Tuesday, July 5, 2016

Mariposa County Grand Jury Final Report 2015-16

July 2, 2016 - The 2015-2016 Mariposa County Grand Jury investigated problems at the Mariposa County Health Department and came up with recommendations for the Mariposa County Board of Supervisors to consider.
The 2015 - 2016 Grand Jury determined to investigate the Mariposa County Health Department (Public and Environmental Health). This review focuses on the organizational structure, staff training, personnel turnover and conflict within the Health Department. For this investigation the Grand Jury focuses on the internal working of the Health Department and does not address customer service.
The Grand Jury conducted numerous interviews with staff from the Mariposa County Health Department, Director of Human Resources and the newly hired Health Department Director at the time of this investigation. Note: The Health Department Director in this investigation has since resigned.
The Grand Jury reviewed dozens of documents including standard operating procedures, organizational charts, job descriptions, resolutions, letters, memorandums, agreements, and emails pertinent to this investigation.
The Mariposa County Health Department consists of Public Health and Environmental Health and is responsible to protect and promote the health, safety and environment of the community by preventing and controlling diseases, environmental hazards, injury and disability, and by educating and promoting healthier lifestyles.
The two divisions of the Health Department are located in separate buildings. The Public Health division is located at 5085 Bullion Street while the Environmental Health division is in the Government Center located at 5100 Bullion Street.
California State law requires that a medical doctor be retained by the County for portions of the Health Department's responsibilities. The Board of Supervisors has appointed a medical doctor as Health Officer to oversee the entire management of the Health Department. The Health Officer (medical doctor) is the highest paid employee in the County of Mariposa. The Health Officer is responsible for the duties required by law for a medical doctor and for the administration of both divisions of the Health Department.
The Health Officer who held the position from 1988 to 2014 has been attempting to retire since 2012. The Board of Supervisors has experienced significant difficulty in securing a candidate who is qualified, willing and able to fulfill the requirements of both medical officer and administrator.
In 2015, a new Health Officer for the Health Department was hired. Serious discord and upheaval within the Health Department ensued for approximately ten months until the new Health officer resigned from the position
The interim Medical Officer, is a local physician, and interim health administrator is the County Administrative Officer. On April 5, 2016 Dr. Eric Sergienko was appointed by the Board of Supervisors as the new County Health Officer. He is expected to start later this year.
Mariposa County is the only county in California that is not a member of County Health Executives Association of California, a wide ranging resource with extensive expertise in administration of county health departments and has areas of focus on small county jurisdictions.
Mariposa County is not accredited by the Public Health Accreditation Board (PHAB). This accreditation is not mandatory, but takes a multi-year process to become accredited and in the future is expected to be tied to funding.
Most counties like Mariposa that have a free-standing health department have an administrative person directing the health department and hire a part time contract physician (typically a local physician) for anywhere from eight (8) hours (for counties the size of Mariposa such as Inyo) to twenty (20) hours a week (for larger counties such as Lake County which has three times the population of Mariposa). According to these counties this structure has enabled the health department to function more efficiently, afforded a considerable savings and made recruitment for health department personnel in small counties easier.
According to the organizational chart for the Mariposa County Health Department the Environmental Health Manager supervises the Senior Environmental Health Specialist and the two Registered Environmental Health Specialists. The Environmental Health Manager, the Senior Environmental Health Specialist and the two Registered Environmental Health Specialists work out of the 5100 Bullion location. The Development Service Technicians located in Environmental Health (5100 Bullion Street) are supervised by the Office Technician who is located in Public Health (5085 Bullion Street).
Additionally, there is a long history of conflict and personnel issues within both divisions of the Health Department.
The Mariposa County Health Department provides a vital public service to this community with regards to both public health and environmental health. It is imperative that this department function productively and without discord.
The job description for the Health Officer, who is the director of the Mariposa County Health Department, is lengthy and involves a wide range of experience both as a medical doctor and as an administrator. The job description states, among other duties, that the incumbent plans, organizes, administers and supervises all services, programs and activities of the Health Department. Further, the incumbent selects, trains, supervises, motivates and evaluates the performance of department staff, provides advice and assistance as needed and provides for or coordinates staff training. The position requires knowledge of principles of management, supervision, training and performance evaluation and the ability to plan, organize and supervise staff. It is noted that the minimum qualifications include supervisory or management experience in a broad range of public health programs is "highly desirable" but not stated as “mandatory”.
As stated in the Mariposa Gazette on November 26, 2015 it would seem the Board of Supervisors has two viable options:
1) Maintain the current organizational structure requiring the Health Department to have a Health Officer (medical doctor) to head the health department, or;
2) Approve a County Health Administrator (CHA) who would serve as department head and a medical officer would be hired as part time and be subordinate to the CHA.
As of the writing of this report the Board of Supervisors has voted to pursue option one based on an on-going contract for advertising, outreach and recruitment for a Health Officer.
Over time, some primary responsibilities listed in the Health Officer job description have been delegated to subordinates which appears to be a contributing factor in the conflict within the Health Department and with other departments.
The previous Health Officer reportedly did not like modern conveniences, such as email, and chose to run the department in a way that would appear somewhat antiquated. Numerous interviewees indicated that there has been little to no updating or modernizing office procedures over the past fifteen (15) or more years. Suggestions to update procedures resulted in an overall attitude of unwillingness to change.
The Environmental Health Manager and Senior Environmental Health Specialist positions were originally contract positions with the State of California. The County of Mariposa reimbursed the State for these costs. In 2010 the State drastically increased the cost to Mariposa County for these positions. Subsequently, the Medical Officer recommended, and the Board of Supervisors approved with Resolution 2010-322, that the two State contracted employees be designated as County employees effective July 1, 2010. Job descriptions for the two positions were approved by the Board of Supervisors in December 2010 with Resolution 2010-563. Due to time constraints of the state contract expiration, these positions were not advertised and recruitment was not done within the local community. The Environmental Health Supervisor and Senior Environmental Health Specialist did not receive training for supervisory or management positions and apparently did not have adequate supervisory experience.
