KDHE departures concern public health advocates

Two sub-Cabinet leaders fired, three others retiring at state health agency

by Andy Marso, KHI News Service

A sudden exodus of internal leaders has public health officials concerned about the immediate future of the Kansas Department of Health and Environment.

Two KDHE leaders were terminated and three others announced their retirements in recent weeks. Combined, the five have more than 80 years of agency experience.

“Our concern is the fact that the Department of Health and Environment is going to be weakened by the loss of all these people who had so much experience,” said Dennis Cooley, a Topeka pediatrician who is one of the state’s most vocal child health advocates.

The two KDHE officials terminated were Tim Budge, the section chief of the agency’s immunization program, and Mindee Reece, the director of the Bureau of Community Health Systems.

The three who retired are Brenda Walker, director of the Bureau of Disease Control and Prevention; Paula Clayton, director of the Bureau of Health Promotion, and Jane Shirley, director of the Center for Population Health and director of Local Public Health.

“All of the names are familiar to me,” said Michelle Ponce, executive director of the Kansas Association of Local Health Departments.

Ponce said she worked with Shirley most often, about once a week. She also worked regularly with Reece and, to a lesser extent, Clayton. She knew Walker and Budge’s roles in the agency but did not interact with them as much.

KDHE, one of the largest state agencies, supports local health departments in their efforts to control disease through a variety of public health and environmental programs. It has a budget of more than $2 billion, but a lot of it comes from fees or federal funds. About $700 million comes from the state general fund.

The changes in high-level personnel are occurring less than a year after Susan Mosier replaced Robert Moser as KDHE secretary.

In addition to the office of the secretary, Mosier oversees three divisions: Public Health, Health Care Finance and Environment.

All five of the recent departures were leaders within the Division of Public Health, which includes eight bureaus. Reece, Walker and Clayton led bureaus. Shirley worked under Reece and Budge worked under Walker, leading sections within their bureaus.

Clayton and Walker are still serving out their final days with the agency.

Sara Belfry, a spokeswoman for KDHE, declined to comment on the changes, calling them personnel issues.
Reece, who was with KDHE for more than 20 years before she was fired in late August, did not respond to a request for comment.

The Community Health Systems Bureau that Reece headed works with local partners to ensure health care is accessible throughout Kansas, including rural areas, and takes the lead in coordinating response to public health emergencies caused by natural disasters and terrorism.

Ponce said Reece had a “wealth of knowledge” about the various local health programs that KDHE supports and will be missed.

“I would say she’s been a public health champion,” Ponce said.

Immunization program in ‘survival mode’

Budge was promoted from within KDHE and had held the top immunization job for less than a year when he was terminated last week. He said he did not see it coming.

“I had planned to be at KDHE forever,” Budge said.

Budge started at the agency in 2008 as an immunization information systems trainer, then moved up to manager of the Vaccines for Children program before taking over as section chief in November 2014.

He inherited a program in a state with falling vaccination rates and said he was committed to bringing them up.

“We were going the right direction, the direction we wanted to go to get back out to the providers and eventually get our immunization rates higher,” Budge said.

He said the reason Walker gave for his termination was an inability to manage his staff.

But Budge said his tenure as section chief was complicated by “mixed messages” about the proper role of the section chief and outdated policy information from his superiors.

”How can I really manage my staff when I don’t have clear information from those above me?” he asked.

Budge said the state’s immunization program also has also been hindered by employee turnover and it was difficult to keep positions filled. As of Thursday, the program’s web page showed six of 20 positions vacant.

Budge said the previous two section chiefs only served for a year.

“The program has been in survival mode for the past three years,” he said.

Walker, who worked with Budge in her disease control and prevention role, said via email that the rapid turnover of the state’s top immunization job in the last few years was an “unfortunate experience.”

“Although Tim had been with the program for years and had established himself with the program as an excellent trainer for the automated registry system, regretfully, those skills did not transfer over into the management of the program and staff within the program,” she said.

Budge, a Topeka resident whose wife is pregnant with their seventh child, said it’s not his intention to speak negatively of KDHE.

He said he was willing to learn on the job but it was unrealistic to expect him or anyone else to absorb all of the state and federal immunization protocols and master the management side of the job in less than a year. He said remaining employees are concerned about their own jobs.

Belfry said via email that though she could not comment on personnel, she would comment on the “recent successes of the immunization program.”

She said the immunization section has implemented an electronic vaccine ordering and tracking system for 350 health care providers in the federal Vaccines for Children program and increased participation in KSWebIZ, a program that logs and tracks immunization records of Kansans kids, to 87 percent of school districts.

“KDHE is proud of the work the immunization program has done recently and continues to do,” Belfry said.
Phil Griffin, the longtime director of the Kansas Tuberculosis Control Program, has taken over for Budge on an interim basis.

John Eplee, a family practice physician in Atchison who chairs the Immunize Kansas Coalition, said the change in leadership could hamper the coalition’s work to increase rates of adolescent immunization in the state. Budge was KDHE’s liaison to the group, which previously was known as Immunize Kansas Kids and includes 23 member organizations.

“Certainly it will be a pretty great loss for us short-term,” Eplee said. “We’re hoping in time this will smooth itself out in terms of the IKC group.”

Cooley, the Topeka pediatrician, said turnover and vacant positions within the immunization division could have a long-term effect.

“We really need strong input from KDHE,” Cooley said. “So if their immunization program gets weakened, then I think that’s going to really make it more difficult for us to improve our immunization rates.”

Loss of institutional knowledge

Clayton was the longest-tenured of the recent retirees, with almost 27 years at KDHE. She did not respond to a request for comment.

The bureau she led is charged with promoting healthy behaviors, policies and environmental changes to prevent chronic disease, injury and premature death. It focuses on areas like managing arthritis and diabetes and preventing heart disease, tobacco use and childhood accidents.

Walker’s bureau is charged with reducing infectious disease and includes three sections: immunizations, sexually transmitted illness and tuberculosis.

Walker, who had 21 years at KDHE, said via email that her last day is Sept. 14.
She said she’s making plans for life after retirement.

“I would like to be involved in an early childhood development program of some type, if I’m not busy as a life coach or travelling with friends and family,” Walker said in an email that was also sent to Belfry.
In a subsequent email, Walker said the agency is moving forward with worthy replacements.

“Just wanted you to know that KDHE has some pretty awesome emerging leaders as well, such as Jennifer VandeVelde, who is my replacement, Brandon Skidmore, who has been appointed Interim Director for the Bureau of Health Promotion and Rachel Sisson, Director of the Bureau of Family Health,” Walker said.

Shirley started at KDHE in 2008 after a 20-year career as a public health nurse in Jefferson County. She was named director of local health in 2011.

After leaving the agency last month, she took a job as a corporate wellness coordinator for Blue Cross and Blue Shield of Kansas, according to her LinkedIn page.

Shirley, through BCBS Kansas media relations staff, declined to be interviewed about her time at KDHE.

Before taking her post at the association of local health departments four years ago, Ponce worked at the Kansas Department of Social and Rehabilitation Services, which is now the Kansas Department for Children and Families.

She said that since she joined the association, local health departments have had a close working relationship with KDHE and she expects that to continue.

“We are seeing some very long-term public health champions leaving the agency,” Ponce said. “And there is quite a depth of knowledge going out the door with them. So, we are a little bit anxious. But you know, we’re trying to see what happens.”

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.

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