History of MoALPHA

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June 2000

Dear Friends;

This is a history of MoALPHA. I think it is a good thing to have it written down, before the "Changing of the Guard" occurs, between my friend Phil Brunner and me. This is a happy evolution. Phil has followed me in other responsibilities, and MoALPHA is lucky to have someone with such dedication to local public health. MoALPHA has grown up, as our Chairman Tom Maddox said, and it is time to have new ideas and new projects.

This history is not for the purpose of touting accomplishments. It is like all histories, a means of adding perspective to the future.

In the early nineties, the Rural Health Administrators were loosely organized and had meetings that were held just prior to the Local Public Health Administrators' meetings. The purpose was to be sure that the smaller health departments had a voice that DOH would hear. This group was encouraged by Dr. Coleen Kivlahan to become better organized, and become more pro-active rather than re-active.

In October 1993, Jerry Roe (then Butler County), Betty Nickell (Marian County), Ivah Braun (Cole County) and Stacey Cox (Ray County) were appointed to determine the organizational structure of the new organization. Judy Schilly (Ste. Genevieve County), Dean Gordon (Linn County) and Peggy Musgraves (Dent County) were to look at the issue of dues. Ross McKinstry (Randolph County), Charlotte Craig (Cape Girardeau County) and Dennis Weltig (then Morgan County) were to be the Search Committee to look for an Executive Director.

On February 16, 1994, officers for the new organization (yet unnamed) were nominated by Bill Johnson's Nominating Committee, and elected. They were Betty Anderson (Ralls County), Chair; Jill Thompson (Lafayette County), Chair-Elect; Dennis Weltig, Secretary; and Pat Tichenor (then Barry County), Treasurer.

Also on February 16, after two prior interviews, the Rural Health Administrators authorized the new Chair, Betty Anderson, to hire Lorna Wilson, former Cole County Health Department Administrator and former Division Director for DOH, as Executive Director. The purpose of hiring an Executive Director was, according to the minutes of an earlier meeting (January 7, 1994), "to hire an executive director or consultant to educate the public and government bodies on the integral role of Public Health and to track legislation issues pertinent to local health department needs".

By March 1994, a dues structure had been established, and 53 counties had paid or pledged their dues, some offering to pay more than their share according to the dues structure. What a start!

During this time, SB 722 and HB 1622, the first of the "health care reform" attempts, were being heard and debated, introducing the Legislature to a large number of new concepts about health care.

At the first formal meeting of the new group on May 12, 1994, several things were decided. The name MoALPHA was unanimously accepted. The by-laws, drafted by Dean Gordon's Committee were approved, with minor changes, and included the dues schedule. The mission statement was slightly amended, and reads as follows:

"To collectively represent to federal, state, and local entities and individuals, the interests of local public health agencies in their efforts to promote health and wellness for Missourians through community assessment; policy development; and assurance of affordable and available health care, health education, preventive health services, communicable disease control, and environmental health services delivered at the local level."

The new organization was to represent all local public health agencies, not just rural agencies. To compensate for that change of focus, a standing committee for Rural Health Issues was established.

The Legislative session ended but not before MoALPHA had become a "presence" at the Capitol. Health care reform died, because of a lack of consensus among promoters as well as Legislators. Zero-based budgeting became the new buzz word. Senator Wayne Goode's SB 426 revised the regulation of on-site sewage systems.

Based on Legislation passed in 1993 (HB 564), 200 school districts became Medicaid providers, out of the 550 districts in Missouri.

The first Annual meeting of MoALPHA, an afternoon and dinner meeting, was held on September 21, 1994 at Westphalia, Missouri, a small rural community south of Jefferson City. Membership was up to 65, and 57 persons attended the meeting. An evaluation survey of the first six months of MoALPHA was overwhelmingly positive. All four original officers were re-elected for a full year. Eight goals for the coming year were discussed and approved. In December 1994, MoALPHA and MPHA held a joint meeting on Managed Care, providing a thought-provoking discussion by Dr. George Pickett, well known public health authority.

