Ottawa Impact stalls health survey again, stakeholders vow to move forward

OTTAWA COUNTY — A typically benign funding agreement for a project to assess health needs in the county became a political football Thursday night as the Ottawa Impact-led county board of commissioners tried to find ways out of a contract it approved earlier this year — but health leaders are vowing to move forward.

At issue: The far-right faction of the board doesn't approve of survey questions found in several surveys the county's health department helps curate in order to identify what's working and where resources are needed to ensure that public health thrives.

Initially brought to the board and approved by committee in February, the memorandum of understanding for the 2023 Community Health Needs Assessment was scheduled for a vote by the full board during the April 27 evening meeting.

After a long discussion that often touched on the appropriateness of specific questions posed to adults and youths — depending on which survey was being discussed — commissioners postponed the vote to the next meeting while they explored potentially renegotiating the already approved contract.

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The Community Health Needs Assessment comprises several surveys and stakeholder interviews to gather input on the health needs of Ottawa County every three years. It's a partnership between the Ottawa County Department of Public Health, Holland Hospital, Corewell Health Zeeland Hospital, Trinity Health Grand Haven, United Way of Ottawa and Allegan Counties, Community Mental Health and other organizations.

In addition to revealing needs and trends in the county, it helps the three hospitals meet regulatory requirements to keep their nonprofit, tax-exempt status. For the county, partnering with the hospitals — rather than each hospital doing an assessment on their own — helps identify countywide trends.

In a joint statement released Friday afternoon, Corewell Health, Holland Hospital and Trinity Health Grand Haven said they were "disappointed" that the board of commissioners delayed the vote to approve the memorandum of understanding.

"The Community Health Needs Assessment includes important research which enables our hospitals and community agencies to accurately identify the health needs of our community, develop strategies to address them, and collaborate to improve health outcomes for all individuals in Ottawa County," the hospitals said in the statement.

"The findings of this assessment are valuable to the health and human service agencies throughout Ottawa County who are working to create a vibrant, healthy and equitable community, and we are committed to moving forward with the assessment."

The contract for the CHNA was initially approved in December by the former board and was ratified Jan. 10 by the current board of commissioners. Tuesday’s discussion was about a memorandum of understanding, which details how funds would come from hospital partners, through the county, to the vendor.

Without its approval, OCDPH Health Planning and Promotion Manager Lisa Uganski said the county can’t pay a $29,000 invoice it received from the vendor earlier this month, despite already receiving $33,000 in funds from CHNA partners that could cover the bill.

After about 90 minutes of discussion Thursday, commissioners voted 7-4 to delay the vote to May 9. Chair Joe Moss, Vice Chair Sylvia Rhodea and Commissioners Roger Belknap, Gretchen Cosby, Jacob Bonnema, Allison Miedema and Lucy Ebel voted "yes," while commissioners Rebekah Curran, Doug Zylstra, Kyle Terpstra and Roger Bergman voted "no."

Moss and Rhodea formed Ottawa Impact after they unsuccessfully challenged state and county COVID-19 mitigation mandates in 2021. They targeted seats on the board in 2022, recruiting like-minded candidates who agreed “traditional Republicans” weren’t enforcing true conservative policies and successfully defeated enough incumbents in the August primary to win the majority.

Since taking office, the OI-linked commissioners have zeroed in on the health department and its leadership — often voicing criticisms during public meetings.

County Health Officer Adeline Hambley is currently suing the board, claiming the commissioners overreached their authority by attempting to limit her state-authorized health duties, including standing in the way of critical contracts the county has with local health providers.

Thursday's concerns centered around questions for the Behavioral Risk Factor Survey, a key component of the CHNA. The BRFS is a phone survey of randomly selected county residents. It's voluntary and only administered to residents 18 and older.

Questions are determined by the Healthy Ottawa Advisory Council, which includes members from OCDPH, local hospitals and other CHNA partners. Commissioners disagreed with inclusion of some topics and felt they should have input on what gets asked of the community.

Not having the survey questions for the BRFS was the reason the board initially delayed approval of the memorandum of understanding in February. That prompted a critical response from Hambley in a subsequent committee meeting, where she told commissioners they had no purview over the survey.

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Rhodea attributed the delay to the board being “committed to not voting blindly on issues." The survey questions have since been provided to commissioners.

Miedema and Rhodea said Thursday that questions in the BRFS asking if respondents have ever contemplated suicide and asking about adverse childhood experiences, or ACEs, could traumatize residents.

“I would like to ask that we step into the shoes of the person on the receiving call in the future and ask if the data gathered from the survey is justified at the expense of the individual subjected to the questions asked,” Miedema said. “I wonder about bringing up potential past traumas, how they affect the individuals after the phone call ends."

“I’m very concerned about what, being put through this, what kind of a place that’s going to bring a person to,” Rhodea said. “I’m concerned about the liability to the county, honestly, about walking somebody through this stuff, bringing up things that maybe they haven’t thought about in a really long time, and they’re left there alone.

