Fresno County could split top health jobs -- but one would be part-time

The Fresno BeeAugust 16, 2013 

Fresno County supervisors could decide Tuesday to split the county's top two health jobs, reversing a cost-cutting move made eight years ago.

But the job separation would not create a full-time health chief -- a role health advocates have long championed, but which has been filled for only two years in the past decade.

Under the proposal for supervisors to consider, the county would repeal a 2005 ordinance that consolidated the health officer and health director jobs. That would allow a full-time health director to focus on the administration and operation of the Department of Public Health, which is facing lawsuits for its handling of medical and psychiatric services for inmates at the County Jail.

The split would give the county flexibility to hire a health director who is not a licensed medical doctor, said County Administrative Officer John Navarrette. Under California law, county public health officers must be a licensed physician. The health department has 483 employees.

WATCHDOG REPORT: Locked in Terror

But the newly recreated health officer position, while required to be a doctor, would be a part-time job. Under the plan, the county's administrative officer would assign the health officer duties to a county employee who is a licensed physician, and that doctor would be paid an additional 10% for taking on the public health responsibilities.

Navarrette said it's unfair to link the proposal to separate the health officer and health director job to issues at the jail, which include allegations of psychiatric medications being withheld from jail inmates. Those allegations were reported in Locked in Terror, a special Bee Watchdog report.

"I don't think it would have made a big difference" to have had a full-time health officer, Navarrette said. "We had a medical person there at the sheriff's department that was overseeing that."

The Board of Supervisors held a public hearing Aug. 6 to repeal the ordinance that consolidated the health jobs; Tuesday will be the second hearing on the proposal.

The plan to pay a county doctor to assume the additional duties of health officer is not a new concept. Fresno County had a similar arrangement between 1997 and 2003, when Dr. David Hadden served as health officer as well as county coroner. The health director was a stand-alone position.

Pushed by community health advocates who said the county needed a full-time public health boss, supervisors sought candidates in 2003. At the time, the county, with 800,000 people, was the largest in the state without a full-time health officer, according to the Health Officers Association of California. It's not known if the county retains that status today with almost 950,000 residents. The association did not return calls.

Dr. Edward Moreno, a Fresno pediatrician, was appointed health officer in 2003 and held the job for two years until he also was appointed to direct the Community Health Department, which now is the Department of Public Health. Moreno resigned in May as health officer/health director.

A decade ago, the Rev. Walt Parry, who served 23 years as executive director of the multifaith Fresno Metro Ministry organization, argued that Fresno needed a full-time health officer. This week, Parry said his opinion has not changed.

"The public health officer is to foster and guard the health of the public in Fresno County," he said. "It should be a full-time position that people should be able to apply for."

Navarrette said Moreno spent most of his time directing the public health department and that the proposal for a part-time health officer would not diminish the attention given to public health.

The county has doctors who specialize in tuberculosis, immunizations and early childhood care who report to the health officer, he said.

County public health officers do more than sign death certificates, said Hadden, who put in six years as health officer during his 30-year career as coroner. The health officer is responsible for spearheading efforts to prevent and control diseases, such as tuberculosis and sexually transmitted diseases, and chronic health problems including obesity and diabetes, he said: "There is a misunderstanding or lack of appreciation for what a health officer does."

If you go

What: Fresno County Board of Supervisors meeting

When: Tuesday, 9 a.m.

Where: Hall of Records, 2281 Tulare St.

The reporter can be reached at (559) 441-6310, or @beehealthwriter on Twitter.

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