The GPH Board met in Special Session at the Geauga County Administration Building, 12611 Ravenwood Drive, Suite 300, Chardon, OH, on January 18, 2023 at 5 pm. Geauga County Automated Data Processing (ADP) live streamed this meeting and a recording is available on the ADP Youtube channel. The Agenda for this Special Meeting was available ahead of the meeting on the GPH website.
Board Attendance: (as seated, from L to R)
Staff Attendance:
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Dr. Jeffrey Cameron - Medical Director/Health Commissioner
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Carol Straniero - Population Health Director
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Daniel Lark, Interim Environmental Health Director
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Adam Litke – Administrator (absent)
The meeting was called to order and the Pledge of Allegiance was recited.
Geauga Public Health Levy.
This was mistakenly included in the agenda, no discussion was planned on this topic.
Operations Planning.
Ms. Brakey and Ms. Roman discussed the status of a possible cooperative agreement with another county.
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Trumbull County – their administrator is going to crunch some numbers and then get back to the Board with their response.
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Lake County – also interested and working on numbers.
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Summit County – they are already having staffing problems and are not interested.
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Portage County – declined to discuss.
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Ashtabula County – no response.
Ms. Brakey is planning to meet with representatives from the Ohio Department of Health (ODH). According to ODH, any cooperative agreement will have to be reviewed by ODH. Ms. Brakey also mentioned that it might be necessary to have the HDAC review the cooperative agreement, according to her reading of ORC 3709.08. She questioned whether the HDAC should have reviewed the contract with Lake County which provides the services of the Administrator and Environmental Health Director.
Reviewer Comment: HDAC review and approval is required when all public health services are included in a contract between public health boards. See ORC 3709.08(D). It is unclear whether GPH is exploring cooperative agreements for all public health services vs a more narrowly crafted agreement for Administrator and Environmental Health Director services.
Ms. Roman emphasized that with any agreement with another county, Geauga would want to maintain its own Board of Health to oversee policy. The agreement should be for a minimum of 3 to 5 years (Ms. Brakey suggested a 5 year minimum). This would allow time to gear up and gear down, and there should be a one year notice for any early termination.
A Lake County agreement would involve some reduction in the salary of the administrator. This would mean the administrator position would have to be re-posted. GPH posted the position at $110,000 to $135,000 and applicants stated their desired salary to be in this range.
Ms. Roman discussed some issues that might lead to a decision for a cooperative agreement. These included: GPH can’t apply for many grants because the district is too small; employee health care expenses are growing; the levy is older, currently it brings in the low $600,000’s but a new levy would only increase that to the upper $600,000’s; GPH employee salaries are $1.5 million and close to $2 million with benefits.
Reviewer Comment: In the follow up to addressing the early termination of the Lake County staffing agreement, a financial crisis narrative has emerged from the GPH Board. As no financial information has been provided to the public, LWV Geauga, through a Freedom of Information Act request to the Auditor’s Office, obtained and reviewed a GPH Budget Performance Report for the calendar year ending December 31, 2022 and a Certificate of Fund Balances as of January 1, 2023. We offer this cursory overview:
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Cash basis loss at 12/13/2022 was ($44,191.59), with both revenue and expenses significantly lower than budgeted. It appears GPH successfully managed expenses in programs where federal and state grant revenues were not realized.
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Total revenues in 2022 were $1,783,780.16 short of the $4,531,326 budgeted amount, with deficits in Federal/State grants ($623,238.40), Sewage Treatment and For Sale of Property Fees and Permits ($709,038) and Private Water System Fees ($300,200).
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Employee Salaries totaled $1,205,289.29 and benefits were an additional $436,875.54. These totals likely do not include the payments to Lake County for the shared Administrator and Environmental Health Director services.
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Encumbrances total $454,644.53. After adjusting for these future obligations, certified available cash on January 1, 2023 is $3,795,710.11.
Regarding GPH’s current operating levy, during a recent GPH meeting, County Auditor Charles Walder noted that at 0.2 mills, GPH has the lowest millage rate in Geauga County. He counseled that GPH has the option to structure a future levy as a “renewal and add” which maintains certain advantageous characteristics while allowing GPH to request an additional amount to cover certified needs. See Jan 4, 2023 Observer Report for more details.
Ms. Roman discussed some of the feedback that was provided in discussions with other counties.
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They noted that Geauga County has had turnover of the administrator and commissioner 3 times in the past 5 years.
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Recruiting for talent has been more difficult
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“We” can’t really do the contingency planning that they need to do because their team is too small. (unclear whether she was referring to the Board or GPH)
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Accreditation standards with ODH would be harder going forward
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You need a strong triad between the Commissioner, EH Director, and Nursing Director to “make it work”
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With a smaller county, community assessments may become more difficult as time goes on
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With a cooperative agreement, there would be some reduction in costs and less employee costs by combining resources. This would include reduced training and the expenses associated with training.
