Hill County Health Department still waiting on ARPA funds

The Hill County Board of Health had a heated quarterly meeting Wednesday, with Public Health Director Kim Berg once again asking the county for the American Rescue Plan Act funds they need to keep their department afloat, with no clear indication that they would get that money despite the commission having voted to allocate it months ago.

In September the commission voted to allocate up to $100,000 in ARPA money to the department so they could pay for the extreme amount of contact tracing and case investigation they are faced with amid the COVID-19 pandemic in the community, but Hill County Commissioner Mark Peterson said in Wednesday's meeting that he hasn't signed any documents authorizing the department to use the money the commission voted to allocate them last year.

Berg, also the county health officer, said in a meeting back in August of last year that her department received no funds from the American Rescue Plan Act, which she said could have been used to bolster her department and keep it sustainable had the Hill County Commission allocated it.

Berg said she had reached out multiple times by email asking for funds to keep the department sustainable along with suggestions about holding public meetings on the subject, but received no reply.

When she saw in the Havre Daily News that the commission was talking about how to use the money, she said, she reached out again to ask why no funds were being allocated to public health given the fact that the pandemic was still ongoing but received no answer beyond that the commission's primary use for the funds was the Milk River Levee project.

After the commissioners voted to allocate the ARPA money to the department, she said at Wednesday's meeting, she asked Hill County Clerk and Recorder Sue Armstrong what she would need to do to get access to that money, and was told to provide the necessary documents, which she did, but was later told that the commission wouldn't sign off on the money because they believed she already had enough money.

"I don't think that ever got stated that way," Hill County Commissioner Diane McLean said.

However Peterson and McLean's hesitance to give the department the money they voted to allocate them was entirely based around recent budget adjustment and grants the department received, which they said calls into question whether the department needs the money.

A number of grants and budget adjustments were brought up, but Berg said they all pay for specific positions and programs, and none address the issues she needs the ARPA money for, namely paying her employees for their work.

Berg said the grants she has access to apply only to new hires of contract tracers and case investigators, which she doesn't have, not for the people who have been working nonstop since the pandemic began and have been being compensated with county general funds because she doesn't have the ARPA dollars necessary to pay them.

McLean said the commission has a lot of grants and budget amendments going through their office and they don't have a clear understanding of what all of them do, but Berg asked them why they didn't get in touch with her to ask about them if they were unsure.

"You do know how to get ahold of me," Berg said.

Peterson said the commission doesn't want to just throw money around and they want to make sure they're being good stewards of the ARPA money.

He said they would set up a meeting between the commission and Berg to get their questions answered and Berg asked to have the clerk and recorder there.

She impressed upon the commission the urgency with which they need the money to pay for the extreme amount of work that needs to be done amid the massive surge in cases in the county.

"I can't anticipate what this pandemic is going to do, and it's very important work that needs to be done," she said.

Board Vice-Chair Erica McKeon-Hanson said the county needs to help the health department do their job amid the surge of COVID-19 in the community, but no commitment was made to do anything other than hold another meeting.

Staffing and pay issues

While the lack of ARPA dollars was the biggest subject of conversation at the meeting Berg also discussed another issue the department is facing, a lack of staffing due to low pay.

Berg said they have three full-time positions, one of which will probably never get filled, because she doesn't have the funding to attract anyone to it.

"We're not seeing any applicants and we need help," she said.

The primary reason Berg pointed to for this lack of applications is the offered pay for these positions which she said is so low it is effectively an insult to potential applicants that worked hard for their degrees and have bills to pay.

"It's a slap to the face to a nurse to offer them $20 an hour after all their training," she said.

Berg said the pay Hill County is offering for these positions is below average even when compared to counties of comparable size and when someone can go to Cascade County where the cost of living is only 7 percent higher than Hill County and get twice as much for the same job it's hard to attract anyone.

