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by Bill Lundquist
Pilot Staff Writer
GOLD BEACH - The Curry County Public Health Department Task Force gave itself a passing grade Monday on what it had accomplished in the restructuring of the department so far, but just barely.
Members looked at clinical services, grants, awards and programs, financial management, and administration.
They gave themselves grades in the andquot;Candquot; range for what had been accomplished.
The general feeling was that Public Health was going in the right direction in its transition to a stand-alone department, but had not yet implemented all the necessary changes.
The meeting got off to an inauspicious start when member Dale Thomas found that only one of the expected at-a-glance reports had been generated. He recommended postponing the meeting until all the data was in.
Public Health Director Barbara Floyd said she misunderstood what task force chairman Dr. Bill Swartz needed. She said the data was in and could be turned into reports at the push of a button.
The meeting was recessed for 15 minutes while the button was pushed. When it resumed, members reviewed the progress of each of the recommended changes.
The task force had recommended that the department have open clinics three days a week in Brookings, two days a week in Gold Beach, and one day a week in Port Orford.
Floyd said all clinics were reduced to those days by the last week in June. She said the Port Orford office would be open to the public every Tuesday, but the days in Brookings and Gold Beach would be variable until the middle of August.
She said that was because one of her nurse practitioners would be working two days a week in the Human Services Department, and was being trained for the assignment. Floyd advised clients to call for appointments.
Task force member Diane Pace said the department needs to advertise exactly what days it will be open to the public.
Commissioner Marlyn Schafer said clients should at least be told what days they can call to schedule appointments.
Thomas said he had recommended the Brookings and Gold Beach clinic days be staggered so a clinic would be available in at least one of the towns Monday through Friday.
He said Floyd's proposal of not having any clinics open Monday or Friday meant there would be four consecutive days with no services.
Floyd said she considered that the best scheduling of her staff at this time. She said people are available at the offices to take phone calls Monday through Friday.
Swartz said the needs of the department's customers were a higher priority than accommodating Human Services.
He said making the offices andquot;user-friendlyandquot; was especially important during the transition.
Commissioner Rachelle Schaaf said she was confident Human Services Director Deb Wilson would accommodate Public Health. Floyd said the schedule had been set for July, and she preferred to leave it that way for now. She said if clients had to be seen, they would be squeezed in, as they always had been.
Schafer said people in Brookings believed the office had been closed. She said the department had not gotten the word out about its new hours.
Pace said other clinics were advertising themselves as alternatives to the supposedly andquot;closedandquot; Public Health offices.
Swartz said, andquot;We need to make this a priority, get the message out next week, and be consistent.andquot;
He said the clinic days should be arranged so there is no more than a two-day gap where no services are available somewhere in Curry County. Task force member Linda Brown suggested printing the hours on flyers and leaving them in strategic places like the senior centers.
The task force had also recommended that the Public Health staff be reduced from 14.9 to 9.8 full-time equivalent (FTE) positions.
Swartz had calculated the cut of 5.1 positions would save the department $234,777. Floyd said those cuts had been phased in during June.
Schafer said the department's salaries had totaled $678,000 last year, and would total $566,109 this year, for a savings of less than $112,000.
andquot;That's an alarming number to me,andquot; said Swartz. He said he hadn't included increased insurance and personnel costs in his figures, but didn't think they could add that much.
Schafer said the discrepancy came from Swartz using Floyd's proposed budget, not her actual budget, as a starting point. He said he would meet with Schafer and figure out exactly how to explain the differences in their figures.
He also recommended using as little of what was budgeted for irregular salaries as possible.
Overall, task force members gave grades of C to B- on what had been accomplished in the clinical services portion of the transition. Schafer said the grade applied to the entire task force, including Floyd and the commissioners, not to any one person.
Brown said the grades were the answer to the question, andquot;How close did we come to our goals?andquot;
Floyd said her staff had been andquot;awesomeandquot; in how they had coped with the changes.
Swartz said the target was to offer 25 clinic days a month with 550 client visits.
Floyd said the three offices totaled 24 clinic days in June, with 450 client visits.
She wondered if the target had been set by including food-handler visits and other items.
Swartz said he did not count food-handler visits, and separated out home visits and immunization clinics. He said the department had averaged about 530 provider/client visits a month. He said the data was not perfect, but offered a place to start.
Swartz said the client visits in June were about 20 percent below target, and not a great concern unless they stayed at that level. If visits did not increase, he said, staff might have to be further reduced.
