Clark County advisory council members question role in light of Public Health leadership change

Members of a volunteer board charged with advising the Clark County Council on public health priorities have raised concerns about whether they can meaningfully fulfill their responsibilities after officials selected a new Public Health department director without their input. The Public Health Advisory Council — consisting of 21 unpaid community members from various backgrounds, such as healthcare, dentistry and law enforcement — makes periodic recommendations to the Clark County Council, which acts as the Board of Health. Members serve three-year terms. During the advisory council’s most recent monthly meeting in October, as well as a recent executive session between advisory council members and the county, tensions were high as members expressed concern over the lack of transparency in the appointment of Vanessa Gaston as the director of the county’s Community Services and Public Health departments. Members also questioned how they could make informed recommendations to the Board of Health or Public Health without an established working relationship with department leadership. Sandra Brown, chair of the advisory council, has served since 2018 and attributes the friction within the group to changes in the Public Health department’s structure. Dr. Alan Melnick, who retired in August amid an assessment conducted by Gaston of the department’s leadership and workplace culture, served as both the Public Health department director and health officer since 2013 due to budget constraints. The roles will once again be separated following Melnick’s departure, with Gaston serving as director of Community Services and Public Health and Dr. Brianna da Silva Bhatia serving as the county’s interim health officer. But the turnover in department leadership, coupled with the loss of institutional knowledge, has left the Public Health Advisory Council at a crossroads as it works to adapt to a period of transition within the county, Brown said. “The structure of Public Health that we’re supposed to be advising on is changing, and yet we don’t know what those changes are or how that’s going about,” Brown said. “I think we just need to take the time to figure that out, and it’s not all going to get figured out overnight.” Communication breakdown For Emily Estes, vice chair of the Public Health Advisory Council and a member since 2023, the council’s ability to influence public health policy is personal. Estes joined after struggling to access prenatal care until nearly her second trimester. Her experience shaped recommendations for the Board of Health and Public Health to look for solutions to expand prenatal care access across Southwest Washington, particularly for women enrolled in Medicaid. She said the Public Health Advisory Council helps fill an important gap by bringing public health expertise and residents’ concerns to county leaders, who rely on the group for guidance as they make decisions in their role as the Board of Health. “When our county councilors run for office, often they don’t know that they’re going to be the Board of Health, and most of them have little to no experience in public health,” Estes said. “Having this advisory council gives them not just the advisement of a couple doctors, but it gives them the advisement of this cross section of the community that represents really diverse interests and experiences.” Prior to Melnick’s retirement, the advisory council was looking for ways to have more direct conversations with the Board of Health and Public Health. Estes said recent changes led to a breakdown in communication. “If recommendations and concerns and that timeliness is not being considered, I think it jeopardizes the work of Clark County Public Health because it can’t be as specifically tailored to being impactful for our community,” Estes said. Michelle Vasquez was a Public Health Advisory Council member from 2021 to 2023 and recently rejoined. She said the recent monthly meeting left her feeling confused about the council’s role and she had never experienced a meeting so “emotionally charged.” She believes that the county has created frustration within the Public Health Advisory Council by excluding the group from decisions about department leadership changes. “I think that if the county had been more transparent that the outcome of what transpired on (October’s) meeting would have been completely different,” Vasquez said. “I felt it was very dismissive.” Questions about role of Public Health director Members of the Public Health Advisory Council had expressed interest in participating in the appointment process for a new director of Public Health since Melnick’s retirement. In an Aug. 18 letter to the Board of Health, the executive committee of the Public Health Advisory Council said the group is responsible for providing input to the Board of Health on the selection of administrative and local health officers, in addition to its role in overseeing the policies and programs of Clark County Public Health. The letter cited the Washington law that creates community health advisory boards, which says they are to “provide input to the local board of health in the recruitment and selection of an administrative officer.” Estes told county councilors during a recent Board of Health meeting that she was cautioned by County Manger Kathleen Otto, Deputy County Manager April Furth and an attorney that her efforts to understand the statute and discussing it in meetings constituted unauthorized practice in law. Asked to verify Estes’ account, Clark County spokesperson Joni McAnally said the county does not discuss matters addressed during attorney-client privileged meetings and could not comment on Estes’ version of events. Other counties in Washington have separated the director and health officer roles, but Estes hasn’t seen a director be appointed without a background in the public health sector — her primary concern about Gaston. A previous description on the Clark County Public Health website of Melnick’s responsibilities as then-director suggests a role that extended beyond general departmental oversight. “As director of Clark County Public Health, Dr. Melnick works with the Clark County Board of Health on public health policy issues affecting the community and the department,” the website stated. In other counties comparable to Clark County, public health directors or top administrative officers have extensive experience working in public health departments or advanced education in the field. McAnally said Gaston’s experience in the public health sector includes her work as part-time CEO of the Southwest Washington Behavioral Health Regional Support Network and serving as a regional representative for Clark and Skamania counties to implement healthcare reform changes. “Public Health has a focus on addressing social determinates of health and Vanessa has 36 years of direct experience working in and managing programs that impact environmental and social conditions influencing health outcomes such as housing, employment, health care, food instability, education and training, community connections, etc.,” McAnally said. She added that the director position was “administrative in nature,” including tasks like “handling the budget, personnel issues, contract and audit compliance, facility and other business functions for the department.” Additionally, a full-time deputy director of Public Health, with public health knowledge, will focus on the day-to-day operations of the Public Health department. This position is currently vacant and under recruitment, according to McAnally. The previous deputy director of Public Health, Danette York, questioned Otto and Gaston after the department’s assessment was shared with all staff. An email acknowledged that some findings and recommendations resonated with staff but said the report included inaccuracies. York’s email also asked why Gaston was selected to conduct the assessment instead of an outside agency or a consultant with a background in public health. No email reply was included in documents released to The Columbian, which had requested the correspondence under the state’s Public Records Act. Brown said the Public Health Advisory Council could have input on public health department leadership but that it’s “not a direct responsibility.” She hopes that more dialogue between the advisory council and the Board of Health will strengthen the relationship between the two groups. “I want to recognize the frustration. I don’t want to de-emphasize that members are frustrated,” Brown said. “I’m frustrated. But this is all new. So how can we learn from this and move forward and have our frustrations work in a positive way?”

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