Health Board wants commissioners to put brakes on restructuring

Burke County’s plan to alter the structure under which the Boards of Health and Social Services operate met with some resistance at the board of health’s monthly meeting Wednesday night.

The changes, however, still seem likely to be approved when they come before the Burke Board of Commissioners for a vote at its meeting Aug. 20, which will also include a mandatory public hearing on the matter.

County Manager Brian Epley presented the plan, which would remove administrative power from both boards and relegate them to an advisory capacity. 

The end goal, Epley said, is organizational streamlining, adding the health department and DSS would operate like any other county department – under the control of the board of commissioners and reporting directly to the county manager. 

“I recognize on the surface this can sound unusual, certainly new,” Epley said. “But again, I think at the end of the day, the only goal here is to make sure we’re all in the same boat rowing in the same direction.”

Afterward, health board members and experts who joined via skype spent the bulk of the three-hour meeting discussing the ramifications.

In the end, the board approved a resolution opposing the “dissolution of the board” and asking the commissioners to launch a comprehensive study of its possible effects.

Epley had presented the plan to the DSS board last month. In the wake of that meeting, some board members registered their concerns about the restructuring, saying it was a bad idea to leave public health decisions in the hands of elected officials.

At that time, both Health Director Danny Scalise and DSS Director Korey Fisher-Wellman said they hoped the commissioners would strongly consider the possible deleterious effects the changes might bring. 

The two departments comprise around 250 employees and have a combined budget of $27 million.

Health Board Chair Isaac Crouch, who has been vocal in his opposition to the change, said Wednesday he has the same concerns, and wondered why the commissioners didn’t consult the board of health earlier. 

“There hasn’t been (a discussion) one in public or in private by the commissioners, coming to us and saying, this is what we want to do, this is why, this is exactly what we think will improve, we’re not going to interfere with your public health initiatives,” Crouch said.

“When you see things going well, you feel strange when out of the blue you’re told, ‘we need to change this.’” 

Crouch cited a 2022 study completed by Karl Johnson of the UNC School of Public Health that said the structure Burke County is seeking to implement can be problematic to those administering public health measures.

Johnson, joining the discussion remotely, said, “By and large, when this decision is made, an advisory committee no longer has the same level of authority and responsibilities. They really become less of an active player in the decision making for the health department.”

Johnson said it’s possible for a number of different configurations to work well, and as many as eight different models are currently in use in the state. But he cautioned that counties adopting structures like Burke is contemplating should proceed deliberately. 

Commission Chair Jeff Brittain said that’s exactly what the commission has been doing for the last decade.

“I think there’s a misconception that we haven’t studied this at all. It’s been on the commission radar for at least the last 12 years,” Brittain, who also serves on the DSS board, said Thursday morning.

Both Brittain and Epley emphasized this isn’t a form of punitive action by the county. 

“That’s not the case,” Brittain said. “We believe those boards have been doing what they were designed to do. But organizationally, we believe those two departments can meet the needs of the citizens better if we were all tightly knit together organizationally.”

Epley added the commissioners were not staging a “hostile takeover,” and they had no interest in taking over the technical aspects of public health.

He said the board would still be able to conduct community health assessments, seek community input, monitor and set goals on strategic planning, meet as often as it wishes, and advise on community health issues. “From an operational and practice perspective, nothing should change,” Epley said. 

Epley emphasized the board would only be dissolved momentarily after the decision – members who want to continue serving would immediately be re-appointed by the commissioners.

Kirsten LeLoudis from the UNC School of Government, also speaking remotely, said the duties of the health director would not change.

But there was still an undeniable sense of trepidation among some board members.

“We work hard here as a group, and if we turn into an advisory board, we will be like the other board – lambs to the slaughter – believing that the commissioners can do no wrong,” said member Gwen Stephens.

Scalise was still concerned as well. He said a prospective employee he interviewed from another county had been fired from a previous job because she refused to give a higher inspection grade to a restaurant whose owner was connected with a county commissioner. Scalise didn’t want that to happen in Burke County.

Later, in a lengthy discussion about the language of the resolution, which was drafted and introduced by Crouch, both Dr. Joel Welch and Dr. Anthony Frank said reconfiguring the hierarchy of the various boards may not necessarily be a bad thing. 

That discussion led to changes in the wording of the document, but a reaffirmation of the board’s commitment to the health and well-being of Burke County’s residents remained.

The resolution was unanimously approved.