Mills County Public Health Office Future Uncertain After Staffing, Program Cuts
The future of the Mills County Public Health Office remains uncertain, even after two of the seven agency employees who were abruptly and publicly discharged from their jobs during an emergency meeting of the Mills County Board Of Health last Wednesday were temporarily reinstated to their jobs during a special meeting of the same board on Monday night.
As of now, Mills County Public Health is staffed by six employees, down from 11 prior to last week’s emergency meeting.
The financial stability of the agency has been a focus of concern and discussion over the past nine months among members of the Board of Health and Mills County Board Of Supervisors. Members of both boards in attendance at last Wednesday’s meeting said the decision to drastically downsize the agency by eliminating staffing and services was difficult but was ultimately made in the best interest of Mills County.
The emergency meeting was called after it was determined MCPH probably wouldn’t have the cash flow to operate through the month of January and additional taxpayer dollars couldn’t be allocated to the agency as the result of an inquiry by the state auditor’s office into the improper use of grant dollars by MCPH. Funding for MCPH comes from a combination of county taxpayer dollars and outside grants for multiple services the agency provides.
“The state auditor has issued a directive to Mills County to no longer supply taxpayer funds to the public health department,” said Assistant Mills County Attorney John Pfeifer. “Also implied, it is in the county’s best interest to follow the directive.”
The state auditor’s office issued the directive to Mills County after learning the Iowa Department Of Public Safety had terminated a crisis intervention grant for MCPH because the agency had violated terms of the grant application agreement by supplanting grant funds (not using the dollars for acceptable expenses / purposes).
The crisis intervention grant is federal funding that gets funneled through the Iowa Office of Drug Control Policy (ODCP) to local agencies and programs.
According to an Oct. 11, 2024, letter from the Iowa Department Of Public Safety sent to then MCPH Administrator Brenna Crouse (one of the employees dismissed during last Wednesday’s meeting), the ODCP determined the agency replaced existing and budgeted county funds with grant dollars. The ODCP also determined MCPH provided false, misleading or inaccurate information in emails and conversations with OCCP staff, quarterly progress reports and claims for reimbursement of funds through the grant program.
Megan Major, a new member of the board of health, said she was angered by the letter.
“In reading it, it’s a lot more than just misappropriating the funds,” she said. “It is requests for information that were never given,” Major said. “It’s making me very angry to read this because this could have been prevented. We did not have to be in this spot. The time to act was a couple months ago.”
Crouse defended MCPH in response to Major’s comment.
“With that grant, we did everything we could to mitigate the circumstances. I had phone calls, I met with them virtually, I gave them information they were asking for after that meeting,” Crouse said. “This letter is a result of that meeting we had one-on-one with them and then they requested payback of the grant.
“I paid back the funds they had given us during that time frame and then as a board, we had met and made action steps on what to do so this doesn’t happen again. Those action steps were for me to meet with my grant contractors to make sure the grants are in good standing, which I have done with all the grant contracts. All of them have stated there are no concerns with the budget or with their billing claims – their documentation that they’re receiving. They have no concerns with the services that are being provided from those grants.”
Multiple Leadership Changes
Mills County Board Of Health Chair Darcey Butts stressed that the allegations involved funds being “shuffled between accounts.”
“It was a lack of knowledge of what that grant was supposed to be used for,” he said. “Some of that money was transferred temporarily out of that account into another account. They call that supplanting. I had no idea what the word supplanting even meant until it was brought up to us a while back.”
oard of Health member Sandra Leaders stated that multiple leadership changes have taken place at MCPH over the past few years and there are multiple factors that contributed to the agency’s financial struggles, including the manner in which the Mills County Board Of Supervisors allocated taxpayer funds to the agency.
“People were placed in positions to take over some of the office management and the different grants. I think some of that was education things that got missed along the way, so I don’t think there should be any finger-pointing or that it was anybody’s fault that this happened,” she said. “I think as a board, we did try to rectify these, but due to the fact that there were so many changes made over the last years has brought us to the situation we’re at now, along with the board of supervisors deciding on how it was appropriately going to give us our funding.
There’s a lot of pieces here, people. There’s not just one or two.”
Jack Sayers, the Mills County Board Of Supervisors’ liaison to the board of health, said he campaigned the last nine months to protect MCPH funding, but was not aware of the severity of the problems until recently.
“I was not aware of the gravity of this situation until after Amber Farnan (county auditor) took office, a week after the election, and fully explained to me the problems with public health,” Sayers said. “This grant is not the only thing. It comes down to in addition to that public health’s revenue has been inflated in years past and then you do not receive the grants. When that happens, you come back to the board of supervisors and you request funding. That money, a lot of it, would be put into grant lines. When that happens, that is supplanting.”
Mills County Legal Concerns
Both Sayers and fellow county supervisor Richard Crouch, said they’re concerned supplanting of grant funds and a subsequent investigation by the state auditor’s office could put other county grants funded by the federal government in jeopardy, including dollars for other departments.
“That is not just the board of health, that implicates the board of supervisors. That calls into question whether conservation can receive grants for their parks, whether the roads department can receive federal grants for their bridges, whether the sheriff’s office can receive grants for their K-9 unit,” Sayers said. “It calls into question over the last 25 years worth of grants. If if gets investigated, what are they going to find if all of our I’s aren’t dotted and our T’s aren’t crossed?”
Crouch said he doesn’t like making the cuts to MCPH staffing and services, but shared concerns similar to Sayers’, noting that he’s had conversations with the Iowa Attorney General’s Office about the matter and they’ve made no guarantees that future action won’t be taken against Mills County.