In January 1995, the Executive Board approved making Committee Chairs a part of the Board. In addition to the Organization and Membership Committee (Dean Gordon), Legislation (Ivah Scot Braun), Education (Charlotte Craig), Rural Health (Edna Potter), new committees were added. They were Environmental Health, Nursing Administration, Metropolitan Health Departments, and the Behavior Change Committee which was to include nutritionists, social workers, mental health and health education professionals.

A new Supportive Membership was added, to allow individuals to receive the newsletter, for a fee of $25.00. A new Legislative session began and Representative Mary Bland filed her first try for a Universal Health Assurance Program. Other health care reform measures were filed.

Charlie Stokes resigned from his long held position as Deputy Director, effective January 20, 1995 to become head of the CDC Foundation.

Also in January, the first draft of an act to acknowledge that the core functions of assessment, policy development and assurance of service delivery were essential elements of any health care reform process. It recognized the importance of state and local public health agencies in providing these functions. This was the first appearance, of "core functions". The bill was filed by Senator Jerry Howard (SB 403), and Dr. Kivlahan, Director of DOH, and Betty Anderson for MoALPHA testified in favor of the bill. Quick action on the bill in the Senate resulted in a 30 to 0 passage, and the bill went to the House. In early May, the bill became bogged down with multiple amendments, including an abortion amendment and died.

MoALPHA was fighting a Governor's recommended cut in funding for local public health agencies, and an even larger cut for school health initiatives. An all-out effort was launched by MoALPHA to get this money restored. This effort was successful and $3.4 Million was appropriated, over the $1 Million recommended. Again, because of a dispute over abortion language in the family planning section of the budget, there was a threat that family planning money might also be lost. The budget was completed however and sent to the Governor, by the May 5 deadline.

The proposed Collaborative Practice Rule regarding standing orders and protocols between physicians and nurses (both RNs and advanced practice nurses) was printed on January 17, 1995, the same day the Governor released his budget recommendations.

The DOH Bureau of Nursing was dissolved, and a Director for the Center for Local Public Health was being sought in June 1995. MoALPHA became a member of the CHART Partners. The Task Force on Core Functions was meeting, with MoALPHA and MPHA at the table.

Jill Thompson was elected Chair of MoALPHA, for the 1996 year, at the October 11, l995 Annual meeting at Nick's Homestead, in Jefferson City. Don Crawford (Dunklin County) was elected Vice Chair; Pat Tichenor, Treasurer and Jane Regina (then Platte County) was elected Secretary.

Managed care contracts between HMOs and local public health agencies were being worked on all across the state. There were 76 paid members of MoALPHA, in 1995.

In 1996, the Core Public Health Functions bill from last year was filed again by Senator Howard, and titled SB 726. Again, MoALPHA testified for the bill. The bill became stalled in the Senate Committee, over the issue of local public health agencies becoming involved in local ordinances related to CAFOs (Concentrated Animal Feeding Operations). The bill did come out of the Senate, however, with the aid of amendments proposed by Dr. Kivlahan. It passed the Senate, but time ran out to address it on the floor of the House. MoALPHA also testified in favor of children's immunization bills.

MoALPHA joined with MPHA in co-sponsoring an evening legislative reception, in February 1996. Multiple managed care bills involve many pieces of the original health care reform bill originated by Dr. Kivlahan.

MoALPHA held its February 14 meeting, at the State Capitol, with 36 health departments in attendance. Walter Young was appointed the new Director of the Center for Local Public Health. The Collaborative Practice bill was still being cussed and discussed. Comments from MoALPHA had been submitted.

The first MoALPHA Educational conference was held on April 18, at the Capitol Plaza Hotel, with 50 attendees. The topics included in this conference, included Certification, Core Functions and Contracts - still popular subjects in 2000. There were 73 paid members of MoALPHA by the date of this conference.

Another legislative session ended, with new law for DNR regarding CAFOs, successful legislation regarding children's immunizations, maternity benefits, mental health and a constitutional amendment to create a Department of Aging (unsuccessful). $1.7 Million was appropriated for local community-based assessments of health issues.

