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— Dr. J. Edward Hill, Mississippi State Department of Health

"Once all this is ironed out, I think the Mississippi State Department of Health board of directors needs to go out and look for a very objective evaluation of the entire Mississippi public health system," advised Dr. J. Edward Hill, appointed to the board in July 2006. Most board members chose Hill at their February 2 meeting to be the official spokesperson for their body.

A family physician from Tupelo, Hill was elected three times to the American

Medical Association (AMA) board of trustees and ascended to chair in 2002. He was elected president-elect in June 2004 and assumed the presidency in June 2005.

"Getting an outside, objective analysis won't be hard to do," Hill affirmed. "The Association of State and Territorial Health Officials have an enormous array of materials and expertise that could be invaluable and apolitical to help restore the trust and credibility of the Health Department."

Politics must be removed from the management of public health, emphasized Hill.

"I'm not so naive to think we can accomplish that totally, but to some degree we must," he said. "The future does concern me; we need a rolling — and by that, I mean evaluated every year and updated as needed based on changing conditions — three-to-five-year strategic plan."

After reviewing a PEER (Performance Evaluation and Expenditure Review) committee report and listening to 30 hours of Senate testimony about problems riddling the state health department, "there's no question we need leadership," said Hill. "This is not a management issue — managers are a dime a dozen — but a leadership problem. Jim Hunter wrote that you don't manage Marines into battle; you lead them!"

Hill's additional concerns center on board members' conflicts of interest. "They shouldn't even exist," he said. "I'd prefer to have people on the board without conflicts and have advisers from the various stakeholders. Another issue is board development. Other organizations work with their board members so they understand their role and improve their ability to oversee the work of the administrative officer they hire."

Multiple reorganizations of the state health department, a bloated top-management tier at headquarters, a dwindling workforce at the local level statewide, and dramatic increases in infectious diseases became the norm after the retirement in December 2002 of former State Health Officer Dr. Ed Thompson. Critics blame Dr. Brian Amy, state health officer since Thompson's departure, and the divided state board of health for broad-based public dissatisfaction of state health department operations.

"How do we go back?" asked Myrtis Franke of Gulfport, chairman of the board of trustees for Memorial Hospital and a member of the state board of health from 1996 through June 30, 2002. "Everything has changed so much. We need an Alton Cobb (nationally acclaimed state health officer from 1973 to 1992) to come back in and put the organization back together again."

Her appraisal of Amy as state health officer has dropped from "the right thing" to "appalling."

Public health advocates question whether the state board of health, Mississippi lawmakers, or the courts will decide the future of public health in Mississippi.

At press time for this edition, the Senate had passed SB 2764 to sunset the state health department and wipe out the current state board of health after June 30, reducing the number of a revamped board's new members to seven, yet allowing any board member to be reappointed. That bill would cut the current state health officer's salary from $213,315 to $1 per year, sunset the position on June 30, and allow the governor to appoint a new state health officer from three candidates submitted by state board of health members. The Senate would get confirmation authority. Potential new board members would have the authority to fire the director and would be required to abide by stricter conflict-of-interest rules.

The House of Representatives had taken no action but had expressed steadfast resolve not to allow gubernatorial appointment. Some House leaders also suggested disagreement with other specifics of SB 2764.

The state health officer presented his "plan for corrective action" in December, but the board refused to approve that "go forward" plan. Some members wanted to remove him from office that day, but on a 7-to-5 vote failed to oust him.

Only four board members attended the Jan. 11 meeting, which chairperson Mary Kim Smith moved unexpectedly from the traditional second Wednesday to Thursday. Lacking a quorum, but in a conference room filled with concerned citizens, reporters, and about two dozen public health workers from Jackson, the Hattiesburg area, and the Gulf Coast, Smith renamed the meeting a "Gulf Coast Public Health Summit." She attempted validation of the session with a mention of the board's "obligation to come to the coast to check on our brothers and sisters after the devastation of Hurricane Katrina."

