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Some two years after the Mississippi Joint Legislative watchdog agency critically reported on a two-year investigation into public health, Senate Public Health Chairman Alan Nunnelee said the worst problem has been fixed and he expects to see positive results by July 2008.

Mississippi Joint Committee on Performance Evaluation and Expenditure Review (PEER) released “a limited management review of the [Mississippi State] Department of Health” in November 2005. Afterward, print and broadcast journalists statewide delved into the details of the scathing report. A three-month series of Senate Public Health Committee hearings in 2006 revealed huge holes in public health credibility and services — as well as a science-based prediction of bigger problems to come.

During the 2007 Legislative session and under Nunnelee’s leadership, with cooperation of House Public Health Chairman Steve Holland, legislators rewrote administration portions of public health statutes.

Nunnelee reported: “We took care of one of the worst problems, the potential conflicts of interest among board members. What we have now is a significant improvement.

“To completely revise the Board of Health and get a new management team in place was a major undertaking. The new law was just implemented July 1; we should not expect to see immediate restoration because the problems are so severe. I am elated with the new Board and a good management team, particularly Dr. Ed Thompson as interim State Health Officer and Dr. Mary Currier as interim state epidemiologist.”

Thompson was state epidemiologist from 1983 until he became State Health Officer in 1993; Currier followed as state epidemiologist, a position she held until she joined the faculty at University of Mississippi Medical Center (UMC). Thompson retired in late 2002, becoming deputy director for public health practice at the Centers for Disease Control and Prevention in Atlanta.

They and numerous fellow Mississippi State Department of Health (MSDH) workers, many retirement-eligible, left a conflicted policy-making board and new, threatening, and unproven management team. PEER said the ensuing loss compromised the department’s ability to deliver services and improve performance. Specifically, PEER cited a diminished “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.” PEER said the factors “compromised the department’s ability to deliver services and improve performance.”

PEER said in the 2005 report, “management decisions of the current State Health Officer, who assumed the office in October 2002, have negatively impacted the department’s operations.”

Then State Health Officer Dr. Brian W. Amy had reorganized the historically stable department four times within months, creating “confusion among the staff members, including several key staff members expected to implement the changes, concerning their roles and responsibilities and the reasons for the changes.”

From investigative news reporters, Mississippi learned that under Amy the number of employees making more than $100,000 grew from two to 15. Those making more than $70,000 a year rose from 36 to 51 from 2002 to FY 2006, and Amy added two positions at more than $90,000 a year.

“Meanwhile,” reported The Clarion-Ledger, “salaries of those doing the work have stagnated. While the department has lost nurses and inspectors hired to keep Mississippi’s food and water safe, Amy’s salary has also increased so that he now earns more than $188,057 - almost $66,000 more than Gov. Barbour.”

By February 2007, Amy’s salary had jumped to $213,315 the highest-paid non-education official in the state.

Editorials commented that services for children also declined: “In 2002, 76,710 children received services at state health clinics, dropping to 56,736 by 2005. Clinic sessions in the Children’s Medical Program dropped from 650 to 234. The number of pregnant women served declined from 11,500 to 7,750 [with] “little accountability. Amy generally refuses to talk to the public. Notice he is not quoted in the series. This should be the most transparent, open agency in government, but it has become a fortress.”

Nunnelee, named Senate Public Health Chairman in 2004, had noted problems surrounding an inside-the-Department of Health unit called the Infant Mortality Task Force, a body created in an earlier session to study and recommend ways to improve infant mortality status.

Nunnelee recalled, “In 2004, the task force was scheduled to sunset. When I looked at the task force, its meetings, and results, I learned that the task force had not met in several years. Even though the task force was scheduled to sunset, politically, it’s difficult to sunset such a group; so I agreed to extend the repealer for a year with a strong recommendation to the Department of Health that the task force become active and show some results.

“In 2005,” he said, “the Infant Mortality Task Force still had not met; again I was ready to sunset it but decided to give a stronger admonition that we expected work and results.

“In 2006, they still had not met — I was furious,” he admitted, “and I did allow the task force to sunset. But we established the Child Death Review Panel and moved it to the Department of Public Safety; it’s been functioning well since July 2006 and making recommendations; now DPS wants the Panel to be moved back to the Department of Health.”

That experience, learning that “other groups also had not been allowed to function ― serious problems!” and calls for help from public health advocates prompted Nunnelee to take leadership action. In August, September, and October, 2006, he and fellow committee members conducted public hearings about public health policies and practices. Admittedly somewhat uncomfortable in a role other than “peacemaker,” Nunnelee and others soon saw “enormous problems within and among State Board of Health members and in Mississippi State Department of Health (MSDH) organizational structure and management.”

