There was no formal motion nor a vote, but Ron Wetherell, chairman of the Cherokee County Board of Supervisors (BOS), informed those gathered April 17th in the board room, that the supervisors will be the primary contractor for health care services and that the Cherokee Regional Medical Center (CRMC) will be the subcontractor for health care services that the county has direct control over designating.
The decision comes in light of the fact that the county is eliminating the county public health nurse office. The Cherokee County Board of Health had voted at an earlier date to turn all the services provided by the public health nurse office over to Careage Management, a Sioux City based company that operates a nursing care facility in Cherokee, among others.
The decision on who the subcontractor is did not have to be made officially until May. The only decision that had to be made official on Tuesday was whether the major contractor would be the BOS or BOH, but supervisors had told people that the public would be informed on April 17, what entity would be the subcontractor so that plans could be made.
In a related matter, the supervisors approved budget adjustments, including $108,263 for the physical health and social services portion of the budget.
Dr. Thomas Gary, BOH chairman, indicated that the BOH will also use CRMC for those services not under the direct authority of the BOS. This decision is being made to keep the various services integrated, although Gary expressed disappointment with the BOS decision.
"We are disappointed that you chose to go against our wishes but we will be supportive of your decision."
Gary strongly disagreed with supervisors who believed that the public health department was creating a growing cost to the taxpayers.
Others at the Tuesday meeting presented even stronger disagreement with the BOS.
"I am very disappointed that you have chosen not to continue a valuable service," said Bev Zieman, former county auditor, "You have taken away health choices."
"I have never been as ashamed of a public body in my life," Butch Sleezer, BOH member, told the supervisors. He said that the BOS had bullied and threatened BOH members and employees.
Jack Clark said that the biggest domestic issue in the '08 election will be health care. He indicated that the county does not have its priorities correct and criticized spending for such things as the county weed commissioner and "Ronnie's Highway," (a road project that will accommodate construction of a bio-diesel facility.
Wetherell said that the supervisors are not planning on providing any less service for public health. "Why would we provide less service?" he asked.
Terry Graybill, supervisor, criticized an assumption that a $75,000 federal reimbursement for a county health care program would be available in the future.
Wetherell and Gary disagreed on whether adjustments to the current year's budget reflected an increase in operating cost of the public health department. Gary contended that there is always expense when closing out a department and that revenue would offset most of the expense of the budget adjustment of $108,263. He said that at the end of the fiscal year there will still be about $61,485 in accounts receivable.
Other expenses this year will be a payout for comp and vacation time of the health department staff that would otherwise be taken over time as staff time off. There was also a payment of $20,925 since the start of the calendar year for a computer software package that will be worthless to the county after it no longer operates the health department.
Wetherell contended that counting the future accounts receivable in the present budget would be comparing revenues over a period longer than one year against expenses of only one year.