Elsewhere in this paper, you will find an advertisement from Jefferson County seeking a new Health Officer, a part-time health professional charged with working with officials and agencies to “ensure health program efficiency and compliance with laws, rules and regulations…enforce health codes, standards, practices and procedures…[and] control the spread of disease.”
And you might wonder: Who would want this job?
As The Monitor has reported, the county decided last month not to renew the contract of Joan Van Duynhoven, who had served as Health Officer for 14 years. That followed six months of increasing fractiousness between Van Duynhoven and the county’s Health Board, Commissioners, attorney, and other officials as they attempted to navigate the murky swirl of the COVID-19 pandemic.
The precipitating events driving Van Duynhoven’s departure, according to Commissioner Leonard Wortman, were her decision in late August not to allow a pro rodeo event in Boulder and her “misleading” statement regarding the “arbitrary” cancellation of non-conference high school sports contests.
But the real problems went deeper than that. They started with an ambiguous Montana statute describing the powers and duties of the Health Officer, who is a mandated county contractor authorized to “take steps to limit contact between people in order to protect the public health from imminent threats, including but not limited to ordering the closure of buildings or facilities where people congregate and canceling events.”
Statute also requires the county Health Board, a group of at least five officials, with appointing the Health Officer; and with acting to “protect the public from the introduction and spread of communicable disease or other conditions of public health importance.”
So, who was in charge? As it turns out, the Health Board was. Jon Ebelt, public information officer for the Montana Department of Public Health and Human Services, confirmed that “the health officer is hired to act on the board’s behalf.” County Attorney Steve Haddon had made a similar determination back in July, but the Health Board took no action. Van Duynhoven continued to make decisions without the Health Board’s formal input, just as she had for 14 years before the emergency.
The Health Board grew increasingly restive, settling into what seemed like a mutually passive-aggressive stand-off with Van Duynhoven over the power to make decisions serving the county’s public health. That didn’t end well for Van Duynhoven.
Now, the county has the chance for a do-over. What might that look like? It’s worth examining the example of Teton County, whose public health function offers an appealing model of, well, functionality.
Back in March, which feels like another eon, as Governor Steve Bullock declared a state of emergency in the face of Montana’s first reported COVID-19 cases, Teton County health officials met to figure out how they were going to work together. Yes: They would work together! Tim Sinton, a physician’s assistant who serves as the county’s Health Officer, was there. Sinton is chair of the seven-member Health Board, which also includes County Board of Commissioners Chairman Jim Hodgskiss. Melissa Moyer, the Health Department director, was part of the discussion.
The first thing the Board decided, on the advice of Attorney Joe Coble, was to institute an emergency rule to the effect that the County would, in any case, abide by the Governor’s directive and all future directives. That legal commitment, Moyer, noted, would make enforcement easier.
Then, it settled on a process for handling decisions related to the emergency. Moyer’s Health Department was being flooded with questions and requests from businesses wondering if and how they could reopen; from restaurants wondering how far apart tables should be; from golf courses seeking guidance on logistics.
“We were getting a little overwhelmed, and we knew there would be times we would have to say ‘no’ to things, and that’s a hard thing to do,” Moyer said.
So the Board agreed: Individuals and institutions would submit plans to the Health Department, and Moyer and her team, with advice from Sinton, would approve those that met the conditions of the Governor’s directive; and provide feedback to help reshape those that didn’t. And when plans were clearly problematic, Moyer would kick them to the Board for evaluation: “So the ‘no’ isn’t coming from the health department; I’m going to let the Board make a decision.”
The Health Board, which previously had met only quarterly, scheduled meetings as needed to review difficult plans. These meetings were public, and it invited public participation and input — which it got, sometimes in torrents — on decisions.
In May, the Board approved a youth rodeo after its sponsor, the Montana High School Rodeo Association, promised no spectators from the community and temperature testing and symptom questionnaires for contestants, as well as handwashing and hand sanitizing stations, social distancing, and mask wearing in close quarters. It okayed a limited 4-H competition for members and their immediate families only.
Then came July 4th and the American Legion rodeo. The Independence Day weekend is a big deal for Choteau, regularly bringing 10,000 people into town from across the state and beyond.
“As we got closer to the date, a lot of other communities were canceling events,” said Choteau Chamber of Commerce President Steve Dogiakos. “We were looking to hold ours, but we had to balance that against community safety.” (Among other things, how could they safely go ahead with the traditional “pitchfork fondue,” with steaks grilled on the ends of pitchforks?) “I talked to Melissa [Moyer] quite a few times,” Dogiakos said. “She wouldn’t give me any direct order, but she would say, ‘If this were me, this is how I’d do it.’ She helped guide us through the process.”
As July 4th neared, Choteau had its first COVID-19 outbreak — and the Chamber scrapped its plans. The Legion, however, still wanted to go ahead with its pro rodeo event, its biggest fundraiser of the year. “We did put quite a bit of work into developing a strategy and plans for social distancing,” said Commander Jerry Collins. The Legion split the traditional one-day event into two days, to reduce crowding. It separated its bleachers to ensure greater distancing. It ordered masks and bandanas.
“They put together a really good plan,” Moyers recalled. “Really thoughtful.” But it wasn’t good enough to overcome the reality that the event would attract too many people. In a split vote, the Board denied the proposal.
Was everyone happy? Very predictably, no. “My sense was, this was getting killed even before it got to a vote,” Collins said. “There wasn’t a whole lot of open-mindedness.” Said Hodgskiss, the County Commission Chairman: “There’s undoubtedly some bitterness. But I don’t know how long that will last. You just suck it up.”
Discord or not, here’s what we take away from Teton County’s example. First, the various players have worked well together because they agreed up front that doing so was in everyone’s interest. The Health Board, the Health Officer, and the Health Department were on the same page because they committed to uphold the Governor’s directive – and to anticipate new ones. The County Commissioners were on board from the start.
And everyone agreed on a sensible process that allowed the Health Department the autonomy to make most day-to-day decisions but the flexibility to escalate the tougher calls. That process was transparent to all, allowing both for public input and for appeals.
As Moyers has observed, it’s not a perfect system. “It’s just what we stumbled across, and I’m not sure it would work in every county.” But it’s done the job in a difficult time, and it’s a valuable model as Jefferson County considers how to best serve the public health interests of its residents. Health Board chairperson Christina Binkowski has already hinted at her desire to move in that direction: “It’s imperative we all sit down and discuss these plans and directives so everyone involved can have input,” she told The Monitor. We applaud that instinct.
Joan Van Duynhoven won’t be involved in whatever emerges. That may well be for the best – but we’re grateful for her conviction and leadership amid both an unprecedented crisis and a striking lack of support for her efforts. And we wish her successor, who will inherit a challenging role at a critical moment, better.