Public health represents a challenge most people wish someone else would handle. After all, the business of indigent or uninsured health care is tricky – lots of need with not enough service providers willing to accept and treat a growing and underserved population.
The El Paso County Board of Health and the Environment has been given responsibility for overseeing of the Pikes Peak region’s public health programs by the El Paso County Board of Commissioners. The five individuals appointed to set County policy and to oversee programs/budget for restaurant and septic health inspections, water quality and for the availability of immunization vaccines have recently come under scrutiny. According to El Paso County Commissioner and Board of Health liaison, Tom Huffman, the Board of Health has not operated at maximum efficiency, nor has it always acted in the best interests of the taxpayer.
In an interview for the Colorado Springs Business Journal, he compared El Paso County’s Health Department budget to that of ten other Front Range counties, noting that the El Paso County’s $5.5 million taxpayer cost ($4.5 million is collected from taxpayers and another $1 million includes in-kind administrative and budgetary support) is higher than any of the other ten Front Range counties, except for Boulder County.
Huffman recently attended a Board of Health meeting where he expressed the need for careful fiscal analysis – especially when deciding whether or not to pursue State or Federal grants requiring El Paso County to supply matching funds and in-kind resources. He also joined a majority of Commissioners in replacing one-term Board of Health member, Dr. Jack Dillon (a Penrose-St. Francis representative) with a business citizen rather than a licensed doctor – alarming the local medical community and Board of Health members.
The outspoken commissioner also noted that all the major local health care providers including the two hospitals, Community Health Center and Pikes Peak Mental Health typically submit candidates for vacancies on the Board. “Each of these candidates represents an organization with an agenda,” said Huffman. “The hospitals know there’s no profit in indigent care, and Community Health cannot afford to take care of the uninsured based on their current budget and state funding cutbacks. As a result, Board members from these organizations may be pre-disposed to let the county’s Board of Health add more unfunded or under-funded programs to its plate.”
The medical community, typically removed from county politics, opposes Dillon’s departure and the decision to replace him with a businessman with no medical background. Dr. Jim Simerville, El Paso County Medical Society spokesman and former Medical Director for PacifiCare sees the decision not to appoint a licensed M.D. to the Board as setting a dangerous precedent.
“We are facing a critical shortage of doctors for Medicare patients and a decrease in patient managed care coverage,” says Simerville, “but we are also concerned about the health and safety of our residents. Our membership is unanimous in its opinion. The Health Department is currently in very capable hands with Rosemary Bakes-Martin as Acting Director and with Karen Ramstron as Chief Medical Officer,” he said. “Where we have a problem is that there is currently no licensed doctor on the Board, and our chief medical officer does not have the necessary authority to do her job. Under the current structure, she’s vulnerable to county politics and budget issues.” Simerville also believes Huffman’s “socialized medicine” label on Health Department services prejudices local conservatives against the medical community.
In response, Huffman admits that he used the term to point out that programs such as Medicare or other government-sponsored healthcare was legislated into existence by elected representatives. “Medicare is socialized medicine and that’s okay,” he counters, “but my point is that the Board of Health members are not elected by the taxpayers and therefore cannot commit El Paso County to services over and above their budget.”
Simerville, along with former Board of Health Director, Dr. John Muth, believe that Huffman’s suggestion that the El Paso County Medical Society appoint an additional liaison medical advisor to the Board of Health will not work. “The members voted the liaison/advisor concept down,” he said. “When it comes to making public health decisions regarding disease epidemics or the possibility of bio-terrorism, we believe a knowledgeable medical professional should be the final authority – and should have a vote.”
Simerville is supported by a number of high-ranking private sector doctors and administrators throughout the Pikes Peak region. In a prepared statement, Steven Reich, M.D. and Medical Director for Colorado Springs Health Partners, supports the Medical Society’s stance. He said, “The Health Department is an integral component of our community’s health care infrastructure. Active representation from a licensed physician, considering the current situation we face (referring to bio-terrorism threats or possible disease epidemics), is necessary for the success of the Health Department and the well-being of county residents.”
“My goal is not to keep doctors from participating as Board members,” said Huffman. “In fact, I’ve been a dental and medical provider throughout my civilian and military careers. As an instructor of nuclear biology and chemical warfare in the Navy, I learned a great deal about the kinds of threats posed by today’s bio-terrorists. I do understand the need for an umbrella organization to serve as the community resource for public health. That’s not the issue.
“The problem is that we can’t be naïve in the way we approach dealing with indigent care and public health programs. El Paso County, unlike the Red Cross or Goodwill, is not a charity. The Health Department was recently eligible to renew a State grant for $53,000, (down from the previous year’s $57,000 funding for the same program), but one of the requirements was that the County foot another $193,000 in expenses to actually deliver the program. The cost of the grant was actually more than $240,000. As tight as the County budget is right now, we have to be extremely critical in what programs we support.”
For now, the relationship between El Paso County and the Department of Health is improving. “We weren’t involved in the decision to let Dr. Dowe go,” Huffman said. “That was handled by the Board of Health. They decided to end her contract because of performance issues.” Terry Harris, County Administrator, agrees that communications and financial dealings between the two organizations have smoothed since Dowe’s departure.
“My goal as a supporter of the Board of Health and the Environment,” said Huffman, “is to develop a smarter, more efficient way to deliver the medical services our community needs.” According to Huffman, he and City Councilman and, Ted Eastburn, have already had preliminary conversations with other community decision-makers about how to bring all interested parties together to assess both the challenges and the assets available for public health.
“We do need a clearinghouse or an umbrella organization that includes representatives from the hospitals, Community Health Center and Pikes Peak Mental Health, El Pomar and the City for example,” he said, “to make sure we’re not duplicating services, and that we are taking care of all our citizens. That’s the next step.”