During interviews conducted by the Grand Jury it was disclosed that the Environmental Health Manager actually supervises one of the Registered Environmental Health Specialists (REHS) and the Senior Environmental Health Specialist supervises the other REHS. However, the organizational chart does not reflect that reality. Additionally, while the Environmental Health Manager and the Senior Environmental Health Specialist are both tasked with supervising all Environmental Health employees, including support staff, the organizational chart shows the two Development Services Technician positions assigned to Environmental Health are supervised by the Public Health Office Technician who is located in a separate facility. Overall, the separate locations of the two divisions of the Health Department presents specific challenges.
The Environmental Health Manager, by also having the title of Director of Environmental Health, is easily confused with the Public Health Department Director. In the past the Health Officer has tasked the Environmental Health Manager to represent the Health Department in meetings of department directors which has contributed to the conflict within the departments. The department directors need to speak freely with each other and cannot do so when the representation in a meeting is not equal or among peers. This is especially vital for policy and personnel issues.
As reported by interviewees, little or no cross training is conducted. It is suggested by some that specific training and experience is denied to certain employees, thus making advancement impossible and negatively affecting moral. For example, the two Registered Environmental Health Specialists (REHS) are not encouraged to get the training and/or certifications for the Environmental Health Manager and Senior Supervising Environmental Health Specialist positions. Should either of these two previous state contracted employees choose to leave Mariposa County for whatever reason, the two subordinate REHS who have been dedicated to serving Mariposa County would not qualify to be promoted.
This investigation revealed that promotions to management or supervisory positions appear to be given to employees based on their length of service without consideration given to manager/supervisor abilities. An employee who performs the job well may not necessarily possess the knowledge, skills, or personality to be a good supervisor or manager. Training for management and supervisory positions has not been offered or required.
This investigation revealed numerous accounts of the following:
Employee turnover due to bullying by supervisors.
A toxic work environment with supervisors acting with hostility.
Supervisors do not effectively or adequately address conflict and tolerate inappropriate behavior.
Unequal treatment among equivalent status employees.
Heavy handed and dictatorial management.
Instances of high stress, reducing employees to tears resulting in the need to retreat to compose themselves.
The job descriptions/responsibilities for each position is not accurately reflected in the organizational chart and does not indicate a clear chain of command.
Some employees expressed concern about repercussions if they brought any issues to management. Some stated that complaints been brought to management but have not been acted upon. Some employees were hesitant to talk with the Grand Jury or meet with the Grand Jury even under the protection of confidentiality
The Board of Supervisors has hired a Medical Officer to direct the Health Department and he is expected to start later this year. If this situation should prove to be unsuccessful, or in preparation of future Health Department staffing, the Grand Jury recommends the following:
The duties afforded to a Medical Officer/Health Department Administrator may possibly exceed both the time availability and the typical combined talents of one person. The Grand Jury believes that Option 2 as stated above is a better resolution to the difficulty in filling this position. It is recommended that in the future the Health Department be restructured as follows:
Administrator: Full time position to act as department head and direct the entire department; and,
Public Health Officer: Part time position to be a medical doctor responsible for medical duties as required by law and subordinate to the Administrator.
NOTE: It is further noted that this structure might result in savings to the County to be used in other areas of pressing concern and allow for easier recruitment of qualified candidates.
In the absence of approval for this restructure of the Health Department the following recommendations are made by the Grand Jury:
The job description for the Health Officer should be revised to make supervisory or management experience mandatory, and;
Due diligence on the part of Mariposa County Board of Supervisors should be paramount to make certain the candidate hired for the position of Health Officer/Administrator is qualified as both a medical doctor and, more importantly, an administrator.
The Health Officer should seriously consider becoming a member of the County Health Executives Association of California and investigate the possibility and/or future necessity of accreditation by the Public Health Accreditation Board.
The Health Department Director/Medical Officer should directly supervise and be actively involved with the Environmental Health division, making job descriptions and organizational charts reflect accurately the delineation of job duties and responsibility within the department.
Support staff in Environmental Health (Development Service Technicians) should be supervised by the Environmental Health Manager, not by a supervisor located at a separate site.
Any department head meetings involving either division of the Health Department should be attended by the Health Officer and any decisions or conclusions made between the department heads involved should then be disseminated to staff for implementation. These department head meetings should not be delegated to a subordinate.
Supervisors/managers should be required to attend ongoing training in personnel management and supervision in order to obtain the necessary knowledge and skills for maintaining a positive productive and healthy work environment. In addition, the Health Officer should continuously monitor supervisors to make certain they are adequately performing their responsibilities.
The incoming Health Officer, Human Resource Director, County Counsel and possibly the liaisons from the Board of Supervisors should be involved in an effort to pinpoint the source(s) of hostility and bullying and resolve the issue as soon as possible.
Managers and/or supervisors and employees who are not availing themselves to training, which must be offered, or who continue to contribute to the discord and hostile work environment should be demoted or terminated from employment with Mariposa County.
NOTE: The Grand Jury is excited, encouraged and looking forward to the changes forthcoming in the Health Department under the direction of Dr. Eric Sergienko.
The Grand Jury requests a response from the Board of Supervisors.
The Grand Jury invites a response from the most recent Health Officer.
July 2, 2016
Sierra Sun Times
Source: 2015-2016 Mariposa Grand Jury Report

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