Ravalli County’s Incident Management Team (IMT), formed on March 18 to help coordinate the county’s response to the COVID-19 emergency, started off with County Commissioner and Health Board Chairman Jeff Burrows serving as incident team commander. This was soon changed, and County Health Officer Dr. Carol Calderwood took the helm. Now, the Ravalli County COVID-19 IMT has hit another bump in the process, as members of the County Board of Health registered some strong complaints about being left out of the IMT’s deliberations and left uninformed about decisions that were being made by the team.
The issue came before the Health Board after Commissioner Jeff Burrows placed an item on the board’s agenda to consider the option of passing a local declaration that would make it a criminal offense to violate any of the state’s and/or county’s mandatory shuttering directives such as closure of non-essential businesses. As it stands, without a local declaration by the county health board, the governor’s directive can only be enforced by the county attorney filing civil charges against the alleged violator. But Burrows then withdrew his original agenda item and changed it to read: Update on COVID 19 situation in Ravalli County with Dr. Calderwood (PHO and IMTIC) and Karyn Johnston (PHN) and Royce McCarty (County Attorney)
At the regularly scheduled meeting, Dr. Calderwood told the Board, “You have parallel authority with the Health Officer. You are a partner.” She said that some stakeholders attend their daily morning meetings and they were welcome to attend as well. She said they were trying their best to communicate with everyone involved.
“Communication has been slim with us,” said Health Board member Katie Scholl. She said that the board members had only received three phone calls since the IMT was formed in March and had received virtually no information about what was going on.
Dr. Calderwood apologized, saying, “We didn’t realize that it wasn’t being referred to you further. We felt like we had a liaison with your group.”
Scholl had also made a request for the minutes of the IMT meetings which were still not produced but Scholl was assured that they would be forthcoming.
Health Board member Dr. Michael Turner said that state law places the responsibility for the community’s health squarely in the hands of the Health Board.
“It’s not the County Attorney’s, or the Sheriff’s, or anybody else’s and I think some of us feel that we have not been included.” He said the board received an email stating, “It has been decided…” with Calderwood’s name and names of other IMT members, “but none of you are on the board. Three people who are not board members have decided that this board was not to consider something. I think somebody is trying to usurp our authority.”
Dr. Calderwood said, “I understand how you feel, but the situation that happened was we were trying to gain extra tools. I could have gone forward to make decisions on my own and I wanted to consult with this board.”
Calderwood said that she and the Public Health Department had a good relationship with the board and she wanted to include them on this decision. She said that the item was put on the agenda but in subsequent discussion it was decided that it was not necessary to go down that path.
“We decided we had enough tools already without pushing you guys forward to make that decision,” said Calderwood. She said the board could still make that decision at any time, “but we just didn’t feel we needed more at the time, so the same person who put it on the agenda took it off.”
Turner responded, saying that the board did not know that, and that Commissioner Burrows’ name was never mentioned.
“Who is responsible here in this community?” asked Turner. “It is we up here.”
Calderwood apologized for having “missed some communication.”
Commissioner Burrows said, “I have been involved from the very beginning and it did become uncomfortable as to how far I was there in my capacity as commissioner. I know there was a shortcoming on my part as far as keeping the Board of Health involved. It was not intentional. Things were happening fast.” He said the point now was to address how it could be made better.
“How much do you want to participate and what do you need?” he asked the board.
“All of it,” said Scholl. “Whatever information you need, we need to understand, if the board is going to make a decision about it.”
Calderwood apologized once again, saying, “We just took off and we were bombarded. We do apologize.”
Sheriff Steve Holton, who serves on the IMT, spoke up, saying they weren’t getting anywhere by pointing fingers and pushing buttons.
“I’m ready to move forward,” he said. “A lot of people are putting in a lot of hours seven days a week and nobody’s been excluded. Let’s just fix this thing and move forward.”
Turner said that nobody was trying to criticize the current efforts by all the volunteers and IMT and the public to deal with this emergency.
“This is not a criticism of what has been done,” said Turner. “It’s just wondering why the board with the statutory authority has not been brought into it.”
