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, June 27, 2007, at 1:00 P.M.
MEMBERS PRESENT:
Jim Wetherington, Mayor
James H. Sullivan, M.D.
Howard Willis, M.D.
Banks H. Carroll, M.D.
Isaiah Hugley, City Manager
MEMBERS ABSENT:
Mrs. Brenda Dozier
James A. Lawrence, D.D.S.
OTHERS PRESENT:
Ed Saidla
Margaret Gosden
Eileen Albritton
Pam Middleton
LaQuita Rogers
Cheryl Johnson
Jerome Deal
Karon Bush
Kathy Sledge- Ledger Enquirer
Dr. Sullivan asked Pam Middleton to proceed with the review of the FY2008
budget. Ms. Middleton stated that she would review the Financials. Ms. Gosden
stated that she would present the FY2008 budget discussion. Ms. Gosden stated
this budget estimate was done in January. We submitted the anticipated budget
to the City as a Funding Request. There have been a number of significant
increases passed on to us that affect where we are at this date. The
Legislature in this session, passed a 3% Performance Based Increase for
employees, but only funded part of that increase in Grant-in-Aid. They
reassigned the nursing classes to assist with the crisis in recruitment and
retention. There exist a 30+% vacancy rate; therefore we cannot compete with
the private sector. They reassigned the pay within the class but did
fund the entire cost. Finally, the Department of Community Health?s (a separate
agency) Board set the health insurance rates for both employees and the
employer share. This was done in October or November and sent to the Governor.
While employees will receive a 3% performance based salary increase if they
perform adequately, their insurance premiums will go up 10%. This makes
recruitment and retention more difficult. The major budget is an increase in
the employer?s share of 6.13%. When you apply this rate as a total payroll tax,
the effect is very large. To illustrate, if you take the financial report and
look on the front sheet, you will see that $587,922 was budgeted for health
insurance last year, for next year, $688,001 has been budgeted. So you are
talking a difference of $100,000 and when you couple that with the fact that
the Prior Year Program Income amounts vary, the difference has been made up
through Qualifying Local Funds. This is the Fund Balance we carry from year to
year. Ms. Gosden stated that thank goodness this is a large county with a lot
of different funding resources at its disposal. The small counties are in
serious trouble. There are two counties that do not have a Fund Balance to go
to, one being Talbot less than $2,000 in their Fund Balance and Schley County
less than $2,000 in their Fund Balance. Ms. Gosden stated that she presents the
FY 2008 Budget to the Board Members to inform them what measures have been
taken to address these problems thrust upon us since the budget was last
discussed in February, 2007. Be assured that the Management Team and the senior
staff here will take all measures to economize and minimize the amount of
qualifying local funds actually committed as opposed to budgeted.
Dr. Willis asked if this would mean a cut in personnel. Ms. Gosden stated that
the Talbot County Commission has given an additional $9,000 and that keeps the
health department good for another year, she is not sure about Schley County
which meets tomorrow where $8,000 is needed. The funding from the City is the
same as last fiscal year. Even though an increase was requested, we were not
granted one. Ms. Gosden stated that she had been told by Dr. Janice Carson, who
has visited this Board, it is the view of the Division and the Department, that
local public health is a local issue. If the counties want to have a health
department, the Division and the Department believe that the majority of that
funding burden needs to be shifted to the local area.