“He said, “I can’t guarantee that. Public Safety caught this. Public Safety turned it over to us. We have to turn it over to the DOJ (Department Of Justice) and it’s entirely up to DOJ and company,’” Crouch said. “What I worry about most, it won’t just be on public health. It will cover the whole county - roads, conservation, emergency management among departments that count on grants.
“Folks, I don’t like what we’re doing tonight, but we have to do this, I guess, in order that we hopefully save Mills County, because if they come in and start investigating, it’s not going to be pretty.”
Closed Session
After discussions concerning the reasons behind their decision to cut MCPH staffing and services, the board of health went into closed session for about 45 minutes to discuss which employees would be let go.
After returning to open session, the board of health terminated two and laid off five MCPH employees one by one during a roll call vote.
Crouse was one of two employees terminated, along with retired MCPH Administrator Sheri Bowen, who had originally returned to the agency as a consultant but was recently administering the regional Emergency Preparedness Grant for the county. They will receive no additional compensation as a result of their dismissal.
The employees who were laid off were told they’ll receive regular compensation for 10 days pay and accumulated vacation and keep their health insurance benefits through the month of January.
On Monday night, five days after the emergency meeting, the board of health unanimously recalled the lay-offs of Belinda DeBolt and Amanda Blackman. They will keep their positions through June 30 as readiness and response coordinators for a 12-county area in southwest Iowa. Mills County is contracted through June 30 to coordinate hospital preparedness and public health emergency preparedness programs as the regional facilitator of the Iowa Department Of Health and Human Services Emergency Preparedness Grant, which covers the salaries and benefits for DeBolt and Blackman. Their positions will end on June 30.
The MCPH employees who were dismissed during last Wednesday’s meeting were instructed to immediately turn in their employment badges and other county-owned property and gather their personal belongings. They were escorted from the building by law enforcement officers from the Mills County Sheriff’s Office.
In addition to DeBolt and Blackman, the board of health is retaining four MCPH employees – home healthcare workers Liz Boston and Janet Hill, Parents As Teachers administrator Kim Frink, whose entire employee salary and benefit package is funded by a grant, and nursing coordinator Katelyn Murtfeld, who is taking on administrative duties as well. The pay and benefits of the employees retained will not change.
Home healthcare will now be the primary focus of the MCPH office with several programs and services potentially lost as a result of the funding and staffing cuts, including the NEST program for young mothers and tobacco and substance abuse prevention programs. The board of health terminated two grants at Monday’s meeting and tabled decisions on some others that fund MCPH programs but no longer have employees to administer them.
Both Sayers and Crouch said the county is committed to providing homemaker and home health care services to Mills County residents despite downsizing of the MCPH office.
Speaking at the regular meeting of the board of supervisors Monday morning, Sayers stated, “The board of health has made some very, very heart-wrenching changes, but they had to legally be done in a way that people could continue to have home health services and we could take care of the elderly here in Mills County.”
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The Mills County Board Of Supervisors and Mills County Board of Health released the following statements on Thursday regarding the reduction in MCPH staff and services:
Mills County Board Of Supervisors Statement
The Mills County Board of Supervisors regretfully announces a significant reduction in staffing at Mills County Public Health (MCPH), effective January 8, 2025. This decision follows months of careful consideration, exhaustive exploration of alternatives, and a steadfast commitment to balancing the County’s fiscal responsibilities with its duty to serve the community.
The reduction stems from several critical issues, including a lack of transparency with the Mills County Board of Health, instances of fiscal irregularities, repeated misrepresentation of revenue by the MCPH administration, and other troubling practices. Following guidance from multiple state and federal agencies, as well as legal counsel, the Board of Supervisors determined that we are legally prohibited from providing additional county funding to MCPH due to ongoing investigations into the agency’s misuse of funds and lack of accountability. Allocating further taxpayer dollars to MCPH will jeopardize grants for other essential county departments, including Mills County Secondary Roads, Mills County Conservation, the Sheriff’s Office, and others. While the Board of Supervisors' initial instinct was to support MCPH through these challenges, the financial risk to Mills County’s government and taxpayers was too significant.
In response, the Board of Supervisors, along with the Auditor’s Office, has worked diligently to preserve home healthcare. A thorough review of the MCPH budget revealed sufficient remaining funds to retain two home healthcare aides and one nurse. This decision ensures that home healthcare services in Mills County will remain intact and unchanged, reflecting a major concern and priority of our constituents.
The decision to reduce staffing was made with great reluctance, fully recognizing the profound impact on the dedicated individuals who have served our community with professionalism and care. The County is committed to providing resources and support for affected employees during this transition.
This is a challenging time for Mills County, but it also presents an opportunity to reevaluate how essential services are delivered and to strengthen the long-term sustainability of our public health system. The Board remains committed to transparency and accountability and encourages residents to share their thoughts and concerns as we move forward together.
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Mills County Board Of Health Statement
The Mills County Board of Health (BOH) regrets to announce a reduction in staffing levels at Mills County Public Health (MCPH). This difficult decision came after exhausting all available alternatives to avoid it.
Incoming and current board members were informed of the Board of Supervisors' legal inability to provide additional funding for the department. Upon review, it became evident that mismanagement, a lack of transparency by previous BOH members, and insufficient oversight contributed to this outcome. The current BOH is dedicated to collaborating with the Board of Supervisors, legal counsel, and other stakeholders to ensure proper oversight and effective management of Mills County Public Health (MCPH).
Remaining funds will be allocated to maintaining home health services. Additionally, in partnership with the grant provider, the Parents as Teachers program will continue. While the loss of other MCPH programs is deeply felt, the Board recognizes the importance of reevaluating how services are delivered. We are committed to working with the Board of Supervisors to build a sustainable public health system.
We encourage Mills County residents to share their thoughts and concerns with us as we navigate this challenging time.