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Interim State Health Officer Dr. Ed Thompson said just before the August Board of Health meeting that he’s “not glad I had to come back, but I’m glad I can be” of assistance to help restore integrity and credibility to Mississippi’s public health system.

Having returned in July as the proverbial valiant soldier on the white horse, he has “put spurs to the process” and “hopes to be gone before the end of this year. I expect to be here four or five months, but would rather have four than five.” Thompson said a company representative will take part in an August meeting concerning the permanent State Health Officer (SHO) recruitment firm, Korn/Ferry — based in some 69 offices across North America, Europe, Asia/Pacific and Latin America. With a clear indication of required and desired experience and work qualifications from the Board, the firm is expected to work quickly to advance the employment process.

Thompson, also chair of the Department of Preventive Medicine at the University of Mississippi Medical Center (UMC), said public health workers are ready to have “a real public health doc” back at the helm for the long haul. He spent his first month doing what a good epidemiologist does: fact-finding and analysis. In presenting those findings to Board members on Aug. 8, Thompson admitted the report covers points that surprised even him.

“I knew about the Senate hearings in 2006 and had read news accounts,” the interim SHO said. “But now I’m seeing what was going on–seeing the reality of it all, and I’m surprised at the extent of the shut-off of communications, even among the Department’s own employees!”

As Thompson met and talked with employees both in the central office at Jackson and in several county and district sites statewide, he heard a resounding call for the same two items: a current telephone list and “our names and faces back.” Some individuals had even laminated tattered papers with phone numbers and names by organizational unit, latest published in 2003.

“It’s worth noting,” said Thompson, “that the agency has been working with at least three organizational charts: the one last approved by the previous Board; the one proposed but not approved by the Board in December 2006; and a third that indicates the way they were actually working. We ask the Board to approve that existing ‘working’ structure as the least disruptive for now, and we’ll publish whatever they approve; employees haven’t seen an organization chart in some four years!”

Beyond phone lists and organizational charts, history also will reveal a gap in official minutes that otherwise would reflect public health activities from Sept. 25, 2006, through July 2, 2007.

The now-defunct Board of Health in place after approval of the September 25, 2006, minutes failed to act beyond a Dec. 13, 2006, “called” meeting to hear then State Health Officer Brian Amy’s “plan for corrective action.” Only four Board members attended a Jan. 11, 2007, meeting, which then Chair Mary Kim Smith moved from the traditional second Wednesday to Thursday. Lacking a quorum, members present could not legally approve minutes from December’s session.

Smith failed to call another meeting, so most of the other Board members did — for Feb. 2, 2007. They aimed to call for the battle-scarred Amy to step down but, on advice from the Office of the Attorney General, took no action and adjourned. Before the split Board could even attempt another meeting, the Legislature “sunsetted” that Board, dissolved the State Health Officer position, and provided for reconstitution of a Board of Health and State Health Officer for the beginning of fiscal year (FY) 2008.

Thompson said the current Board cannot approve minutes of a group that no longer exists; so they themselves must review the regulatory actions that would have been recorded and take appropriate action now. He said the dozen-and-a-half proposals, adoptions, revisions, recommendations, and appointments fall under a new “consent agenda” process. Revisited and new items without controversy can be expeditiously handled yet allow sufficient time for discussion of issues that catch a Board member’s, industry group, or individual’s attention.

August items included health planning, health facilities licensure, environmental health, communicable disease, vital records, and professional licensure.

The “regular agenda” covered health planning, environmental health, and emergency planning and response proposals.

Thompson’s report covered his second-found, resonant theme from employees: “I was amazed at the copies of the ‘Faces of Mississippi’ logo that had been hidden away for four years and have suddenly re-emerged. The faces are back as officially adopted by the Board in 2000 for both the Department brand and the Board’s official seal. Without spending a lot of money, we can and have made a big difference to our employees. And we’ll update and provide a new phone list every month.”

Communication, Health Indicators, Resources
Primary big ticket issues involve communications, health indicators, and fiscal and human resources, Thompson reported.

“A big problem I already knew about was that the agency had not provided information to the public on public health issues,” Thompson admitted. “The first day, I pulled [the communications function] back under the State Health Officer and began to reposition the agency as a credible voice for public health. It really doesn’t cost money to tell the truth and to tell the public what’s going on!”

Even though the Department of Health has had written communications policies since 1980, Thompson said one of his first actions was to “establish a policy to flow information out to the public.”

“We reported confirmed and probable diseases, established a protocol for West Nile virus cases, and reinstituted timely publication of disease reports,” he said. “The reportable diseases registry is being published within two weeks of the end of every month, and we’ve reached an agreement with the Board of Medical Licensure so they will e-mail the Morbidity and Mortality Report, with a brief explanation of the statistics, to licensed physicians statewide every month. We’re beginning to once again get information into the hands of people who need it.”

Critically important health indicators–dramatic increases in the infant mortality rate, tuberculosis cases up after 15 years of decline, and sharp increases in primary and secondary syphilis–cannot continue without significant attention and intervention, Thompson said.

“Specific health indicators are a problem, but the enormous underlying problem continues to be that the field staff has been allowed to decline to dangerously low levels–insufficient to meet our mission,” he warned. “As one example, five years ago, we had 66 disease intervention specialists working; now we have 34.”