“I was at fault,” said Burrows. “There is no question that we have left the Board of Health out of the loop for the last three weeks. There’s not much more we can say about that.”
Turner said, “So let’s just go on from here. We can’t change the past, so let’s just make the future go better.”
It was agreed that the Board would receive minutes of the IMT meetings, the daily press releases which they had also not been receiving, and phone calls when any new positives are reported.
On the day of the Health Board meeting, April 8, the number of people testing positive for COVID-19 in Missoula County was 24 and there were three confirmed cases in Ravalli County. County Health Nurse Karyn Johnston said that in efforts to track and contain the disease, 177 county residents had been tested and that all the tests have come back negative with five pending. [Since that time and as of Monday morning, April 13, an additional two people have tested positive in Ravalli County, bringing the total to five.] Johnston said that an extra nurse had been hired to meet the demands related to the emergency and that another full-time nurse has been hired to fill a regular staff position.
Marketing and messaging strategies for informing and educating the public about the emergency and the emergency restrictions and protocols being invoked were discussed and it was agreed to fund the efforts up to $10,000 with funds now being made available to local government through the CARES Act.
The Board considered public comment, including comments from Jim Olsen which included a few written comments and by telephone. Olsen said the Board should have started three weeks ago on forming a plan by considering what is likely to happen, and what needs that could generate.
“You are thinking in terms of what you have, not what you need,” he said. He said they should also be considering a “worse-case scenario.” He said the Board needed to be “pro-active.”
“You don’t have to ask hospitals and clinics to cooperate with you,” said Olsen. “You have the authority to integrate them into this effort.” He also mentioned some constitutional issues cropping up, noting that the emergency directives let people go to liquor stores but not to church.
Dr. Turner agreed with Olsen about the hospitals and clinics. “I think he has a point. We can’t let Marcus Daly [Memorial Hospital] do their own thing. They are a part of the county. They have a responsibility and we have to integrate that.” The hospital has established its own Incident Management Team.
Scholl agreed with Turner, saying, “I don’t know. I agree, I’d like to know more. To say Marcus Daly has a plan, that’s OK, but we need to know what it is.”
Deputy County Attorney Royce McCarty confirmed that under the Governor’s directive, the ability to enforce the directives is given to local county attorneys who can proceed with an injunction or a restraining order in civil court to force compliance. But the Board does have the authority to make a stricter directive that would allow for criminal penalties.
“We decided not to try it,” said McCarty, who is a member of the IMT. “There was no real desire to do it. No one was in favor of that avenue.”
“I understand that,” said Turner, “but it would have been wise to have brought it up and then stated that instead of saying ‘we decided’.”
Calderwood responded, saying, “I didn’t want to put something so harsh before the board when we haven’t really tried the mechanisms already in place,” referring to the use of civil suits.
“We would probably not have gone through with that,” said Turner, “It may be too harsh and perhaps unnecessary. But what came through was that somebody out there in the ether had decided that.”
“And it did,” said Burrows, “and I think we learned a lesson. So, bottom line is we need to do better down the road on consulting with the Board and getting that input before deciding.”
Returning to the issue of the hospital’s IMT, Dr. Turner asked what the hospital’s plan was. Scholl said that she had lots of questions as well.
Burrows said, “I think we are hearing loud and clear that Marcus Daly needs to be more of a player than they’ve been and get more information out there.”
Dr. Calderwood (who works in a clinic associated with the hospital) told the Board that they had asked to have a liaison member present at the hospital’s IMT meetings but that the hospital had declined.
“They say it is mostly internal planning,” said Calderwood.
“That’s not an option for them” said Turner.
“They need someone from our board there,” said Scholl.
“Let’s get that message to them,” said Burrows. “I can make a call. They need to be a community player and we will just put it to them and see.”
Turner responded, “If that doesn’t work then as the Board of Health we’ll tell them they have to do it.”
Asked to respond to the Board of Health’s discussion, Marcus Daly Memorial Hospital Marketing Director Amy James said the hospital had no comment to make concerning the Board of Health’s deliberations.