Hertford County ponders next move

Published 12:00 am Thursday, April 29, 2004

WINTON – Whatever the outcome of a public hearing scheduled for here on Monday, the general health and well being of Hertford County residents will not be jeopardized.

That thought sits high atop the priority list of Hertford County Manager Don Craft. He said the recent break-up of the Hertford-Gates Health Agency (HGHA) does not leave Hertford citizens in limbo as far as their healthcare is concerned.

&uot;We are not worrying over this situation,&uot; said Craft in reference to the decision made earlier this month by the Gates County Board of Commissioners to withdraw from the two-county health district. &uot;Our Health Department will continue to function.&uot;

However, the Hertford County Board of Commissioners must now reach a decision of which direction the single-county Health Department must take effective July 1. By state law, this decision must be made no later than June 30.

At the request of the HGHA and the Hertford-Gates District Board of Health, the Hertford County Board of Commissioners have scheduled a public hearing on the prospect of reorganizing public health services in Hertford County as a Public Health Authority. That public hearing has been set at the regular Board of Commissioners meeting at 9:45 a.m. on Monday, May 3, 2004 in the Commissioners’ meeting room in Winton.

According to Craft, the Commissioners, after listening to public comment, may vote to accept or reject the Public Health Authority suggestion. They also have an option to defer action until a later date.

However, creating a Public Health Authority isn’t the only option. The Commissioners may choose to create a regular county health department, one that falls under the direct supervision of the County Manager and County Commissioners. Or they could opt to join an existing health district, such as Gates County chose to do, or join with another county to form a new health district.

&uot;Any of those three options will work for us,&uot; noted Craft. &uot;The way I see it, whatever decision our Commissioners reach following the public hearing will be the right choice. There is no wrong choice in this case. Our Commissioners will listen to the public’s input on this matter and then come to a decision that will benefit all of our citizens.&uot;

According to Hertford-Gates District Health Director Curtis Dickson, his Agency’s management and staff, and the District Board of Health, prefer the Public Health Authority option because &uot;it makes the most sense for the easy transition of our public health agency in a matter that will protect the vital programs and services of our local health department, as well as protecting the jobs and livelihood of our health agency staff.&uot;

To date, there is only one county (Cabarrus) in the state that operates as a Public Health Authority.

&uot;Public Health Authorities march to the beat of their own drum,&uot; noted Craft. &uot;They operate under the decisions made by their Health Board. Those Board members are appointed by the Commissioners in that particular county, but they (Health Board) then are free to operate and perform their duties independent of county authority.&uot;

Dickson said the single county health department under the administrative management of the county manager &uot;is problematic because of the great differences between the Health Agency’s existing salary schedule, fringe benefits, and personnel policies and procedures when compared to Hertford County’s.&uot;

He said many complicated issues would be encountered in such a conversion, including freezing or reducing existing staff salaries where those salaries fall beyond the top step of the county salary schedule. This would make such staff ineligible for merit raises, cost of living adjustments or any other pay increases until the county salary schedule catches up with the staff’s existing salary level.

Dickson pointed out that the Health Agency currently has many employee benefits that are different than Hertford County’s. These include a quarterly retention bonus for nurses to encourage them to stay with the Health Agency in a very tight nursing market where competition for nurses is fierce, as well as a sign-on bonus to encourage nurses to join the Health Agency when a vacancy is available. The Health Agency currently reimburses business mileage driven at a higher rate than does Hertford County. The Health Agency’s personnel policies and procedures are geared to the benefit of its operations currently, but these policies would have to be changed to go under Hertford County administration.

