The city of Livingston last week sued Park County Health Officer Dr. Laurel Desnick, the Park County Health Department and the City-County Board of Health, alleging that the health department’s failure to disclose the addresses of positive COVID-19 patients to city dispatchers has led to first responders being unnecessarily exposed to the virus.
The petition, filed in Park County District Court, seeks to require the health department to disclose all positive cases to law enforcement. The petition argues that the health department is violating federal, state and local laws by failing to do so.
The Park County Health Department announced Monday that it has agreed to provide addresses of positive COVID cases to law enforcement. That policy change is in response to the lawsuit, the department said in a statement.
The department had previously provided addresses associated with positive COVID cases to law enforcement, but only with patient approval, under a July agreement with the city, but fell behind as cases increased in the county.
Desnick, a retired doctor who works as Park County’s health officer part-time, said the department has attempted to keep up with those notifications, but has been unable to do so while struggling to keep up with daily operations amplified by the pandemic. The department currently is down three full-time positions, including its director, and just hired more contact tracers to help keep up with the influx of recent cases.
The lawsuit is the latest development in a rocky relationship between the city and the health department that reflects the broader politicization of the pandemic. The city is effectively suing itself, as it is a member of the city-county health board, represented by City Commissioner Quentin Schwarz. Schwarz did not respond to a request for comment.
Michael Kardoes, the city manager, has consistently challenged the health department’s interpretation of state health directives, including a temporary refusal of ambulance service to the southern half of the county and not requiring law enforcement to wear masks despite a statewide requirement.
Across Montana, health officers have had difficulty getting public buy-in for health and safety measures, and some health officers have resigned or been fired as a result of disagreements with local government officials.
Kardoes did not respond to multiple requests for comment for this story. In early September, Montana Free Press filed a public records request for emails related to the city’s COVID response. The city has yet to provide the requested records, despite initially saying they would be made available Sept. 21.
Julie Anderson, former director of the health department who left earlier this summer for a different job, said the city’s conflict with the health department during the pandemic has been “a waste of time, energy and taxpayer money.”
INFORMATION FLOW
At issue in the lawsuit is an April 7 directive from Gov. Steve Bullock providing guidance on how health departments should notify emergency responders about COVID-19 cases in their communities. The directive suspends state health care privacy standards to allow additional disclosure of information to first responders.
The city’s petition argues that first responders, who often interact in close quarters with residents who call 911, should know when they are going to be in proximity to someone who has COVID-19 so they can wear appropriate personal protective equipment.
The petition argues that Bullock’s directive means health officers are required to disclose the information. The health department has taken the directive to mean that it may choose to disclose the information, Desnick said.
The city of Livingston oversees emergency dispatch and provides ambulance services to the majority of Park County. In July, the city temporarily halted ambulance services and ambulance transfers from the southern part of Park County, which is outside of the city’s regular jurisdiction. Southern Park County’s dispatch is overseen by Yellowstone National Park, which has said it does not want the address information. The city often assists with ambulance services in the southern part of the county, since the area’s ambulance services are volunteer-run.
At the time, Anderson, who was then director of the health department, said emergency responders should treat everyone as if they were positive, and that the city’s decision to halt ambulance services put residents at risk. In declining to share address information for positive COVID cases with first responders, Anderson said, she was concerned about patient privacy.
After the ambulance shutdown, the city and the health department reached a temporary solution: contact tracers would ask COVID-positive patients if they wished to have their address disclosed to law enforcement. Patients who declined were asked to promise to notify dispatch if they were COVID-positive upon calling for services.
However, as positive cases increased, the health department stopped these opt-in notifications, the petition says. The petition says the city has not received a list of positive cases since Sept. 25.
On Oct. 6, Wilsall Fire, Livingston Fire and Rescue and the Park County Sheriff’s Office responded to a call of “a delirious patient in need of an ambulance” in Wilsall, about 30 miles north of Livingston, according to the petition.
After the patient was taken to the hospital, emergency responders learned that the patient and multiple family members had tested positive for COVID-19.
The departments had responded to the Wilsall call without proper PPE, and as a result, the responders had to quarantine, the petition said. That effectively put the volunteer Wilsall Fire and Ambulance department out of service, and put a quarter of Livingston Fire and Rescue and one Park County Sheriff’s deputy out of work for two weeks, the petition says.
Even with the addresses being released, the health department said in a statement that it “does not guarantee that First Responders will not be exposed to COVID-19.” First responders can interact with people who are undiagnosed or asymptomatic, the health department may not know about new cases immediately and there is frequently “missing or inaccurate contact information for new cases.”
Dispatchers are supposed to use an expanded script to ask if anyone in the home has COVID-19. Under CDC guidelines, all health care responders should be wearing universal personal protective equipment if a county has moderate to sustained transmission of the virus, which Park County currently does.
POLICE DON’T WEAR MASKS
In the statement, the department also encouraged “all law enforcement and EMS” to follow CDC and health department guidance and directives from the governor — guidance that is currently not being followed in Livingston.
After Bullock issued a statewide mask mandate July 15, the city of Livingston ruled that police officers do not have to wear masks. The health department disagreed with the city’s interpretation of the state’s mandate, and received several complaints from citizens who felt uncomfortable with officers not wearing masks, Anderson said.
Following the ambulance disagreement and the mask decision, members of the Park County Commission and the Livingston City Commission called in a third-party facilitator to help navigate the relationship between the city and the health department.
At a July 20 meeting, the two sides attempted to talk through the working relationship between the government entities, especially the city’s executive branch, including Kardoes, and the health department, including Desnick.
The meeting, which was not open to the public, was attended by many county and city officials at the Park County Fairgrounds. It started off civilly, but tensions escalated about an hour and a half in, Anderson said. Anderson’s version of events was corroborated by several government officials who attended the meeting.
As the conversation moved toward the mask issue, Kardoes, the city manager who ruled that Livingston police do not have to follow the state’s mask directive, said it is unsafe for police to wear masks because they need to be able to show their faces in order to de-escalate situations. At worst, police officers wearing masks could result in an officer shooting a civilian because they are unable to de-escalate, Kardoes said, according to witnesses.
Those comments upset many meeting attendees, including Anderson. Several attendees voiced concerns about police having that quick of a trigger finger.
As the three-hour meeting concluded, Kardoes interrupted Desnick several times. Kardoes asserted to Desnick that she was willing to put officers in harm’s way by requiring them to wear masks. Desnick finally attempted to end the meeting, saying she was done talking to him. Kardoes refused.
“No,” Kardoes said, according to meeting notes from an attendee. “This is how problems get solved.”
Shortly afterward, the facilitator ended the meeting.
Asked during a recent interview with Montana Free Press about the meeting, Desnick said she was disappointed with its outcome.
“It was a huge disappointment. I would have much preferred to come out of the meeting with a partner instead of an adversary,” Desnick said. “That type of interaction serves no one. What serves the people of Park County is us working together.”
Kardoes did not respond to a request for comment.
In the months since, the relationship has not improved. Following the Oct. 6 incident in Wilsall, Livingston Fire and Rescue employees attended an Oct. 13 meeting of the City-County Board of Health and asked the board to reconsider its nondisclosure policy. In its petition, the city said the board of health did not address its complaints, forcing the city to file the lawsuit.
Desnick disagreed. She said the board had scheduled an Oct. 22 follow-up meeting to discuss the issue, but canceled it after the petition was filed.
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