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GPH has a track record with Lake County due to the contract for services of Mr. Litke and Mr. Lark.
Ms. Brakey added that Lake County provides a greater breadth of public health services compared to Geauga, and a cooperative agreement with them might help Geauga qualify for more grants and provide more services to Geauga residents.
Dr. Rood asked whether the discussions with other counties included any discussion about GPH’s ability to maintain current services such as immunizations for the Amish. Ms. Roman responded that the question was asked “what do you want” and that obviously GPH needs to meet all of the minimum requirements. And Ms. Roman stated she’s not sure “what’s above that” but that’s something GPH would ask and they would provide.
Ms. Roman said more detailed discussions would be needed. Dr. Rood said we would want to maintain current services. Ms. Brakey said there might be more efficient ways to provide some services. Mr. Piraino said he is all for efficiency, but it’s crucial that we maintain the same services we’re currently providing. Ms. Brakey said it’s a math problem: if we continue on the path we’re on and hire an administrator and an EH director, will we need to cut back services? Or if we go with a cooperative agreement we might be able to maintain the same level of services.
Ms. Roman said it’s going to take a team of people and a lot of time to map out all of the details if we go with a cooperative agreement. And we have until the end of June. If we don’t go with a cooperative agreement, then we have to figure out how we’re going to come up with the money and how we’re going to find the talent for the administrator and the EH director. She said we’ll know more after Ms. Brakey meets with ODH whether there are any other boundaries the Board has to work with.
Ms. Roman said she would like to have a discussion about where do we want to have the administrator placed? If we go through a cooperative agreement, and “all the work is really another county’s employees”, then what are the duties of the administrator? Do we have a person who we get from another county, or is it a person we hire ourselves to be here and then coordinate?
Dr. Rood stated that when they met with Ron Graham of Lake County that Ron thought there would be economies of scale in a cooperative agreement. Preliminary financial modeling confirmed that. While Dr. Rood would like for the Board to have full control, under a cooperative agreement the Directors would be employees of another county. He is OK with that as long as it’s specified what GPH’s needs are and those needs will be met. The Administrator would not have supervisory responsibility but would be observing and coordinating with the employees. This role would mean the administrator position would not have as high a salary as in the current posting. Also the GPH Board should have a voice in expressing dissatisfaction if that is necessary.
Ms. Jones said it’s most important to her that no matter who “owns” the employee, it’s important who has control over the decision making of that employee. She feels that should be spelled out in a contractual way that protects the public as well as “us”. Regardless of who employs the Administrator, she would expect the same of them with respect to maintaining a relationship with the public, with other stakeholders in the county, and to represent the Board and communicate with the Board in the same way. So she is indifferent to whether the Administrator is an employee of Geauga or another county which has a cooperative agreement where all of this is spelled out.
Ms. Roman listed the responsibilities of the administrator if they are an employee of GPH with no HR responsibilities:
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All fiscal work
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Coordinate with the other county regarding employee issues
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Keep relationships with Geauga County officials and schools
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Accreditation process and duties
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Possibly write and coordinate grants with the other county
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Serve as public relations person for the Board and handle complaints regarding service issues
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Prepare and update fee schedules
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Do work for the Board
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Oversight of policies related to non-employee functions
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Public records requests
Ms. Roman asked whether this is worth the salary listed in the current job posting, and if not then the job would have to be re-posted.
Ms. Brakey asked who is the advocate for Geauga County if everyone is contracted from Lake County? How will the Board know about complaints, who will residents complain to?
Dr. Rood commented that the current situation is working well (as stated in a previous meeting, it’s working better than it has in a while), and we currently have an administrator who is not here every day and who is employed by another county. Discussion continued about how important it will be to make sure the administrator, if employed by another county, needs to continue to have the responsibilities outlined by Ms. Roman. It was mentioned that the current administrator, Adam Litke, cares about the county and we are lucky to have him and hope to get someone comparable.
Dr. Cameron asked whether any other counties in Ohio have done something like this. Ms. Brakey said no, and that is part of her conversation with ODH on the 19th. She said there are many other counties that are in a similar situation as us. Ms. Roman said there are counties that have taken responsibility for cities within the county. It was emphasized that the Board is not talking about merging with another county. Mr. Piraino stated that Geauga could set an example for other small counties that are in a similar situation. He said that ODH was shocked when the Board replaced the previous full-time commissioner with a full-time administrator and a part-time commissioner, but they had no problem with it.
Ms. Roman shared that the two counties they are considering collaborating with asked why Geauga doesn’t just hire a full-time commissioner. She said when they were trying to replace the previous commissioner there were no qualified candidates. She believes this is because Geauga is a small county. Dr. Rood said while there are no counties with a similar cooperative agreement, there are other small counties in Ohio that have failed to support their health district. He wants to make sure that ODH knows that we’re trying to avoid a situation where we can’t support a health district.
