One Year, Montana’s Rolled-Back Public Health Powers Left Some Places in Limbo

A year after new Montana law stripped local health boards of their regulatory jurisdiction, confusion and power struggles are creating a patchwork monitoring system that could change the way they care. to public health after the disease has subsided.

The law, enacted last April amid condemnation of mask orders and covid detainees in the industry, gives elected leaders the final say in establishing a health rules. Proponents of her case have argued that elected officials should be held accountable if they violate that authority, while opponents of the change have argued that politics should influence health decisions.

Matt Kelley, CEO of the Montana Public Health Institute, a nonprofit dedicated to strengthening health systems, said local health organizations have a responsibility to protect their communities, but said the law limits their power to do so.

“Everyone who’s got a job that they have to take responsibility for something but don’t have the power to actually do that job, they know how hard and what kind of damage it is,” Kelley said.

The law is part of a wave of bills passed in state legislatures amid an epidemic. At least 26 states have passed laws to restore public health controls. Montana judges have passed some of the most drastic changes, including removing restrictions on religious gatherings and banning facilities – including hospitals – from requiring vaccination. covid-19 or any other disease.

Prior to the new law, health boards based on what was chosen by local governments set health regulations and allowed health services for their areas. The measure limited the powers of the health boards to allow them to issue orders at a risk, although appointed officials could change or revoke those orders. The elected officials also have a final say in the selection of health officials. But local health offices and day -to -day health programs are not expected to be affected by the new rules.

The law left county commissions to oversee county health boards and city councils to oversee health plans. But for local governments with corporate health clinics, the law is not clear; they are left to define their own “management team” to provide focus.

As a result, those cities and counties will need to re -create agreements to explain how their team works, said Kelly Lynch, executive director of the Montana League of Cities and Towns.

Some people did not know. In some areas, the detention has local officials debating who will get the ballot and how much to change each. Elsewhere, the founding bodies did not explain how they worked.

At the beginning of April, four of Montana’s largest counties – Missoula, Cascade, Yellowstone, and Gallatin – had not completed their administrative bodies. Public health classes were left in limbo. Many of the health officials held in the center are new to the work after the resignation or retirement of their staff in the face of a polarized public.

When D’Shane Barnett was hired as a health director for the Missoula City-County Health Department, he expected the new rules to pass quickly. After one year, he is waiting.

“The other consequence is I don’t know who my boss is,” Barnett said.

County spokeswoman Allison Franz said local officials hope to prepare an interlocal agreement for county and city leaders in June.

Until then, Barnett said, he will try to convince local government officials about the workings of his department. “Right now, everyone, but it won’t last forever,” he said.

David Bedey, a Republican state ambassador from Ravalli County who introduced the new law last year, said the idea is to shift health care power to elected officials rather than illness. While politicians aren’t smart about the roads, they do make the rules of the road – and the same idea applies to public health, he said.

Bedey said he was surprised it took so long to form government agencies, but he hoped they would.

“The idea here is for the local authorities and the citizens in those countries to fix this among themselves,” Bedey said. “If they have rules that are waiting to be approved, it should give them a lot of effort.”

John Felton, Yellowstone County health chief, said the law has created confusion in the largest state. There, four states – the county, the cities of Billings and Laurel, and the city of Broadview – are covered in the inspection of a health center, RiverStone Health, which has its own offices and provides medical services. medical services outside of the nature of most health care facilities. the state.

Felton considers the impact of re-examining future changes in non-covid areas of public health, such as food preparation regulations or how artists apply to the new ink of customers. He is waiting to see how local leaders explain how a government agency should interact with other new laws, such as how to prevent health officials from going through the motions. a business and its customers.

But with the low level of covid cases, those difficult questions emerge.

“Without the haste and worry of someone imposing masking requirements or a residence limit, it’s forgotten,” Felton said.

Although vague, Felton said he would do if the public had a health problem that bothered people: “I will do what I believe is the right thing to do and fix it later if I don’t want to. others in the way, or they feel it is against the spirit of the rules.

By law, the authors have written a part of its purpose to address problems or situations that occur during a public health crisis, not to avoid the incompetence of the local health board. Gallatin County Commissioner Joe Skinner, a supporter of the change, said the inspection of restaurants, septic tanks, and the like would be left to health workers.

“When you start limiting people’s freedom, closing jobs, demanding certain things like masks, it’s not a healthy decision,” he said. “It’s a political decision to be made by the elected people.”

For months, Skinner and his county committee members wanted to be the same delegates on the new public health authority that oversees the Gallatin City-County Health Department. City leaders from Bozeman and Belgrade opposed the closure. County officials have signed a petition allowing a delegate from each city, but some public health workers – Kelley, a former Gallatin City -County health officer – have not opposed the plan in the past. the law on requiring the county’s consent to the transfer of the health course. .

Bozeman Mayor Cyndy Andrus said city officials are looking into the latest idea. “Congress probably made a long -term decision because I would call it a short -term event,” he said. “You see, 99% of what health care programs do is not related to disease.”

In Missoula, Barnett said it’s time to understand all the implications of the law. “This has added a layer of bureaucracy, and brought the popular concept to public health,” he said. “There may be consequences and consequences from this bill that we won’t see for years.”

KHN journalist Jacob Owens provided this story.

KHN (Kaiser Health News) is a government news agency that publishes in -depth news coverage on health issues. KHN is one of three major projects at KFF (Kaiser Family Foundation). KFF is a non -profit organization that provides information on health issues in the nation.

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