The Cherokee County Board of Supervisors (BOS) will make a decision on the primary contractor for public health services on April 17.
The choice is between the board of supervisors itself or the Cherokee County Board of Health (BOH). The contractor will appoint a subcontractor or more than one subcontractor to provide services currently provided by the Cherokee County Public Health Nurse Office, an office that will no longer exist at the start of the next fiscal year on July 1.
The matter has been one of discussion and controversy since January of this year, with the BOS and BOH taking differing views on how services will be replaced. The BOS further explored the matter at two meetings this week. On Monday, the BOS had a conference call with Julie McMahon of the Iowa Department of Public Health. On Tuesday, the first item on the agenda at the regular weekly meeting was discussion with Dr. Thomas Gary, chairman of the BOH, and Dan Myers, President of Careage Management, LLC , one of two entities to present a proposal to provide the health care services now provided by the county nurse's office.
State law gives the county BOH certain responsibilities independent of the BOS. The BOS has certain direct responsibilities on state mandated health services and can appoint whatever entity it chooses to provide those services. For other services, the BOS and BOH have to mutually decide the method of providing the services.
There could be more than one entity chosen as a subcontractor for services but it is not known whether that would be practical. Careage Management out of Sioux City and Cherokee Regional Medical Center (CRMC) have both submitted proposals to provide all the services currently provided for a set price plus the grants and fees available for the services.
The BOS members have expressed a preference for CRMC and the BOH has voted to use Careage Management.
A stated reason for the BOH preference of Careage Management is that Careage has stated that its intent to hire most or all of the present staff of the health nurse office and honor the benefit levels achieved based on seniority. CRMC has also indicated its intent to use health nurse office staff.
Neither entity has guaranteed all the present staff will be hired nor will those initially hired necessarily be kept on should it be impractical to do so. The primary difference in the stated intention toward present county health nurse office staff is that CRMC will regard all such staff to be new employees while Careage intends to honor seniority.
Among reasons for the BOS preference for CRMC is that it is a local entity that could not walk away from a contractual obligation. It was noted that although Careage is based in Sioux City, it does operate a facility in Cherokee and there would be a contract signed for services.
Dean Schmidt, supervisor, has stated that the intended non-profit organization would be a separate entity from Careage Management and any liability of the former would not be carried by the latter organization. Schmidt suggested that a bond is needed to guarantee performance.
"It seems that we've been at each other's throats. We can't do that anymore. We have to work together," Gary told the supervisors. Gary stated that there were miscommunications regarding the matter. Gary was highly critical of the Chronicle Times coverage of the issue, referring to the newspaper as an unreliable source of information.
Gary urged a quick decision regarding the matter so plans could proceed on setting up the service. Careage Management would need to set up a separate non-profit entity to provide at least some of the services. Myers said that setting up a non-profit entity can be a rather quick procedure although it would not necessarily have the status needed to accept tax deductible donations, a process that is much lengthier.
Gary stated that there is now only one subcontractor proposal. He said the CRMC proposal is now off the table.
When contacted Wednesday morning, John Comstock, CEO of CRMC, stated that the initial proposal from CRMC contained a deadline for a response but the hospital has submitted a written clarification that CRMC is still interested in providing the services as originally proposed.
"Our proposal is still on the table," Comstock said.