At the end of this month, the Mississippi Department of Health (MDH) is abolished, an action taken in part to remove State Health Officer Dr. Brian Amy, who had threatened to sue the Board of Health if he was fired. The Legislature took the unusual step of allowing the state agency to sunset after the Mississippi Senate held hearings that indicated some major deficiencies at the agency.
“It was fairly unprecedented,” said Rep. Steve Holland, chair of the House Public Health and Human Services Committee. “We abolished the department and recreated it. There were obvious deficits in the leadership at the Department of Health. Dr. Amy just lacked the vision needed, I think, to bring the public health function to where it should be. I still personally feel Dr. Amy is a fairly qualified person who got off on some bad footing and was caught up in the web of the Senate investigation that cut no slack.
“At the end of the day, we reorganized the Board of Health. In doing that, we abolished the personnel, including the director. Probably that is not the normal way of doing business, but the general consensus of the Legislature was it had to be done. Sen. Alan Nunnelee (chairman of the Senate Public Health and Welfare Committee) felt it need to be reorganized.”
Holland said some of the most important changes included reducing the size of the Board of Health and including strong conflict of interest provisions for board members.
“We increased the number of doctors on the Board of Health, yet kept it a broad based healthcare board,” Holland said. “I think what we are going to see is a new vision, especially with the nomination of that board of a new state health officer. Like many of us as we travel in the journey of life, we reach a time to renew, rededicate and improve. That is what we did with the Board of Health. And I think it is going to be good. It is going to be fresh air. I have a lot of hope, and am going to be watching it very carefully.”
The Legislature also has to do its part, Holland said. In recent years, funding for the health department has decreased 35%.
“That is my fault and the fault of 173 other legislators and the governor for not adequately funding the board,” Holland said.
Sen. Nunnelee said he expects changes at the agency to result in a department that is much more responsive to the health needs of Mississippi.
“We eliminated the old Board of Health and put in a new Board of Health,” Nunnelee said. “A new state health officer will be appointed sometime after July 1. I would say the problem I saw in the Board of Health was in two areas. We saw that at times the Board of Health itself acted apart from the general interest of the State of Mississippi as a whole. There were some board members who appeared to be acting more on personal interest than the interest of the state as a whole. There were some conflict of interest allegations. We did put in much stronger conflict of interest requirements for board members.”
He added that it appeared the management style of the health department leadership team was not getting the results needed.
Approximately half of the previous Board of Health members were reappointed to the new board. Another change is that previously the board was appointed entirely by the governor. The new board of nine has five members appointed by the governor, two by the lieutenant governor and two by the attorney general.
One of the more graphic areas of testimony regarded field-level restaurant inspectors testifying they were told not to fail restaurants in inspections for any reason. Nunnelee recalled one incident where a restaurant inspector testified about finding several active birds’ nests over an area where meat was stored in a meat market, plus a dead rat crawling with maggots on top of a stack of Styrofoam trays. The inspector sent an e-mail saying that there was a sign in the market stating they had passed the health department inspection.
“What am I to do?” the inspector asked.
Another issue that particularly concerned Nunnelee is that funds from vehicle moving violations that were supposed to be used to provide local emergency management service agencies with the funds to buy equipment to handle emergencies were instead being used to buy office equipment at the Department of Health. The advisory council that was supposed to decide how to disburse the funds to buy equipment hadn’t been called to meet for several years.
“I can’t say a person died because of this,” Nunnelee said. “But those local emergency responders were denied the funds they needed to buy necessary tools and equipment to do their job because someone in the Department of Health wanted new office equipment and computer monitors.”
Another major issue involved handling of tuberculosis (TB) cases at the state. A Legislative Committee on Performance Evaluation and Expenditure Review (PEER) examination found MDH reported its TB treatment data to make it appear more successful. The PEER report said after department employees were instructed “at the risk of their jobs” to increase the number of TB patients currently in therapy from 80% to 95%, the staff changed the definition of what constituted “currently in therapy,” resulting in a 6% increase.
The report also charged that field staff failed to initiate TB treatment on groups such as homeless people because of the difficulties in keeping those individuals current on their treatment. PEER said that action could represent a future public health threat, as untreated cases could become active.
The PEER report also concluded the health department suffered from serious morale problems, unnecessary restriction of professional channels of communication, a failed budgeting model and the loss of experienced employees. The department has been reorganized four times since Amy became health officer in 2002, which PEER alleged was illegal.
Contact MBJ contributing writer Becky Gillette at firstname.lastname@example.org.