“What we’re doing to our people is not OK.”

Marcia Mansaray, deputy health director, said the surveys are carefully crafted, participants are consenting adults and surveyors are well trained to fully explain the sensitive nature of some questions.

"There’s a very careful intro and (the questions) are at the end of the survey," she told The Sentinel on Friday. "They are given an option to not answer those questions, but we prepare them that these are sensitive questions. If they decide to answer them, we let them know they can stop at any time, but then we also provide them with a local contact with (Community Mental Health) if they want to talk to anyone and it causes any feelings that are difficult."

Mansaray said, although some of the questions can be uncomfortable, the information is invaluable to help mitigate health risks.

"Many studies have demonstrated what was not previously known, that what happens to you as a child, the risk to your health as an adult grows exponentially with each additional adverse experience that you accumulate as a child," Mansaray said. "Researchers believe that it’s due to stress; there’s a significant decrease in the length of your life."

She said the research has helped health experts link things such as obesity, cardiac disease, diabetes and mental health conditions to adverse childhood experiences, but knowing what the issues are is vital to protecting public health.

"It’s really helpful to use that information to inform and educate the community and the individuals. Because you can do something about this — you don’t have to carry that for your whole life. And there’s things we can do when children are children … to mitigate the impact of those events," she said. "So even if they have one of those events, there are things we can do that will make a difference lessening the impact that has on them throughout their lifetime."

Questions related to ACEs were asked in both 2017 and 2020. Questions about suicide have been in every iteration of the CHNA since the county got involved in 2011.

Moss and Miedema seemed to indicate a willingness to break or alter the contract by removing the BRFS.

“I also understand that if the board were to object to any of the questions, the only way we could exercise oversight at this point is to terminate the survey,” Moss said.

Uganski clarified that Moss meant terminating the contract, to which he responded, “Yeah. Because we can’t change any questions or give you input on the questions. We’ve been specifically told that.”

“The county could cancel their contract with the vendor,” Uganski said. “I think that then our partners would find a way to still have the survey take place, but not use the health department or the county as a fiduciary.”

Miedema asked about approving the memorandum, but removing the BRFS from the CHNA. Because the contract has been approved, it would need to be renegotiated or terminated to remove the BRFS. Moss said it would be “unwise” to approve the memorandum if there was interest in adjusting the contract.

“The board could work toward terminating the contract; there’s a clause that says that it could be terminated, you know, basically for any reason at any time,” he said. “But if we were to approve the memorandum of understanding, you could argue it would be very unwise to try to then terminate the contract since the memorandum of understanding is receiving funds to complete the contract.”

Later in the meeting, Zylstra questioned if “the underlying reason for the delay is for us to explore the ability to break a contract.”

“I think I heard the word renegotiate or consider a change. But break? No,” Moss responded.

Uganski said the hospitals have to find a way to complete their regulatory requirements, including a survey, if the county removed itself from the process, but it would hurt the county’s reputation as a community partner.

“These collaborative partnerships are really important to us and the work that we do,” Uganski said. “I really want to make sure that we continue to be seen as a good partner in this community and that people want to continue doing this work with us.”

Commissioners also raised concerns about questions in the Youth Assessment Survey, a separate initiative that's not part of the CHNA. Rhodea and Cosby brought up the YAS several times, despite Uganski stressing each time that it wasn't part of what was being voted on.

The only connection from the YAS to the CHNA is that data from a prior YAS survey may be referenced as a secondary source in the maternal child health assessment part of the CHNA, Uganski said.

The commissioners took issue that the YAS, administered to 8th-, 10th- and 12th-graders every other year, asks questions about sexual activity, referred to as reproductive health in the survey. Uganski said school districts can opt out of the entire survey or opt out of the reproductive health portion. Parents are also notified and can opt their students out of the reproductive health section.

Mansaray said many schools highly value the information gathered from the YAS.

"Because this is what we’re living with every day with these kids. We care about them," she said.

Moss told Uganski that it “might be really good to get way ahead of the YAS survey” and come to the board before much work is done, as “it sounds like some board members object to some of the questions.”

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Uganski said she doesn’t think there will be a funding request for the YAS coming to the board this year.

Mansaray said public health protection will continue — with or without the cooperation of the county.

"I feel like the health systems can continue to move forward. It's a duty of public health to assess the health of the population — that’s part of our statutory duties," she said. "And it’s a duty of the health systems to consult public health when doing this, so we must be at the table with them."

— Contact reporter Mitchell Boatman at mboatman@hollandsentinel.com. Follow him on Twitter @SentinelMitch. Contact executive editor Sarah Leach at sarah.leach@hollandsentinel.com. Follow her on Twitter @SentinelLeach.

This article originally appeared on The Holland Sentinel: Ottawa Impact stalls health survey again, hospitals vow to move forward