Will Douglas County Pull the Plug on its Public Health Division?

A decision may come in January, when new county commissioners take office, assuring at least one more chapter in an ongoing saga that began last spring with a surprise announcement.

The Douglas County Public Health Division will remain on life support until next year.

The county may decide to shut down the agency and turn over public health services to the state, which is what the county commissioners announced would happen back in June, before they changed their minds two months later. But for now, the plans are on hold.

Since two new Douglas County commissioners take office in January, it's anyone's guess what will happen. If they do choose to shut down the division, Douglas County would become the first county in Oregon to get out of the business of safeguarding public health.

“This whole process has been very clumsily handled,” said Dr. Robert Dannenhoffer, CEO of the Douglas County coordinated care organization Umpqua Health Alliance, which scrambled for a solution last spring when the commissioners first announced that the county would no longer provide mental health services. “It makes very little sense.”

Dannenhoffer was a panelist Monday night at a healthcare forum in Roseburg sponsored by the League of Women Voters of Umpqua Valley. Dawnelle Marshall, the director of the public health division, who was also on the panel, said at the meeting that any plans to shut down her division were on hold, and that to implement such a change would require more than 90 days, the amount of lead time commissioners had originally given in June.

When reached for comment following the meeting, Marshall declined to speak to The Lund Report without first speaking with Susan Morgan, the county commissioner who has been leading the effort to shut down the division. Morgan, who declined an invitation to speak at the forum Monday night, did not return a separate call for comment by The Lund Report.

Last month, Morgan gave several reasons why the county was considering closing down its public health services. She told the News-Review, the local paper in Douglas County, that she was concerned about costs and that coordinated care organizations could do a better job improving the health of low-income patients.

Dannenhoffer is not aware of any formal talks among health leaders in Douglas County to discuss the fate of the public health department. Earlier this year, “people from the state asked if there was a group that would discuss this. My response is, 'Don't waste my time and ask me to bless something that's already been made. I'm not willing to put a rubber stamp on a decision that somebody else made,’” he said.

“What we're hoping is, there will be a vibrant county discussion about what would be best for public health, and then after that discussion, some decisions will be made,” said Dannenhoffer, who is also CEO of Architrave Health in Roseburg, a partnership between Mercy Medical Center, and its physician alliance, Douglas County IPA.

“I don't think there are many people who are dogmatic and believe nothing can change. As long as the change is reasonable,” he said. For instance, the county could contract out a water testing program to another county, if it wished.

According to the Douglas County web site, the Public Health Division provides “essential public health services,” including immunizations and communicable disease control, parent and child health, adult health, family planning, health education and promotion, public health preparedness and the Women, Infants and Children nutrition program.

In fact, the Women, Infants and Children program might be improved in the county if it was administered through the local federally qualified health center that already provides primary care services to children, Dannenhoffer said.

But there are limits to what non-governmental agencies can provide. Dannenhoffer points to the recent history of outbreaks of diseases like Hepatitis A, syphilis and Shigella. “You really need a public health department to [handle] that. We're dealing with stuff like pertussis all the time.”

If there is a silver lining to the story, it's that the community has been able to come together in a pinch. Dannenhoffer said, pointing to the funding for the new mental health court in the county. Designed to divert the mentally ill away from jail and into needed healthcare services, it began hearing cases in August; Douglas County joined 12 other Oregon counties and two cities that have such a court.

Funding for the court came from Greater Oregon Behavioral Health, which contracts with the state to provide mental health services in Douglas and 15 other counties in Oregon, along with Douglas County, the city of Roseburg and the medical group Architrave, to help restore a funding cut to the Douglas County District Attorney’s Office. The Lund Report wrote about the court in August.

Another positive development is the implementation of Centricity electronic medical record software, which allows mental health providers and primary healthcare providers to share patient information for the first time. The Community Health Alliance, a new nonprofit mental health agency formed when the county decided not to provide mental health services, has been in charge of the roll out.

In other developments, Dannenhoffer’s name has surfaced as a potential candidate to become the next administrator of the Oregon Health Authority, however has not confirmed whether he is, in fact, interested in the position. 

Christopher can be reached at [email protected]

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