COMMISSIONERS: Members can't agree on how to fund health department

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BAKERSVILLE – The Mitchell County Board of Commissioners spent nearly 90 minutes during a Friday, April 24, budget workshop discussing Toe River Health District funding for the 2020-21 fiscal year that begins July 1.

TRHD has requested $478,059 for 2020-21, an increase of around $25,000 from the 2019-20 request of $462,000, of which all but $17,000 was funded with money from the reserve containing what remained of Mitchell County’s portion of the $2.9 million from the 2015 sale of home health services to Pruitt Health.  

Mitchell County Manager Tim Greene said the reserve from the sale of Pruitt Health is a caveat to the TRHD budget request.

“At some point, we are going to run out of reserve and have to fund whatever it cost to run the programs or reduce programs,” Greene said. “We can do the full request, which would protect our reserve and probably even build it some, or we can back off of the full request.”

The TRHD request does not include funding for a second nurse the district has been without the past two years.

“With their current request, if we want to fund it 100 percent and hire the nurse back and we’ll add it to our allocation,” Greene said. “We have the option of saying we’ll do what we have in the budget, go ahead and hire the nurse, and it can eat into the reserve.”

Board of Commissioners Chair Jacob Willis asked Greene to request an organizational chart from TRHD Director Diane Creek.

“Since I sit on (the health) board, I know they are doing a great job,” said commissioner Jeff Harding. “But I would love to hear from them in person, Diane (Creek), and especially Betty (McKinney) to explain the increase from last year to this year because it has gone up. I would also like to hear their take on the request for the nurse because that’s going to take it up another $60,000.” 

TRHD has around $272,000 in Pruitt Health reserve money remaining.

“The usage is what will be interesting to see because Avery uses about four times the environmental services Mitchell and Yancey does, of course, they have more buildings,” Willis said. “It’s like going into a restaurant, and I order a six-ounce filet, and Jeff orders a 12-ounce filet. Should we pay the same because we are getting the same service? We shouldn’t pay the same for that.”

All three counties do share employees, especially during this pandemic, Harding said, adding there have been nurses from the other counties come to Mitchell.

“Be very cautious how we use our reserve money we have put back because of the COVID-19 virus,” Harding said. “The expenses from this virus will cause the costs to go up.” 

Willis said the cost of funding the health department in 2015-16 was $304,971, and in four years, it has increased by $170,000.  

“In 2017-18 they requested 312,728 and Mitchell County was the only county in the two-and-a-half years (commissioner) Danny (Burleson) and I were on the board that gave 100 percent of what they requested,” Willis said. “Then, we turned around and looked at the services we were getting, and we were getting a third of the volume of services of Avery County, and that’s why we went and met with (AppHealth). My only statement would be any other agency we have any kind of funding oversight of that went up 150 some thousand dollars over three years we would take a real hard, long look at.” 

Harding told Willis that’s why he thinks the board should meet with Creek and McKinney so they can answer any questions.

“I’d like to see the revenues, too, because we have opened up the primary care portion of this,” Willis said. “How much of that revenue does Mitchell County see to offset these costs? When they pulled primary care back in, I’d like to see if she’s made any money off that or if it’s just an added expense because the Bakersville Clinic can clearly do the same thing. (Creek) can outsource that.” 

Greene said it comes down to any funding that is less than the revenue it generates is going to come out of the reserve. 

“Their budget is just like ours,” he said. “They are saying we need to give them $478,000, but after the year happens, we may only need to fund $400,000. We don’t know and aren’t going to know that until after the fact, but it’s all going to flow through the reserve one way or another.” 

Board of Commissioners Vice Chair Matthew “Vern” Grindstaff said if the nurse were included in the funding request, it would make any decision easier. 

“It’s not in there, and they need a nurse,” he said. “I don’t know if I can make a decision today on that.”

Commissioner Steve Pitman said the funding increase is “a big lump,” and he would like to understand it more before making a decision.

“We are over a barrel on it now,” Willis said. “The bottom line is when they deplete that Pruitt fund, then Mitchell County is either going to have to pay 100 percent of what they request or send (Diane), and it won’t be me, but send her however much you think is reasonable for her to run the health department on. Then, if I were on this board, I’d tell her she has to figure out how to run her own agency. I wouldn’t tell her what services. She’s supposed to be the expert, so she ought to know what services Mitchell County needs and what services Mitchell County doesn’t and be able to run her department just like any other department head we’ve got. If we tell (Mitchell County Transportation Director) Sheila (Blalock) she has to run her department on $325,000 a year, and then she has to decide where the cuts are going to come from and how to run her department. That’s really the only option you all are going to have in the future.”

Commissioner Danny Burleson mentioned the options of switching districts or the county operating the health department. 

“We’ve already seen that’s not going to work, and that’s why we took all the money last year out of Pruitt Home Health because we were going to go to AppHealth,” Harding responded. “Let’s just be honest. We were going to take our money and run to AppHealth and, all of a sudden, AppHealth didn’t fall into place. There’s no way Mitchell County can run its own health department. Well, we can, if you want to double that price.”

Grindstaff said it doesn’t matter why the board did what it did this past year concerning funding, but what matters is what the board is going to do this year and how it is going to do it.

Harding said the health department didn’t take the money out of Pruitt Home Health, the board of commissioners did.

“Now we just got to decide if we are going to fund them at their total request and trust they can run the health department with this funding, or are we going to drop that request and say now you have to figure out what you fund and what you don’t,” Grindstaff said. “It’s not up to us what she does with the money.” 

Greene reminded the board that reducing services reduces revenue. 

Burleson suggested funding the health department $250,000 and taking the rest out of the Pruitt Health fund, essentially depleting the reserve fund balance.

Harding the suggested funding the health department $400,000 and taking $78,000 only out of the Pruitt fund, adding he is not willing to empty the Pruitt account.

“If we drain (the Pruitt fund) now, then all the cards on our table when it comes to funding,” Pitman said. “If we do what Jeff says, we probably got another year or two years of that money.”