It was a tuberculosis outbreak two years ago that started the discussions. The revelations last year that Fulton County wasn't spending all the grant money it received to combat HIV fanned the flame.
The paired frustrations with the Fulton County health department led to legislation to make the county's health director a state employee. Supporters say it might lead to more cooperation, to better oversight.
That legislation passed the Georgia House and is expected to be taken up by the Senate in the coming weeks. Its sponsor, Jan Jones, said it’s long past the time when Fulton should have its own health department. It’s the only county in the state that does.
“Infectious diseases do not respect county lines,” said Jones, R-Milton. “It is important that we get this capital city and county more in line with the rest of the state.”
The current proposal would allow some control to remain with the county, which would appoint four members of a new seven-person Board of Health. While the health director and four other top employees in the department would work for the state, the rank-and-file workers would remain with Fulton County.
Fulton commissioners voted 4-2 to support the legislation. Commissioner Joan Garner, who was in favor of it, said she thought the county and the state could work out the governance issues that might arise. But Commissioner Emma Darnell was wary of the proposal.
“What benefits do we have in turning our public health operation over to the state?” she said.
The bill, HB 885, would repeal the law that allows counties with more than 800,000 residents to have their own health departments. That would keep other large counties from breaking off on their own.
The new Fulton health board would take charge of public health regulations. The county’s Department of Health and Wellness would separate from the existing Public Health Department.
Jones said the changes would allow more collaboration between the county and the state. With outbreaks like drug-resistant tuberculosis and Zika, and increased prevalence of HIV, better coordination is necessary to contain health risks, she said.
“I’m concerned about what will fail if we don’t do it,” she said. “I think in the end, it will be a very good thing.”
A spokeswoman for the state health department said she would not comment on pending legislation. Last month, Fulton hired a new health director — Kathleen E. Toomey — who is scheduled to start her job in mid-March.
Toomey, who most recently worked as the country director in Botswana for the Centers for Disease Control and Prevention, was previously the director of the division of public health within the state’s department of human resources. Fulton County manager Dick Anderson said Toomey’s experience working with the state would be a benefit if the change goes through.
Some of the issues that Jones cited could be solved with Toomey at the department’s helm, county leaders said. Garner suggested that delaying the implementation for a year would give the state and the county a chance to see what impact Toomey might have. It would also leave more time to work out the details about who has what responsibilities in a split system.
Good management and coordination with the state would achieve some of the same goals, Anderson said. But he told commissioners he didn’t see a downside to supporting the shift.
“It brings a tighter alliance with the state and a quicker response to major health outbreaks,” he said. “You would control the board of health. That, to me, seemed like a reasonable trade-off.”
Garner said commissioners would have to be clear about where their interests differed from the state’s so the county could continue to pursue its priorities if the combination does go through.
As the system currently works, Jones said, the county largely operates in a silo. Representatives have often missed statewide meetings where coordination does take place. The state, she said, is in a better position than Fulton to help with public health crises.
Additionally, Fulton has dealt with issues at its health department. Last year, the county had to return $8.8 million in HIV prevention and testing grants because it failed to spend the money in time. The county was able to recover about $3.4 million.
And an audit of the department showed a pattern of mismanagement. One employee was accused of shredding documents and skimming money. The department did not keep up with required food service inspections.
“We have not had the embarrassing public health failures that Fulton County has had,” Jones said.
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