Local board members in Oklahoma and Tulsa counties are casting a skeptical eye at a House bill that would give the state health commissioner a voice on their local governing boards and veto authority over any future picks for executive directors.
House Bill 2504, by Rep. Chris Kannady, R-Oklahoma City, could come before the full House as early as Tuesday after passing a committee vote in late February. The bill would give the state’s health commissioner one appointment on the nine-member governing boards of the independently run Oklahoma City-County Health Department and the Tulsa Health Department.
The Oklahoma and Tulsa county health boards are funded by local property taxes, federal grants and fees for services. Their budgets don’t come from state appropriations. Some health officials said the bill is a power grab by the state against local control and funding. The bill doesn’t allow the independent county departments to adopt regulations stricter than the state.
“As a citizen, it’s definitely concerning to me that this is an attempt to go around local control and prevent an independent health department that’s funded by the county and the city to try and handcuff us in adopting rules and regulations that are led by the state,” said Adam McLain-Snipes, a board member on the Oklahoma City-County Board of Health since 2019. “The people who are closest to the problem are the people closest to the solution. I don’t think it’s wise or full of a lot of wisdom to pre-empt in that way.”
The state Health Department is scrambling to cover an unexpected $10 million shortfall that emerged over the summer. Along with employee furloughs, layoffs and contract cuts, the agency sought payments from county-city health departments, which refused to pay.
One seat out of nine isn’t enough to swing any vote on the two county health boards, but the state health commissioner would also be part of a nominating committee for the director of those county health departments if there’s a vacancy. The mayor and chairs of the county commission would also be on the nominating committee. Under the most recent version of the bill, the health commissioner would have veto authority over any pick.
Tulsa board of health member Mike Stout said he’s worried that veto power would make the appointment process more political since the state health commissioner is appointed by the governor.
“Our health department is funded through local ad valorem tax dollars and grants,” Stout said. “And now the state wants to come in and have a role without having any actual skin in the game.
“I really haven’t seen a coherent message or a coherent explanation for why this bill even exists and why it’s even necessary. Every explanation I’ve heard has basically withered in the face of evidence and facts.”
Chain of Command Questions
In advocating for the bill in committee, Kannady said he saw first-hand how the chain-of-command in the state’s response to the COVID-19 pandemic got blurry with the independent health departments in Oklahoma and Tulsa counties. Kannady, a lieutenant colonel in the Oklahoma National Guard, was called up to help with the pandemic response.
“We’ve created a structure which still gives the city-county health departments authority, but also puts in the state health department to have some kind of administrative alignment so we can be better prepared to respond not just to this pandemic but the general routine functions of the health department,” Kannady said in the hearing. “It’s a good balance. It doesn’t remove the current directors. It only kicks in if there’s a vacancy.”
The latest version of the bill also makes some changes to the job requirements of the state health commissioner, adding a master’s degree in public health to the list of allowed qualifications. Kannady did not respond to a request for comment Monday on that change. The Senate has not yet taken up the nomination of Dr. Lance Frye as health commissioner.
Frye, in a statement, said the bill is an opportunity to rethink how the state delivers public health services. He said local control is critical and the state already works with the Tulsa and Oklahoma County health departments to discuss strategy.
“I believe, and have discussed with Rep. Kannady, that a unified vision for public health is critical to improve health outcomes in our state,” Frye said. “How that unified vision is accomplished, however, is up to policymakers to decide.”
Dr. Bruce Dart, executive director of the Tulsa Health Department, said Kannady hasn’t talked to him directly about the bill or any concerns he’s had with the Tulsa department.
“We have worked closely with the Oklahoma State Department throughout the pandemic, and have not received feedback that is negative,” Dart said in a statement. “We have always been very responsive to the state. The Tulsa Health Department staff have worked and sacrificed for over a year now and have done an exemplary job responding to this historical pandemic.”
Relationship Strained in 2017
Tensions between the state health department and its independent counterparts in the state’s two largest counties aren’t new. The health department’s financial scandal in 2017, where it couldn’t account for $30 million, led then-Gov. Mary Fallin to form a joint commission to study how the departments could better work together. The financial problems led to the resignations of the top two leaders at the state health department, which is on its fourth health commissioner in the past four years.
Before the financial crisis became public, the leaders of the state health department at the time tried to pressure the Tulsa and Oklahoma departments to pay for some of the state’s apparent shortfall, asking for more than $1.5 million from those counties. The boards of health in both counties refused the state health department’s request.
The Joint Commission released its report in spring 2018. Among its recommendations was the formation of a joint council to coordinate county health departments. It also called for better transparency in budgeting and data sharing, not only among the three departments but among the state health department’s central office and its own county health departments. Former state Health Commissioner Gary Cox, who at the time led the Oklahoma City-County Health Department, led the commission’s study.
“Counties, in cooperation with Central Office, must be able to exercise local control over defining and implementing foundational public health services to best meet the needs of the communities they serve,” the report said.
Oklahoma County Commissioner Carrie Blumert used to work at the Oklahoma City-County Health Department. Blumert said she’s personally opposed to HB 2504 but can’t speak on behalf of her fellow commissioners.
“The fact that it’s an independent agency allows it to be a little more nimble and a little more aggressive in the way they tackle things locally,” said Blumert, who represents District 1. “OCCHD is working so well right now, and from talking to staff there, they are light years ahead of the response that the state health department is doing with COVID.”
In a COVID-19 shortened legislative session last year, lawmakers changed the law dealing with independent city-county health departments to allow Cleveland County voters to form their own independent health department if the county meets certain population thresholds.
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