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North Carolina DHHS leader Aldona Wos spoke to the state’s public health workers gathered for their annual conference, but revealed few details about her plans to remake her department.
By Rose Hoban
The head of the state’s Department of Health and Human Services, Sec. Aldona Wos, addressed public health leaders and workers on Thursday night but offered little insight on how her department plans to make the transition to privatized Medicaid.
In her 30-minute speech, Wos praised the work of the people gathered and asked for their ideas. She then left after taking three pre-screened questions.
The speech was given in Asheville at the annual convention of the North Carolina Public Health Association, one of the largest gatherings of North Carolina’s public health leaders and workers this year.
Wos talked about the good work being done in many departments, praising some local health departments for innovation while scolding one unnamed department for junk food in the vending machines outside classrooms where nutrition classes are held.
“I said, ‘What, are you guys kidding me? You just spent millions of dollars … for teaching people how to eat properly and then, literally, that distance, and you’re asking them to buy candy and soda?’ There’s no common sense in that,” Wos told the crowd. “Everyone [should be] attentive to what you’re selling inside the departments of public health and social services.”
She encouraged more counties to consider merging their departments of social services with their health departments, a move that’s been made easier by a law passed by the General Assembly in 2012. <link> Wos stressed the efficiencies that could be achieved through such mergers.
“In the last few months, I really learned the key to public health is collaboration,” said Wos, who is an MD but has not had formal training in public health. “We must have our local public health departments working seamlessly with our departments of social services, but also with the other parts of our communities and society and our not-for-profits on the ground.”
Hints at changes
Wos reiterated the call to reform Medicaid, which she called “one of the biggest challenges in the health of our state.” She also hinted at forthcoming news about the state’s mental health system.
“We’re aggressively moving forward [with] a mental health reform for the state,” Wos said. “We will be unrolling some of it very shortly, to realign not only the LME/MCOs but to also figure out how to get more community-based health care.”
She praised the telepsychiatry program passed and funded by the General Assembly this summer as one of the ways to keep more people out of emergency rooms and jails.
Wos also talked about a looming shortage of public health workers and the difficulty of finding qualified workers, such as with a forensic pathologist position that was vacant for almost a decade, largely, she said, because of the salary offered.
“I forcefully enough lobbied and pleaded and showed the data, and received permission to have a higher salary so that we can have some hope of recruiting for a forensic pathologist,” Wos said. “And when we increased that salary, which required enormous permission from higher-ups to have that happen, we received applications.”
She also talked about her difficulty in recruiting nurses to state hospitals, some of which have vacancy rates of up to 20 percent, and which end up being staffed by more expensive agency nurses.
“I can’t find nurses to work there because of the salaries,” she said. “We pay $40-something-thousand for a nurse to work in a psychiatric hospital.”
“I pleaded my business case for weeks into months – with the legislature, with the governor, with the office of state budget – until I received legislative permission … for the nurses in our facilities, to pay them more,” Wos said. “At the end of the day, we have to figure out how to compensate people, how to encourage people to come into noble professions.”
Wos wrapped up her comments with a long anecdote about a monkey that bit a woman on Lake Norman this summer. She gave responses to three pre-screened questions but did not take live questions from the audience. She then promptly left the gathering.
Several attendees declined to comment on Wos’ address, citing DHHS restrictions on speaking to the media or expressing reluctance to do so due to their organizations’ relationships with the state.
Michael Clements, former president of the Public Health Association, said he found the speech unsatisfying. Clements is retired from the public sector.
“I would have liked to have asked her why some of the decisions that are being made are very contrary to the well-being of our citizens and public health,” he said, referring to the proposed privatization of Medicaid.
“That’s a real important question for us as we continue to care for people who are uninsured, and Medicaid does provide that service for people of low income,” Clements said.
Clements also expressed frustration at some of the recent hires made by Wos, referring in particular to the hiring of Margaret Peale as a Medicaid advisor. Peale, who has a master’s degree in public health education and taught at East Carolina University for several years in the 1990s, has been a stay-at-home-mother and anti-abortion activist for most of the past decade.
“I would have thought that [Wos] would have taken the opportunity to look at those people who have been working in this field for 20, 30, even 40 years to be a part of that discussion,” Clements said. “Many of the people at this meeting could have fit that bill.”
As Wos arrived, she was accompanied by a DHHS employee who identified himself as Jason Simmons and said he was a health advisor to the secretary. Simmons prevented a reporter from N.C. Health News from asking Wos a question, stating that all questions for the secretary must go through spokesman Ricky Diaz.
Diaz was not in attendance at the gathering.
According to news station WRAL, Simmons, a former campaign aide to presidential candidate Mitt Romney and subsequently to Gov. Pat McCrory, has no listed educational background or experience in health policy.