Determining the Decider

Tennessee State Capitol Building

Determining the Decider

State Sen. Richard Briggs turns back an attempt to take public health decisions out of the hands of the county Health Department.

by scott barker • June 10, 2020
Tennessee State Capitol.

State Sen. Richard Briggs beat back an effort by another Knox County Republican legislator on Tuesday to strip the power to issue health orders from public health officers.

At issue: Should elected leaders or health professionals make public health decisions?

State Rep. Jason Zachary, who represents Farragut and Southwest Knox County, sponsored an amendment to a caption bill that would place the authority to issue public health orders with county mayors instead.

The proposal would have affected only the six Tennessee counties that have independent health departments — Knox, Shelby, Davidson, Hamilton, Madison and Sullivan. Health departments in the state’s other 89 counties are essentially satellite offices of the Tennessee Department of Health.

If the measure had made it through the Legislature and was signed by the governor, Dr. Martha Buchanan, the director of the Knox County Health Department, would have been able to advise County Mayor Glenn Jacobs on the ongoing response to the COVID-19 pandemic, but all decision-making would be his.

Under the current arrangement in Knox and the other counties, the public health officer — Buchanan in Knox County — has broad powers to issue binding orders to protect public health in emergency situations. Buchanan has issued the orders governing Knox County during the response to the novel coronavirus pandemic.

For Briggs, a heart surgeon, the issue boiled down to choosing who will make decisions about public health — a politician or a public health professional.

“Should we have a political person who is going to be dealing with public opinion, who’s going to be dealing with economic forces, social forces, or are we going to have, in the large counties, health officials who are going to be looking at data?” he said.

Also, Briggs said, the timing was a problem — changing important decision-making processes in the middle of a crisis could cause problems. “Now is the wrong time for us to be setting state law and state policy without really knowing the natural history of how all this is going to play out,” he said.

Sen. Brian Kelsey, R-Germantown, agreed. “I worry that we might be changing the system in the middle of the game in a way that might be very detrimental to health,” he said.

Zachary’s proposal came in the form of an amendment to a caption bill, which is a legislative proposal so broadly written initially that it can be amended in many, sometimes surprising, ways.

The bill Zachary used concerned how to handle conflicts of interest involving local officials. His amendment read, “If a county experiences a county-wide health emergency, including, without limitation, a state-wide declaration of the existence of a health epidemic, a county-wide epidemic, or the imminent threat of an epidemic, resulting in the need for health policies that affect the entire county, the county mayor shall establish and implement such policies under advisement from the county health director or county health officer, or both, as necessary.”

The first hurdle for the bill came Tuesday in the Senate State and Local Government Committee. Briggs was filling as committee chair for Steve Dickerson, a Nashville Republican who was absent.

Briggs launched into a speech about how politicians in other countries followed or ignored public health officials. Sweden, he said, which didn’t take measures to partially shut down its economy, now has the highest mortality rate from COVID-19 in the world, while New Zealand, which cut out virtually all economic activity, doesn’t have a single active case.

Briggs also gave an epidemiological history lesson that included the 1918 worldwide influenza pandemic and more recent outbreaks of SARS, MERS and Ebola.

Ferrell Haile, a Republican from Nashville who is speaker pro tempore of the Senate, presented the bill to the committee. He conceded he did so only as a favor to Zachary.

Haile framed the proposal as a way to bring the state’s six independent health departments into alignment with the other 89 counties. “The thought process behind this is that it should be the same throughout the state,” Haile said.

Briggs and Kelsey said there is a reason the state’s largest counties have their own health departments and different approaches to the pandemic.

“Nashville is very different than Grundy County; Memphis is very different than Fentress County,” Briggs said. “It’s like we’re in two different worlds.”

Kelsey and Sen. Todd Gardenhire, who represent parts of Shelby and Hamilton counties, respectively, said they had not heard any complaints about the arrangement from their constituents, even though they would be affected by the bill as well. (Hamilton County Mayor Jim Coppinger sent a message during the meeting that he supported the amendment, Gardenhire said.)

Zachary did not respond to requests for comment and the reasons behind his amendment. The office of Knox County Mayor Glenn Jacobs, who has expressed frustration with the slow pace of reopening the economy, said he was not involved with Zachary’s proposal.

“We didn’t have anything to do with that,” said Mike Donila, Jacobs’ communications director. “We didn’t push it or go to him.”

The Knox County Health Department became aware of Zachary’s proposal a day ahead of time, but said it would approach public health issues the same way no matter who makes the final call.

“Regardless of whom the law gives decision-making powers, we will continue to make recommendations based on science and data to protect the health, prosperity and well-being of our community,” the Health Department said in a statement.

Briggs’ solution was to send the bill to “summer study,” with the idea that Lt. Gov. Randy McNally and the Senate Health Committee could form a task force to look at the structure after the worst of the pandemic has passed. Summer study, however, is often a graveyard for bills, so the likelihood of any changes in the near term are slim.

Haile, who was Zachary’s surrogate, did not object to the maneuver and said it might be beneficial to study the matter further. The committee voted unanimously to send the bill to summer study.

Briggs said it’s important to determine the right way to respond to a public health crisis. “If we do this wrong,” he said, “when the next one comes we may not be so lucky.”