New & Improved Local Health Officers

(from Maine Townsman, December 2007)
By Kate Dufour, Legislative Advocate, MMA

During the 2007 Legislative session, Maine’s lawmakers enacted LD 676, An Act to Implement the Recommendations of the Task Force to Study Maine’s Homeland Security Needs (PL 2007, c. 462).  As part of that legislation, the Maine Center for Disease Control (CDC) was assigned two tasks related to local health officers (LHO).  First, CDC director, Dr. Dora Ann Mills, was tasked with creating rules for ensuring that by June 1, 2009 all LHOs would be “qualified by education, training or experience in the field of public health.”  Second, Dr Mills was tasked with modernizing the LHO statutes to develop “a strong local health officer system that is able to function independently of the Department of Health and Human Services.” 

LHO Qualifications & Training

As part of the debate on LD 676, the Maine Municipal Association expressed concern with the Legislature’s interest in mandating LHO qualifications and training standards without making the standards available for review and comment prior to their adoption.    As originally drafted, the bill would have adopted the training mandate and directed the CDC to write and implement the standards without any further legislative review.  Municipalities objected to this approach because it asked municipal officials to blindly accept whatever standards would be created by the state.  Acknowledging those concerns, the Criminal Justice Committee amended the training provision element of the bill by designating the rules to be “major substantive,” thereby requiring legislative review before being finally adopted. 

While the amended version of the bill ensured that the rules would be reviewed by the Legislature before being officially implemented, municipal officials were still concerned that municipalities would have difficulty adhering to the rules.  Municipal officials remained concerned that mandatory standards would negatively impact recruitment and the cost of providing the service.  With respect to recruitment, municipal officials believed that if the requirements were too onerous, communities would have a difficult time finding "volunteers" to provide the services.  Municipal officials were also concerned that if the new requirements caused "volunteers" to stop providing the services, then communities would be faced with the added expenses for paying LHOs larger stipends or hourly wages to provide the service; the health officer function would be pushed by Maine law from a volunteer service to a professional occupation.  Under current law, with the exception of three of Maine's largest cities, the MMA's 2007 Salary Survey reports that on average the LHOs receive a stipend of $500 per year.   

As directed, the CDC has published and held a public hearing on its proposed LHO training and education rules.  As proposed, the rules: 1) require LHOs to complete one CDC-provided six-hour training course every three years; 2) require training sessions to be held annually in eight regions in the state; 3) require the training sessions to be provided free of charge to participating LHOs; and 4) authorize, on a case-by-case basis, the CDC to grant an exemption from the training standards to an individual who possesses education, training, experience or a familiarity with the responsibilities of LHOs.  

At the December 12th public hearing, MMA provided testimony commending the CDC for its efforts to draft rules that were not overly burdensome to implement.  However, MMA did offer an amendment. 

As proposed, the CDC is authorized to grant a grace period from the training standards of up to six months after the appointment of a LHO, provided the LHO meets the standards before July 1, 2009.  At the public hearing, MMA raised concern with the time limit on the grace period.  Since municipal officials will continue to appoint LHOs long after July 1, 2009, MMA believes the 6-month grace period should be provided as a general rule for all LHOs.  The act of providing appointees the time necessary to achieve the training requirements is common.  For example, code enforcement officer appointees have up to twelve months after beginning employment to meet mandatory training and certification requirements.  The Association was concerned that it would be difficult to require a potential appointee to attend the training prior to being officially designated as the community's LHO.  It is difficult enough to find good people to serve in these volunteer positions.  Maine law should not make that task harder to accomplish. 

Although the public hearing has been held, there is still an opportunity to have your opinions heard, as the CDC will be accepting written comments until 5 p.m. on December 26, 2007.  Written comments can be submitted to Christine Zukas-Lessard, Maine CDC, 11 State House Station, Augusta, ME 04333-0011. 

Modernization of the LHO Statutes.

To assist the CDC in crafting the new and improved LHO statutes, Dr. Mills held eight listening sessions with local health officers across the state in late October.  During those sessions, three important issues emerged.  First, there was general confusion among LHOs about their role in the community.  At the listening sessions, several of the LHOs commented that they had not been called upon to provide any services since being appointed to the position.   Second, several LHOs expressed a need for training, as well as a list of the resources available to help accomplish their tasks.  Many session participants commented that they were unaware of the resources available to help guide LHOs through the process.

Most importantly, however, municipal officials expressed a belief that the role of the LHO should be limited and narrow.  In a historical content, the LHO system was created to assist the state in its efforts to prevent and stop communicable disease; for example, to help prevent a town-wide outbreak of a flu.  Since the state cannot be in all places at once, the local health officer system was designed to be the "eyes and ears" of the state, serving a communication function, primarily.  In the recent past however, the Legislature has reviewed several proposals seeking to expand the roles of LHOs.  Of particular interest are proposals that would have LHOs involved in environmental issues, such as mold in residential buildings and outdoor wood boilers.  Municipal officials are concerned with these proposals because they shift enforcement responsibilities without providing adequate resources.  The property taxpayers would be on the hook under these proposals to fund the programs created and mandated by the state. 

Municipal officials believe they have an appropriate role in ensuring that residents have access to the services and resources needed to address their health issues.  Specifically, municipal officials stressed that their role should focus on providing information to the state regarding public health issues facing residents and providing information to residents about the resources available to address health issues and concerns. 

As a result of those public meetings, the CDC drafted legislation titled An Act to Modernize the Local Health Officer Statutes.  As drafted, the bill essentially creates two roles for the LHO, with one role played during non-emergency times and another role played during an officially declared emergency.  In the absence of a declared emergency, the roles of the LHOs would focus on providing information to the state regarding the cases of communicable diseases occurring within their communities and working with CDC to provide health information to residents.  During times of declared emergencies, LHOs would be required to provided additional services as mandated by the CDC.     

From a staff perceptive, MMA supports the proposed modernization of the statutes for two reasons.  First, it consolidates all of the longstanding mandatory responsibilities of the LHO into one convenient location in the statutes (Title 22, section 451).   Second, the roles of the LHO are focused on assisting the CDC in preventing and stopping communicable diseases during normal times, outside of declared emergencies.  Only in a declared emergency, and only if necessary, would LHOs be required to provide additional services.  This approach alleviates the municipal concern that LHO responsibilities would be unreasonably expanded.

The proposed changes will now be submitted to the Legislature for its review.  An official MMA position on the bill will be obtained when MMA's 70-member Legislative Policy Committee meets on January 17, 2008.