The regular meeting of the Columbus Board of Health was held in the
Administration Conference Room of the Health and Human Services Center on
Wednesday, November 19, 2008, at 1:00 p.m.
MEMBERS PRESENT:
H. Banks Carroll, M. D.
Mrs. Brenda Dozier
James A. Lawrence, D. D. S.
Mayor Jim Wetherington
MEMBERS ABSENT:
Mr. Isaiah Hugley
Howard Willis, M. D.
Todd Jarrell, M. D.
OTHERS PRESENT:
David Arrington for Mr. Hugley
Dr. Zsolt Koppanyi
Ed Saidla
Pam Middleton
Eileen Albritton
Karon Bush
Sheila Mayfield
Joanne Strickland
Larry Young
Charlene Ellis
Dr. Carroll called the meeting to order and asked if there were any questions
or comments on the previous minutes of October 22, 2008. Dr. Carroll asked for
a motion to approve the minutes. A motion was made by Dr. Lawrence, seconded by
Ms. Dozier and approved by those members present.
Dr. Carroll asked for any Excused Absences for today. He stated that Dr.
Jarrell and Dr. Willis are absent today and he needed a motion to approve the
Excused Absences. A motion was made by Dr. Lawrence, seconded by Ms. Dozier and
approved by those members present.
Dr. Carroll called on Mr. Larry Young with Albright & Fortenberry to present a
report on the FY2008 Audit. Mr. Young reviewed highlights of the audit report
and stated that no irregular issues had occurred. Mr. Young complemented the
staff for their work. Dr. Carroll asked if anyone had questions for Mr. Young.
Dr. Carroll called on Sheila Mayfied, Columbus Nursing Administrator to give a
Nursing Update. Ms. Mayfield stated that during the QA Site Visit, we are
required to put together a community health profile for each of our health
departments and with the help of her staff, she had put together the community
health profile for Muscogee County. (A handout was given out with the
information.) Ms. Mayfield pointed out for example the Women?s Health section,
as a result of some of the Legislative concerns that have come to light. Ms.
Mayfield stated that if the Board Members wished to have a copy of the complete
report that she would be happy to get this for them. The Women?s Health Program
is seeing a substantial cut in the budget and this is not just affecting the
fact that we can?t provide the services to the client which is the main thing;
we are also seeing a significant turn over in our staffing issues, with the
morale being challenged there. Dr. Carroll asked if that meant that we are
losing our current staff. Ms. Mayfield stated that within two months, there
have been three resignations and a transfer. These are key players that are
employed that we definitely did not want to loose. There is nothing that we can
do, our hands are tied. In Women?s Health it self, we have lost the Manager and
we have lost one of our Nurse Specialist, who was up and rising. At the present
time we have a full time staff in Women?s Health with one Nurse and one nurse
training. Dr. Carroll asked if these people were staying in the community,
hospitals and various others?Blue Cross and Blue Shield has taken two from us.
A recent resignation from Child Health and she quoted $8,000 increase in salary
by going there. The Nurse from Women?s Health quoted a $7,000 salary increase
from going to Blue Cross and Blue Shield. The Nurse Manger that left did not
quote a salary but stated that she would be able to stop working a second job.
Most of the Managers and Nurses have second jobs just to make ends meet. Some
of the things shared as to why they are leaving and of course salaries are some
of the concerns not only that they are looking down the road. There are no
raises in sight, the cost of living at this point, because of the 3.5% that was
anticipated, is not being available. They also stated that they felt that the
Performance Management Process was rewarding average employees when they knew
that they had gone above and beyond which there is no discrimination. Ms.
Albritton stated that means that if you do well you only get 2% or if you do
just enough to meet your performance expectations that increase is also
allocated by the State is the same. Dr. Carroll stated that for a super
performance there is no acknowledgement ?.Ms. Albritton stated that a good
evaluation is given, and a thank you?.but in terms of salary?.nothing is given.
