While Independence has completed its operations overhaul with the Health Department and closed the department's building on Liberty Street, some public health advisers maintain their concern about the city's decision.

The city announced Feb. 28 it would shift certain Health Department services to other departments and discontinue some services duplicated by the Jackson County Health Department. Health Director Andrew Warlen was let go, and Mike Jackson in the Community Development Department was named acting director.

In a May 1 letter from the Missouri Public Health Association to City Manager Zach Walker (copied to Jackson, Mayor Eileen Weir, members of the city's Public Health Advisory Board and other local health officials), MPHA Vice President Bernard Malone expressed the group's “profound sense of disappointment and bewilderment” at the decision. Malone recognized the city's fiscal concerns and the need to see if any duplicated services could be reduced but said the “apparently fragmented approach” to how core health services would be handled or covered appears “ill-advised.”

The city's Public Health Advisory Board received a few hours notice before the announcement, board member Don Potts said, which probably wasn't much less than Warlen received. Besides the lack of notice and board consultation, Potts said, he like Malone said the plan seemed to ignore the City Charter.

That voter-approved document states in section 3.23, “There shall be a department of health, the director of which shall be the director of health.” That director is to have a master of public health, public health administration or equivalent-related degree, or be a physician with experience in public health administration.

Both Jackson and Special Projects Manager Christine Heinen, who will have oversight from the city manager’s office, have master’s degrees in public health. The city is continuing the charter-mandated functions – to enforce and administer state laws and city codes related to public health and sanitation, food licensing and inspections.

Given those two, Walker said, he believes city staff was still in line with the charter, adding that the reorganization was announced after much consultation with legal staff.

The changes

In all, Heinen said Monday in an update for the City Council, 18 staff members were transferred to another area in the city, an epidemiologist moved down the street to the Jackson County Department, two employees retired (one had already planned to do so) and five found jobs elsewhere. Ten vacant positions were eliminated.

With the changes, food inspections are now done out of the Community Development Department, where code enforcement already had been transferred from the Health Department a couple years earlier – part of a regulated industries division that also includes the Rental Ready program and business and liquor licensing. All the animal control officers remained and now work with the Police Department, as they often work with police officers on calls involving animals. A couple employees transferred to Parks, Recreation and Tourism as part of an expanded community and employee wellness program (the Farmers Market).

“If anything, we're making a stronger commitment to wellness,” Walker said.

Services that had been duplicated by Jackson County included immunizations, vaccinations and vital records.

The moves saved an estimated $375,000 in this year’s budget, but Walker said it was as much about helping sustain long-term financial health in the city.

Concerns

Malone, a retired deputy director of the Kansas City Health Department (the lone city health department left in the county), said he questions if the moves – citing chronic disease prevention in Parks and Recreation, for example – still leave the city with a comprehensive approach to community health.

Malone said he could have found more agreement with a similar result if the city had taken a different path.

“Had they taken a public health approach instead of an economic approach, yes,” he said.

Similarly, Potts said it’s possible the board could have reached a similar conclusion if it had been involved in prior discussions. He was pleased with the decision to have Jackson direct the transition, he added.

Walker said that because the moves involved people possibly losing jobs, he didn’t want to have a public debate beforehand.

Malone and Potts said they’re not aware of other cities in Missouri, and few elsewhere, that have essentially dissolved a health department. In many cases, a county or regional health agency serves the public.

“Some health departments have reduced dollars and services; in Missouri, many services provided are grant-funded,” Malone said, noting that Missouri has the fewest funds per capita appropriated in public health in the nation.

“We’re concerned about the future of public health in Missouri,” he said. “We’re really looking strategically at the services (across the state).”

Moving forward

Bridgette Casey, the county’s health director, said that since the announcement four months ago, her department and Independence’s staff were in regular communication. The resulting transition, she said, was “seamless” and a collaborative process between the county, Truman Medical Centers, the city and the Missouri Department of Health and Senior Services.

Thanks to additional state grant funding from the transition, Casey said her department is hiring five additional staff members. The epidemiologist filled a position that opened prior to the Independence announcement.

The county Health Department will provide reports to the Public Health Advisory Board as requested.

While Walker said he talked with some board members soon after the changes were announcement, the full board met earlier this month for the first time since those changes.

“Their overriding concern is making sure public health is still a concern,” Walker said. “They want status updates. They’ve asked provocative and thought-provoking questions.”

Potts called the meeting fairly benign, but most importantly the board will continue to meet.

“We are going ahead,” he said. “To best serve the city, we also want to check with the county, but we still have misgivings.”

“I’m hopeful,” Malone said of the Independence’s moves, “but with a healthy dose of skepticism.”