By Josh Margolis
HAVRE, Mont. (NMB) – Wednesday’s quarterly meeting of the Hill County Health Board quickly grew contentious as Health Officer/Director Kim Berg expressed issues with funding and staffing.
ARPA
In September, the County Commission agreed to provide $100,000 in ARPA funding to help with contact tracing efforts at the Health Department.
However, the Commission never signed off on the funds, and Berg says that was never communicated to her Department.
“I am just wondering when we will see some of our ARPA funds,” said Berg.
Commissioner Mark Peterson said shortly after they voted to approve the request, they were made aware of an additional grant of about $70,000 the Health Department had received for contact tracing, so they decided to hold off on providing the allocated funds.
“The obligation (from the Commission) of up to $100,000 if needed is still there,” said Peterson. “That has not gone away. We just haven’t signed any documents. But we do have a question on this grant fund, these extra funds, that was given to the Health Department. So can you help us understand there and clarify that for us?”
Berg responded by saying that she was never contacted by the Commission with this concern, and stated that the grant fund was an amendment to the Public Health Emergency Preparedness Grant (PHEP).
“(The amendment) was to fund brand new contact tracers who have to be new hires. I don’t see any of that funding unless there are new hires. Nobody is applying to work at the Health Department. Contact tracers, case investigators who are working are being paid out of county funds, because I don’t have ARPA money to pay them.”
“Please forgive us, but we do get really burdened down with the amendments to contracts to grant funding,” said Commissioner Diane McLean. “Help us understand where that contract…”
“Nobody has come to me to ask about any of this. And (the allocation of ARPA funds) was signed in September of 2021,” said Berg, who reiterated that her Department would only receive the PHEP amendment funding if new contact tracers were hired and expressed frustration about the lack of a formal process for dealing with this issue.
“When I asked the Clerk and Recorder how do I utilize ARPA funds, she told me to write out the budget amendment or appropriation or whatever it was and get it to you. Then I hear nothing. Then I hear from the Clerk and Recorder that you are not signing it because I have enough money. Nobody asks me questions and it is very frustrating.”
“I don’t think that ever got stated that way,” responded McLean. “But anyway, we have considerable questions as well. Yeah, you’re right, we haven’t gotten back to you, but that’s…these things come and we’re not certain that we always understand how they work.”
“I understand that, but you do know how to get ahold of me,” answered Berg.
“True,” replied McLean. “I guess we are not aware that you were having to use your county funds to pay people.”
Peterson said to try and resolve this issue, they will be setting up a meeting next week with Berg and Clerk and Recorder Sue Armstrong. Peterson asked Berg to provide numbers to the meeting of her Department’s expenses since they voted to allocate the funds.
“The problem with ARPA funds is we have a lot of needs that we’re looking at. We want to get them to the places that we feel are the most important without just giving out a bunch of money that may not be 100 percent needed. And then somebody else has to suffer for that. So we’re just trying to be good stewards of the money that has been allocated to us, and try and get as many areas covered as we possibly can.”
Berg said she will be at the meeting and that all she is looking for is the ability to use the funds the Commission previously said they would allocate.
“I don’t care how I can access it,” Berg said. “I probably won’t need the whole $100,000. I really hope I won’t. Because I’m hoping that cases start going down. But I can’t anticipate what this pandemic is going to do, and it’s very important work that needs to be done.”
Staffing Concerns
Following that conversation, the meeting immediately shifted into a related discussion about staffing challenges the Health Department is facing.
“We have three full-time positions, that one (Public Health Nurse) will probably never be rehired at this time, because I don’t have the funding for it. But two (Family Planning Coordinator and Health Program Assistant) we have not gotten applicants for. And then we have the Sanitarian position that’s been listed for I don’t know how long. We are not seeing any applicants and I need help. There has to be something done. We are posting for an RN position at $20 an hour. When you can go as a brand new graduate at the (MSU-Northern) Nursing School and start out at $26 an hour at (Northern Montana Hospital)…I’m competing with a hospital that’s giving $25,000 sign-on bonuses. And I know public health isn’t all about the money, I get it, and we’re not going to be able to pay at that level, but there has to be something done. It is a slap to the face to a nurse to offer them $20 an hour after all of their training.”
Berg then provided the meeting attendees with a spreadsheet showing that the hourly wage offered for numerous Hill County Health Department employees is significantly less than other counties are providing. For example, the spreadsheet says Hill County offers $20.82 an hour for WIC (Women, Infants and Children) Coordinator, compared to the state average of $28.80. For a Registered Nurse, Hill County’s wage begins at $20.82 an hour, compared with the state average of $29.26, the small county average of $26.57, and the large county average of $37.31.