&uot;One of the key issues, in my opinion, has been the ability of our Health Agency as a District Health Department to be flexible in its budgeting process and to be creative in developing important public health services for the benefit of our community,&uot; said Dickson. &uot;We have had the flexibility to develop an innovative Uninsured Medications Program, for example, that is providing prescription medications to those with chronic diseases that cannot afford to purchase such medications. We have been able to budget excess revenues generated by our Home Health Agency to provide for many unfunded public health mandates. That excess revenue would not remain with the Health Agency if it operated as a county health department.&uot;

Dickson said the lack of flexibility in managing its own finances and using funds available to provide needed services that would occur as a single county health department would likely cause the Agency to have to reduce its staffing levels and layoff existing staff.

&uot;In addition,&uot; he said, &uot;the entire burden and responsibility of our current $5 million operating budget would fall on Hertford County. If there were a shortfall, Hertford County would have to make up the difference.&uot;

According to Craft, the current Hertford County budget includes a direct appropriation of $290,172 to the HGHA.

&uot;We write them a check and they spend it as they see fit,&uot; said Craft.

Additionally, Hertford County is responsible for the utilities and the upkeep on the HGHA buildings located in Winton. Craft stated those annual expenses were budgeted at $19,708 for the current fiscal year.

When asked what type of financial impact the county would experience by completely taking over the health department, Craft said that was a hard question to answer.

&uot;Because the health department is an income-producing entity, we would have to closely study their accounting books in order to make that calculation,&uot; Craft said.

In the meantime, Dickson said it would be extremely difficult in a short period of time to persuade another nearby county to join in a new District Health Department. Hertford County could decide to join an existing District Health Department, such as Albemarle Regional or the Martin-Tyrell-Washington District Health Department.

&uot;Our Board of Health, and our Agency staff, have no desire to be a part of Albemarle,&uot; said Dickson. &uot;Martin-Tyrell-Washington District has extended an invitation to Hertford to join their District, and that might be an option, but we are not connected geographically.&uot;

He said joining an existing and larger District Health Department would dilute Hertford County’s control over local public health decisions and establishment of services needed in the community. The County would only have one or two representatives on the other District’s Board of Health, as compared to seven to nine local citizens on a local board of health or a Public Health Authority governing board.

&uot;The advantage of a Public Health Authority over a county health department is that the single county Public Health Authority can function similarly to the multi-county District Health Department we have had for 65 years,&uot; said Dickson. &uot;The Hertford County Board of Commissioners would appoint the Public Health Authority governing board, which would be responsible to the Commissioners, but the Board would retain the authority to manage its own administrative affairs, control its finances, and operate vital public health programs without the bureaucratic involvement of county administration.&uot;

One other important difference is that under North Carolina law, the local hospital would have a senior administrative serve on the Public Health Authority governing board. &uot;This would further increase collaboration with Roanoke Chowan Hospital,&uot; said Dickson.

Another key element in this decision-making process by the Hertford County Commissioners deals with the status of the current employees within the county health agency.

The Health Agency currently has 77 staff members as a two-county District Health Department. Some nine staff members will remain with the Gates County unit of Albemarle Regional. Five vacant positions are being eliminated due to the split, and Dickson said he was working to save an additional six positions that he identified as &uot;at-risk.&uot;

&uot;The Public Health Authority option will give us some flexibility to try to retain these at-risk positions,&uot; said Dickson.

Dickson pointed out that the current Health Agency as a District Health Department has been creative and innovative in public health service delivery. It has increased its operating budget from $3 million to over $5 million in the past five years, with a corresponding increase in public health service delivery. It turned around its Home Health Agency from losing $200,000 a year five years ago to generating $700,000 excess revenues this past year.

The Health Agency has developed innovative new programs and salvaged existing services that were about to end. These include the diabetes program, the Bear Care Center, the breastfeeding program, and a high-risk newborn outreach and referral service that were about to end. It includes the establishment of an innovative &uot;Healthy Hearts and Souls&uot; cardiovascular disease risk reduction program in African-American churches, the &uot;Helping Hands&uot; free, volunteer medical clinic for uninsured populations, an AIDS/HIV medical specialty clinic, and the Carolina Access Medicaid case management program, among others.