Mr. Hugley stated that his only comment was that the State can not have it
both ways. They want to introduce House Resolution 900 that says that no
advalorem tax locally will go to the local government it will all go to the
State. They want to send that money back to you and to give to you they will
send you what you got the year before. So if the advalorem tax is diverted to
the State by way of House Resolution 900, if that passes, there are concerns
with that, then you want to tell us at the same time that responsibility is
going to be a local responsibility, cannot have it both ways. Mr. Saidla and
Ms. Gosden had a brief discussion regarding this issue. Dr. Sullivan asked if
there was any legal recourse. Ms. Gosden stated that this information came to
us so late that we cannot do anything. The Master Agreement was received on
Tuesday, afternoon. Mr. Rumer is out of town. Ms. Gosden stated that she did
not have the final Grant-in-Aid figures for FY2008 until last Thursday
afternoon, at 4pm. In fact, the figures were significantly higher than what
they ended up being and we were told that it was based on Workers Compensation,
Unemployment Claims and Professional Liability Claims that had been received
from DOAS. At the point where Ms. Gosden was told this, she had already met
with twelve of the sixteen boards. Now all of those budgets must be redone. The
position is truly stated by Dr. Carson and the Commissioner ?if you all want
health departments, then the local government is going to have to pick up the
burden?. Mr. Saidla stated that they mean that they are going to provide the
health department with a certain amount of money but that the State is not
going to be the primary funder of local health departments. It is going to be
up to the local community to decide what level of public health services are
provided and what level is funded. Ms. Gosden stated there are seven health
departments in this district that are hanging on the edge.
Ms. Gosden referred to an item that was placed in the board books (asking if
the members had seen Good Morning America) referring to the CMOs /HMOs
problems. Ms. Gosden stated that the Prior Year Program Income, $100,000 less
which is a direct result of not receiving payment for Medicaid services. We
have legitimately rendered services to patients but yet they the CMO?s have not
paid us for them. Mayor Wetherington asked if anyone has spoken with the local
delegation regarding this issue. Ms. Gosden stated that they had. Mr. Saidla
stated that they have spoken with them and the City has provided a lot of
assistance also. We are really tightly controlled from the State because the
DHR falls under the Executive Branch and we have been severely restricted in
what we can even communicate as educational information to our Representatives
in terms of these particular issues. Good support has been received from the
local delegation. Dr. Willis asked how strong are these local boards in
Talbotton. In the small communities, you do not always have strong boards. The
City of Columbus under charter appoints the membership of the Board of Health.
This has always been a strong professional physician driven board. This is not
the case in small counties. They feel overwhelmed with information. It is
difficult for them at times to get quorums. Even when they are interested and
engaged in a problem, they feel helpless in pleading their case. For example:
Webster County is one of the most engaged, educated boards that we have that
know what the problems are about but they are so small, they don?t have a
voice. Mr. Saidla stated that Webster County is now looking to consolidate like
Chattahoochee County has done.
Dr. Willis stated that he wonders if it would not be important for the district
to build these boards and to have seminars to offer a retreat to let them
experience the expertise that we have and then create some board to board
liaison. Instead of Webster County being a board that stands out there, we all
stand together. Ms. Gosden stated that she and Mr. Saidla has heard over and
over they remember the joint meetings that Dr. Sullivan all called here in
Columbus when you met with the seven small boards. Probably what needs to done
is some more of that kind of activity so that they are more empowered. They do
look to this Board because we are the lead board for the District to stand up
for them. All 16 of the boards have joined the Georgia Public Health
Association and we are going to encourage attendance at the GPHA convention.
There will be board building sessions conducted there that are excellent.
Mr. Saidla stated that Dr. Koppanyi is on the committee developing education
and training for Boards. Ms. Gosden stated certainly in the event that the
small health departments have to go part-time or start sharing staff, that is
going to be a crisis to the next level size health department. When communities
begin closing down, nurses are not there five days a week, then they goes to
the next largest place. That will place a strain on Americus, Cordele places
like that, the next level size health department from the small ones.
Dr. Willis stated that he could put together a board development course if the
District wanted him to. Mr. Saidla and Ms. Gosden stated that would be great.
Ms. Gosden asked for a motion to accept the budget. A motion was made by Mayor
Wetherington, seconded by Dr. Sullivan and approved by those members present.
Dr. Carroll asked for approval for two Excused Absences for the meeting. One
for Ms. Dozier who is out of the country in China and for Dr. Lawrence who is
out of state in Florida. A motion was made by Dr. Willis, seconded by Mr.
Hugley and approved by those members present.
Dr. Carroll asked for a motion to approve the minutes of the last meeting. A
motion was made by Mr. Hugley, seconded by Dr. Sullivan and approved by those
members present.
Dr. Carroll asked Mr. Saidla for comments.