MoALPHA was increasingly concerned about contract and other problems between DOH and the locals. District Offices did not seem to be "in the loop" and could not provide the help locals need. On July 1, MoALPHA Chair, Jill Thompson wrote to Dr. Kivlahan, reciting the many concerns that had been expressed at the June MoALPHA meeting. The Director met with nine members of the Executive Board at the Cole County Health Department on July 10. The meeting discussed the concerns expressed by MoALPHA, and the DOH's written response to these concerns. A subsequent meeting between the Board and Dr. Kivlahan was held in October 1996 to discuss the progress toward resolving issues between the DOH and locals. It was at this meeting that Dr. Kivlahan announced the appointment of Owen Smith as Center Director.

November 6 and 7, 1996, was the first two-day Annual Educational retreat, held at the Inn at the Grand Glaize Resort, at Osage Beach, Missouri. Bernard J. Turnock, MD, MPH, from the School of Public Health at the University of Illinois, was the Keynote speaker. The meeting was a great success and allowed for good interchange of ideas. Forty-one health departments participated. Jill Thompson was elected to serve another year as Chair, Peggy Musgraves was elected Vice Chair, Jane Regina was re-elected Secretary and Shirley Rutz (Phelps) was elected Treasurer. MoALPHA had 79 paid members in 1996.

In 1997, MoALPHA again co-sponsored the Legislative Reception with MPHA. MoALPHA held their regular February membership meeting the following morning. Legislation that year seemed vaguely familiar - many more managed care and insurance bills, family planning and the abortion issue, and the DOH budget bill.

DOH requested $1.2 Million that year for local health, but the Governor recommended an increase of only $650,000. The budget was not resolved by the constitutional deadline, and the Legislature went into a Special Session, 30 minutes after the close of the regular session. The budget was not finalized until May 22, and it contained language that prohibited Planned Parenthood from receiving state funds.

Family planning contracts were delayed until October 1, 1997, and because of the appropriation language, contracts were awarded on the basis of bid proposals. This was a very unhappy time for local public health agencies, and MoALPHA was heavily involved. Due to the bid process and subsequent evaluation of proposals, several long- term public health providers of family planning were suddenly without funds. Other agencies were given bids that had insufficient staff or facilities.

An April MoALPHA meeting on the subject of local public health legal issues brought out 46 attendees. A June meeting in Jefferson City, featured Charlie Stokes, presenting a discussion on the increasing number of Foundations, and how local public health agencies can access funds from these not-for-profit groups.

MoALPHA has been meeting regularly with MAOPS and Missouri State Medical Association, to improve relationships between private physicians and local public health. Part of this activity was a survey of all local agencies regarding the physicians they have as employees or volunteers to assist with clinical care. MoALPHA and MAOPS had a joint poster session at the October 1997 APHA meeting, in Indianapolis.

On June 11, 1997, Governor Carnahan announced the appointment of Maureen Dempsey as the new Director of the Department of Health, effective immediately. Dr. Dempsey had been with the Department since 1991. One of her first official duties was to meet with the MoALPHA Executive Board, on June 13. One of the main topics of discussion was the concern MoALPHA had about moving too rapidly into local public health certification. Movement into strategic planning and core functions were also discussed, as well as what the role of the Center for Local Public Health should be. It was a refreshing meeting. Dr. Dempsey also attended the June 19 MoALPHA Educational meeting.

A September meeting brought Paul Halverson, DrPH, to MoALPHA, to give us the national perspective on local public health accreditation. Dr. Halverson had just joined the CDC Public Health Program Practice Office. Forty-six local public health agencies attended the meeting at the Capitol Plaza. Paul got an ear full from the locals who vented their concerns about state/local relationships. Fortunately, Paul gave back an ear full about the importance of accreditation to locals.

Dr. Dempsey, Deputy Ron Cates and Lorna met for a long meeting on October 1, that covered a multitude of topics: the relationship of the Center with program divisions; consolidation of contracts; the ineffectiveness of the Advisory Council; moving from core functions through setting standards and ultimately accreditation; family planning contracts, and finally, state and local relations. It was a straightforward meeting.

On October 15, the Executive Board met to consider where MoALPHA was, and to plan for the next year. MoALPHA had 78 members. The Metro Committee identified MOHSAIC and contracts as their biggest problems. Family Planning and contracts in general, were the main topics for all Board members.

