New health officer advisor hired
A new advisor to oversee the position of Nemaha County health officer has been hired by the Nemaha County Commissioners. The change was announced at the end of the county commissioners meeting on Monday, Sept. 27.
Following a 15-minute executive session on Monday, Sept. 27, commissioners Gary Scoby, Dylan Keim and Jason Koch voted unanimously to hire Dr. Mark B. Steffen, MD, at no cost to Nemaha County, and ask for the resignation of Dr. Irving A Cohen, MD, MPH, FACPM, DFASAM, who they were paying $1,000 per month. The change took effect Friday, Oct. 1.
The former health officer role was held by Jane Sunderland of Sabetha, which was contracted by Nemaha County through Nemaha County Community Health Services (NCCHS). Sunderland held this position for 17 years. Sunderland was supervised by Dr. Kevin Kennally of Sabetha, who also resigned from his advisor position.
When Sunderland resigned from her health officer position, NCCHS revised their contract with Nemaha County, which no longer included providing a health officer for the county. This placed the role of Nemaha County public health back in the hands of the three commissioners. Thus, the commissioners started searching for two people to fill the roles of county health officer and advisor to the county health officer.
After struggling to find someone to fill the role, the Nemaha County Commissioners decided to hire Nikki Keim – wife of Commissioner Keim – on an interim basis, during their Monday, Aug. 30, meeting. N. Keim agreed to hold the position until the commissioners could find someone more permanent. Commissioner Keim abstained from voting on hiring N. Keim.
During the same meeting, the commissioners discussed hiring Dr. Cohen, after there was no interest from any Nemaha County doctor to fill the role. According to Commissioner Keim during the Aug. 30 meeting, Dr. Cohen had “shown interest” in filling the role as the advisor to the county health officer.
“His name is Irving A Cohen, MD, MPH, FACPM, DFASAM,” Commissioner Keim said during the Aug. 30 meeting. “He was chief resident at John Hopkins Hospital. He has done things. He has wrote many books. He has a masters in public health and preventative health. I think this gentleman is very qualified for the position. He is a retired doctor from Topeka.”
After further discussion, the commissioners decided to hire Dr. Cohen, starting on Wednesday, Sept. 1.
September 13 Meeting
After being hired, Dr. Cohen, traveled to Seneca on Monday, Sept. 13, to meet the Nemaha County Commissioners for the first time.
During the meeting, Dr. Cohen – who has advocated for masking and vaccinations during the COVID-19 pandemic – said Commissioner Keim had told him the role would be “strictly advisory.”
“From what he [Commissioner Keim] sent to me, my role would be strictly advisory to you, and I’m basically toothless. That’s not going to shut me up,” Dr. Cohen said.
“We agreed to disagree on certain things,” Commissioner Keim said.
“I mean you’ve got a situation here where I may end up siding with some of the folks that don’t agree with some of the things you’ve done, and I’m going to tell you that,” Dr. Cohen said. “I don’t have authority to do much with it, and I do not wish to be used as someone whose name is on a piece of paper, to say, ‘oh well, he okayed this,’ when that’s not the case.”
“We appreciate your knowledge,” Commissioner Keim said.
“Well its kind of a gray area Dylan, because the statute really sounds like it says, I’m supposed to being supervising, Nikki,” Dr. Cohen said. “So, I think if that is the case, that changes the level of responsibility that I have.”
“My idea for the advisor, I don’t think requires much,” Commissioner Scoby said. “Our former health officer was good at what she did and I think her interaction with the advisor was minimal. I think once or twice a month, minimal. So that just gives you an idea of where we’ve been.”
“That is the way it should be if there are people who are experienced,” Dr. Cohen said. “Kansas is kind of loose on what it allows, because it has so many diverse counties. You can’t expect every county to be the same. The more you can do in house, the better. Nikki was telling me that she has learned how to feed things through to the State in terms of contact tracing. The problem is the State is saying right now, that they are going to take 10 days that they can contact the person. Well, by that time you’ve missed the opportunity to limit spread [of COVID-19]. So the more you can do in house, the better, with what resources you have”
Dr. Cohen also said the amount of local doctors that Nemaha County has, is a “valuable asset” to the county.
“I’m hoping I can help you out,” Dr. Cohen said. “Your local doctors are resources.”
During Dr. Cohen’s Tenure
During his tenure with Nemaha County, Dr. Cohen spoke with multiple stakeholders throughout Nemaha County who are interested in the health of the citizens. These stakeholders included physicians, advanced practice nurses, nurses, health and administrators, both the former and current Nemaha County Health officers and administrators, a manufacturing executive, a school board member and a school teacher.
According to Dr. Cohen, the purpose of speaking with these individuals was to elicit their views on the strengths and weaknesses of protection from COVID-19 and the impact of the epidemic within Nemaha County.
Dr. Cohen began working on compiling his results from his conversations with stakeholders and had his findings in “final editing,” when he received a call from Commissioner Scoby on Wednesday, Sept. 29. According to Dr. Cohen, Commissioner Scoby said “the commissioners had located another individual as an advisor that they were more comfortable with.”
