The Board of Health’s agenda for last Friday contained an item particularly troubling during a pandemic, “Staffing crisis at Health Department”.
On December 2nd, BOH members warned Advisory that its staff was overworked and near a breaking point. It appears that point was reached for at least one of them.
In the Friday meeting in which she referred to Southborough’s cases as “exploding”, the Public Health Nurse was confirmed to be resigning. Also resigning is the longtime Public Health Director. (Though he will still support the department in a limited capacity.) On top of that, the Board is losing current members this spring – possibly all of them.
The Board of Health is now attempting to hire a part-time interim Public Health Director to oversee the department starting in January. That includes Southborough’s Covid contact tracing and case management program. Unfortunately, funding limits/restrictions and confusion over a Town Counsel opinion have complicated attempts. Adding to Board woes are tensions with the Advisory Committee.
One bright spot. . . the Board is applying to hold a Covid-19 Vaccine Clinic for vulnerable residents. (The topic has been a sore spot between Advisory and BOH.)
Recently, BOH members told Advisory that the Health Dept is something people don’t want to invest in when things are good. The work is mainly invisible unless something goes wrong. Then when a catastrophe hits, the bare bones budget and minimal staffing leaves the dept struggling to meet needs.
This summer, the Board discussed pushing for a more robustly staffed model. Their proposed budget would change the Public Health Director and Administrative Assistant from part-time to full-time. It would also add a full-time Public Health Nurse while keeping the part-time nurse.
The vision extends beyond the Covid pandemic. BOH Chair Mary Lou Woodford told Advisory that Covid shone a light on gaps already there. As the Town reduced Public Health services over time, needs have increased (e.g., more communicable diseases, tick borne illnesses, and a host of others.) Issues that Southborough needs to deal with include emergency preparedness documents and plans that are out of date.
Responding to state guidance on responsibilities, the Board wants to pursue Public Health Agency accreditation. Current Public Health Director Paul Pisinski’s expertise is in environmental health. The BOH is looking to hire someone with public health expertise, including on new technologies and state requirements. Beefed up roles would better encompass work the BOH deems important functions of the department.
Originally, th0e Board intended to hold off on staffing changes to the next fiscal year in July. They hoped to bring the proposal to Annual Town Meeting this spring. This month, they asked Advisory to support funding changes sooner. They expressed worry about their ability to serve the Town in the near term.
Over the years, Pisinski shifted from full time to part time, then to half time. Nurse Emily Amico was hired in the spring to work half-time. (Pisinski is meant to be semi-retired and Amico has three children remote schooling from home. Neither wanted full-time hours.) Throughout the pandemic, both have been working about double their expected hours. And Amico’s responsibilities have encompassed duties normally handled by a Public Health Director.
On Friday, Woodford confirmed Amico is resigning. She also indicated that Pisinski is making a change to help the Town. She told fellow Board members that salaries freed up by their resignations, would help fund an interim part-time Public Health Director. Pisinski will still assist the Town as an independent contractor. His main focus would be areas that help the Department’s Sanitary Inspector. (The inspector hasn’t been able to keep up with the work caused by a construction boom. According to Pisinski that’s partly due to soil inspections that are much more time consuming these days.*) He would also be able to mentor a new hire.
Amico is willing to work into February, or to resign sooner if the Board needs her to.
Legal complications for hiring
For BOH’s near term staffing plans, the Board is trying to hire Heather Alker, MD, MPH. (Dr. Alker was a “phenomenal reference” made by former BOH Chair, Dr. Louis Fazen.)
On Friday, Woodford said Alker expressed interest in the full time Public Health Director position. The Chair disclosed that an interim Director would still have to compete with other candidates reviewed by a search committee. Alker was willing to take the temporary stint for $85/hour, 20 hours/week, with no benefits.
The Board voted to contract Alker, if they are able to get past a legal hurdle.
Back in June, Town Counsel informed the Board that a revised statute prohibited them from continuing to hire staff by contract. Woodford said that no case law was cited, and the advice was in contradiction to advice from the state association of Boards of Health. She was asking to have Counsel rescind or revise the opinion.
If the opinion stands, anyone working for the board would have to be hired under the Town’s Salary Administration Plan (SAP). That would mean that the Board would be unable to add any new positions. As Personnel Board Chair Betsy Rosenbloom told BOH and Advisory, SAP positions can’t be added before July. They need to be approved by Town Meeting for the next fiscal year.
Other Staffing issues
Speaking of SAP employees, the department currently splits a Town Administrative Assistant position with the Assessor’s Department. Woodford indicated on the 2nd that the staffing model wasn’t working for them. While the Assessor has been very flexible, Admin Barbara Spiri hasn’t been able to dedicate full time hours to their department. On the 9th, Advisory Chair Kathy Cook indicated that the Town Administrator was confident that they could fill in admin hours for the Health Dept through other Town staff.
While the Department has brought per diem nurses, the amount of time they have been able to give has been limited so far.
The Department has also been making use of the state’s Contact Tracing Collaborative. According to Amico, the service appears to have improved over time. Initially, they had a higher percent of people that they weren’t able to make contact with. Amico tells me that she has had better success making contact with residents when she personally reaches out. But with the recent overload of cases, she has been turning them over to CTC.
Earlier in the pandemic, Amico would touch base with active cases each day to check in on symptoms. Now both she and the CTC are in surge mode. Once initial contact is made, it is up to patients to follow up if they have questions. Amico acknowledged that about a third of the currently reported 94 active cases are probably out of isolation by now. But she hasn’t been able to keep up to officially clear them as inactive. (This week, Amico held another flu vaccine for Southborough students.)
