Since the novel coronavirus hit Knox County in March, Dr. Martha Buchanan, the county’s public health officer and director of the Knox County Health Department, has led the local response to the pandemic.

The county code requires that the health department director answer to both the mayor and the Board of Health.

She has made her decisions in consultation with Knox County Mayor Glenn Jacobs, Knoxville Mayor Indya Kincannon and other stakeholders, including business leaders. 

But in the end, she has been the official issuing the orders closing non-essential businesses and then allowing their gradual reopening — along with the restrictions on capacity and requirements to wear masks and other stipulations — under powers granted county public health officers under state law.

That will change somewhat this week as the Health Department considers whether to move to the third phase of a three-phased economic reopening plan. On Wednesday, the Knox County Board of Health will meet to consider the COVID-19 economic reopening plan for the first time. 

The Knox County Law Department has advised that the board must sign off on policies Buchanan develops in response to the COVID-19 pandemic. Buchanan was poised to make an announcement about Phase Three on Friday, but said she put that on hold after consulting the Law Department. 

“The data looks good at this point for continued progression, but we will wait to make any recommendation on what the next phase will look like until after the Board of Health meeting,” Buchanan said on Friday.

Knox County has seen an uptick in confirmed COVID-19 cases in recent weeks, a development health officials expected and warned would likely occur. The Health Department announced 22 new cases on Friday, and another 21 were added over the weekend.

Other measures, however, are still looking positive. The Health Department has been able to launch new-case investigations within 24 hours and initiate contact tracing within 48 hours. Hospitalization rates are low — eight of the 105 active cases required treatment in hospitals on Sunday — and hospitals are retaining their capacity to treat more patients.

Buchanan issued her first public health order in response to the pandemic on March 20, closing bars and limiting seating capacity in restaurants. She issued an order closing all “nonessential” businesses on March 23.

Buchanan then issued an order allowing the first phase of a three-phased reopening to begin on May 1. On May 22, she announced Phase 2 of the reopening could begin after Memorial Day. Wednesday’s Board of Health meeting could determine when Phase Three can begin.

Knox County Law Director Bud Armstrong said Friday that the Board of Health needed to be involved all along, but to his knowledge has not met to discuss the measures Buchanan has taken. He said the board’s participation in the process would place the arguments for or against restrictions in the public realm.

“People can see the rational basis behind that, and you can agree or disagree with it,” Armstrong said.

Knox County is one of six counties in Tennessee that have an independent Health Department. Health departments in the other 89 counties are satellite offices of the state Department of Health.

In his executive orders in response to the pandemic, Gov. Bill Lee has allowed the six independent health departments broad latitude to craft economic reopening plans based on the unique situations in their communities. 

The Board of Health is one of Knox County’s lesser known public bodies and its meetings are covered under the state’s Open Meetings Act. 

The county code stipulates that the Health Department director must “act in concert with, and meet all applicable policies established by, the county board of health.”

According to Armstrong, the reopening plan is a policy document that can't go into effect unilaterally. “All policies that are implemented must have the approval of the board,” Armstrong said.

The county Law Department previously pushed the Health Department to make public the meetings of its reopening task force, which gave Buchanan informal advice on how to proceed. The Law Department was publicly silent on the matter in March and April, when the orders were being issued. Armstrong said Friday that he doesn’t monitor all boards and commissions, and at the time he had no reason to think that the Board of Health was not involved.

County law puts the Health Department director, who is appointed by the county mayor, in a position that could lead to conflicts. “The director of the department of health shall report to, and work in concert with, the county board of health, in addition to reporting to and working with the county executive,” the code states.

In other words, Buchanan has to answer both to Jacobs and the Board of Health, and there is no clear direction in the county code about how to resolve any conflicts between her two bosses.

One of those bosses, Jacobs, has advocated for a faster economic reopening, though he has so far deferred to Buchanan's judgement as the county’s public health officer.

Earlier this month, Knox County Rep. Jason Zachary, R-Farragut, sponsored a bill to take decision-making during health emergencies away from health departments and vest them in county mayors. It was blocked in the Senate by state Sen. Richard Briggs, a Knox County Republican who is also a heart surgeon.

The nine-member Board of Health is composed of a cross-section of the medical community, plus political leaders. 

Buchanan, Jacobs and schools Superintendent Bob Thomas are ex-officio members. The other members are nominated by their professional associations, appointed by the county mayor and confirmed by the County Commission. 

The medical community members are Dr. Dianna Drake, president of the Tennessee Valley Pharmacists Association; Maria C. Hurt, a professor in the University of Tennessee’s nursing school; Dr. Jack E. Gotcher Jr., an oral surgeon and UT’s oral surgery program director; Dr. Patrick O’Brien, a colonel in the U.S. Air Force National Guard; Dr. James E. Shamiyeh, senior vice president and chief quality officer at University Health System; and Dr. Marcy J. Souza, public health director at UT’s College of Veterinary Medicine.

“This is uncharted territory for all of us,” Buchanan said. “I don’t know if they will approve those [recommendations], it will be up to the Board of Health for the direction we will take.”