State Says Health Department Needs Improvement Plan

The Milwaukee Health Department is in trouble.

A new state report requires the department to submit an action plan for improvement within 60 days. The Wisconsin Department of Health Services (DHS) identified three “Foundational Areas of Concern” within the department.

DHS is giving the health department 12 months to get back on track, or it could revoke its status as a level three entity, the highest state certification and one that enables it to receive different grants.

“This delay in certification is a significant issue that can affect funding and bring additional negative attention to the Health Department,” said interim commissioner Marlaina Jackson in an email to city officials earlier this week.

But the issues predates Jackson’s time with the city, and those of the two commissioners before her.

All three of the areas of concern can be traced back to the time of Bevan K. Baker. The former commissioner, from whom Mayor Tom Barrett demanded a resignation in January 2018, led the department from 2004 until it became public the childhood lead poisoning prevention program was failing.

DHS is basing its findings on a December 2019 review, when Commissioner Jeanette Kowalik was 15 months into running the department. Jackson didn’t join the department until April 2020 and became interim commissioner in September.

The report found that the city needs to finalize and implement a strategic health plan, fully implement its five-year community health improvement plan (CHIP) and utilize a board of health. “Additionally, [DHS] and the MHD have had conversations and correspondence regarding other programmatic deficiencies and missed contractual obligations by the MHD,” wrote DHS in its report, without providing specifics.

Why did it take so long for these issues to come to light? The state conducts a 140 review (named for the authorizing state statute) every five years. Then COVID-19 hit.

“The pandemic, which was the reason our work on DHS 140 reviews was suspended in 2020, still continues and will require our full attention well into this year,” wrote DHS deputy security and interim state health officer Julie Willems Van Dijk in a letter dated February 4th.

City officials aren’t thrilled the state did the site visit, then sat on the results for months until the pandemic took hold.

“It’s really unfortunate it came 14 months after the survey,” said Jackson in an interview about the delay. “I understand the COVID response taking priority for all public health.”

She said the review is a routine process and that the department has already made strides in correcting the issues. Jackson, who will soon return to her role as deputy commissioner of public health, is committed to staying with the city to address the issues.

“I think it’s a backlog of things that need to get caught up on,” she said. She cited leadership turnover as one reason the city has struggled to make progress.

The state report also acknowledges this. “The MHD relaunch of the 2017-2022 CHIP needs to reverse the years of neglect by the previous MHD administration,” wrote DHS in its findings about the community health improvement plan.

“During the review, the MHD stated the CHIP failed to launch, receiving no organizational support from the MHD until Commissioner Kowalik’s administration took over the department,” wrote DHS. But DHS said that support wasn’t enough and wants to see more than one staff person engaged with the plan.

And while the city needs to fully implement the CHIP process, it also needs to actually finish a strategic plan.

“The strategic plan as shared is not a viable strategic plan to guide the department,” wrote DHS. The document was to be developed between July 2017 and November 2018, a period which saw Baker, interim leader Patricia McManus and Kowalik lead the department. DHS said the plan shared had placeholders in it. “The MHD must engage the public it serves in the planning process and must determine and track performance measures that may be evaluated and used to inform decision making at the MHD.”

One of the issues the city can likely cross off already. It never had a Board of Health under Baker, even though state law required it. The realization caught council members, and Kowalik, off guard when it was discovered.

The citizen-led board is now chaired by Ruthie Weatherly, a former health department employee and public health consultant. It meets more than is statutorily required. But the state didn’t know that in 2019, Barrett had appointed the members less than six months earlier.

“The Board of Health is still very new; the day of the site visit the Board was meeting in session for only the second or third time. The diverse membership, public health credentials and expertise, and early work of the Board as of the site visit all appeared promising, however, the Board of Health did not have a long enough track record to ascertain if they meet the requirements set out in statute,” wrote DHS. It is asking for specific examples of policy advocacy and engagement on the community health improvement plan.

There is some good news in the state report. Lead only appears once, and it’s in relation to positive action by the board of health. The failure of the childhood lead poisoning prevention program was a black eye for the entire city in 2018.

In addition, five areas of strength were identified: food safety, the public health lab, programs to engage the community understanding of health equity and vision. “The MHD is a health department in transition,” wrote DHS.

That transition will continue.

New, permanent commissioner Kirsten Johnson, approved earlier this week, starts March 1st. She has her work cut out for her.

A full copy of the state report can be found on Urban Milwaukee.