New health commissioner inherits troubled departmentby Tom Scheck, Minnesota Public Radio
Sanne Magnan will be inheriting a Health Department that has some current and past employees demoralized and distressed. Many of the department's troubles surfaced over the past four years under Commissioner Dianne Mandernach, who announced her resignation last month.
The new commissioner will have to win over the public, concerned lawmakers and -- perhaps most importantly -- disgruntled scientists and public health professionals inside the department who worry that the health of Minnesotans is at stake.
St. Paul, Minn. — Diane Mandernach resigned after she was criticized for not releasing information on the cancer deaths of miners in northeastern Minnesota. But many people say problems with the Minnesota Department of Heath go well beyond that specific case.
Minnesota Public Radio News interviewed nearly two dozen past and present Health Department staffers. The consensus is that the commissioner's office has been more worried about bad publicity than good policy, and as a result, the department is far weaker than it used to be.
CONCERNED ABOUT RETRIBUTION
Sources cite several reasons for the slide, including a lack of funding for research and prevention, a lack of commitment to science-based research, and a commissioner's office that micromanages the department.
Most of those interviewed asked that their names not be used. Past staffers who now work for nonprofits and county health departments said they were worried the Health Department would cut future funding as retribution. Current staffers said they were worried about being fired or suspended without pay.
There is precedent. MPR News has learned that an Epidemiologist Program Manager was suspended for a week without pay for something he wrote in the Disease Control Newsletter in 2006.
Richard Danila wrote in that newsletter that the health commissioner decided to discontinue paper copies of the newsletter. The information was correct, but it was an embarrassment to Commissioner Mandernach. Danila declined to comment, but didn't deny he had been suspended.
Acting Deputy Commissioner Carol Woolverton confirmed that Danila was suspended for several reasons.
A legislative hearing in June also revealed that some Health Department staffers were reprimanded for putting controversial subjects in writing. During the hearing, Sen. John Marty, DFL-Roseville, asked Mary Manning, director of the department's Disease Prevention and Control Division, if she was reprimanded.
"It's not that anybody has said that I can't put anything in writing," Manning said. "I have, on certain issues, been discouraged from doing it. And I have been criticized for doing it."
"Can I ask who criticized you?" Marty asked.
"My direct supervisor and the Commissioner of Health," Manning said.
MPR News has also learned that department staffers have been reprimanded for speaking to reporters and members of the Legislature. Diane O'Connor, who worked at the department from 2004 until earlier this year, said she was reprimanded for merely attending an event where lawmakers were present.
"That surprised me, because I didn't talk to any lawmakers," O'Connor said. "I was simply listening and taking in information. But there didn't seem to be any confidence on the part of supervisors above me that I would be able to check myself, and not say something stupid."
POLITICS OVER POLICY?
There have also been efforts to conceal funding shortfalls, delay reports and scrub Web sites that include science that doesn't agree with Gov. Tim Pawlenty's political positions.
Documents obtained by MPR show the Health Department shut down a Web site that provided health information to students. Notes and e-mails show that Education Department officials and the governor's office heard complaints about materials on the site.
Other notes from health managers suggested deleting references to gay, lesbian, bisexual and transgender groups. The site is up again, but those references are gone.
Another note from a manager suggests the Web site should say that abstinence is one way to prevent sexually transmitted diseases. One staffer declined to go into the details, saying it's "extremely political."
A Health Department spokeswoman responded by saying the agency deleted several outdated links on the site. She said abstinence and family planning should go hand in hand.
DOWNPLAYING LACK OF FUNDING
Other documents show the department deleted portions of a report that cited a lack of funding for services to prevent sexual violence. In fact, the department decided to "trash" 3,000 printed copies of the initial report that had been printed, at a cost of $2,600 to taxpayers.
Carol Woolverton with the Health Department said the agency trashed the initial report because officials wanted to make sure the methodology was right.
But notes on earlier drafts show a key concern was funding. The final report does not include references to a lack of funding for victim services, or a line from the original version that said "no state funds are allocated to stem the tide of people committing sexual violence for the first time."
The final version also changed its recommendations to lawmakers. The draft suggested policymakers increase funding for victim services. The final report says "policy recommendations aimed at sexual violence before it occurs should be vigorously pursued." Woolverton said the final language isn't that different.
"We actually made it a stronger statement," Woolverton said. "We often times say we need more funding, but this actually includes a recommendation that we not only need to vigorously pursue and adopt it, but we need to sustain it."
Others don't see it that way. Sen. John Marty said he thinks the department changed the language because of a tight budget.
"We're seeing more and more times when the department is failing to do the right thing," he said.
Marty chairs the Health, Housing and Family Security Committee. He said he's shocked and disappointed that staff have been suspended without pay, that copies of reports were printed and then destroyed, and that Web sites were "scrubbed."
"I think the more you dig, the more you would find. And I think in every one of these cases, the story has been the same thing," Marty said. "The professionals in the department have done a good job. It's the political leaders of the department who are steering it off course."
Marty said the DFL-controlled Senate will not confirm a commissioner who won't fix the Health Department. He said he's worried that the department is no longer focused on protecting the public's health.
LOSING GROUND ON PUBLIC HEALTH
One retired Health Department staffer agrees. Wayne Carlson, who retired as assistant director of community health in 2004, says he's worried the department is losing ground on important public health issues.
"More pregnancies, more abortions, more young smokers." Carlson said. "And I don't think we've even made a dent into the minority communities and their health status."
A former health commissioner says lawmakers and the governor have to take a share of the blame for the Health Department's problems. Jan Malcolm, who was health commissioner under former Gov. Jesse Ventura, declined to talk about former commissioner Mandernach and how she handled the department. But she said policy makers have not put a priority on public health.
"Folks in public health get accused of sort of having a chip on our shoulders because there's never enough funding for public health concerns. I would say, yeah, we acknowledge that that's true, we do have a chip on our shoulders but we think we've earned it," Malcolm said. "There's been a systematic -- for decades -- under-appreciation of the importance of public health."
Malcom said the Commissioner of Health has one of the most difficult jobs in state government. She said a good commissioner will have to advocate for the governor's policies, while listening to the concerns of scientists and public health professionals.