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Bill would ease rules so person with little public health experience could lead Utah health department

(Francisco Kjolseth | Tribune file photo) The Utah Department of Health suits up as it prepares to test staff of West Jordan Care Center for the coronavirus on Thursday, May 21, 2020. The testing is part of a plan to test staff at all long-term care facilities, with centers for memory patients and the intellectually disabled receiving priority.

State lawmakers are looking at easing the public health credentials required for the state’s health department head, as they consider accommodating a new agency leader whose background is largely in business management.

The move has elicited concern from Utah’s largest physicians organization and some state legislators, who say the middle of a pandemic is a time for more — not less — public health knowledge in positions of power.

“We need expertise and experience now more than ever to tackle this pandemic and protect the health of the public,” Rep. Suzanne Harrison, a Draper Democrat and physician, said in a written statement. “It makes no sense to me to NOT have medical doctors and public health experts in leadership — after all, it is the Department of HEALTH.”

At issue is the appointment of Richard Saunders, who took over the Utah Department of Health earlier this month on an interim basis even though he does not meet the existing requirements to occupy the role permanently.

In a Monday meeting with state lawmakers, Saunders acknowledged that he’s spent most of his career as an organizational behavior specialist in the private sector before joining the state’s health department in 2015 as a management consultant.

Traditionally, the head of state’s health department has been a physician, although state law doesn’t require a medical degree for the position and a handful of agency leaders have had a different background. However, a nonphysician must have a master’s degree of public health or public administration or have at least seven years of professional experience in public health, with at least five of those in a senior level administrative position, according to the law.

A bill brought forward by Sen. Allen Christensen would ease those statutory requirements so the executive director would only need to work for five years in public health and spend three of those in a leadership position — making Saunders eligible for the post.

The legislation, SB6006, slated for consideration in this week’s special session would also give Saunders the ability to choose a nonphysician as deputy director of the healthy department. Currently, if the executive director is not a medical doctor, the agency’s second-in-command must be one.

In an interview Tuesday, Christensen argued that the ability to practice medicine isn’t essential for the health department’s executive director, whose job calls for managing a budget and overseeing staff.

“Someone pointed out to me that in hospitals, we don’t assign doctors to be the hospital administrator,” the North Ogden Republican said. “We assign administrators.”

But that’s not a one-to-one comparison, said Michelle McOmber, chief executive officer for the Utah Medical Association (UMA). In a hospital, an administrator relies on a board of physicians for the medical knowledge integral to operating the health facility, she said.

Similarly, it’s important to keep medical experts in high ranking positions within the state’s health department, she said.

“They’re changing the qualifications for the executive director — fine,” McOmber said of Christensen’s bill. “But then in that case, they need to leave a deputy director as a physician.”

McOmber said she’s hopeful her group can work with lawmakers to find a resolution.

Christensen chalks up UMA’s reservations to an interest in protecting its turf.

“If it says ‘health’ in [the title], they want a doctor to be in charge of it,” he said of UMA.

McOmber said the accusation is unfair and she believes UMA is making a reasonable request for medical experts in leadership positions at the health department.

Rep. Ray Ward, another medical doctor serving in the Utah Legislature, said he’s open to Christensen’s proposal, given the difficulty of finding a health department leader who checks all the boxes — a physician, a public health expert and a talented administrator and communicator.

“I would say it’s close to impossible to find all three of those skill sets in the same human being,” said Ward, R-Bountiful.

To make sure there’s at least one high-ranking health official to fill each of these roles, Ward said he’d be in favor of allowing the executive director to name up to two deputies.

A prepared statement from Gov. Gary Herbert’s office said that while medical experts are critical to the state’s COVID-19 response, “so are individuals with experience in leading large scale operations and organizations.”

“This bill allows the Utah Department of Health to rely on both operational leaders and medical experts, instead of requiring individual heads of the departments to be experts in both leadership and medicine,” the statement read.

Herbert’s spokeswoman said that even if an interim director doesn’t meet the legal qualifications, the executive branch has 30 days to send the person’s name to the state Senate for confirmation. The Senate then has another 30 days to consider the appointee, she said.

Dr. Joseph Miner, a physician who spent more than three decades leading the Utah County Health Department, has headed up the state’s health department since 2015. Early on in the pandemic, though, Miner was reassigned to work at home because of health issues that make him more susceptible to COVID-19.

With Miner telecommuting, Gov. Gary Herbert in late March installed the former leader of the Utah National Guard, Adjutant General Jefferson Burton, to lead the health department’s day-to-day response to the coronavirus. Burton, who’s also running for a seat in the Utah House, directed the agency’s coronavirus response for several months.

Saunders had been working as Burton’s chief deputy during the pandemic and took over as interim executive director of the health department on Aug. 1, he told a legislative subcommittee Monday. Miner is serving as the agency’s chief medical adviser.

If Christensen’s bill passes, putting a physician in an advisory role at the health department would satisfy the statutory requirement for a medical doctor in the agency’s upper ranks.

The debate over the medical experts included in government responses to COVID-19 is also ongoing at the national level, with President Donald Trump recently announcing Dr. Scott Atlas as a White House pandemic adviser. While Atlas has been a frequent guest on Fox News Channel and has suggested it would be a good thing for low-risk people to be exposed to the virus, he does not have a background in public health or infectious diseases, according to the Associated Press.

In response to questions about his qualifications, Saunders told state lawmakers that his education is in organizational behavior and that he spent 25 years working in the private sector — in retail, manufacturing, construction and information technology. Five years ago, he joined the health department to improve performance in Medicaid services and rose through the ranks to become an organizational expert for the entire agency, he said.

“So your actual training and experience in public health itself is limited?” Rep. Jennifer Dailey-Provost, D-Salt Lake City, asked Saunders during the subcommittee meeting.

“Yeah, the public health is just over the last five years,” Saunders replied.

There is some precedent to appointing someone without a medical degree to lead the state’s health department. Rod Betit, who was the health department’s executive director during the 1990s and early 2000s, was the first nonphysician to lead the agency, according to a Deseret News article. And David Patton, who was appointed in 2011, had a doctorate in political science but was not a physician.

Editor’s note: This story has been updated to add a statement from Gov. Gary Herbert and to include information about President Donald Trump’s new pandemic adviser, who has no background in public health or infectious diseases.

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