Commissioners at odds over public health

by karla pomeroy

The Big Horn County commissioners last fall wanted to ensure that no county employee was supervised by a state employee, especially when it came to public health. With legislation enacted this year making that possible, two of the commissioners are now seeking to hold the county harmless and without any liability, which could put the majority of the public health services in jeopardy in the county.

In the regular meeting last Wednesday, May 7, the commissioners met with Big Horn County Public Health Nurse Manager Kimberly Cowan, along with Linette Johnson, state supervisor, and Karen Mahan, state nursing chief, via teleconference.

Mahan said they needed to have the county approve the budget for the two administrative assistant employees, one at the Greybull office and one in Lovell. The budget is $79,000, less than the current $82,000 budget.

The county then needs to set a work session with public health to go over the memorandum of understanding, which includes the statement of work, outlining responsibilities of both the state and the county, and the Business Associate Agreement.

Grant said, “I’m not sure it’s worth going any further until we are assured there is no county responsibility.”

Mahan said the MOU is for the Maternal and Child Health services, which are required by state statute. She said public health can bill the state for the time spent on the services and that money comes back to the county, up to $63,000 biannually.

“If you don’t sign the contract you don’t get the revenue,” she said.

Mahan added, “It was originally our understanding the board’s concerned was liability of county employees being supervised by state employees. That’s how the legislation was based, to provide a method in these positions. From our perspective it wasn’t our understanding the county didn’t want any liability.”

Grant said his concern with the MCH documents is that it leaves the county with all the liability of a program the state is running.

MCH includes home visitation services for pregnant women. According to state statute the service “shall” be provided in each county. Other services such as immunizations and long-term care assessments are listed as services that “may” be provided.

Ewen said, “What we asked for is to be revenue neutral and employees to be state employees and it sounds like what we are getting.”

Grant said, “My understanding is that the county wouldn’t have any liability.”

Ewen said the county is liable like any of the county facilities since public health is housed in the county-owned senior center buildings in both Greybull and Lovell.

Hyde asked if the commissioners agreed to the budget would it commit them to a contract. Mahan said no, nothing would be signed but it would allow the budget to be submitted to the governor for approval so the positions could begin to be advertised.

Mahan noted, however, if no contract is signed, services would stop after Sept. 30. Terms of the agreement can be negotiated between the county attorney and the attorney general’s office.

Cowan said about 60-70 percent of the time for the nurses is spent on MCH services. “That’s what we do. We have a huge clientele of moms and babies in our county.”

Mahan said while MCH is mandated by statute, services will be limited without county funds.

Cowan said it would decrease services if the MCH contract is not signed.

Grant said, “If they’re mandated to do the services, then we can drop the program.”

Ewen said he would not go along with that.

“We are charged with the health, safety and welfare of citizens. If we dissolve the program a lot of thought needs to go into it because it’s very important to a lot of people,” Ewen said.

Hyde said, “We want to help fund the program but we want you to run it. It should be so simple.”

He added, however, “What are we going to be able to afford. I’d rather see law enforcement on the streets than health nurses teaching mothers how to change diapers. I hope it doesn’t come to that.”

The commissioners will meet with public health in a work session on May 29.

Per their concern about supervision, the county has reached a new agreement with the University of Wyoming Cooperative Extension Service so the new administrative assistant that is hired will be a UW employee, not a county employee.