The information in the spreadsheet was provided by the consulting organization Yarrow.
“I could go do the same job I’m doing now in Cascade County and get paid double, and the cost of living is seven percent higher,” Berg said after passing out copies of the spreadsheet. “I’m not expecting to get paid that amount, but we have to be able to do some type of analysis of the wages that are being paid and do something to help us get some people to help us out at the Health Department. Right now we’re so short-staffed that I have a bell out front (in the lobby) because nobody can be out front. And I know that we are not the only department that has staffing issues. I know that. But if there is anything we can do to help this county-wide, I am willing to help.”
“The concern I have is that you’ve got some open positions, and so then you all have to absorb the work,” added Health Board member Erica McKeon-Hanson, the Public Health Officer for MSU-Northern. “Because the work doesn’t get to stop, it still has to go. And then legally, you have to have a sanitarian covering Hill County. We’ve had Clay (Vincent) helping us, but now he’s not able to do that. I just really worry about all of you and the wear and tear (from dealing with COVID).”
Without an employed sanitarian, Berg has been acting in that role.
WIC Coordinator Nicole Hungerford said the opening for Family Planning Coordinator – in which being a Registered Nurse is a requirement – is particularly concerning.
“In areas like Hill County, access to birth control and safe sex education and preventive services, pre-natal care, things like that, are very, very important for our underserved communities. And people who don’t have private pay insurance rely on public health services for those sort of things. So the affect of access to birth control, safe sex education, through our Family Planning Coordinator, is 10 fold within our community over generations. So it’s important to have.”
Peterson was the first Commissioner to respond to Berg, saying that many departments are experiencing similar issues and arguing that options to rectify the issue are limited.
“The problem is the county only has a bucket that’s so big. And so in order to meet needs like this, we have two choices: we can lay off people so that we have a smaller group of people demanding wage increases, or we can ask the public taxpayers to pay more money, and that would have to go on the ballot. And then we would live with their decision. If they said no, then our only choice is to either not pay as much, or pay higher amounts to fewer people … Those are our only choices.”
“They’re really not, though,” Berg said. “Have you brought anybody in to analyze how money is being used in the county? Gallatin County just did it.”
“We’ve looked at that pretty closely,” said Peterson. “And I don’t think there’s enough difference there to really…y’know if you have specific, I would really like to see them. Not to send them out to everybody in the world, but I would like to see them, because I’m not finding it. There’s just things you don’t have control over in some departments because of overtime needs and such. Weather conditions on the road department can make a huge difference in a short period of time. And so if you have some ideas and thoughts, I would really like to see that. Because I’m not seeing it myself right now, and I’ve looked because you have mentioned it before more than once.”
Berg reiterated the potential benefit of having an outside consultant take a hard look at Hill County’s finances and said the matrix used to determine wages in Hill County needs a major update.
“It just seems to have kind of no rhyme or reason for why somethings happen one way. One department gets education credit and years experience credit, and no other department does. I don’t understand how that works and how that comes about, when basically every position (in the Health Department) except for Administrative Assistant, you have to have a degree…I value that greatly, and our staff give out of their own pocket to get a lot of it.”
County Attorney Lacey Lincoln said her department will do what they can to ensure the Health Department has the best chance of success for finding employees, and suggested looking to find new ways to promote openings.
McKeon-Hanson said it could help to emphasize on job listings that the cost of living in Hill County is much lower than other areas of the state, and Lincoln said that is certainly something they can look into doing.
Commissioner Jake Strissel encouraged Berg to join other County employees at the MSU-Northern career fair next week to recruit employees, but Disease Intervention Specialist Brandi Williams balked at the suggestion.
“I’ve even talked to recent new grad nurses, and bringing up the position that we have for our Family Planning Coordinator is not a livable wage on our end with their student loan debt and all of those things. So I feel like it would be unfair to offer the wage we currently offer to a new grad nurse and take advantage of their naivetivity, because they don’t know that going into Bullhook (Community Health Center) or the hospital, they could make much more. So I think readdressing the wage for something like that is possibly the only incentive to getting applicants for the position.”
“And most of the nursing, pre-nursing grads, they know about the wages…So it’s going to be an uphill battle,” added McKeon-Hanson.
The conversation on this topic then came to an end, as Peterson, the Board Chair, shifted the discussion to other new business.