On November 19-20, 1997, the Annual meeting was held again at the Lake of the Ozarks. Thirty-nine health departments attended. Peggy Musgraves (Dent) was elected Chair, Tom Maddox was elected Vice Chair, Shirley Rutz was re-elected Treasurer and Melanie Glaus (Mississippi) was elected Secretary. Dr. Dempsey spoke at the opening luncheon and outlined her hopes for increasing Core Functions funding. Marjorie Beenders of the Beenders Marketing Group gave a practical and entertaining session on marketing public health.

An Executive Board meeting in December heard a report from Tom Maddox that the Metro Health Officers, which had been meeting for many years as an informal body called together by the DOH or by one of the "metros", desired to become a formal part of MoALPHA. This idea was enthusiastically embraced by the Board. The new committee would be called the Metro Public Health Committee, and the Rural Concerns Committee would be renamed the Rural Public Health Committee, to give the groups a more positive image.

At this same meeting, it was decided that MoALPHA News would be sent to all Legislators, during the legislative session.

1998 brought a new session but a repeat of old issues. Again the abortion issue dominated budget hearings, and the House considered adding enough money to family planning to assure that only the local state health departments would provide services. MoALPHA took the position that although locals were willing to do what they could, restricting providers would only limit access to family planning. In addition HB 1824 was filed and co-sponsored by 32 House members, that defined family planning services, and specified who could provide them. $900,000 was added in the House budget bill for "alternatives to abortion". Handgun legislation was the second most popular topic.

The $11 Million expansion of Family Planning for bricks and mortar fell by the wayside in Conference Committee, and the restrictive language that appeared in the family planning budget item was repeated for 1999. More court action was anticipated. The issue of permission to carry handguns was sent to a referendum, where it was defeated.

A February meeting had small attendance, due to conflicting DOH meetings, and the April 16 meeting had the same problem. At the April meeting, Gretchen Wartman and Lyn Konstant discussed monitoring practices on the 1997 contract year, as well as reporting requirements for the 1998 year. There were many problems with the MCH contracts. Owen Smith and Lorna have agreed to check schedules with each other, and avoid meeting conflicts in the future.

The March Executive Board meeting was occupied with Core Functions. Chair Peggy Musgraves had met with Dr. Dempsey who asked for full support of the local public health community for this initiative. CAFOs was also an important topic, as six counties have ordinances passed by county commissions that regulate the construction of CAFOs, based on health concerns. Accreditation was also on the agenda, and was more of a concern to small locals, than the larger agencies.

The first MoALPHA Legislative "Thank You" breakfast occurred on May 14, 1998, the day before the last day of the session. By this time, the appropriation for locals had stayed at the Governor's recommendation of $650,000. Over 100 people came to eat and talk, but only eight local health administrators made the trip. Immunizations on MOHSAIC, Contracts, and too many meetings dominated the Board meeting following the reception.

MoALPHA strenuously objected to an attempt to amend the Collaborative Practice Rule regarding non-advanced practice nurses, even though the public health exemption remained in the Rule.

Sewage system loan evaluations became a hot item when DOH announced their intention to privatize these inspections.

The MCH contracts for the next year were a complete overhaul of the way which locals could spend these funds. To coincide with the expanded state coverage of children and post-partum women, DOH turned to outreach and enrollment for the CHIPS program, leaving locals searching for ways to fund their direct services. The "Mandated Performance Measures" became a great source of consternation. Over 100 people attended a "technical assistance" meeting in August, presented by the MCH Division, to elaborate on the changes. Also family planning proposals were being requested for the October 1, 1998 - June 30, 1999 year. The Alternatives to Abortion contracts were also being bid out, and will also be October to June contracts. So much change in the way locals do business in such a short time was extremely difficult.

The Executive Board met in August. Chair Musgraves described her three recent meetings with Dr. Dempsey. Dr. Dempsey also had repeated meetings with local administrators but the changes in MCH contracts, family planning contracts, on-site sewage inspections and immunizations left locals wondering what was coming next. A Board-approved editorial in MoALPHA News, discussing the urgent need to remedy the widening gap between locals and the DOH, was published in the September issue. Also at the request of the Board, position papers on The Safety Net, State/Local Relationships, and Comprehensive Preventive Screens for Children were published in October.

