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— Dr. Brian W. Amy, State Health Officer

Public health and medical leaders throughout Mississippi wonder how lawmakers will address "the mess," as many leaders of the medical community refer to it, which has recently come to light within the State Board of Health and the State Department of Health.

Unless legislators address it, the Mississippi State Department of Health will "sunset" next year. But re-upping the agency already has required uncommon deliberation. Many believe the department and board to be "broken."

Problems related to population-based health surfaced officially a year ago, with Nov. 5, 2005, publication of PEER Report # 481 (http://www.peer.state.ms.us/481.html).

Since then, many Mississippians have referred to both Board and Department negatively, with "the mess" one of the least offensive terms. Board members and Department officials protest they simply aim to meet operational and management challenges and demands.

State health officer Dr. Brian W. Amy doggedly maintains "that public health is about people; we are in the business of customer service. The agency has set forth on an ambitious new program of setting goals, measuring results and improving our performance in the pursuit of public health excellence."

PEER, the Mississippi Legislature's Joint Committee on Performance and Evaluation), saw it differently. PEER concluded the state's once-lauded public health system no longer measured up.

The committee conducted the review in response to a citizen's complaint alleging that management decisions of the current state health officer had negatively impacted the department's operations. The requestor appealed "for investigation of conflicts of interest, deception, and lack of attention to health protection on the part of the board and the department."

The investigation continues as PEER executive director Max K. Arinder, PhD, and his agency remain involved in post-report issues related to the department and the board. They're giving extended assistance to the Senate Public Health and Welfare Committee in its multi-month-long investigation into the department and the board.

Sen. Alan Nunnelee, chairman of the Senate Public Health and Welfare Committee, convened three rounds of investigative hearings on public health in August, September and November. Two former state health officers, previous and current department employees, board members and healthcare experts testified.

They and countless others increasingly question whether and how the department and board function to meet statutory duties. Official inquiries, news reports and editorials statewide prompted development of an overwhelmingly popular public health series blog at http://forum.clarionledger.com/index.php. Hits surge toward 100,000.

Yet, despite outcries from citizens and legislators, board members at their October meeting steadfastly defended their pick of Amy as state health officer and executive director of the department. In 2002, then board members selected Amy to succeed state health officer Dr. Ed Thompson, MPH, who in October 2001 had announced his impending retirement and later became deputy director for public health practice at the nation's public health agency, the Centers for Disease Control and Prevention (CDC).

Some speculate the State Board of Health could try to salvage itself and begin to right the agency through decisive action — receiving resignations or removing management team players — at a probable Dec. 13 special meeting. With the board's next routine meeting to be Jan. 10, 2007, the December event will be a "called" meeting.

"I would much prefer that the board step up and deal with the personnel matters," said Nunnelee. "That would be in everybody's best interest.

"We will have to file legislation. Otherwise, the system will sunset.

"I am very interested in adding 'conflict' language to assure that board members have only the interest of the state as a whole and not personal conflicts in their public health policy-making role. I am also interested in the requirements for the state health officer. Now we require that individual to be a physician and have a master's degree in public health."

Nunnelee and public health advocates think new Gov. Haley Barbour-appointed board members could out-vote longtime stubborn Amy supporters to oust him.

The board in October heard Amy's quarterly report, much of which centered on how the department collects and reports the incidence of infectious diseases, particularly West Nile virus. With specific questions about arbovirus surveillance and reporting from physician members Lucius Lampton, Allen Gersh and Alfred McNair, Amy stumbled, sought assurance from agency staff in the audience, and asserted, "We always report West Nile — we understand the fine points."

McNair asked whether the department's process complies with recommendations from CDC.

Amy answered, "The board can have us collect and report whatever!"

CDC guidelines published in 2003 assert that "appropriate and timely response to surveillance data is the key to preventing human and animal disease associated with WNV and other arboviruses. That response must include effective mosquito control and public education without delay."

Gersh, apparently disgruntled with the department's actions related to surveillance and reporting, said, "I think you've dropped the ball on this."

Immediately after Amy's and the administrative, financial and personnel reports, board members voted to close the session to discuss issues related to employees Jim Horne, Albert Brown, and Amy.

After some three hours in executive session, chairwoman Mary Kim Smith announced the board voted to advise the state health officer of significant concerns regarding the direction of the agency.

Smith said the board expects Amy to deliver a written plan of corrective action at a special Dec. 13 meeting. The anticipated plan, she said, should address reporting of communicable diseases, communications both internal and external, environmental health issues, management and general morale.

The board's focus resembles that of the 2005 PEER report, which cited problems with organizational structure, operational and statutory accountability, communications and an epidemiological function that "has lost much of its public health knowledge base and experience due to a reduction in the number of staff positions, departure of experienced employees, and changes in the communication flow between the central office and field staff. The loss of experienced and key staff in other departmental areas has compromised the agency's ability to deliver services and improve performance."

PEER concluded that "the management team has also restricted traditional professional channels of communication and relationships with external information sources and with public health providers, a situation that could affect the staff's ability to promote and protect public health."

PEER also found that, "contrary to requirements of state law, the State Health Officer has made district administrators, who are not licensed physicians, responsible for directing public health programs at the district level and has relegated district health officers to the role of medical consultants."


December 2006

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