Director says virus cost department ‘hundreds of thousands’
The COVID-19 pandemic has not only exposed West Virginia’s inadequate public health infrastructure, but the state’s general attitude regarding local health departments.
Lee Smith, Monongalia County’s chief medical officer and executive director of the Monongalia County Health Department, said that point was hammered home during a call last week between health department heads and Catherine Slemp, the commissioner and state health officer for the bureau for public health.
“From the state’s view, the bureau for public health doesn’t have a very high regard for us. We were told earlier this week that the association of local departments really has no one they trust to spend money,” Smith said during a recent work session with the Monongalia County Commission.
The combination of all-hands-on-deck response to COVID-19 mounted by MCHD coupled with a 10-week closure of its income producing clinics and services resulted in losses “measured in the hundreds of thousands of dollars.”
Even so, while nursing homes received emergency aid and the state’s Federally Qualified Healthcare System received more than $10 million in federal funding despite, as in Monongalia County’s case, not necessarily being a part of the COVID-19 response, money for health departments has been hard to come by.
“I think one of the major problems we face is that there’s no representation of our interests at the state level and certainly not at the federal level,” Smith said.
He went on to recount the steady decline in public health resources available statewide over the last decade and noted that when COVID-19 hit, the reaction of the Department of Health and Human Resources was to begin pulling responsibilities away from health departments instead of backing them up.
He used the DHHR’s plan to train 300 people to perform contact tracing as one example. The removal of personal protective equipment dispersal from health departments in favor of offices of emergency management is another.
“I’m sensitive to things being taken from our wheelhouse. If someone reaches into my shop and takes something out of there that I used to do and felt comfortable doing, and the money follows it out, then I’m sensitive to that,” Smith said. “There’s this tension between the DHHR wanting to assert their own importance versus what we do at the local level. Unfortunately, they hold the purse strings.”
Sam Chico, president of the Monongalia County Board of Health, said he believes the state views all local health departments the same despite the fact that there are departments with less than two full-time employees while MCHD has more than 40 and is the state’s only academic health department.
“If Logan County can’t stand up a response, that’s understandable. They have one and a half full-time individuals. But if we can stand up a response, or another county, then why do we not receive any support?” Smith said. “We hear from leadership, ‘You guys are doing a good job up there,’ but it doesn’t translate to funding. It doesn’t translate to the support we need.”
Chico also noted the DHHR doesn’t allow health departments to charge sustainable rates for the services they provide.
“If they want us to be self-sufficient, take the handcuffs off. We submit a rate schedule not to make money but to break even, and they reject it,” Chico said. “Sheetz comes in and puts $3 million into a new location. They submit a permit application that’s 1,000 pages with 100 pages of blueprints and all we’re allowed to bill is $250.”
A health department in Pennsylvania doing a similar job would charge $2,500, Smith explained.
For its part, the commission said it would provide a letter of support for grant funds that would allow MCHD to expand its academic efforts.
It also said it would like to sit down with DHHR leadership to discuss the issues.
“The way they’re treating you is the way the state always treats us … ‘Oh, you’re big enough. You can take care of it.’ Commissioner Tom Bloom said. “I’ll tell you right now, we need you. We’ve learned very clearly that we’d rather call you and have you actually answer then call the state and wait.”
In the meantime, Commission President Ed Hawkins said, all parties need to continue to press the issue.
“If the governor still believes that the squeaky wheel gets the grease, we’ll squeak. I’ve stated that before,” he said. “I don’t want to be sounding like we’re the only county in this state, but we’re one of the few counties making money for this state.”