There were 85 members in the Association in 1998 - a record. MoALPHA became an attending member of the Smoking Coalition, a group of associations concerned about potential uses of the tobacco settlement. Also in September, MoALPHA combined their meeting with the first combined NACCHO/ASTHO meeting in St. Louis. Dr. Larry Fields was the featured speaker.

DOH announced their major reorganization on October 28, 1998, splitting the MCH Division into two, the new Division combining all nutrition-related programs. Also the Center lost the District Offices who were now to report directly to the Director's Office. A new Center Director position was created to be over a new Center for Community Development and Health Care Access, the Center for Local Public Health, and the Center for Health Information Management and Epidemiology.

The Annual meeting was at the Lake of the Ozarks and featured Dr. Robert Harmon, former Director of the DOH. It was a great meeting and 50 persons attended. Dr. Dick Biery, who had recently retired as Kansas City director, attended to do the introductions.

Finally for 1998, Dr. Dempsey met with the MoALPHA Board and the open and frank discussion left everyone with a feeling of hope for improved relationships in 1999.

1999 opened with 22 new House members and 3 new Senators and a slew of pre-filed bills.

Forty-one county health people came to Jefferson City for a January Educational meeting and to hear MoALPHA business. This was the first year MoALPHA collected dues for NACCHO, and encouraged new members for both organizations. MoALPHA and MPHA agreed to hold a joint annual meeting this year, which was very exciting. The best news was that DOH had made a strong effort in the past three months to improve relationships with locals and with MoALPHA. Among other things, Lorna met weekly with the DOH lobbyist, Susan Jenkins. Tricia Schlechte, interim director of the MCH Division, requested and received funds from the Governor's reserve, to distribute to health departments that had been denied family planning contracts. Open communication between Dr. Dempsey and MoALPHA continued.

In March, however, the new funding formula for Core Functions contracts appeared, without discussion, review or local public health input. A not surprising uproar occurred and at the March 31 LHAs meeting, Dr. Dempsey announced that there would be no cuts to any locals for the contracts beginning July 1, 1999. Senator Maxwell added another $165,000 to the DOH budget to assure this. This gave locals, Legislators and DOH time to review the formula before the 2000 contracts appear. MoALPHA was very involved and very thankful for this solution.

Thirty-eight locals attended the April 22 MoALPHA meeting, which provided an excellent discussion by Owen Smith, Sue Burton (then Barry), Jim Berry (Taney), Gil Copley (St. Charles) and Clayton Pape (then Platte) on the new combined Core Functions, General Public Health contract.

New DOH rules regarding environmental health were printed in the May 3 register. Again, another uproar. Eventually, DOH withdrew the rule, and plans were made to try to get clarification of the existing laws, through legislation. Partial-birth abortion became the topic in the Legislature, along with concerns about school violence.

The Executive Board met on May 13, following the second annual Legislative breakfast. Over 150 people attended the breakfast, but there was not a quorum for the Board meeting! The funding bill for DOH contained the new three-tiered family planning language that allowed for possible constitutional issues.

Also in May, the MCH Division held meetings in every District Office to receive input on the FY 2000 MCH contract. Also, the new MCH director, Glenda Miller, met with Lorna to try to avoid problems in the upcoming contract negotiations. On May 20, the Center for Local Public Health met with more than 70 local health administrators and finance people to review contract monitoring practices for the new joint contract. These were all good signs.

Turning Point, a Kellogg and Robert Wood Johnson Foundations grant, was received by the DOH to develop descriptions for model health departments. MoALPHA was involved in the site visits that preceded the award. MoALPHA was also involved in the tobacco settlement, as a member of the Missouri Coalition on Smoking or Health, bioterrorism activities, primarily via Dr. Rex Archer of the Kansas City Health Department, and the "CD Memorandum of Agreement", an effort to protect confidentiality of the communi-cable disease data. There was a lot going on.

The Executive Board met June 16. There were 83 members paid in 1999. Dr. Archer was appointed Chair of a new Tobacco Settlement Committee. He presented an overview of the status of the settlement to date, and the importance of MoALPHA participation in preserving a portion of the funds for prevention/cessation in public health.