Disease Intervention Specialist Brandi Williams said graduated nurses have student loan debt to pay off and she's already talked to newly graduated nurses from Montana State University-Northern who say the family planning coordinator position the department is trying to hire for doesn't have a livable wage.

Williams said she wouldn't feel comfortable hiring them even if they were interested, saying it would be wrong to take advantage of their naiveté.

Berg said the department is so short-taffed, due in no small part to this lack of pay, that she needed to install a bell at the front desk since no one has time to sit there.

Williams and WIC Coordinator Nicole Hungerford said having so few staff for things like ensuring access to birth control, prenatal care and safe sex education will have a massive negative effects on the community, effects that will cost the county money in the long term.

McKeon-Hanson echoed that sentiment, saying the knock-on effect of an understaffed health department will be felt in the community.

Berg said public health isn't about money, and she knows they will never be able to offer the same as Northern Montana Health Care or Bullhook Community Health Center, but the department just can't compete with them at their levels of pay.

Peterson said every department is having staffing issues, something Berg acknowledged minutes before, and there's only enough money to go around, saying the only options are to ask the tax payers for more, or lay off staff to pay for it.

"There are some things you just don't have control over," he said.

Berg said the county could hire a contractor to reevaluate how the county spends money, find inefficiencies and help them realign their budgets to allow for raises. She said Gallatin County did just that recently.

Peterson said he doesn't see any inefficiencies to address.

COVID-19 surge continues

All of this comes as the county is experiencing an unprecedented surge in COVID-19 cases.

Berg said, as of last Friday, 59 percent of the county's eligible population is fully vaccinated and 65 percent has at least one dose.

She said the department is trying to maintain a schedule of a few days a week where vaccination is available at the department, especially Wednesdays, but they sometimes have to work around the schedule of their immunization nurse, who is not always available.

She said they are also shifting their approach to contact tracing and case investigation at the advice of the Association of State and Territorial Health Officials as well as the Montana Department of Public Health and Hunan Services, opting to use an online platform, which will hopefully lighten the department's workload.

She said more information on this system would be available down the line, but it should help the department.

Berg said the state is also making an effort to coordinate with the county to improve the state's case tracking system which will hopefully lead to a more up-to-date state tracking map.

When the subject of testing came up, McLean asked if there were any efforts by the department to increase access to antibody testing. Berg said no, but people could probably get one through their primary care provider if they ask for it.

Berg said antibody tests aren't being used much any more because they don't tell people if they have an active infection, just that you may have had COVID-19 at some point.

Possible update to interlocal agreement and board structure

The board also discussed possibly updating their interlocal agreement with the city of Havre to better fit within state statute.

Berg said the current interlocal agreement was written in 1981 and basically says the board can do whatever it wants as long as it keeps the city informed about it, and the document barely qualifies as an interlocal agreement.

McLean said the agreement is indefinite and can only be discontinued by mutual agreement between the county and city.

Berg said recent law changes by the Montana Legislature limit the duration of interlocal agreements to five years, and they need to renew it.

She said she also wants some kind of representation from the city on the board because their work affects people in the city so much and she feels they need a say in decisions as part of a city-county health board.

"Throughout the pandemic there were a lot of decisions made that affected a lot of business in the city, and the city really had no voice in it," she said.

McLean said, according to the law she read the formation of a city-county health board is completely optional, but Berg said a city the size of Havre is required by law either to have its own board or be part of city-county board anyway, so restructuring makes sense.

The board decided to get in touch with the city about it and wait on any efforts to restructure until the interlocal agreement is discussed.

Recent mandate developments

At the meeting, Hill County Attorney Lacey Lincoln also provided an update on how recent efforts by the federal government to implement vaccine mandates on workers are affecting Hill County.

She said the recent intervention of courts blocking an Occupational Safety and Health Administration rule that would mandate vaccines for businesses with over 100 employees has allowed Hill County to maintain the status quo, but the court's opinion indicates that OSHA could create a more narrow rule that would be legal, and she suspects they will try to do just that.

