Georgia could strip public health powers from local boards

Georgia lawmakers are considering a reorganization of the public health system that would strip power from county boards of health and give it to the state public health commissioner, saying the COVID-19 pandemic has underlined the need for a more centralized structure.

Now, each county board must approve its local health director, even when multiple counties share a district director who covers more than a dozen counties. Senate Bill 256 would give Public Health Commissioner Kathleen Toomey the power to choose directors without having to get county board approvals, making Toomey their sole boss.

The measure was discussed by the Senate Health and Human Services Committee on Friday without getting a vote. It would make county heath boards purely advisory, removing any ability to make rules or any requirement that they agree to rules made at the state level.

"This bill is no reflection on the people who work in the department," said Republican Dean Burke, a Bainbridge physician who is sponsoring the bill. "In fact it is an attempt to give them more tools and more resources and a better structure so they can be more effective."

Georgia Department of Public Health commissioner Dr. Kathleen Toomey and Gov. Brian Kemp hold a news conference October 7, 2020 at the State Capitol.

The bill would also allow the state to hire people with public health degrees to be health directors, instead of only physicians as mandated now. The state and districts could instead have one or more chief medical officers who are physicians to oversee clinical operations.

"We have had some trouble filling those health director positions," Department of Public Health lobbyist Megan Andrews told committee members Friday. "It’s hard to find someone who is both a great physician and a great organizational manager."

Bethany Sherrer of the Medical Association of Georgia said her group is concerned that a chief medical officer or officers could all end up in Atlanta and not be able to react to local conditions.

"We don’t have boots-on-the-ground physicians to oversee these day-to-day operations that may affect the health of many Georgians," she said.

In additional to choosing directors, the commissioner would also be able to redraw the lines of the current 18 health districts without local consent. Andrews told committee members it would allow the department to conclude a planned merger of the standalone Clayton County Health Department with the 11-county LaGrange district.

"The county boards are out of the business of promulgating. They’re getting out of the role of micromanaging septic tanks," said Sen. Chuck Hufstetler, a Rome Republican who is an anesthesiologist. "Overall I think this is a much better structure to have consistency across the state and clear guidelines for everybody."

County health department employees, who are paid with a mix of state and local funds, would become state employees. The bill, as currently written, does not alter that funding, but that could change and lawmakers are seeking a cost estimate.

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