On June 17, Dr. Dempsey announced at the Local Health Administrators' meeting that she would not sign standing orders for LHAs, and would not require her medical staff to do so. Talk about an uproar! A committee of the Advisory Council had been formed prior to this announcement, which had authorized a second survey of physician coverage in health departments, but it appeared that advice was needed. A MoALPHA meeting with the practice committee of the State Board of Nursing yielded nothing. A MoALPHA meeting with MAOPS and MSMA produced promises of assistance in finding local physicians for such orders. Again, just as in the case of the Core Funding formula, the abrupt decisions, without prior discussion, worried local administrators.

In July, the Task Force on Development of Core Public Health Funding and Dollars Distribution, appointed by Dr. Dempsey in April, finished their task. This was a hard job and eight regular and eight alternate local health administrators did a great job. MoALPHA, in addition to their representation on the Task Force, was given the opportunity to comment on several drafts.

Contract awards and denials that would become effective on September 1 were faxed out on August 30, 1999, causing serious problems for those agencies who were providing services, but were not funded for the new nine-month year. Need we mention uproar again? Every Legislator in the state was aware of the problems of annual competitive bidding of family planning contracts. Senator Jerry Howard hosted a meeting in Cape Girardeau, along with several Representatives, to hear both sides of the issue, from the DOH and from the locals. Little was resolved.

In September, 43 local public health people met for the fall MoALPHA meeting, to hear Dr. Archer on two subjects - the tobacco settlement and bioterrorism. They were excellent presentations. There was a good deal of discussion at the meeting, about standing orders and three health department administrators - Betty Nickell, Betty Anderson and Jill Thompson - gave their own status reports. Efforts continued to locate local physicians to sign standing orders, and MSMA, MAOPS and MoALPHA met September 28 to work on format for standing orders. Also that month, proposals came out for the Nutrition Education RFP, which was due in November, giving everyone a good amount of time to prepare this new contract.

The October 21 Executive Board meeting heard a review of the plans for the Annual meeting and reports from several committee chairs. Lorna Wilson, Executive Director, announced her resignation, effective July 1, 2000. The Board defined a Metro agency as one with a population of 75,000 or more, however, locals with "metro issues" were invited to join the Metro Committee meetings at any time. Chair Edna Potter reported that the main issues in smaller health departments were still standing orders, on-site sewage and family planning contracts. Gil Copley reported on his research on getting MoALPHA News on e-mail, and that Lorna had equipment that would make that possible. The Board agreed that putting all the newsletters on e-mail should wait until all locals were using it. The Board also discussed at length the current method of evaluation of family planning proposals and had other discussion on obtaining standing orders. More position papers were authorized on the tobacco settlement and on-site sewage.

The first Joint Annual meeting of MoALPHA and MPHA was held November 17-19, 1999, at the Capitol Plaza Hotel. Dr. Mohammad Akhter, Executive Director of the American Public Health Association, and Tom Milne, Executive Director of NACCHO both attended and spoke to the body of 175 attendees including representatives of 43 health departments. Charlie Stokes, President and CEO of the CDC Foundation, provided inspiration and entertainment. It was a huge success and enjoyed by all. At the MoALPHA business meetings, Tom Maddox (Kansas City) was elected Chair of MoALPHA; Gil Copley (St. Charles), Vice Chair; Beth Hutton (Pulaski), Treasurer; and Jan Morrow (Ripley), Secretary. Tom outlined his priorities for the coming year: Executive Director replacement; DOH relationships; on-site sewage; tobacco settlement; Core Functions funding; accreditation and standard; and membership.

1999 was another big year, a contentious year, but there is a lot to be optimistic about for 2000. Local Public Health people are hard working, ingenious, flexible, loving and most of all, my friends. Thanks for the opportunity to be one of you.

More History
Updated April 2003

The year 2000 was the second year of allocating family planning funds through a bidding process. The process was no less traumatic, and again funds were moved from one agency to another. It was a bad time for many locals, even for those who had contracts, because payments were suspended in the fall of 1999, and not resumed until January 2000, due to the Court injunction related to the litigation over Planned Parenthood. Another issue that arose was whether or not nurses needed a physician's order to do a finger or heel stick (they do not). The Blue Cross settlement was reached, and a new Missouri Foundation for Health is being established. Lorna announced that she would retire in July, and the Executive Board established a search committee.

