Thursday, July 30, 2009

Questions: Regionalization of Health Department

These are not my questions, they are someone else's questions. But they're good questions.

1. What are the current services provided by the Health Department by time allocated? I.e. how many hours per restaurant inspections, septic, counter/public assistance etc. This should be expressed by FTE or Full Time Equivalents to allow for a comparison to the next question. Essentially how does the Health Director, staff and consultants allocate their time? What is the duration of the data, or how long has it been collected, does it take into account seasonal variation?

2. What are the planned services provided by the Health Department by the FTE time allocated after regionalization? I.e. how many hours per restaurant inspections, septic, counter/public assistance etc. Who is performing these tasks? Is there a table comparing the time allocation for Newburyport only and Regionalization? Essentially is regionalization the result of an analysis with real local data, or is it a response to a trend in government without any supporting local data?

3. Are there alternate scenarios that save more money without regionalization? Has a report on those alternatives been developed and the regionalization alternative voted as the most optimal to proceed?

4. Given the current level of service, has anyone determined if the services are currently sufficient or are there areas the Health Department should expand or improve services in Newburyport? Essentially how do we know if what we do today is good enough?

5. Have there been scenarios developed that would address possible increased spike in demand from each community, and, are there contingency plans based on these scenarios? Access to additional staff via contract?

6. Is there a benchmarking analysis comparing like communities and their service platforms as individual communities and then as regionalized services? If there is no analysis then what are the criteria baseline operations? How will we know if this works? What are the indicators and how do they relate to services levels and performance?

7. What outreach has been conducted to the Health Department stakeholders such as septic installers, restaurant owners, landfill neighbors, the hospital, local physicians and nursing associations, public safety officials etc? Are they concerned, or satisfied with the current level of services, are there areas that need improvement, or are not needed?

8. Given the Health Department is a permitting and enforcement entity, and most businesses would not want to “rock the boat”, has the review with stakeholders who seek permits or licenses been done anonymously to provide open responses?

9. Have these stakeholders been informed of any service changes, operational needs, application requirements, and had the opportunity to comment? Have the changes in applications methods, fees and other administrative issues been approved as required by each community?

10. Is there an evaluation methodology to determine if the program is successful? What are the measurable components of the methodology, and who determines if the performance outcomes are met? When the evaluation is conducted, what are the milestones, under what conditions; public hearing etc.?

11. What are the protocols for responding to health emergencies when the demands conflict between municipalities? What town will receive priority services and under what criteria is the community triage going to occur.

12. What if a health issues in one community is caused by the actions of another community? Are there conflict of interest disclosures planned to be filed in each community?

13. Each community has emergency operations plans, or policies, or other like plans. In each of these plans it is necessary that the Health Department plays a specific role. Have the plans in each community been reviewed to determine if a joint crisis across three communities can be addressed by one department? Has that review been conducted with the respective public safety officials? Have or will the plans be amended to reflect the change in operational response based on the Regionalization?

14. Given that each community views enforcement, proactive programs, and other issues differently, how will the Health Director reconcile the policy shifts between communities and sustain credibility by providing consistent response and actions? What are the ordinances and policy directions in each community and how do they relate to the Health Director’s methodologies? How does one handle the diverse precedents when the Health Director could be called into court and asked to respond to a question such as: Why did you enforce this issue against my client in Town “A” but not in Town “B”? Is there a policy across the three communities that reconciles the various approaches and provides consistency? How do the departmental mission statements and objectives of each community align? Have the application methods in each community been reconciled to create a consistent approach?

15. What happens in the event the Health Director is required to act as an enforcement agent against a municipality based on a vote of the Board of Health of that community? (i.e., leaking sewer line with no action by Town, or Water boil order ignored by Town, etc. ) How is that handled when an employee of Newburyport, the Health Director, may act against another community as an agent of that community by agreement? Can the community terminate the regionalization contract to stop the enforcement by the Health Director? What happens to the residents of that community if that occurs? Who protects their interests?

16. The next three questions assume that consultants will fill inspectional gaps. The Health Department most likely will be augmented with consulting staff paid by a fee system, such as restaurant inspectors, septic inspectors etc. Who sets the standards for the consultants, are the standards available? Have or will they be procured within the required statutes? Who evaluates the consultants? How does a business or person grieve consultants’ services? Who holds the contract with the consultants? If Newburyport holds the contract what is our liability for negligence by a consultant? Consultants are typically asked to post a bond for insurance purposes, will this happen and for how much?

17. The use of consultants diverts revenue from the City to the consultants from the licenses and or fees to cover the costs of inspections. Has there been an analysis on lost revenues which could be paid to the general fund and will now be paid to consultants? If City staff performs the inspections under Newburyport only scenarios, does the revenue exceed the regionalization benefit?

