Public health authority debate continues

Republican lawmakers are taking aim at the rule-making powers of public health boards and officers in response to COVID-19 precautions that critics say ignored other factors, like impacts to small businesses, without a way to contest those rules. 

On Wednesday, legislators with the Senate Public Health, Welfare and Safety Committee held a hearing on SB 108, which would remove the authority of local public health boards to set health policy and require them to get the approval of an elected governing body, like a city council or county commission, before taking actions like enforcing health regulations or issuing health orders. 

The proposal, sponsored by Sen. Doug Kary, R-Billings, is one of at least three measures lawmakers are considering that are designed to remove authority from health boards and give it to elected officials. Some local health officials implemented COVID-19-related restrictions stricter than the state’s public health directives. 

“Epidemiology is a science, and we should listen to it. Economics is also a science. Who’s listening to that?” asked John Iverson of the Montana Tavern Association during Wednesday’s testimony. “I appreciate what the public health people are doing, but they’re not looking at that. That’s why we’ve got to take this to a higher level.”

The push comes as local health officials have dealt with their own challenges during the pandemic, like protests outside their homes, lack of support from elected officials and stress from long hours and politicization of their work. 

Opponents of the bills, including the Association of Montana Public Health Officials, the Montana Primary Care Association and some elected county officials and health board members, have said conversations about the power of public health officials are welcome, but only once the current pandemic subsides. 

“We in the public health field welcome input about how the public health system can work better, and how public health officials can be more efficient and responsive when events such as a pandemic occur,” Matt Kelley, Gallatin City-County health officer, said last week in testimony opposing HB 121, which is similar to Kary’s proposal. 

On Tuesday, lawmakers conducted a hearing in the House Local Government Committee for HB 145, sponsored by Rep. Paul Fielder, R-Thompson Falls. That measure would remove the power of local health boards to enforce health regulations. Under the proposal, health boards would only be able to issue recommendations to businesses violating local health regulations or other rules regarding issues like food safety or garbage disposal. Health boards could recommend enforcement actions, but would need approval from elected bodies like a city council or county commission to enforce regulations.

Other proposals include HB 121, which the House Local Government Committee heard last week. That measure, sponsored by Rep. David Bedey, R-Hamilton, would allow public health boards to issue health orders during a health emergency, but elected officials could rescind or amend those orders. Health boards would be prohibited from issuing orders in non-emergencies, and would need elected bodies to approve any recommended orders. 

Proposal sponsors and supporters say the changes are needed to ensure that appointed health officials can be held accountable for their decisions. The proposed changes would also give the public more opportunity to influence public health policies that affect them, they maintain. 

Groups in favor of giving elected bodies the responsibility of instituting and enforcing health orders have also said the changes are needed to ensure that policy decisions and compliance actions are weighed against potential impacts to businesses, local tax revenue and jobs. 

Shelby DeMars, testifying on behalf of the Montana Association of Oil, Gas and Coal Counties, told lawmakers Wednesday that the organization believes that making sure “decision-making ability is in the hands of those local elected leaders” is necessary because “we’ve seen some pretty serious impacts of late of public health orders, and we want to make sure that when those orders are formulated, that they also take into consideration the business community.” 

Opponents counter that the proposals would insert politics into decisions that should be based strictly on science. They’ve also said the changes would delay decision-making on issues that often require urgent action, as in cases of a food-borne illness outbreak or sewage spill, by necessitating the approval of elected officials. In addition, opponents have said that accountability for local public health systems already exists, since health boards are composed of people — often city council of county commission members — appointed by elected officials. 

“I wonder if we are reacting to a once-in-a-lifetime pandemic or trying to fix a statutorily created public health system that isn’t really broken,” Joe Russell, the Flathead County health officer, told lawmakers Wednesday on behalf of the Association of Montana Public Health Officials. 

Ross Miller, chairman of the Missoula City-County Health Board, testified Wednesday that rather than rush to enact changes to health board authority, a reasonable first step would be to pass a bill requiring a study to examine the issue after the session. 

“We’re just in the middle of a 100-year pandemic,” he said. “Once we break through to the other side, [that] might be a very good opportunity to take a look back and take a little bit of time for a measured look, and a thorough look, at where we could improve.”