MoALPHA's priorities in the 2000 legislative session were the use of Tobacco Settlement funds, and promoting a possible increase in Core Functions funding. One of the critical issues between local health agencies and the DHSS was the changing role of local environmental public health specialists, from being an "agent" to being an employee of a LPHA contractor. This was symptomatic of the changing relationships between DHSS and locals, from parent/child, to buyer/seller. A NACCHO seminar on the new Environmental Health Needs Assessment attracted 45 attendees on February 17.

A proposed on-site sewage bill was the most controversial of the legislation for public health at mid-point in the session, in addition to the increased Core Functions. The House had not put in the Governor's recommended $500,000 increase, but the Senate did, a matter that was resolved in conference committee. This resolution came in May, and the increase stayed in the budget.

Owen Smith, who was truly a friend to local public health agencies, announced his resignation from the Center for Local Public Health, effective April 28, 2000.

At a MoALPHA Executive Board meeting on April 19, it was announced that Phil Brunner would be the new Executive Director of MoALPHA, beginning July 1. MoALPHA has 86 members.

The new Core Public Health Functions contract came out with interesting language, stating that locals are given the "authority" to perform what is asked for in the contract. In other words, this was a partial resolution of the "agent" issue previously described.

160 persons attended the 3rd annual Legislative "Thank You" Breakfast at the Capitol.

Mahree Skala, former Deputy Director of the Division of Environmental Health and Communicable Disease Prevention, was announced as the new Director of the Center for Local Public Health, and Shirley Rutz, former Director of the Phelps County Health Department, as Deputy Director, beginning July 1, 2000.

In August, Phil Brunner put the MoALPHA News on e-mail. This was a first, and the beginning of MoALPHA's interest in electronic communication. One of the stories in that newsletter was a meeting between the Board of MoALPHA and the new leadership of the Center. The topic of discussion was improving relationships between DHSS and LPHAs.

Governor Carnahan, his son Randy and primary aide, Chris Sifford died on October 16, a great loss and shock to those who worked with him, and for Missouri.

MoALPHA had a very successful Annual Meeting at the Chateau on the Lake, at Branson, Missouri. There were 80 registered attendees, the largest Annual Meeting to date. It was a productive and fun meeting. Very shortly thereafter, the Board of MoALPHA entered into a contract for the development of a web site for the public, but particularly for Association members.

2001 opened with the realization that state revenues were not going to meet projections, and the beginning of budget cuts and layoffs that are still going on in 2003. This year was the first year that there was no increase in Core Functions funding, in five years. Every effort was made to keep level funding, in the Governor's office, by the Department and by MoALPHA and the local public health agencies. Core Funding stayed at the $9.5 million level, a long way from the estimated $25 million it would take to adequately provide state funding for locals.

Increasing health insurance costs averaging 30% and a decrease or level funding in programmatic funds made difficult times for locals.

The MoALPHA web site became active in February 2001, and showed as many as 21,630 "hits" in April. It was quite a hit, even by universities and colleges, the National Institutes of Health, and CDC. Of course, the Member's Corner (Bulletin Board) is by far the most popular part, creating topics on a total of 23 subjects, by May. Dave Guile of Nexus Communications Group, and web site manager for MoALPHA, offered a low-cost web site development, for individual MoALPHA members.

At their meeting in August 2001, the Executive Board responded to considerable feedback from members and appointed a committee to look into concerns about the current contracting procedures between DHSS and local agencies. The committee consisted of Betty Anderson (Chair), Sandy Clarkson (Chariton), Ivah Scott (Cole), Gil Copley (St. Charles) and Tom Maddox (Kansas City). Also at this Board Meeting, Tom Maddox (Chair) reported on meetings with the Center for Local Public Health, on voluntary accreditation, and MoALPHA was asked to participate in a development work group.

The Annual Meeting of MoALPHA was held on October 7-9, again at Branson's Chateau on the Lake. Only 48 attended the meeting, perhaps because of travel restrictions in many local health department budgets. Gil Copley was elected Chair of MoALPHA for 2002, and Tom Maddox completed two years, as Chair.

Dr. Rex Archer, director of the Kansas City Health Department, testified before the US Senate Subcommittee on Labor, Health and Human Services, Education and Related Agencies, Committee on Appropriations on October 3, 2001. Rex was the NACCHO chair of the Bioterrorism and Emergency Preparedness Committee. He described for the committee what had been done to date to prepare for bioterrorism, and what needed to be done in the future. This was shortly after the September 11 attack.