Efforts to negotiate change with the board then in place and to mitigate the problems fell short; so he and other legislators once again allowed the “sunset law” to kick in. Legislation in the 2007 session eliminated the previous board, deleted the state health officer position, and prescribed new direction for a revamped board and Department of Health.

The reconstituted board met July 2, recalled former State Health Officer Dr. Ed Thompson as interim director, and promised — as articulated by board member Dr. Ed Hill of Tupelo — “to be diligent, prudent, and very professional in actions and strive for complete transparency in our oversight responsibilities as well as any potential conflict of interest. We want to re-establish a solid sense of credibility and respect from the public and would ask the employees of the Department of Health for patience as well as trust as we begin our work. We must earn that trust as quickly as possible. From the medical community, we would ask for support and even help if they were called upon to assist our efforts.” Thompson immediately seized the opportunity to once again speak for public health in Mississippi.

PEER had recommended the “management team should examine the effects of its restrictions on staff communications, including the flow of data from the field to central office staff and the flow of advice and direction from the central office to the field.

The Department of Health should evaluate the content, frequency, and means of distribution of information on public health trends (e.g., the morbidity report) and determine how to get this information into the hands of practitioners.”

Taking the interim post and keeping his job as chairman of the Department of Preventive Medicine at UMC, Thompson admitted having known that “the agency had not provided information to the public on public health issues. 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 so, the current communications office pays about $450,000 in staff salaries and at least another $200,000-plus to vendors of communications-related contracts. In FY 2007, the department paid Widmeyer Communications of New York some $347,000 for contractual services.

Communication vehicles include the typical Web site, a television studio and production team, press releases, print materials and a radio show on MPB, with a six-month contracted cost of $25,000 for production and broadcast.

Such emphasis and expenses concern vocal public health advocates who question the department’s 2009 budget request of $16 million to increase staffing in district and county offices without trimming what many have called a “bloated bureaucracy” at the central office. Numerous writers on The Clarion-Ledger’s “public health series” forum have called for the board and Thompson to remove non-protected employees to whom Amy awarded huge pay packages.

The daily newspaper reported in 2006 that their four-month investigation showed the staffing of front-line workers restaurant and wastewater inspectors, nurses, disease intervention specialists and others declined steadily after Amy took over in October 2002.

Thompson told the board in August that he could eliminate the deputy health officer, chief science officer, and a research position and reallocate some central office employees to other funding sources to immediately add limited field workers.

Presenting the 2009 budget request and public health indicators in September, Thompson told the Joint Legislative Budget Committee that Mississippi ranks No. 1 nationwide in obesity, at the top in infant mortality, first in heart disease death rate, second in deaths from unintentional injuries and in diagnosed diabetes, third in adult smoking rate, and fourth in cancer death rate. Infant mortality in Mississippi soared alarmingly in 2006, experiencing the largest one-year increase in 40 years.

Thompson told legislators the Department of Health needs nurses, down to 308 in 2007 compared to 354 in 2003, and disease investigators, reduced to 34 in 2007 from 50 in 2003. With the $16 million infusion, he would hire critically needed staff: 31 nurses, 24 nurses’ aides, 13 disease investigators, 12 child care licensure inspectors, 20 nutritionists, 13 social workers, 11 environmental specialists, 42 clerks, and 75 individuals to address vital statistics, infant mortality, and other public health problems. He would reclassify and/or reallocate funding for 382 positions, including nurse’ aides, health information technicians, data control clerks, environmentalists, and health program specialists.

The interim state health officer also requests about $20 million in bond authority to build a new public health laboratory, a project on the table and all-but-funded before his 2002 retirement. During Amy’s administration, Nunnelee said, staff presented a funding scheme that — upon examination — “fell upon itself like a house of cards.”

Thompson’s 2009 budget request garnered praise from legislators. Holland saluted Thompson because, he said, “We cut 34.7 percent in public health funds over the past four years. We’re living in a new day and age of public health, and Ed Thompson’s a remarkable man to lead us.

“I think he’s right. We have a good new board, and with the right long-time state health officer, we must put our emphasis on public health or we’ll be in an abyss we cannot crawl out of.
“It’s unbelievable that we’re not worse off because of the decreased funding. If you don’t know the people in the counties, you need to go get acquainted. Please take seriously the funding request. We’ve got to provide funding, and I encourage this body and the legislature as a whole to do so.”



November 2007

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