`t appear to me to be a good listener, but maybe that`s because I’m too big a talker,” she said, with a laugh. “I left because I felt that I would not be able to work well with him. As a group, the retirees have been very concerned.”

“We have no reason to be on the defensive,” said Danny Miller, deputy director of the State Department of Health, who said the The Sun-Herald`s Jan. 11 article, “Health Bosses Grow as Nurses, Staff Disappear,” was “a complete, infactual, erroneous story about position ch
an
ges here.”

“If an employee retires and we hire a new employee, did it show as an extra person?” he said, adding that 16 employees have retired in the last 18 months and many of those positions have not been replaced.

According to state personnel records, 54 central office employees and 94 field workers retired, resigned or were terminated between January and July 2003. Of those vacancies, 49 central office employees, but only 29 field office employees, have been hired.

“Like many agencies battling a nursing shortage, we’ve had to resort to contracting with nurses because we can offer more flexibility that way,” said Miller. “Some people are willing to work two or three days a week but don`t want a full-time 8-to-5 job. The same situation has occurred with the decline in environmentalists, which can basically be attributed to the salary structure, which we’ve been working diligently for three years to get increased. This problem existed before Dr. Amy got here.”

Smoke and mirrors, said a state health department retiree.

“Danny will tell ‘X’ that administrative costs have not gone up, that it is budget neutral, even though all these new pins have been created and people promoted,” he wrote. “This is a budget game. They took unfilled positions that were never going to be filled and downgraded them. A good example: the WIC IT positions (that) appear on the budget. The vast majority have never been filled and will never be filled. The real issue is actual expenditures. ‘X’ should ask for the actual payroll expenses for November 2003 and November 2002, broken down by the field and central office.”

Where`s the PEER committee?

At its Sept. 9-10 meeting, the 10-member PEER Committee voted to review some complaints about the state health department, referring other matters to the new members that would be appointed after the first of the year. On Dec. 19, the committee released a report stating that “the regulation of wastewater disposal systems has been subject to potential inconsistencies,” which “could result in potential health hazards and the possible expense of replacing systems.”

Regarding the Food Protection Program, the PEER Committee reported that State Department of Health environmentalists “do not always adhere to program policy governing the frequency and timeliness of inspections of food facilities. This reduces assurance to the public that the food served at these facilities is safe.”

Mike Cashion, executive director of the Mississippi Restaurant Association (MRA), said the shortage of inspectors is not a new problem.

“Several years ago, the MRA sent a letter to the appropriations committees supporting an increase in the MDH appropriation to hire more inspectors and increase their pay level,” said Cashion. “Understanding that the department was strapped for cash and realizing that inspectors would have to get recertified in food safety training, the MRA actually is paying for and conducting the re-certification of existing inspectors and the initial certification of new inspectors. We have absorbed thousands of dollars worth of material and classroom expense on behalf of the health department.”

The current shortage of inspectors has caused some problems with the frequency of inspections, and restaurateurs are concerned that with an influx of new inspectors flooding the field, there may be inconsistencies in the inspection process “due to the proverbial learning curve and the apparent lack of structured training,” said Cashion.

“I do think the health department has become acutely aware of the problems and are considering steps to fix the issues out there,” he said.

New PEER Committee members normally are appointed in January. House Speaker Billy McCoy (D-Rienzi) made PEER Committee appointments the same day he announced committee assignments. However, Lt. Gov. Amy Tuck (R-Maben) has not appointed new Senate PEER committee members, and her office did not return phone calls for this article by press time.

“The PEER Committee can`t do anything until the Senate committee members are appointed,” said Arinder. “But when we do convene, our agenda will include looking at operational issues of the state health department and issues concerning the oversight of the state health board.”

“This is a matter of pressing public interest,” said Dawkins. “We need to take care of this immediately. I thought the investigation would already be in progress by now because I assumed that the PEER appointments would be made. I’m really befuddled by what is taking so long. It`s not only delaying this investigation, but other investigations. We need to remove any sense of impropriety for the board of health.”

While its critics assert that the State Department of Health is battling a myriad of problems, the health and welfare of Mississippians is in a potentially perilous situation, said healthcare advocates.

“Public health is so important to any state, but it is critical to state like Mississippi,” said Morrison.

When asked if the department simply had an image problem, Miller, who has worked for the PEER Committee and is a former Mississippi Department of Transportation employee, said “with whom?”

“I’m not aware of any problem,” he said. “We have a very good relationship with the Legislature. We are doing some things here that are cutting edge, such as utilizing data analysis and control charts to measure performance. We were the first agency to implement the performance accountability act passed by the Legislature last year. We have a number of success stories, and have done a lot of very good things in the last year or so and are headed full-speed ahead.”

Healthcare advocates say that if Barbour plans to achieve the goals outlined in his healthcare proposal, changes will need to be made.

“Mississippians can be assured that my office will be monitoring the situation,” said Barbour. “My healthcare plan will prevail.”

Contact MBJ contributing writer Lynne W. Jeter at mbj@thewritingdesk.com.

About Lynne W. Jeter

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