Members of the public had an opportunity to give opinions on whether Mackinac County should try to extricate itself from LMAS Health Department, but found that many of their questions remained unanswered about how the county would set up and administer its own proposed health department at a public hearing last week. County commissioners, who propose a split from the four-county consortium, made it clear that they will receive public opinion, but that Chair Dawn Nelson and Commissioner Calvin "Bucky" McPhee are not yet willing to share with the public all of the information that they are privy to as board members providing oversight to the administration of LMAS, which is undergoing investigation for overbilling to Medicare.

The public hearing at the Mackinac County Courthouse Wednesday, November 4, drew testimony from several people who are in favor of splitting from Luce, Mackinac, Alger, and Schoolcraft (LMAS) Health Department, and a few people who questioned how the county would set up its own services. Brian Schoenborn, the former health officer for Mackinac County, did not give an opinion but took the podium with documents in hand and offered to disclose health department financial information to any member of the public who asked. None did.

Each county commissioner and county clerk Mary Kay Tamlyn spoke briefly and expressed views in favor of the split, then Mrs. Nelson spoke on behalf of the commission for most of the duration of the hearing.

County Board Chair and Several Citizens Favor Split With LMAS experiencing financial difficulties and cutbacks in services and staff, Mackinac County should separate from the department and create its own single-county department, Mrs. Nelson said to the audience of roughly 30 people composed of LMAS employees, Mackinac and Luce county employees, and concerned citizens. Some approached the board with their questions, opinions, and concerns about the proposal.

Joe Durm, former Mackinac County commissioner who also served for a time as the county's representative on the LMAS board, said he supports the division. Having served on the LMAS board, Mr. Durm said he also thinks the finances there were mismanaged. He charged LMAS Medical Director James Terrian's interest in broadening services, extending some to Delta and Dickinson counties, was part of what led to the current situation, particularly in home health care.

"His baby was home health care, which in my opinion we never seemed to be above water in that one. He always thought that was the cash cow, but he didn't show that in the figures. He really didn't," Mr. Durm said.

Jim Fenlon of St. Ignace, whose wife has been an LMAS home health patient, requested the county withdraw from LMAS. Mr. Fenlon is director of the Mackinac County Equalization Department.

"We're presently in a situation where there are very limited resources available for home health and hospice services in Mackinac County," he read from a statement he had prepared. "I personally feel that this is a direct result of poor management practices and record keeping on the part of LMAS."

Mr. Fenlon said his wife was administered an uncomfortable test by a therapist from LMAS, but had to endure taking it twice when the results were lost by the agency.

Hospital Support of Commissioners Does Not Suggest

Further Role, Nelson Says

Among those unequivocally supporting the split from LMAS is Mackinac Straits Hospital, which sent a letter of support to commissioners Wednesday at the commission's request. Does the hospital support the move because it plans to take over the functions of the health department? No, it does not, hospital CEO Rod Nelson told The St. Ignace News, rather, the hospital's support is merely a no-questionsasked vote of confidence for the decision of the board of commissioners.

"We'll support them in any direction they go into," Mr. Nelson said. "I don't know what that entails."

In regard to the hospital picking up some health department services under the proposed new department, "No, we've not discussed that with the county," Mr. Nelson said. "I don't know what our relationship would be."

County commissioners have not attended the hospital's board meetings and the issue has not been discussed there, Mr. Nelson said. One commissioner asked the hospital for a letter of support the same day as the public hearing, he noted.

The hospital's letter, signed by Ronald Mitchell, chairman of the board of Mackinac Straits Health System, says the board extends its support "for the Mackinac County Board of Commissioners in their decision to withdraw Mackinac County from the current Luce, Mackinac, Alger, and Schoolcraft (LMAS) Health Department. We fully support Mackinac County forming its own health department and will support the decision to the best of our ability."

Mr. McPhee, who serves on the LMAS board alongside Mrs. Nelson, supported the division. Commissioners Mike Patrick and Lawrence Leveille said many of the constituents they represent are in favor of the split, also, even without knowledge of the plan to do so.

Do Other Counties

Plan To Withdraw?

Pointed questions on how a county health department could be established were also asked at the hearing. Mrs. Nelson said she has already been given the green light to break away from the consortium by the Michigan Department of Community Health in Lansing, but beyond that, local plans would need to be developed.

"We have a commitment, not a plan. We are not at liberty to divulge all of it," Mrs. Nelson told the public .

She expressed a personal desire to continue providing home health services through a new department and reassured residents of the western end of the county attending the meeting that their geographical needs would be taken into consideration as plans develop.

Mr. Durm asked the commissioners if other counties are considering separating from LMAS, as well. Mrs. Nelson replied she did not know. LMAS health board members from Alger and Schoolcraft told The St. Ignace News they have no intention at this time to split from LMAS.

"We're hopeful we can maintain the health department as it is," said George Ecclesine, who serves on the LMAS board of health.

When asked about the possibility of partnering with Chippewa County Health Department, Mrs. Nelson mentioned the distance for workers to travel as a prohibitive factor. Commissioners did not seem inclined to pursue such a partnership, but did not formally rule it out, either.

How Would Mackinac Set Up Its

Own Department,

With Oversight?

