Benton County fires entire board of health, blames former members for spending increase

The Benton County Board of Supervisors abruptly fired all members of its county health board earlier this month, offering an explanation that has raised more questions than answers.

After sending termination letters Oct. 3 to all five members of the Benton County Board of Health, the Benton County supervisors clarified their decision Tuesday, issuing a statement through the county attorney's office that said "the primary reason for the action was to reverse the 130% increase in the budget implemented by the Benton County Board of Health."

Former Board of Health members — who had not received any explanation as to why they were terminated from their voluntary board positions until Tuesday — say they are baffled.

The Board of Supervisors had approved the funding increase earlier this month, not the Board of Health. In addition, the budget amendment was the result of a proposal the Board of Supervisors supported and which health board members say they had cautioned against because it ultimately would cost the county more money.

"If they did not want to approve the funds that were being requested by the Board of Health, they could have simply denied them through the budget amendment process," said Kaitlin Emrich, a former Board of Health member who is also the director of the Black Hawk County Health Department.

Benton County Board of Supervisors and the Benton County Attorney's Office declined to comment further.

Benton County Board of Health abruptly terminated with no explanation earlier this month

In a letter signed by all three Benton County supervisors, members of the county Board of Health were notified their appointment to the board was terminated effective immediately. No cause was cited in the Oct. 3 letter, which was sent to board members' homes.

An explanation came in a second letter dated Oct. 6 in which the county supervisors cited a section of Iowa law and stated the board "has chosen pursuant to its powers not to continue your appointment."

The abrupt firings, as well as the supervisors' silence, have left larger questions on how the county intends to manage public health and environmental health services moving forward, now that Benton County has gone without a Board of Health for nearly a month.

In Iowa, county boards of health oversee environmental health and public health services, such as investigations for communicable disease outbreaks or lead poisoning prevention efforts.

Collectively, the Benton County board members had 21 years of experience on the Board of Health, and many of its members were instrumental in local public health initiatives in the county and across eastern Iowa, said Dr. Margaret Mangold, former chairperson of the Benton County Board of Health.

"We had a vision, and I'm just really afraid that all of that institutional knowledge is lost," Mangold said. "Those years of building those relationships and strengthening community partnerships is just going to go away."

Disagreement traces back to hospital's decision to end public health contract

Earlier this year, the Board of Health and the Board of Supervisors were entrenched in discussions about shifting the county's public health model after the county's sole hospital ended its longtime contract to offer public health services to Benton County.

In many of Iowa's counties, local hospitals subcontract with county health departments to offer public health services. Until earlier this year, that had been the case in Benton County.

Virginia Gay Hospital in Vinton elected to end its nearly 30-year agreement with the Benton County Board of Health and the Benton County Board of Supervisors as of June 30 and announced the hospital would no longer provide public health services.

The decision was in part driven by state officials' recent push to focus on population-based health services instead of direct health services that local public health departments traditionally offered in the past.

In a letter dated March 1, the hospital's board of directors decided this recent shift indicated it was "a good time for the hospital to step away from public health duties and focus on home health and other services for our patients."

As a result, the county had to develop a plan to provide those public health services to residents, Mangold said.

Board of Health fired 2 weeks after request for additional funding for public health staff

In developing a county-based system for public health and environmental health services, the Benton County Board of Health members came up with two options for the next steps, as outlined in minutes from a May Board of Supervisors meeting.

Board of Health members preferred the first option, Mangold said, because it would be less expensive by requiring the hiring of one administrator to oversee public health and environmental services.

However, the Board of Supervisors opted for the second proposal, which would keep the county's environmental health and public health wings separate, meaning the county would have to maintain two administrator positions. Both Mangold and Emrich said health board members made it clear the new model would result in a need for more funding.

The Board of Supervisors voted to approve that measure in a May 2 meeting, with no discussion among the supervisors.

"The statement that came out (Tuesday) that they're dissatisfied with the 130% increase in the budget doesn't really align with the decisions that were made and in conversations that we were having in April and May," Emrich said.

Last month, the Benton County Board of Health put forth a request to amend the county's budget to allocate an additional $74,202 to the board. The funding would be used to hire a full-time public health staff member, a move the board said would help support the public health administrator.

However, Benton County Auditor Hayley Rippel said the Board of Health's total request amounted to $136,565, including $62,363 the board was expecting from a state grant.

Rippel said the county used that amount in its calculations, meaning the Board of Health's total budget for the rest of the fiscal year totaled $320,205 — a roughly 74% increase from the $183,640 originally allocated to the board at the beginning of the year.

But if the county receives that state grant, the Board of Health's new budget would be $218,026, which is about a 19% increase from the department's original allocation.

The 130% increase cited by the Board of Supervisors is the difference between the $136,565 in additional funds the Board of Health requested and the new budget total of $320,205.

The proposal was brought by Benton County Public Health Director Grace Petrezelka in the Sept. 19 supervisors meeting. Supervisors did not raise concerns about the request during the meeting.

The Board of Supervisors approved the public health budget amendment on Oct. 3.

That same day, the Board of Supervisors sent termination notices to the members of the Board of Health.

Following the ouster, the Benton County Board of Supervisors indicated there were plans to build a new county health board, according to other reports.

Mangold said she's concerned about the steps the supervisors plan to take to build a new Board of Health, stating the board is meant to be autonomous from the county Board of Supervisors.

"(The board members) are not supposed to be under the supervisors. It's not the supervisors' job to build a board," Mangold said. "They appoint them, but the board of health should feel like they can tackle sometimes controversial things in communities related to health."

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm

This article originally appeared on Des Moines Register: Benton County blames budget hike on health board, fires all members