Commissioner Lucie La Bont said people in Port Orford believed that their office had closed. Thomas said Port Orford had the biggest drop in clients.
He also wondered if Floyd had addressed the transportation issue. He recommended paying for Curry Public Transfer tokens to get clients to the clinics.
Floyd said she had not had a chance to work on that yet, and Swartz agreed it might take some time to implement.
He said the target was 20 client visits per clinic day in each office. While Brookings was close, at nearly 19 a day, Port Orford had only 12 visits a day. Swartz said if that didn't increase, Floyd might have to think about having a clinic day in Port Orford only every other week, or having one a half day every week.
He said she might also consider having the clinic day on a Saturday or evenings to attract more clients.
andquot;It's not OK to say you're open and not seeing clients,andquot; he said.
Thomas said Brookings was only 5 percent off target. Floyd said that demonstrates the system will work. andquot;Once you contact the people who think you are closed,andquot; he added.
Floyd said she has planned community forums to help inform the public.
Swartz said a report will also be generated showing the utilization of hours budgeted for grants, awards and programs to make sure the department didn't spend more than it received from those sources.
Thomas said the home visits were below target in Gold Beach.
WIC Coordinator Kathie
Wills said nurses were frustrated trying to train for the WIC nutrition program and fit their home visits in too.
She said mothers assume their babies are on the Oregon Health Plan, but sometimes they are not, or the computers don't show it, so the home visit is not billable.
Swartz said it will be a big project to make sure everyone eligible is on the Oregon Health Plan, but it is vital to the success of the department.
Public Health employee Nancy Baum said she and three volunteers will attend training in Coos Bay on how to register people for the Oregon Health Plan. Floyd said the department's VISTA volunteer will go too.
The task force had recommended upgrading the Ahlers billing and collection system, and Brown said that upgrade is on a fast track. She said the staff will receive three days of training, beginning August 26.
Floyd estimated her accounts receivable at $60,000 to $80,000 a month.
Overall, members gave grades in the C to B range for the financial management portion of the transition.
Brown said with the new system, that could be an A by the end of August.
Floyd said she had maximized charges for overhead to those sources of revenue.
She admitted she still wasn't where Swartz wanted her to be on that issue. She said even the county hasn't yet figured out a way to charge for indirect costs.
Swartz asked Floyd if the sources could be charged retroactively for overhead and indirect costs. She didn't know if that was possible.
Public Health Educator Dave Manzella said he has been charging the tobacco-cessation grant all along for indirect costs like materials, postage and administration.
andquot;We've done that for all the grants,andquot; said Floyd, andquot;but not in a systematic way.andquot;
Brown said the county's new computer software will be able to track grants across fields.
The transition had also cut public health educator hours from 1.7 FTE down to .6 FTE. Manzella said he is trying to keep up with his tasks, but has not had time to promote the Public Health Department in general.
Floyd said she hoped to use her VISTA volunteer to do some marketing for the department.
andquot;You've had a huge reduction in hours,andquot; Swartz told Manzella. andquot;I realize you're not a magician. You need a plan in place. You need priorities. You should not try to do everything you did before.andquot;
Floyd said she would work with Manzella to develop a clear work plan by the end of the month.
Overall, task force members gave a grade of C for the grants/awards/programs part of the transition.
Swartz felt the public health director needed to be more andquot;hands-onandquot; and be out in the clinics.
Floyd said she had been to the Brookings clinic three times and to the Gold Beach clinic once in June. andquot;There are a huge number of tasks to keep the department going. The director has to make those decisions day by day. You can't run the director's schedule by committee. I'm doing the best I can to keep the program moving.andquot;
She said there would be more time for hands-on work once the transition is complete.
Swartz said the task force had also asked the commissioners to act as a board of directors. He asked them how they were doing.
Schafer said they are working to revise the job description of the public health director.
She said they are also working to solve internal problems, like with the switch to new software. She said the commissioners did the right thing by moving public health out of the general fund.
Swartz said he had also met with the Public Health Advisory Board and updated members on the changes.
Member Barbara Stover asked the commissioners to think where the advisory board would fit in while they revise the director's job description.
Floyd said the advisory board is not state-mandated, but has been helpful to her.
Task force members gave a grade of C- to the administration portion of the transition.
They agreed to meet again at 10:15 a.m. Aug. 12 in the courthouse annex to assess the progress of the transition.