Three physicians unable to attend told Smith the Gulfport meeting "was inappropriately rescheduled, without adequate notice."
"We also have concern that the meeting was rescheduled by the chair with the intent to manipulate the votes and actions by the board," wrote H. Allen Gersh of Hattiesburg, Lucius Lampton of Magnolia, and Kelly Segars of Iuka. "We would like the chair to schedule a special meeting in the near future with an attempt to get all of the board members present to deal with the many problems at the Department of Health. We also respectfully ask that Dr. Amy neither proceed with any major restructuring of the department nor engage in the dismissal of any senior employees until he receives the mandate of the full board."

Smith declined to call another meeting, so a majority of board members did — for Feb. 2. One of those members, Lampton said it was "past time for Dr. Amy to step down. With all that has happened, he will be unable to fix the department's problems."

Not only did Amy not resign, he hired a lawyer and secured a temporary restraining order to prevent the board from taking action regarding his employment status. The seven members who met aimed to decide the fate of Amy. But on advice from the attorney general's office, they adjourned without taking action. They plan to reconvene on Feb. 28.

Before a local report from Coastal Plains Public Health District IX Health Officer Dr. Robert Travnicek at the Gulfport meeting in January, Franke addressed the board: "On behalf of myself personally and the board of supervisors, I am pleased to express appreciation to Dr. Travnicek and his staff for all the work they have done before, during, and since Hurricane Katrina. He has done an awesome job despite people who would have liked him to fail."

Among other work assignments on the board of health, Franke chaired the search committee to recruit a replacement upon Thompson's retirement at the end of 2002. Travnicek was on the short list of candidates.

Dr. Allen Gersh, among current board members who called the February 2006 special meeting, was board of health chairperson when Thompson indicated his plan to retire. Minutes of that October 10, 2001 meeting show Gersh's intent to "set up a search committee to select a search firm to assist in finding Dr. Thompson's replacement."

As chairperson of the search committee and at a special session on March 14, 2002, Franke presented three search firms for the board's consideration: The Pace Group in Tupelo; Physician Executive Management Center in Tampa, Fla.; and HPI in Phoenix, Az.

John Lovorn with The Pace Group — whose experience in economic development and familiarity with state government included having recruited then Gov. Ronnie Musgrove's appointee as director of the state's economic development department — told the board he could present three to five candidates by May 3, with May 10 set as an interview date. On the search committee's recommendation, the board chose The Pace Group to conduct the search.

Lovorn presented three candidates:

· Dr. Brian Amy of Abbeville, La., an LSU medicine graduate and former surgeon with only three years of public health experience at the regional level in Louisiana and two master's degrees from Tulane University School of Public Health and Tropical Medicine;

· Dr. Robert Travnicek, who earned his medical degree from the University of Nebraska and master's of public health degree in health policy and management from Harvard School of Public Health. He also offered 14 years' work in public health systems and 21 years in the private practice of family medicine;

· Dr. Martin P. Wasserman of Ellicott City, Md., an honors graduate of the University of Maryland School of Law and MD graduate of Johns Hopkins University School of Medicine, who had worked a year as administrator of the Oregon State Division of Health, five years as secretary of the Maryland Department of Health and Mental Hygiene, seven years as a local health officer in Maryland, and nine years as director of the Virginia Department of Health and Human Services.

Franke said The Pace Group designed the May 16-17, 2002, candidate presentation process so that every board member would have ample opportunity to "know" the candidates through their curriculum vitae, through social interaction at breakfasts, lunches, and dinners, and through interviews with each, using the same 26 questions for all.

For this report, Franke said all three candidates "were equal. The Board made the decision that we believed was the right choice at that time." She said Amy's personality won the votes of most board members, and they worked until all could agree unanimously.

How does she evaluate Amy's performance? "I'm appalled now," she said. "I have a real passion for public health, but everything has become too politicized. We need both the board and the department to consider policies best for the whole state, not for specific instances or certain people; we need honor and integrity."


March 2007

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