The state Senate Committee on Health, chaired by Senator Marvin Singleton, also held hearings on Missouri's level of preparedness.

Officers of MoALPHA for 2002 included Copley, Jan Morrow, Vice Chair (Ripley County), Tom Maddox, Immediate Past Chair (KC), Beth Hutton, Treasurer (Pulaski County), and Stephanie Browning, Secretary (Columbia-Boone). Lorna Wilson was appointed Interim Executive Director from May until July 1 after Phil Brunner's resignation. On July 1, 2002, Ross Marine became Executive Director and Lorna Wilson was named Associate Executive Director.

Gil Copley, Chair of MoALPHA, declared 2002 to be a "Year of Partnership" for MoALPHA. One example, was a jointly sponsored bioterrorism seminar on March 19, with MoALPHA, MPHA and the Missouri Hospital Association, and a joint MPHA/MoALPHA Annual Meeting in October 2002. MoALPHA also participated in the Annual Missouri Milk, Food and Environmental Health Association Meeting in April.

The newly formed "Contracts Committee" met in January 2002, to determine the objectives of the committee, and the attributes or characteristics of a successful contracting process were decided on. They were consistency, accountability, trustworthiness, profitability, ease of audit, customer friendliness, respect for contractor, and timely processing. A second February meeting was held to finalize the "fleshing out" of these attributes. It soon became clear to the Committee and to the Executive Board that there were more issues than just contracts.

The legislative session for 2002 opened with even more dire concerns regarding the declining state revenue, combined with 80 legislators finishing their last terms, under "term limits".
Mr. Copley testified at the public hearings in the House Budget Committee on Health and Mental Health, along with Pat Thomas of Cass County and Marcia Murphy of Clinton County. The Governor, DHSS and MoALPHA all supported level funding for Core Functions in light of the fiscal crisis in Missouri. Fortunately, both Family Planning and Core Functions money, remained in the budget.

The Legislative "Thank You" Breakfast was held at the Capitol on May 8, with an attendance of 180. This event is getting more popular every year.

The August Executive Board Meeting was held on August 13, 2002. Along with the Board members and staff was a guest, Shirley Rutz from the Center for Local Public Health who reported on the Center's desire to help LPHAs educate their new Senators and Representatives after they are elected in November. She stated that there would be presentations in each District Office; that a template would be created for LPHAs to use to prepare information for legislators about local public health issues; that a video on public health would be produced and duplicated for requesting LPHAs; and that there would be issue papers created on many subjects, and put out on the web for locals to use in talking to their legislators.

Through the chairman, Betty Anderson, the Contract Committee recommended that representatives of the Executive Board meet with DHSS Interim Director Ron Cates to discuss locals' dissatisfaction with contracting procedures. A draft letter to Mr. Cates was distributed and edited. Environmental Health Chairman, Ron Boyer, reported on the survey of environmental health specialists statewide, and it was agreed the summary of results would be sent to the DHSS.

In response to the letter sent to Mr. Cates, a meeting was held with Mr. Cates and Executive Board members. Mr. Cates warmly received the suggestion that MoALPHA and the DHSS have a formal agreement to increase early communication on issues, and resolve issues before they become crises.

In September, the Executive Board held a one-day retreat to discuss what should go into such an agreement.

The second Joint Annual Meeting of MPHA and MoALPHA was held at Lake Ozark, Missouri, on October 28-30, with 97 in attendance. In the MoALPHA Business Meeting, the members expressed their appreciation to Phil Brunner for his hard work for MoALPHA. The group received a report from Tom Maddox regarding the history and progress of the Contract Committee and the potential for a MoALPHA/DHSS agreement.

A meeting was held with the DHSS and MoALPHA (Lorna) to discuss educational meetings for LPHAs. This is particularly an issue in environmental health, because of the decrease in staff and budget in that section. MoALPHA agreed to assist in any way that was helpful to the locals, and at the same time doable within staff and fiscal resources of MoALPHA.

2002 was a busy and fruitful year for MoALPHA. There were 93 member agencies.

Lorna Wilson

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