Donna O'Grady, supervisor of Portage Township in the western part of the county, asked the commissioners what services could be offered by the five employees currently working for the department in Mackinac County, whether additional employees would be hired if a "full scope" of services could not be provided, and what plans the commissioners would have for the west end of the county. She also questioned why Mackinac County's contribution to LMAS was increased from $18,000 last year to $84,000 this year, and if there would be oversight of the new health department.

"One of the things this board hadn't talked about but that had been on my mind is that we will do, or I would hope to do, a satellite office on the west end," Mrs. Nelson said. The proposed office would serve Portage, Newton, Garfield, Hendricks, and Hudson townships.

The board was not prepared to answer the rest of Mrs. O'Grady's questions.

As LMAS has downsized over the past year, only five residents of Mackinac County work for the department, Mrs. Nelson said. In terms of adding staff, Mrs. Nelson told The St. Ignace News, the matter is still under consideration.

Pat O'Grady of Curtis asked that the amount it costs the county per person to remain in LMAS to be published (see sidebar). He also asked if it would cost less per person in the long run to create a single county health department, and if the services would be the same or better.

Mrs. Nelson pledged the services provided by Mackinac County would be the same or better. She said she would like to see home health care, even if in a smaller form, to be provided by the proposed department.

Mr. O'Grady also expressed concern about the level of service the west end of the county would receive. He praised the LMAS Newberry office's efforts.

"I have absolutely no complaints with the service I've gotten from the men and women in that office. No matter what we ask for in Curtis, we have always had somebody come from that office and handle it. Whether its a health issue or one of our festivals, we've always had somebody come out there in a timely basis and handle everything," Mr. O'Grady said of LMAS service.

He said he could not support the split based on the limited information provided by the commissioners.

If LMAS is experiencing administrative or managerial problems, then those should be fixed by the board, rather than breaking off, he said.

"Get good management and leadership" of LMAS administration, he suggested. "Fix what's broken and act responsibly."

"We're getting more of a lobbying here, rather than an information gathering," Mrs. Nelson said in reply to Mr. O'Grady's comments, and suggested he bring his remarks to a close. "We're getting your opinion, but you're lobbying."

Also from western Mackinac County, Jim Ramelis asked commissioners whether workers from an office in St. Ignace could reliably serve his area. He expressed concerns about pregnant women having to travel farther to St. Ignace, rather than Newberry as they do now, to obtain services, for example.

While offering him reassurance on this concern, Mrs. Nelson also said, "There's a lot underneath all of this, Jim, I hope you realize that we're not here to debate."

The County's Role

of Oversight, and the Role

of Public Information

The question of the county's liability may be taken up by the courts, Mrs. Nelson suggested. Asked by an audience member whether the county will still have to pay back its share of the overbilling costs, even after the county leaves LMAS, Mrs. Nelson replied that will be a question for attorneys to resolve.

She did not estimate the legal costs involved.

The commissioners explained their desire to separate from LMAS has been a result of poor administration and bookkeeping, which has been an ongoing problem for years, they said. Mrs. Nelson said much more is occurring at LMAS than people know about, but she did not consent to elaborate.

Mrs. Nelson and Mr. McPhee's role as elected county officials serving on the LMAS board is to represent the citizens of Mackinac County.

Two representatives from each of the four counties comprise the LMAS Health Board. The board's role is oversight of health department operations, including accounting. Such boards, known as local governing entities, are "ultimately responsible" for local public health administration and governance, according to "Michigan's Guide to Public Health for Local Governing Entities."

Citizens have a right to know whats going on in government by opening to full public view the processes by which elected and nonelected officials make decisions on citizens' behalf. This right is protected by the Open Meetings Act and Freedom of Information Act. The decisions, and deliberation toward those decisions, of elected officials are made in meetings that are open to the public, under the Open Meetings Act.

Although Mrs. Nelson reminded speakers that the sole purpose of the hearing was to hear their opinions about the proposed split, she also took the opportunity to publicly repeat her personal objection to the release of information in an article published October 29 in The St. Ignace News. The information she objected to sharing with the public was an estimate that the county may have to share the consortium's responsibility in paying back $300,000 to $400,000 for overbilling to Medicare. The information was legitimately obtained by the newspaper during an interview with Mr. McPhee, but Mrs. Nelson said the figures were given "off the cuff." They were labeled in the newspaper as an estimate, pending the completion of the Medicare audit.

Consortium's Liability Could

Cost Much More

At that point during the hearing, Mr. Schoenborn, the former LMAS health officer seated in the audience, interjected that the figures the health department could ultimately be responsible for may actually go up to $3 million or $4 million as Medicare's investigation continues.

Mrs. Nelson objected to his comment, and said she did not want to release those figures, as nobody is sure what the numbers will actually be.

"Those are numbers I didn't want to get out tonight because why put the fear of God in everybody. We don't know, those aren't numbers we know. He threw it off the cuff just like what the paper wrote off the cuff. That's off the cuff. I'm sorry, Brian, but don't throw out big numbers that will put a fear into these people," Mrs. Nelson said.

A district health department's role in a community was not defined by commissioners.

After the hour-long hearing, Mrs. Nelson said the next step is to continue looking into the division and how it could work. Mr. Leveille said maintaining contact with the west-end will be important in the future as decisions on how to go forward are made. Mr. Patrick told The St. Igance News the matter will be explored during the next county commission meeting, Thursday November 12. Nick Derusha, Health Officer for LMAS, said he was unaware of any other counties wanting to separate from the health department. If Mackinac County does leave, the health department would have to look into how the departure would affect LMAS financially.