Ms. Mayfield stated that most of these nurses are senior nurses?the Women?s
Health Nurse Manager had been here 12 years and some nurses that had come up
through the ranks with her that started as LPNs that have gone back to school
to go that extra mile?to earn their RN degree and they are still at the low end
of the totem pole when it comes to compensating. Public health nurses go
through a lot of training we are not your run of the mill nurses?.we have to do
pap smears, breast exams and things that have been historically reserved for
physicians and so they are working under protocol providing those
services?..including STD treatments and testing. As we loose nurses, we loose
our ability to do community outreach. An example is the Vote/Vac effort we did
during early voting when we gave about 297 immunizations. This type of effort
will have to stop because we do not have the staff to go out into the community
anymore and that is what public health was founded on. We are cutting ourselves
short in clinic and we are not able to serve the community in the aspect in
which we would like. Another thing that is surprising ?..looking at cuts to
the Family Planning Budgets ?.in reference to the report that was in relation
to Women?s Health and the report indicated by the Guttmacher Institute for 2007
annual report that 66.4M women of reproductive age (13-64) in 2006 that more
than half of those women (36.2M) were in need of contraceptive services and
supplies. The shocking part of that is that about 17.5% of that 36.2M were in
need of public funded contraceptive services and supplies and that was due to
the fact that they were 20 years or younger and that their poverty level was at
250% below poverty. This is the population that we are dealing with. They don?t
have health care insurance and with all of the changes in government, we don?t
know if they are going to be eligible for health care insurance based on
policy, regulations and rules, etc. The health department may be it for a long
time for some of these people?and if we are not here to provide the services?I
don?t know where they are going to get it?..The teen pregnancy rate is already
flying through the roof and have been going back up as a result of some of the
cuts that were done in 2006?.so we are seeing the impact of that coming back to
haunt us?.and the mothers are getting younger?.they are dropping out of school
?.with our programs we try to encourage GEDs or going back to high school to
complete your degrees?but it starts with the parents?.if you can?t somehow get
those parents on the right trail?.then the kids can?t change and the cycle
starts over and over again?..Ms. Mayfield stated that this is very passionate
to her and she has been in public health for ten years?.she started her career
at the Teen Center and has worked her way through the system and this is the
worst in ten years. There has been two years without a raise?.but it wasn?t
this bad?.and now it is at the point where our retention is awful, we can?t
keep our nurses and this district has prized itself on being able to retain its
staff?its not happening right now?..and she is taking it personal. Ms. Dozier
asked if Ms. Mayfield would she be able to say this tomorrow at the Legislative
Luncheon? Dr. Koppanyi asked the Mayor if some special options sales tax money
could be used for this? Mayor Wetherington stated there would be no way that
this could be done since this money has already been designated and
specifically identifies how that money will be spent. Ms. Dozier asked if there
were some funds or something within the budget and Mr. Arrington stated that
revenues are slowing down just like the State of Georgia?we are struggling
now?..on how we are going to be able to move forward meeting the obligations
that we have made for this fiscal year. Dr. Koppanyi stated that he has just
signed three resignations today?.Ms. Albritton stated that is just for
Columbus?.but this is happening throughout the District. Ms. Albritton referred
to the data regarding Family Planning that Mr. Saidla had shared before?.we are
seeing decreases in the number of women that Family Planning Services can be
provided for?.and this is a direct link as to the lack of staff to provide the
services. Dr. Carroll asked if this was happening in all of the health
districts? Ms. Albritton stated that all the districts are experiencing this
similar turn over with only 500 public health nurses statewide. Ms. Albritton
stated that when you cut nursing staff hours from 100% to 75% time because you
can?t pay her the 100% time?then she goes somewhere else to work?.that is why
you close down?because they need full time employment or they go elsewhere?..we
tried to recruit a Nurse Practitioner for the HIV Program?.it took nine
months?.to fill the position and finally the salary had to be increased 15%
above what is currently being paid to our Nurse Practitioners?.this position is
critical and is federally funded and if we do not provide a certain level of
service?.we would lose the funding?.Mr. Saidla?.stated that our salaries for
nurse practitioners is about 80% of the actual market value for a nurse
practitioner?even with that addition?that is the disparity between our salaries
at this point and the market and we have had nursing shortages forever?.but the
real issue is that now?.before we were losing the nurses that would come in?we
would train them for a year or two?they would get really good?.we would spend a
lot of money training them and then they would go off to make more money. Now
we are not only losing those?..but now we are losing the nurses we have ten,
twelve, fourteen years invested in. We use to figure that if we got you here
for ten or twelve years?you would hold on?because you could not afford to
leave?...but now the salaries are such?that folks can afford to walk away from
State Retirement in order to make more money. Ms. Mayfield stated that in
January when this new retirement comes forth?it is going to make it even more
difficult ?they will come in with 30% ?..and where some came in with 50% and
the senior nurses with 90% retirement package. Dr. Carroll asked if there was a
game plan in place to address these funding issues outside of funding how to
attract recruits?..money is the primary issue?.training is the challenge
because the State through the budget cuts have decided to discontinue or
greatly delay training that is really needed so that we can get these new
nurses that we have been able to hire?.and some of those persons are actually
people that worked in the private sector and because we had 60% retirement
options?.have come back to work to get a retirement. The changes that are going
to occur in January?..we are probably going to loose that avenue there?.The
bottom line is the dollars and cents and the funding?.to fund to keep these
nurses. There are a number of nurses that are getting close to retirement as
well?.and we will be losing them in the next few years?.and many of these
nurses already have 30 years of service in and several of them are saying it
may be worth their while to go ahead and retire and work in an area hospital
for two or three years and then retire??if they could make more money in those
two years?and just take their retirement?..
