A proposal by the Alabama Department of Public Health and its State Board of Health to eliminate public hearings prior to rule changes is raising concerns about transparency and access.
The department says the change would save money.
Brian Hale, general counsel for ADPH, said he suggested the elimination of public hearings when staff members were asked for ways to cut costs. Public Health is responsible for controlling disease, providing medical services and enforcing public health laws. Hale said whenever the department has a proposed rule change, a public hearing is set and a court reporter is hired to transcribe it for about $400. Hale said he or another attorney usually facilitates those hearings.
“Ninety-seven percent of the time, no one shows up,” Hale said.
Jennifer Crook, a certified professional midwife who lobbied the Legislature for years to decriminalize midwifery, is worried about the proposed change. Midwives go through ADPH to get birth certificates for the babies they help deliver.
“For me, professionally, it is concerning that they could change a rule or create a new one that would affect our profession without us having the ability to publicly comment one way or the other,” Crook said.
Hale said state law requires that the public have a way to communicate to the agency. Written comments could still be submitted, he said.
“We’re not by any means cutting the public out, we want the public to participate,” Hale said.
Crook said there’s a difference between writing a letter or email and being able to speak directly to agency leaders.
The State Board of Health is an advisory board to ADPH. That board, per decades-old state law, is the Medical Association of the State of Alabama, physicians’ professional association.
“To have public access to decisions and conversations is extremely important,” Crook said. “This does not feel transparent to me.”
State law says that prior to the adoption, amendment, or repeal of any rule, the agency must give 35 days notice of its intended change and “afford all interested persons reasonable opportunity to submit data, views, or arguments, orally or in writing. The agency shall consider fully all written and oral submissions respecting the proposed rule.”
A public hearing on the potential end of public hearings is set for Oct. 17. Hale said a final decision could be made in December. He said he’d be open to having public hearings on specific rule changes, if requested by the public. He also said some other state agencies don’t hold public hearings, but take written comments.
“We’re just looking to save costs and be good stewards of our money,” Hale said.
Public health is looking for ways to save money after losing about $21 million in revenue this year that it previously received from Alabama Medicaid to manage the care of some Medicaid recipients. Alabama Medicaid now has contracts worth up to nearly $89 million with seven private entities to manage the care of most recipients.
Public Health Officer Scott Harris said the agency’s various bureaus have been asked to come up with money-saving ideas. For county health departments, that means considering consolidations and shared staff.
Harris said ADPH explained that it is protecting services to its “most vulnerable populations,” particularly in rural areas where there’s less access to health care.