Finances, governance are among issues
By Marcy Stamper
A large withdrawal from an emergency fund at Okanogan County Public Health, differing opinions about wages there, and other issues have prompted the county commissioners to scrutinize the county’s health district — along with the board that oversees it.
The situation also has the Public Health staff taking days of unpaid leave.
The health district, which is funded by state and federal grants, license fees and the county, often draws on its reserve fund to bridge gaps in cash flow. But when the district had to borrow $100,000 at the end of last year — nearly emptying the fund — it got the attention of the county commissioners.
“The biggest thing was the $100,000 shift — that woke us all up,” said Commissioner Sheilah Kennedy, who said the commissioners are looking at the long-term stability of the health district.
Public Health maintains the reserve account, which it built over the past two decades, because its revenue fluctuates, but had never needed $100,000 before last year, said Ella Robbins, administrative coordinator for the district. “That is a large amount,” she said, noting that it had depleted all but $5,000 from the account. In a typical year it borrows only about $20,000, she said.
Now all 12 employees of Public Health are taking one furlough day every month for two years to replenish the fund. So far, $40,000 has been restored and the health district is on track to repay the full amount by the end of next year, said Robbins.
“We’re putting money into a reserve account courtesy of the employees’ sacrifices,” said Dave Hilton, the environmental health director.
Board of Health
At the same time, there have been changes in the Board of Health, which oversees the district. Until recently the board had six members — the three county commissioners and the city representatives, one from each commissioner’s district. The current charter specifies that city representatives must be an elected official or city clerk.
But when one board member — Lee Webster — stepped down as mayor of Brewster, he became ineligible to serve on the board since he was no longer an elected official.
That prompted further scrutiny of the charter and led the commissioners to remove board member Ralph Malone, who, although he had served on the board for 13 years, is Omak city administrator but not an elected official. That left only the three commissioners and an Oroville City Council member.
At a meeting in early July, the county commissioners passed a resolution changing the charter and reducing the total membership to five — the three commissioners, an elected city official, and a representative from the medical or environmental health sector. But after questions from Public Health staff and the public about the legality of that action — since the topic had not been on the agenda — the commissioners rescinded it a week later.
The commissioners then formed an advisory committee to review the existing charter and recommend changes. The committee plans to recommend enlarging the board to seven — the commissioners, a city representative from each district, and a professional from the medical field, according to committee member Andi Ervin.
They would expand the criteria to include city managers as well as elected officials, said Ervin. State law permits members of the public to serve as long as they don’t outnumber the elected officials.
“Our goal is to do our best to ensure compliance with state law while respecting the need for multiple voices and some level of autonomy,” said Ervin.
District or department?
Day-to-day operations at Public Health are run by a management team — one for community health, who deals with communicable disease; one for environmental health, for water and septic systems; and one for administrative support services. But as a health district, it is overseen by the Board of Health as opposed to being a county department.
Several staff members at Public Health said they favor the Board of Health arrangement because it creates a system of checks and balances, with representation from community members and medical professionals in addition to the county commissioners.
By state law, the district also has physician oversight. John McCarthy has been the district’s health officer for the past decade and reviews and consults on decisions by the staff.
Staff cuts, few raises
Among the issues that have come to the surface is a 10-percent cost-of-living increase for Public Health staff approved by the Board of Health two years ago. The staff had not had an increase since 1999 so, after a survey of salaries at comparable health districts, the administrative team proposed a 10-percent increase at its September 2013 meeting. “It was quite a discussion,” said Robbins.
The two city representatives voted for the increase, while county commissioners Kennedy and Jim DeTro voted against it. (Commissioner Ray Campbell was absent.) As chair, Malone cast a vote to break the tie — for the salary increase, said Robbins.
Shortly thereafter, when the county commissioners cut other departments’ budgets by 10 percent, they cut 20 percent from Public Health, said Hilton.
Robbins said their salaries are still below the industry average. On top of that, the staff has been reduced from 24 to 12 over the past five years, she said. “The work force has been cut in half, but the jobs don’t go away — most of us are multi-tasking,” said Community Health Director Lauri Jones.
Kennedy said she wants to look at whether staffing is appropriate. “The furlough days have an impact — we can only pile so much on the staff,” she said.
Confidence in staff
Within an atmosphere described by some as tense, there is one area of unanimity — confidence among Public Health staff, the health officer and the commissioners that the staff effectively safeguards the public’s health. “I have no concern about how they handle health issues,” said Kennedy.
At Public Health, the staff has more than 240 years of collective experience, said Jones, who has worked there for 12 years. Hilton has been there for 20 years, and Robbins for 35. “There’s a large body of knowledge and expertise,” Jones said.
“I believe OCPH has a devoted, mission-centered, hard-working cadre of employees who have been working diligently in spite of collegial layoffs and shrinking resources,” wrote health officer McCarthy to the Board of Health in February. “Their commitment inspires me and gives me confidence in a public health system that is underfunded and generally not appreciated.”
McCarthy also cautioned the board not to be “penny wise and pound foolish.”
“Attending only to the short-term horizon in public health is potentially costly in the long run and … the county cannot afford this,” he wrote.
As part of their review of Public Health finances, the commissioners want to better understand unfunded mandates from the state, said Kennedy. She said the state requires certain services but provides no help with money.
She suggested they look at mandates to see if the county really has to follow them, and potentially identify issues to raise with state or federal legislators for help in “untying our hands.”
Asked to provide examples of state mandates, Robbins pointed to the district’s monitoring of an individual with tuberculosis last year. In that case, Public Health asked for financial help from the state and received extra assistance, she said.
The majority of Public Health’s revenue comes from state and federal grants and licensing fees. Less than 10 percent of its funding comes from the county, and it returns a portion of that to the county for rent, information technology services and accounting, said Robbins.
In 2014, 28 percent of Public Health’s $1.25 million budget came from the state, 20 percent from the federal government, 42 percent from license and permit fees, and just under 10 percent from the county, according to Robbins. The 2015 budget is $1.16 million.
The Board of Health met with a state auditor on July 30, part of a regular biennial review of finances. The auditor noted that the health district’s finances had declined in 2014 and said it cannot continue to transfer money from the reserve account. He noted that Public Health’s financial position continued to improve as of May 2015.
Cash flow seems to be one of the problems, since even committed grant money often comes in late, said Robbins. In addition, last year the Board of Health approved the license-fee schedule later than usual, so that annual fees — for things like swimming pools, hot tubs and food establishments — weren’t paid until the next fiscal year, she said.
Kennedy wants to see the health district budget for programs and services but not spend the money until it is in hand. The timing of grants and other receipts is among the issues she expects to address in budget discussions with the health district in the next few months, she said.
“I don’t know why it’s being portrayed that it’s a huge fight,” said Kennedy. “That’s not the case. But it’s serious — the last two months they paid out more money than they brought in.”
With rapid changes in the national health care system, there will be even more issues to consider, said Kennedy. “Do we throw more money at it or plan for savings?” she said. “We’ll probably have some tough discussions, but survival is the only option.”
The commissioners will review recommendations on the charter on Aug. 17.