Issues with Advisory
Despite the staffing changes, the department is still likely to need financial support to fund needed staff hours this year. The Board has been using CARES Act funds to cover extra staff hours and support by per diem nurses. Those funds expire December 31st. The Board has been grappling with how to fund needs for the following six months. [The CARES Act funds deadline has been extended to the end of 2021.**]
The Town has a Reserve Fund to cover emergency expenses. Use of funds requires Advisory Committee approval.
On December 2nd, Advisory and BOH discussed the situation with no vote taken. In subsequent meetings where members weren’t present to defend their rationale, BOH and Advisory tempers flared over the other’s recent positions. The Town’s ability to hold a Covid Vaccine Clinic is the main point of contention. But competing visions for staffing has also caused tension.
At Advisory’s December 9th meeting, Cook noted that they weren’t yet in a position to approve any funding. Details around BOH’s ability to contract staff and the costs were uncertain. Cook said that they would consider the request when the time was right. But members sought to provide a framework of understanding for BOH. They discussed what they would and wouldn’t consider supporting.
In a discussion the prior week, Advisory made clear that they want to look into regionalizing department services rather than hiring more staff with benefits for FY22. Woodford pointed out that our state is unique in requiring each Town to run its own Public Health Department under a Board of Health. Even Towns that regionalize have their own boards, and some even have staff for certain roles/services.
As for the interim funding request, member Jason Malinowski raised concerns that it would cover staffing and resources for their wider long term vision. His view was that Reserve Fund Transfers should be limited to expenses caused by the pandemic. Other members agreed.
Cook posited staffing should be for per diem nurses only. Advisory member Andrew Pfaff countered that if BOH should be able to hire someone to supervise nurses if needed.
Members then discussed their dismay over learning the Board might prevent the Town from holding a Covid vaccination clinic.
In the December 2nd discussion, Woodford clarified that the purpose of holding a Covid clinic one would be similar to a flu clinic. Providers won’t have access to the vaccine in the short term. The Town clinic would help serve seniors and people with disabilities that have access challenges. She also warned that if BOH had insufficient systems in place it wouldn’t receive the vaccine.
Prior to the December 9th meeting, Woodford apparently informed Advisory that BOH was unsure it could hold a clinic. Advisory indicated that the Board was unwilling to sign off on an application.
Advisory members took umbrage at the message. They interpreted that if Advisory didn’t fully support BOH’s staffing request, BOH wouldn’t allow the Town to apply for the vaccine. Member Tim Martel referred to it as “games being played”.
to communicate to the BOH that we would look favorably on reserve fund transfers for additional BOH resources that are temporary or contract in nature contract (not full-time, not benefitted employees) that would also facilitate a Covid Vaccine within the Town administered by the local health department.
The Committee noted to have meeting minutes “amplify” that Advisory won’t consider any Reserve Fund transfers unless BOH works with the Town Administrator and other authorities to submit an application for the vaccine.
In BOH’s December 18th meeting, member Nancy Sacco objected to Advisory’s decision as extortion.
Applying for the vaccine requires submitting a plan to administer it. BOH member Dan O’Rourke said they wanted to provide a clinic but without sufficient staff they worried about their ability to responsibly run one. Woodford outlined that a lot of logistics are involved in holding a clinic. Most Covid vaccines would require 2 doses. Tracking and monitoring is required, and data collected needs to be entered in the system within 24 hours. Additionally, the Pfizer vaccine has extreme refrigeration requirements that would need to be met if that was the vaccine allotted.
However, based on discussions between the 9th and 18th, Woodford asserted they could move forward if they have a partner. A partner like Walgreens or CVS would handle the time consuming details.
State legislators referenced the pharmacies’ roles in vaccine distribution at the last Board of Selectmen meeting. The concept was hashed out in a meeting between Malinowski, Woodford, Town Administrator Mark Purple, Southborough Fire Chief Achilles, and Selectmen Sam Stivers.
Woodford said Malinowski, who works in emergency management, volunteered to assist Purple in determining logistics for holding a clinic. At the December 16th Advisory meeting, Malinowski updated that everyone felt better after the recent sit down.
At Friday’s BOH meeting, members anticipated that, if approved by the state, a potential clinic for vulnerable residents would likely be sometime in the spring.
Upcoming Board Vacancies
On top of her full time job, Woodford told Advisory she has been dedicating about 10 hours per week in her role as Chair. That will end this spring, when she moves out of Town and becomes ineligible to serve. O’Rourke isn’t planning to run for re-election in May for personal reasons. And Sacco indicated that she is near the end of her rope. Her day job is as an ICU Nurse which has been stretching her thin. She didn’t want to run for re-election in the spring but chose not to leave the board in the lurch mid-pandemic. She’s not sure how much longer she can hang on.
If one position becomes vacant, the Board of Selectmen and remaining BOH members would work jointly to appoint a replacement until the Town election. If all positions are vacant, the responsibility would fall fully to the BOS to fill.
No information was shared on what would happen if no one volunteers for appointment or runs for election.
*Pisinski explained that most of the “good land” for development in Southborough (and region) is gone. Developers are now trying to build septic in parcels with shallow land over bedrock. It’s even more complicated in Southborough due to reservoirs and the amount of wetland. (Last week, the Board approved new requirements for applications and fees related to issues around soil testing.)
**Updated (1/4/20 2:04 pm): I initially reported that the federal “News reports on the new federal spending package indicate that it won’t change that situation. The stimulus billl doesn’t include funding for states and municipalities.” While it doesn’t include new funds, I missed that it extends the deadline for spending the original funds. That means there are CARES Act funds still available to use for municipalities to be reimbursed for unbudgeted expenses caused by Covid.