COLOMBIA, SC – Public health workers in South Carolina have been tasked with keeping the state safe for 143 years, since lawmakers created a health council in 1878 after an outbreak of yellow fever killed 20,000 Americans.
As in most states, the South Carolina public health agency was underfunded and overburdened long before it had to maintain an exhaustive defense against a virus that humans had never seen before.
Criticism has grown on all sides since then – because of a slow launch of tests, the agency’s refusal to release detailed data on the first cases and for appearing to marginalize its main epidemiologist.
Now, a new director has entered what many see as a leadership vacuum, but lawmakers who intend to dismantle the Department of Health and Environmental Control are not leaving him out.
Dr. Edward Simmer is the first doctor to run the agency in almost four decades – a fact that surprises Simmer himself. He told the Associated Press in an interview that he will put science at the center of his relations with the public, the legislature and the governor.
“Obviously, there are political aspects to what DHEC does. My focus is to be as non-political as possible, ”said Simmer.
Unlike most public health agencies, South Carolina’s portfolio has included environmental regulation since the 1970s. It now has nearly 4,000 employees, overseeing everything from water quality, dams and landfills and distribution of vaccines.
The expanding agency responds only indirectly to elected officials, through an eight-member council appointed by the governor. State officials have said for years that he has become very powerful and uncontrollable.
Lawmakers accused the agency of not advocating strongly enough for preventive measures or of rejecting Republican Governor Henry McMaster’s decisions to reopen companies. They said the DHEC team evaded responsibility by allowing the board to decide how to distribute limited vaccines; whereas the council, composed mostly of businessmen and only one doctor, lacks transparency; and that board members moved very slowly to find a new director after the last one left, in the middle of a pandemic.
Senate President Harvey Peeler is ready to split DHEC, pooling public health functions with the state’s mental health department and channeling environmental licensing operations to other state agencies. McMaster said he supports the separation of DHEC as well.
“Nobody is in control of DHEC and it has not been for a long time,” said Peeler in December, when he announced the bill that would restructure the agency.
Public health agencies have become political scapegoats across the country after years of inadequate funding, and the lack of federal leadership and coordination has made responding to the pandemic all the more difficult, said Simon Haeder, professor of public policy at Penn State.
In some other states with Republican-controlled legislatures, such as Michigan, Montana, Ohio and Oklahoma, lawmakers are seeking to restrict the powers of proactive state and local health departments.
In South Carolina, the prevailing sentiment is a desire to make the agency more effective, after the response was hampered by a series of politically appointed directors who did not last and other staff turnovers.
“You can make any structural changes you want, but you need to choose people who are really good at it,” said former governor Jim Hodges, who served from 1999 to 2003.
Senator Dick Harpootlian, a Democrat from Columbia who protested the agency’s refusal to close deals that violated public health guidelines, said the plan to split DHEC is a “distraction” and is the board that should be replaced: “They were useless. Useless is an understatement. “
There are signs that other basic functions of the agency are being lost.
Water pollution licenses lost at three state coal plants languished for about a decade before environmentalists sued the agency last summer to do their job. The agency finally agreed in January to review the licenses.
“To give up your responsibility to ensure that you are protecting citizens from the state of pollution is a very serious deficiency,” said Amy Armstrong of the South Carolina Environmental Bill.
More recently, a computer system switch has left families and funeral homes without death certificates, while bodies awaiting cremation stacked in at least one funeral home, The Post and Courier.
Still, people who worked closely with the agency say that dividing DHEC without adequate funding and staff will only make matters worse, and that trying to do so during a pandemic is inconvenient.
At a minimum, the two sides of the agency should coordinate even more closely as risks to human health increase due to climate change and other environmental threats, said John Simkovich, regional director of public health who left in 2013.
Public health resources were cut by lawmakers during the Great Recession, and the mandates of council members expired under Governor Mark Sanford. His successor, Governor Nikki Haley, remade the board, and Catherine Templeton, previously hired by Haley to cut jobs in the state’s labor department, was named director. Templeton initiated further cuts, centralizing offices and laying off experienced employees.
Dr. Robert Ball, one of the state’s leading infectious disease epidemiologists until 2012, said morale had plummeted after Templeton’s arrival, prompting an exodus of long-standing employees that quickly drained institutional knowledge.
Salaries remain relatively low for trained scientists and health professionals, so younger employees quickly start earning more elsewhere, former employees say.
Simmer told lawmakers who confirmed this month that he believes the agency’s environmental and public health halves complement each other. He asked senators to give him a year of work to think about reforms before trying to dismantle the agency.
So far, he said, no one has promised him this time.