Mayor Wetherington stated that it is really going to be a challenge for all of
us in the public section. For us to meet the needs that we should be meeting
with the State budget going down, down, down, we are going to have to do more
with less. This is true in our government and true of all agencies. In the
government?s retirement system, $60,000,000 has been lost in the downturn of
the economy. We were at about $220,000,000 down to about $161,000,000?.it is
terrible?.hopefully the worst is over?but no one knows?..Ms. Albritton stated
that fewer clients will be seen because of lack of staff to serve them. The
long term case impact is of great concern because of the increase of teen
pregnancy, drop out rates, etc. Dr. Carroll stated that this message does need
to be communicated to our Legislators so they can understand the impact ?as it
impacts the community and the lives around us?then when they see high rates of
teen pregnancy and STDs, etc. and they say what is causing this?.then we need
to clearly communicate what is going on and why.
Dr. Carroll stated that he wants each one to have a positive attitude because
our attitudes affect those around us as being in positions of leadership. We
don?t need to go around our employees with gloom and doom. We understand the
reality of what is going on?but that is when leadership really steps in ?.we
need to be creative and work together.
Dr. Kopppanyi stated that we are going to participate in the Legislative
Luncheon scheduled for tomorrow at the Columbus Convention and Trade Center.
Dr. Koppanyi stated that each Board Member has a packet in their book which
includes details that are going to be brought forward to the Legislative group.
Dr. Koppanyi recalled that the Board of Health passed a Resolution recommending
that the Division of Public Health become a separate department. This is a very
essential situation?.and have leadership and knowledge of public health as to
what is happening in the Districts. Our system is totally different from DFCS
and Mental Health and how the services are delivered. The Governor in August,
in spite of what the four Legislative Committees recommended to establish a
separate Department of Public Health, decided that we should join the
Department of Community Health. We are very concerned about this situation,
because the Department of Community Health has really no clue on how to deliver
health care services. A few years back, the Department of Community Health took
over administration for our primary care clinics in Talbot and Webster County
and after four months they had to give them back to Public Health because they
did not know how to provide and administer clinical care.
We still believe that Public Health should be a separate department. Also, the
problem of Family Planning, the cuts are much deeper than earlier expected
because one of the things that has happened was that the DHR Commissioner
suddenly withdrew $7-1/2M of TANF funds. She has redirected these funds to
other programs. These funds have been withdrawn. These funds provided the
majority of the Teen Program and the Teen Centers funding. We are maintaining
the Columbus Teen Center here because this Board and Boards before have
believed in the need for teenage pregnancy prevention. Ms. Albritton stated
that the extra hardship is that these cuts are on top of the cuts that we were
told that we would get?in addition to the other cuts that the other departments
were taking. Dr. Koppanyi stated that a total of $683-684,000 is the total
amount of cuts. One rumored proposal is to reline the Districts and possible
save money by consolidating several Districts. Dr. Koppanyi expressed concern
how that would impact our 16 counties since our District goes all the way to
Cordele, Vienna and Georgetown, etc?.a 200 mile radius?he is the only public
health physician for the District. We provide a lot of consultations to private
practitioners; we investigate outbreaks, legal issues and other public health
matters. If you add to this, another five or ten or fifteen counties it would
be very difficult to handle everything. Mr. Saidla said that the concerns are
real according to some of the rumors that have been heard and because of
whatever reason the Governor and some others interest in perhaps of not wanting
to support Columbus as much as some other areas?that Columbus would loose being
the lead county for this area if consolidation takes place?it appears that this
consolidation would go in a different direction which would have a major
financial impact on the overall community in terms of the staff as well as the
State Program dollars that come through Columbus as the lead county. Those
funds would probably dry up and go away. One of the rumored proposals is that
LaGrange and Troup County would probably be the lead area or perhaps Albany
would be the lead for our area. Our district would be divided up. Currently the
lead counties are close enough to the other counties that they are able to
provide assistance and support. We do a lot more that just administrative
activities, we provide a lot of hands on direct service delivery from the
District. So we are concerned about losing our jobs or being shifted to
someplace else ?but most importantly?the impact that it would have on Columbus
as well as the neighboring smaller counties that we support. Ms. Dozier asked
if that would include the BioTerrorism?Mr. Saidla stated that yes?that would
impact it greatly. Dr. Koppanyi stated that the MMRS Program would continue
since it is based on the Columbus MSA and is monies that flow through the
Columbus Health Department. Our MMRS area also reaches across the river to Lee
and Russell County. We have a wonderful interstate coordination and
partnership. We also have very close ties with EMS and Fire and have been able
to do a lot for our Region. Ms. Dozier asked if LaGrange or Albany becoming
the lead would negate anything that the Board has done? Mr. Saidla stated that
it would make it a lot more complicated. Mr. Saidla stated that all of the
Districts are very concerned about the status of the districts. We have a
unique hybrid public health system in Georgia where you have the State and then
the Districts and the Counties. However, when properly funded, the Georgia
system is really the ideal public health system because it puts the services at
the grassroots level where it can best serve the community and people.
Dr. Carroll asked Pam Middleton to present the financial report to the Board.
Dr. Carroll asked if there was any other business to discuss. There being none,
the meeting was adjourned.
Respectfully submitted:
______________________________
Charlene Ellis, Secretary
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