After Dr. Cohen’s Resignation
Following Dr. Cohen’s resignation, Commissioner Scoby said that the commissioners had not discussed asking Dr. Cohen to resign prior to their meeting on Monday, Sept. 27, but that Dr. Steffen had “presented himself and said he would do it [take the health officer advisor position] for nothing.”
“So, we just decided to do it [hire Dr. Steffen],” Commissioner Scoby said. “Commissioner Keim talked to him and said Dr. Steffen would do it for nothing, so that was the reason for the change.”
Dr. Cohen also answered a few questions regarding his time as the advisor to the Nemaha County Health Officer.
“That [the Nemaha County health officer advisor] was my position,” Dr. Cohen said. “Although, if you look at the way it was structured, I had no actual authority over what the health officer did, which I’m not sure if that met the statutory requirements for an advisor.”
Dr. Cohen said he was not surprised when the commissioners asked him to resign.
“Going in, when I was first contacted [by Commissioner Keim] and the situation was explained, I agreed to take the position because they needed to have someone there,” Dr. Cohen said. “From what they [the commissioners] had told me, I expected that my recommendations to them would not be to their liking. Clearly, they seemed to have some views that were not supportable medically by science. I felt that rather than say to them, ‘I don’t agree with you and I wont talk to you,’ it was just the opposite. I felt like it was my duty – if I was to work with them – to show them what certain things really meant and how to best approach things. Perhaps, they expected less of me, and simply wanted to fill a requirement.”
Dr. Cohen also said that being “physically distanced” from Nemaha County would make the position more difficult.
“If one of the local doctors was an advisor to them – even though the local doctors may not have the same background in public health [as Dr. Cohen] – they are more in touch with the community,” Dr. Cohen said. “I think that the division was a weakness, the division between the local doctors and the commission. They [the commissioners] need to pay attention to the local doctors, nurses and nurse practitioners and the whole health care picture. It is important to pay attention, because these are not remote people working for a giant corporation, which is the case of medicine in big cities. These are local people, who are in touch with their patients and they can see exactly whats going on.”
Dr. Cohen’s Suggestions for Nemaha County
The report – which Dr. Cohen gave to the Nemaha County commissioners just one day after being asked to resign – was also released to The Sabetha Herald, by Dr. Cohen. Dr. Cohen provided many suggestions for Nemaha County based on his conversations.
“I believe it [the report] presents much useful information for you, your citizens and my successor,” Dr. Cohen said.
The suggestions listed below are directly from Dr. Cohen’s report
Unfortunately, the State backlog is 10 days behind, which is more than the incubation period for this disease. The result is that contacts may not be notified until after they have spread it to others. In my opinion, this current arrangement is considerably less effective than the integrated team of the past. At this point, I think it is important that the leadership of the county and the healthcare professionals of the county attempt to rebuild those bridges that previously existed, respectful of each others responsibilities and knowledge.
County Risk Standing
Nemaha at 58 percent, ranks 11th in the state for fully vaccinated residents age 12 and above. This compares to a statewide rate of about 60 percent.
This good news looks bleaker when we look at age distribution. First the most vulnerable group, age 65 and over has an excellent record with almost 84 percent vaccinated.
For all adults 18 and above, this drops to about 62 percent. Ages 18 through 64 group has a lower rate.
The 12 through 17 age group lags far behind, about half of the current Kansas level. KDHE showed only 17 percent were fully vaccinated, compared to about 34 percent statewide.
My recommendation is that the County join forces with the medical community to become an advocate for immunization for younger people, as it previously did with older residents. This should extend even further, to protect children 5 and above if and when the vaccine approval is given for that age group.
Nationwide, the upsurge in cases has been blamed on the Delta variant, but a large part of it was hastened by the decline in mask usage in crowded public gatherings.
The CDC, in recognition of the upsurge, went back to earlier guidelines that require masks for all people, vaccinated or not.
Next to vaccination, the use of masks is the most valuable tool available to control the epidemic without oppressive over-regulation that would cause further disruption of normal activities.
My recommendation is that the County return to a stricter standard or at least recommendation regarding mask usage. It should be possible to do so without preventing or unduly disrupting normal activities of County citizens and businesses. If the County is reluctant to establish a standard with the community, at least do so within County government itself. This would be an important step and set an example for the community.
I recommend that the County government advocate strong protection for children at school, particularly universal masking, as well as all other elements of a multi-faceted policy suggested by the CDC. Although this can be done in concert with the local school districts, the County should be prepared to offer this as a service to those districts, who consider it a burden, using federal COVID-19 funding to do so.
Other things to consider
Total or almost total vaccination should be our goal.
Protecting our community is not an intrusion of our personal liberty.
Current vaccinations work. They are saving lives.
Children are susceptible to the virus.
Nemaha County Report - Dr. Irving Cohen
6-CDC MMWR Arizona Masking in school comparison
5-CDC MMWR California Classroom Outbreak
3-Systemic versus Mucosal Immunity Review
2-Distance Guidline Review