18. Given consultant based services, how do you manage complaints and investigate abutter’s concerns when you will not get a fee because there is no permit fee required to file a complaint. Essentially who determines if a septic system is not to code when the request is not based on a fee paid for a permit but a complaint by an abutter? Do you charge people for complaints? How many complaints were issued for all of the communities across all service sectors for health?

19. Has each community done every conceivable management and budget analysis before regionalization was considered? Are there other areas that could be regionalized that would not dramatically affect health services? What is the actual net savings in dollars to Newburyport, without caveats? Have the respective Finance staff of each community independently reviewed and certified the numbers?

I don't have a lot to say about this agreement, except that instinct tells me that it's not good. The whole landfill situation has given me a bad taste for how our health dept. deals with deals gone bad.

Add to that the fact that the famous 'independent" legal opinions all came from the same law firm ... the one that is also advising about the landfill ... and we can all see (and smell) how that's going.

I guess I did have a lot to say.


Dick Monahan said...

In general, I believe there should be lots of regionalization. However, like all other changes, it should be thoroughly thought out. I don't think this one has been.

BTW, Blogger's spell checker doesn't think "regionalization" is a word. And, it doesn't think "Blogger's" is a word, eithre.

Gillian Swart said...

Good points, Dick ... "regionalization" is indeed a non-word that I use frequently. I hardly ever refer to myself as a "blogger," though. It sounds so unsavory, don't you think? (Bracing myself for comments about unsavory and my blog ...).

Bubba said...

So if it were being consolidated with Amesbury in control you would support it ? Or are we reasoning by red herring ?

Gillian Swart said...

Bubba, I think I might support it more if Amesbury had not virtually eliminated its own health dept. before the agreement was even drafted, the jobs had all been advertised and if there had been more scrutiny by a truly independent entity (as in, not the shared law firm - not to impugn K&P's integrity). Jack Morris said today in an email, "Unfortunately, I think the plan needs to be better understood." Well - whose job was it to explain it to people understand?

Bubba said...

Well now that's a completely different argument. As for whose job it is to explain it - Keezer ? Moak ? Harrington ? all of the above ?

Gillian Swart said...

Whoever drafted the agreement, of course. I think the Amesbury Municipal Council did a lot better job of going over it and explaining it to one another than did anyone here (they have, I think 3 lawyers on the board). I'm still holding on to my point about the landfill, as well. I think that Morris' email only confirms what I said the first time - Nbpt jumps into deals without knowing all the repercussions and then flounders around when it goes bad. Although I have to say that the health dept. did take some positive steps to try to get NV to comply with the rules (but only after Moak took office).

Bubba said...

" Nbpt jumps into deals without knowing all the repercussions and then flounders around when it goes bad."

Now you've really lost it - given that nearly all, if not all, of the principals have changed since then, it's rather silly to characterize the behavior of an entire city. NEWBURYPORT doesn't do anything - people do and the players have changed.

On the other hand, politicians tend to live in the now and often leave the consequences to their successors - but that's not unique to Nbpt.

Gillian Swart said...

Ummmm ... Bubba, by "Nbpt," I meant city officials. I don't live in other cities, I only live here. And I see/hear an awful lot of comments other places aside from this blog along the lines of "here we go again" when the city (Nbpt) starts up a project. Do I need to name them all?

Wind energy ordinance, first Nock solar project, PI water/sewer, that failed development at Towle bldg ... those are just some of the ones that have gone awry just since I've lived here.

Yes, the landfill Moak inherited - and I think he did what he thought was best - but he didn't listen to the City Council and it sure appears like he's on way too friendly terms with Thibeault.

(Calling him and 'ratting out' Derrivan? C'mon!)

This deal was pushed through in a rush and with no independent opinion of its merits. I think it could have been good, and I hope they come up with something better.

You McMoaks are starting to annoy me.

Bubba said...

"You McMoaks are starting to annoy me."

Who said anything about Moak ? The council has (mostly) turned over as well. The decision makers have ALL changed for better and worse. Again your logic is flawed - "Previous (yet different) officials made a rushed decision therefore current officials will make a bad decision"

PS Your ad hominem is showing...

Gillian Swart said...


I think my evidence of flawed/badly carried out deals by the current administration stands for itself.

My ad hominem be damned - you have presented no evidence that the solar deal and/or the wind energy ordinance were not pushed through in haste and were not well thought out.

And read my latest post (not written yet) with more about the landfill.

Bubba said...

I agree, the solar deal is the mayor's turd and the turbine ordinance the council's. Of course you referenced neither in your original post. I can only comment on what you write.

I heard of justifiable homicide - but justifiable ad hominem ?