Vaccine Mandate
County Attorney Lacey Lincoln said that the County will not be impacted by the Supreme Court decision to require COVID vaccines for employees of facilities that receive Medicare funding since the County is not involved with any of those facilities.
Lincoln said other Counties such as Missoula will face larger impacts as they try to grapple with the mandate potentially running afoul of House Bill 702.
Bullhook CEO Kyndra Hall, the newest Health Board member, said impacts to them will be minimal since over 90 percent of their employees are vaccinated. She said the new vaccine deadline from the federal government is March 15th.
Public Comment
During the public comment portion of the meeting, Board member and Commissioner Diane McLean talked uninterrupted for nearly eight minutes.
McLean, who is running for re-election this year, said she was speaking in her capacity as a member of the public and provided misinformation about the effectiveness of the COVID vaccines and advocated for better promotion of treatment. McLean’s remarks began with her quoting an editorial from Dr. Peter McCollough, who was fired from a job for peddling misinformation on COVID. It continued with more false claims, including that COVID vaccines are not effective against the Omicron variant.
“Are we indeed using our public health dollars in the most effective manner? I’m just going to go down a little rabbit trail here a little bit with the whole money thing,” McLean said in part. “We all know that Pfizer and Moderna have billion dollar profits this year. We all know that many, many public entities: counties, schools, states, have had influxes of dollars that have been incredible.”
McLean then urged for more promotion of healthy lifestyles and read from a piece of paper which she says was the transcription of a Public Service Announcement from El Salvador.
“When I watch TV, when I listen to radio anywhere, pick up a newspaper, whatever, I see: vaccine, vaccine, vaccine, vaccine. But are we promoting any other mitigating factors to help us with this virus? … This PSA is from a third-world country, it’s from El Salvador, for crying out loud. I look at the money that we’re spending in our newspapers and across our media to promote a vaccine…”
At that point, McLean cited statistics of adverse health impacts from the vaccines from a recent VAERS report. These reports can be submitted by anyone and “may contain information that is incomplete, inaccurate, coincidental, or unverifiable.”
“Can we not do something for our people at the people level? Instead of spending this money the way we are spending it, can we not promote healthy lifestyle health diet…exercise?”
This remark led to strong backlash from the public health professionals in the room, who emphasized that they already do these things, with Berg adding that the public has not been given any input into how the County is using it’s COVID-relief funds.
“I did offer an option to the County: put out a survey. See how Hill County’s population feels that that money should be spent. How could it best impact this community. That didn’t happen. I have offered that. Our Health Department does post about getting outside and being active and eating healthy. And we have been posting since the beginning of the pandemic about other things you can do besides getting vaccinated. We do that, Diane,” said Berg.
Disease Intervention Specialist Brandi Williams added that the Health Department is prohibited from recommending treatments, saying those decisions should be made by a primary care provider.
“And good luck getting into have that conversation, because our health care system is so inundated with cases because people aren’t getting vaccinated,” Williams added. “We’re having mutations and people are having severe infections.”
“There are a lot of cases in vaccinated people. But there are not a lot of hospitalizations or deaths,” said Berg. “And when you think of vaccination, it is not to completely stop any case from possibly happening. It is to lessen the severity, lessen the hospitalization rate, and lessen the death rate. And this vaccine has effectively done that.”
Other items discussed
- Berg said the Health Department will be shifting away from universal contact tracing and case investigations for COVID and will now be using an online platform. This was a decision made by the Association of State and Territorial Health Officials and DPHHS and Berg says it will save the Department significant time once the transition is completed. This is HIPAA compliant and for the general public only, not for congregate living settings. More information on this change will be available in the coming weeks.
- WIC Coordinator Nicole Hungerford said client numbers are stable and extra funds for fruits and vegetables will continue to be available at least through March, which is a massive benefit for the community.
- The Board welcomed new member Kyndra Hall. She is replacing Kristi Kline, Source Water Specialist for Montana Rural Water Systems. Kline served on the Board since 1997 but decided not to seek another term to the volunteer position due to her workload.
- With Kline gone, the Board held an election of officers. Peterson was chosen as Chair, McKeon-Hanson as Vice-Chair, and Hall as Secretary.
- Hall said Bullhook now has rapid PCR COVID tests that also check for the flu and strep throat.
- Berg said the Health Department will get its first shipment of rapid antigen tests from the state soon. The tentative plan is for the 930 or so tests to be distributed at a drive-thru event on February 8th at the Fairgrounds, but details are being finalized.
- McKeon-Hanson said Northern is struggling to keep up with demand for rapid antigen tests, and they aren’t even able to reserve a backorder.
