Columbus, Georgia

Georgia's First Consolidated Government

Post Office Box 1340
Columbus, Georgia, 31902-1340
(706) 653-4013
fax (706) 653-4016

Council Members

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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