She said the county doesn't have any county-run health care facilities so the rule that Medicare- and Medicaid-funded facilities must require vaccination doesn't affect the county.

Bullhook Community Health Center CEO Kyndra Hall, now a member of the board of health as well, said Bullhook Community Health Center's workforce is more than 90 percent vaccinated so it won't affect much of their staff.

McLean spreads COVID-19 misinformation

Wednesday's meeting capped off with a lengthy public comment made by McLean, one filled with vaccine misinformation, conspiratorial accusations and criticisms of public health that were refuted by Berg and her associates.

McLean said she was making her remarks as a member of the public, not as a commissioner or health board member, and focused her remarks around the promotion of vaccines, which she said, incorrectly, were being promoted by public health and the media to the exclusion of all other things.

Along with promoting unverifiable stories about the supposed side effects of the vaccine, she said, again incorrectly, that it doesn't work on the omicron variant of the virus, currently the dominant strain in the U.S.

Berg said, while vaccinated people are getting the omicron variant, they are not getting nearly as sick, or being hospitalized and dying at the same rate as the unvaccinated.

Williams criticized the way McLean evaluates her sources of information, encouraging her to be more careful when looking for reliable sources.

"Frankly, Diane, I see what you share when you read your things on Facebook and in the news that you see, and those are not citing peer-reviewed scientific studies," she said.

Berg and her colleagues said information needs to come from reliable scientific sources an presented in context otherwise it could be misleading.

Berg and her colleagues also took issue with McLean saying public health in general is not promoting healthy lifestyle choices like diet and exercise, saying that people with conditions like diabetes and obesity are at higher risk of getting sicker when they contract COVID-19, comparing them unfavorably to public health in third world countries.

"We do that, Diane," Berg said.

Williams and Berg said promoting things like that are an integral part of what public health does and those efforts have never stopped.

They said WIC Coordinator Nicole Hungerford, who was present at the meeting, does that on a daily basis, and even if McLean meant her comments to refer to public health generally, having them made in front of people like Hungerford makes them direct accusations.

Williams also said public health cannot make recommendations for people regarding treatment as it is out of their scope of care.

She said treatment is a discussion for individual health care providers.

"Good luck getting in to have that conversation, though, because our health care system is so inundated with cases because people are not getting vaccinated," she said.

Public health nationwide has been promoting ways to stay healthy amid the pandemic, but has stressed that none of these things are a replacement for vaccination which is and has been the best preventative tool they have against the virus, as it keeps people from getting extremely sick, being hospitalized and dying.

Vaccines also cut down on transmission, which leads to less opportunities for the virus to mutate, and less variants.

McLean also complained about how public schools use their COVID-19 relief funds, something public health has no control over, a fact that Berg and her colleagues pointed out.

Peterson eventually attempted to intervene and stop McLean's speech with little success.

McLean eventually criticized public health for how it uses its COVID-19 relief money and Berg said she has repeatedly suggested that the county do a survey to get community input on what they want COVID-19 money to be spent and she's never been responded to.

McKeon-Hanson said the department is doing great preventative work, and that's why they need to be fully staffed and supported.

She said one of the greatest threats to public health right now is misinformation, the spread of which has serious repercussions.

She said she hopes everyone in the room remembered that and makes sure the information they're using is reliable.

A farewell to Kristi Kline

During the meeting members of the health board also said their farewells to former board member Kristi Kline, who said in a letter to the board that at this time her workload makes the prospect of another term impractical.

Kline's letter said she values the work of public health for the people of Hill County and she will continue her advocacy for their cause.

She said she looks forward to the board making forward progress toward a more healthy community.

Kline had served since 1997, and Peterson said her valuable service to the community will be missed.

McKeon-Hanson said Kline was extremely helpful to her in the early days of her time on the board and wishes her the best.

Kline's seat is now occupied by Hall who was also elected as the board's new secretary.