Ms. Roman said that by doing a cooperative agreement, over time we may be able to expand services. Ms. Brakey gave the example of qualifying for certain grants that we couldn’t do on our own because we’re too small. They also discussed the differences in services between Geauga, Lake, and Trumbull. One difference is that Lake and Trumbull are both unionized while Geauga is not.
Ms. Roman asked the other members what they want to do as far as hiring an administrator.
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Ms. Brakey said we should contract for the administrator assuming we have a cooperative agreement.
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Ms. Jones said she is in favor of a cooperative agreement and she thinks the emphasis has to be on the contract. Ms. Brakey said that Brian (attorney for the health department) is already getting going on that. Once the Board chooses a county, that’s a thing for the lawyers to start hammering out.
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Dr. Rood said a cooperative agreement is the fiscally responsible thing to do. If we don’t, then the costs go up. The economies of scale are in our favor. Lake has 5 times as many employees. They might have other services that we could piggyback on. We should discontinue the current search for an administrator, because not only are we going to have difficulty affording that, but it seems we’re going in a different direction where even if we hire a person the job duties will be different.
Administrator and Environmental Health Director positions
Ms. Jones discussed the applicants for the administrator position. Two of the four people she and Ms. Roman interviewed are highly qualified. Ms. Roman agreed. She thinks the Board should have control over who is selected as the Administrator if they have a cooperative agreement, even if the Administrator is an employee of the other county. She proposed bringing the candidates to an executive session. Ms. Brakey did not believe they could do that, and Dr. Rood noted that it wouldn’t make sense anyway since those two people have different salary expectations than what the eventual position will support under a cooperative agreement. There was extensive discussion about how the administrator would be hired under a cooperative agreement, which county would post the job, do the interviews, etc. and what would Geauga do if they didn’t agree with the eventual choice. These details would have to be worked out by the attorneys to make sure the administrator is someone the Board approves of and is a good fit.
It was suggested that candidates will not be notified of anything yet, they have not reached the end of the 2-3 week window that they were given for further communication about the job. The input from ODH in the Jan. 19 meeting will be important.
Cooperative Agreement - Pressure to Decide
Ms. Roman asked the Board to decide soon about a cooperative agreement.
Mr. Piraino said they will have more information from ODH and a more detailed response from Trumbull by the regular board meeting next week. Piraino and Roman emphasized that through the work of the past month, they have learned a lot and have a clearer understanding of the options.
Dr. Rood requested that a decision about a cooperative agreement be made next week.
Ms. Jones said they might need to wait longer until they have more feedback from Trumbull County.
Ms. Brakey said that if they announce next week that they’re going with a cooperative agreement, “how are we going to staff this district until that agreement is in place”. And until the Board sees the actual agreement all spelled out, they can’t really make a decision. But it seems like the Board is supportive of doing a cooperative agreement so it’s worth the effort to continue fleshing out what it will look like.
Ms. Roman said the Board has to make it clear in the next few weeks that this is the direction they want to go, because they’re going to have to pull together teams of people to start filling in the details of the agreement. Dr. Rood agreed that next week the Board should decide to pursue the agreement and put a hold on any other option for now.
Ms. Roman also wants to go over the list of reasons and pros and cons of working with another county. She wants to make it clear that GPH may not have the funds to stand alone. There was a discussion of some of the current budget issues such as funding for nurses, and legal costs.
Ms. Jones stated that they will make a decision by next week which of 2 directions the Board is going, and based on that they will remove the job posting and notify the candidates.
Public Comment
Points of interest from the public comment portion of the meeting (two people spoke):
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The Board stated that Lake County is interested in a new level of cooperation; they are not interested in the current contracts that are being terminated
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GPH is collecting money from the current levy until the end of 2024, so they have a few more cycles where they could have a new levy on the ballot. They have tabled doing a levy in the May election, but they might do one in November. They want to be fiscally responsible and they want to be informed so they can inform the voters why a levy would be needed. Each item on the ballot shares the $18,000 cost, so November would be cheaper with more items sharing the cost.
Executive Session – There was no Executive Session.
The meeting was adjourned at 6:20 pm.
Next meeting: The next Regular meeting is scheduled for January 25 at 5 PM at Geauga County Administration Building, 12611 Ravenwood Drive, Suite 300, Claridon, OH
More Information: http://gphohio.org/
Minutes available when posted: http://gphohio.org/Board-of-Health/Board-of-Health-Minutes
Postings available here: https://www.facebook.com/GPHOHIO
Name of Observer : Nina Lalich
Reviewed by: Shelly Lewis
The League of Women Voters of Geauga is a 501(c)(3) nonpartisan political organization that encourages informed and active participation in government, works to increase understanding of major public policy issues, and influences public policy through education and advocacy. They do not support or oppose individual candidates or parties. Learn more about the LWVG at www.lwvgeauga.org.