Mr. Saidla stated that in the first week of June, a two day meeting in Atlanta
was held with the DHR Commissioner and the State Public Health Staff to discuss
various issues to inform the Health Directors concerning funding issues we have
discussed today. The Health Directors have continued to try to explain the
importance of why there needs to be a local board of health and a local health
department presence in all of communities, the idea that you can shut down
small rural health departments, send a nurse out once a week or maybe every
other week, and actually expect them to be able to provide services or meet the
needs of those communities. This concept does not really work. It was explained
the importance of having that daily public health presence in the community
particularity related to Emergency Preparedness and Bio Terrorism type issues.
We need staff daily, to see people on a daily basis and to give immunizations
if you expect to have resources available when Pandemic Influenza or any other
issues come up. You must have well trained nurses who know what to do if you
actually expect to take care of the community in a crisis whether that is
pandemic, hurricane or a tornado or whatever the situation is. Mr. Saidla
stated that it is appreciated what this board continues to do to support the
efforts and certainly appreciate what the city has done to allow us the
assistance of the Delegation and the Lobbyist and others that has certainly put
our points out there that this Board had last year to the Delegation is very
important. It is apparent through many of the things that the Legislators did
during the last session; they understand many of our perils. The Legislature
actually passed the budget containing a provision to move nursing salaries to
85% of market value rather than 75% of market value as the Governor proposed.
The Governor used his line item veto and vetoed that particular provision. The
Legislator also asked questions concerning the 6.13% increase in health
insurance employers share. They felt that the increase was too high. Again, the
Governor exercised the provision to reduce the increase. He stated that this
issue was a decision only for the Department of Community Health to make.
Clearly the Legislators in many ways understand our situation. The Legislative
Study Committee met last year and came back with an excellent report which
clearly outlined the importance of our public health departments and requested
that appropriate funding be increased to provide for local health departments.
In the end of May or the first of June the Governor?s Office of Planning and
Budget sent down two individuals to interview us, spending a full day here, to
determine where Grant-in-Aid funds are used and provide an adequate answer to
the Governor?s question. Richard Young from the Governor?s office of Planning
and Budget visited Columbus interviewing Laquita Rogers, Margaret Gosden,
Eileen Albritton, Dr.Koppanyi and Mr. Saidla. They are to make a final report
back to the Governor by the end of July.
Dr. Carroll asked if there were other districts that have lead counties like
Columbus that are urban with rural counties in the same situation that Columbus
is. Ms. Gosden stated, absolutely! Dr. Carroll asked if we had communicated
with them and if there is a united front? Ms. Gosden stated this problem
involves the ring counties; not Metro, not Fulton, not Dekalb but rather
Gwinette, they are Henry, Fayette, Cobb, Douglas, Cherokee and Clayton
counties.
Ms. Gosden stated that she was not aware of the advalorem tax. Mr. Hugley
stated that House Resolution 900 is a resolution introduced by speaker
Richardson, himself, that would remove all property taxes (advalorem taxes)
from all counties and they would replace it with a 4% sales tax and a 4% flat
income tax. They would collect that money and then they would look at what your
property taxes (advalorem) are and through that 4% sales tax and 4% flat income
tax, they would provide you back in revenue what you generally or normally
would collect in advalorem taxes and so you would have no property taxes. There
are a lot of questions about this whether this is a guaranteed event; what
happens if the economy takes a decline and you are not collecting as much State
money then how would you guarantee that you can give as much as you have been
getting and if you don?t; what happens to services and what happens to some
even smaller counties depending more heavily on advalorem taxes then we do. Ms.
Gosden asked if it was a carry over from one session to the other? Mr. Hugley
stated that it was introduced the last night of this years session. Mr. Saidla
asked if it would carry over to next years session?
Dr. Carroll asked if there was any other business to bring before the Board.
Ms. Albritton stated that she wanted to remind everyone that National HIV
Testing Day is coming up soon and she asked the Board Members to be on the look
out for the TV spots advertising this.
Dr. Carroll asked if there was any other business to discuss. There being none
the meeting was adjourned.
Respectfully submitted:
______________________________________
Pam Middleton, Secretary
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