At the conclusion of a contentious hearing before the Cherokee County Board of Supervisors on Tuesday regarding the removal of Dr. Thomas Gary from the Cherokee County Board of Health, Gary requested a vote by a show of hands on whether the supervisors would confirm or rescind a decision in May to remove him from the BOH.
After Ron Wetherell, chairman of the supervisors, indicated that there would not be a vote on that matter at that meeting, Gary said that the supervisors do not need to consider reversing the decision and that he is resigning from the BOH.
He said that the supervisors are usurping the authority of the BOH, violating section 137 of the Iowa Code.
David Appleby and Butch Sleezer then also submitted resignations to the board of supervisors. This leaves only Dr. Ed Burkhalter and Elizabeth White on the board of health.
The supervisors voted in a special session on May 25 to remove Gary from the BOH. They approved a letter to Gary at that meeting citing eight points for the removal of Gary, the most recent and the most serious, according to the supervisors, was the selling of the county's Medicare identification number to Careage Management for $1.
At a subsequent supervisors meeting, the supervisors consulted with Robert Eps, a Medicare fraud investigator for a multi-state region, operating out of Kansas City, Mo.
Eps explained that the entity that possesses the Medicare number receives payment for whatever services are provided under that account. Eps said that an appointed county official would not have the authority to sell a federal identification number.
"I'm not sure that any federal laws were broken but in terms of common sense governance, this is simply wrong," Eps had said.
At the meeting this week, Gary addressed the issues raised in the letter one at a time.
Regarding the sale of the Medicare number, Gary said that he was told that the sale would be legal and that Careage Management would be willing to assume any liability associated with the Medicare coverage. Gary said he was trying to reduce the county's liability. He said he was also concerned with keeping continuity of service for people being served and concerned about continued employment for health department employees following the elimination of a county operated county health nurse's office, This office ceases to exist as of July 1. Another reason Gary cited was giving the public the right to choose services.
"There is too much being made of this Medicare number," Gary said.
This conclusion was echoed by Gary's attorney, Will Cook, who joined Gary at the long supervisors' table on Tuesday. Cook described the issue as a sucking chest wound that he wanted to put a bandage on.
Cook said that the advice that was acted on was that the sale of the Medicare number was legal but that a different opinion was later given. Cook said he doesn't know the legality of selling the Medicare number but the supervisors should have consulted with Gary to find out on what advice he was using on which to base the sale of the Medicare number.
Gary raised some side issues that brought angry responses from two county officials present.
Regarding a form that had been filled out by the county health nurse, Gary said that only three people knew that such a form had been filled out prior to Gary being asked about it by the county auditor. Gary said that the only way that he can think of that anyone would know about it, other than the three people, would be someone going through papers in the health nurse's desk. He challenged the supervisors to explain what other way that knowledge would have been obtained.
Bonnie Ebel bristled at the assertion. "Nobody went into that office. We don't do that," Ebel stated.
Ebel and Gary disagreed over the timeline of when the information would have been available through Martha Graham in the state office where the form was eventually filed.
Gary also referred to an appointment he had with James Tiernan, the county attorney, that was cancelled because Tiernan was collecting signatures - "I presume because of the election."
Tiernan said he had made it clear that he was collecting signatures on a county business matter, not for the upcoming election.
Wetherell discussed the process of obtaining a Medicare number, noting that Careage Management could not bill Medicare until obtaining that number. He stated that the number would have value to Careage Management.
Wetherell also stated that other members of the BOH did not know about the sale of the number before it occurred.
Dean Schmidt, supervisor, said the county wanted to retain the number because if the arrangement with a private provider doesn't work out in five or so years from now, the county would not have to go through the process of obtaining a number again.
Mark Leeds, supervisor, said that the county health department is in the hole financially.
There have been claims and counterclaims during past discussions about the financial accountability of the county's public health department.
Kristin Cedar, who has worked for the county health department, noted that the board of health is composed of volunteers, unlike the board of supervisors, and that it might be harder in the future to find good people to provide public service.
There were other comments made on Gary's behalf by members of the audience.
Connie Ladwig said that the supervisors should have taken time to study the matter before acting. She said this would have caused less stress on everyone involved.
"I disagree," Wetherell said, "People just don't like change."