Trying to put a positive spin on bad news, Thompson said that “figuring out how to fix it is more important than looking back to see how and who allowed it to happen.”

Solutions
Thompson aims to repair damages with infusions of new state money―a $16 million request for funds having been submitted in the August 1 budget proposal to the Legislative Budget Office.

Thompson himself intends to present the request in September to the Joint Legislative Committee, emphasizing that 99 percent of that request is earmarked for counties and districts — 87 percent for direct-care positions and 12 percent for support staff–and only 1 percent for the central office. The $16 million in state funding comprises only about 15 to 20 percent of the Department’s whole budget, the bulk coming from federal grants and fees.

If appropriated, that money could become available in July 2008–but not soon enough to turn the tide against rampant disease outbreaks and too many babies’ dying before their first birthday.

“We might divert some resources from the central office to the field,” Thompson said, thoughtfully. “Much of the bloated bureaucracy [that emerged during the previous administration] collapsed of its own weight. Nobody remains in what was called the Office of Decision Science. We can eliminate a few central office positions and re-fund some important positions. We can shift nursing posts to fill critical gaps and hire three or four new disease investigators. Where we can, we’ll take central office dollars to the field.”

The State Personnel Board, he said, OK’d salary realignments for nurses’ aides, clerks, and some social workers, but the Department did not have money to implement the upgrades.

Yet another “glaring problem,” Thompson pointed out, is that the “public health laboratory desperately needs to be replaced — the time is long past to do that.”

Legislators in the 2006 session approved a bond bill to construct the new lab; the Department spent “hundreds of thousands of dollars on planning,” Thompson said. But the previous management team’s scheme to repay the bond money fell short, stopping the release of any bond aid.

“This year,” Thompson promised, “we’ll advance an honest appraisal for paying. But, in reality, this much-needed public facility will have to be built with public funds. Construction should have started two years ago.”

Outside Insight
“I think our Chair should be our primary spokesperson for the Board,” offered Dr. J. Edward Hill of Tupelo. “However, [with Dr. Lampton away this week], I have been very impressed and encouraged by anecdotal encounters with Mississippi State Department of Health employees who express thanks to the new Board and pleasure with the interim SHO, with several telling me that morale at the health department has improved greatly.”

Daily discussion on the Clarion-Ledger-sponsored “public health series” forum (see http://forum.clarionledger.com/viewtopic.php?t=33) shows that posters share mixed thoughts and feelings about “the renewed efforts to restore public health.” Many applaud positive changes yet deplore the thought that the Department continues to be top-heavy with still-in-place-from-the-Amy-regime incompetent staff in key management positions; they pledge ongoing contributions to the “rebuilding,” both as constant observers and advocacy participants.

Shannan Parker, formerly of Tylertown and now living out-of-state, planned to be in Jackson for the August meeting: “Hubby and I have already taken the days off ... Aug. 8 is the four-year anniversary of the day my son contracted S. typhi. VERY important day for this family! The grading system will again be brought before the Board. . . I met with Ed Thompson a couple weeks ago and really did get a wonderful feeling for his plans. Rome wasn’t built in a day and the Mississippi Department of Health will not recover from Amy’s damage overnight either. Doctor Thompson’s a good person... I have to believe that in my heart.”

In an October 2006 post, “Shannan” told her personal story: “Three years ago my then three-year-old son contracted a near fatal case of Salmonella typhi from a restaurant in Pike County. The bacteria traveled into his intestines and caused his intestines to literally turn inside themselves as his body digested them (an intussusception). He required an emergency surgery on August 11, 2003, to save his life, just three weeks before his fourth birthday.

“My son suffers from stomach spasms, horrible pains that leave him rolling on the ground unable to stand until they pass or his meds kick in,” she revealed. “This is only one of the little reminders he was left with, though; his doctors have made it all too clear that only time will show us the full extent of the damage done to his little body.”

Recalling the emotional toll, Parker said she contacted the health department several times over the next few months, “requesting an inspection of the restaurant I believed responsible for my son’s illness. I called the Pike branch several times each. I asked nicely, completed all the proper forms and once even sat in their parking lot crying, begging the manager of that department to inspect the restaurant and allow me to see the inspections and complaints ... it wasn’t inspected until six months later.”

Months passed, with Parker attempting communication with public health officials but getting no answer.

At last summer’s Senate Public Health Committee hearings, she said, “I nearly became ill hearing [MSDH Health Protection Director] Jim Craig’s testimony. My son nearly died from food contamination. Do you have any idea how it feels to realize that many restaurants are passed without even being inspected? How about knowing that a restaurant with 12 critical violations was allowed to remain open so that the health department wouldn’t upset one of their customers?”

Proposed modification to food protection regulations have been on the Board’s table for nearly a year, with former and current member Dr. Kelly Segars pushing for reform, holding to the USDA Food Code, but also establishing a scoring system of A, B and C so the public can more clearly know and understand any food service establishment’s inspection result and status in regard to Hazard Analysis And Critical Control Point (see www.fsis.usda.gov/Science/Hazard_Analysis_&_Pathogen_Reduction/index.asp).

As both Board and Department employees address such life-threatening issues and try to re-establish an organization that “protects, not neglects” public health, Thompson promises candid, continuing communications based on sound public health science: “If any Board member during my interim calls a cardboard box a septic tank,” he said, “it’s still a cardboard box!”



September 2007