Madison County Board of Health recommends Emily Sayer as interim health officer for 8 weeks

MADISON COUNTY — At a special meeting, the Madison County Board of Health unanimously recommended that Emily Sayer serve as interim local health officer for an eight-week period while the county’s current health officer is on field research.

The recommendation, made by Madison County health officer Margaret and seconded by board member Sheila, will be forwarded to the Madison County Commissioners for formal appointment. The board’s discussion also covered statutory qualifications for a health officer, the separate role of a medical director who signs vaccine orders, legal and malpractice concerns for volunteer physicians, and local preparedness steps for a possible measles response.

“The subject for the agenda tonight for the special meeting is for the board of health to discuss and possibly, if you choose, to recommend an interim health officer for an 8 week period while Margaret is going to be out doing some field research,” Emily Sayer said at the start of the meeting. Sayer told the board the appointment would be interim and that Margaret is expected to resume duties when she returns.

Board members reviewed statutory requirements. Emily Sayer read from the Montana Code Annotated, saying that the health officer may be “the medical provider, a person with a master’s in public health, or a person otherwise approved by the department” — language the board noted refers to the Department of Public Health and Human Services. The board emphasized that state approval can allow nonphysicians with equivalent experience to serve as health officer.

The group clarified the difference between the health officer and the medical director. “The medical director is the one who… signs the orders for us to provide immunizations,” Sayer said, describing the medical director’s role in signing standing vaccine orders and providing case consultation for clinicians. Board members noted the medical director is contracted through the county commissioners, while the Board of Health formally recommends the local health officer.

Colton Lauer, Madison County deputy county attorney, briefed the board on legal exposure. “The county has to have a local health officer,” Lauer said, and noted the principal liability concern is the county’s ability to act quickly in the event of an outbreak or other public-health emergency. He urged the board to ensure reliable availability to issue orders when needed so the county can meet its statutory responsibilities.

Board members discussed whether the interim appointee should hold a current Montana medical license and malpractice coverage. Dr. John Fountain, who offered to serve as a volunteer backup, described personal constraints: “I’m an anesthesiologist, I’m retired. I don’t carry malpractice insurance anymore,” he said, explaining that an active license requirement could create malpractice insurance obligations and deter volunteer physicians. Fountain also described past litigation experience and the practical costs of legal defense in contamination cases.

Some commissioners’ communications, the board said, had signaled a preference for an actively licensed physician; the county attorney and board members said state statute does not strictly require an active medical license for the health officer if the person otherwise meets the statutory educational or experiential standards and is approved by the Department of Public Health and Human Services.

Board members named local clinicians to contact as potential medical director or interim physician cover: Paula Christiansen (nurse practitioner, Ruby Valley), Leo Bartletti (Ruby Valley), Martin de Groot (PA, Madison Valley), Dana (former county public health director), and a retired DO colleague suggested by a board member. Sayer said she would begin outreach to the hospital medical directors and the clinicians named and report results to the board. She told the board there is a special commissioners’ meeting scheduled the next day to consider the board’s recommendation.

Margaret made the motion to recommend Sayer as interim health officer: “I’d like to make a motion and, have Emily be our interim health officer for Madison County, until my return.” Sheila seconded the motion. The board recorded unanimous approval. The board chair noted the recommendation will be conveyed to the commissioners, who must take the formal appointment action.

The meeting also addressed local preparedness in light of increasing measles activity in Montana. Board members reviewed the county’s communicable disease response plans and discussed thresholds for expanding immunization clinics. Sayer said state immunization-program guidance and available vaccine supplies influence whether the county can run outreach clinics, noting that neighboring Gallatin County had already deployed mobile clinics after detecting cases.

Operational items discussed included recruitment for nursing staff (Sayer said she was close to making a hire), the potential to use retired local nurses for immunization campaigns if needed, and whether the county could facilitate titer testing for people uncertain of their immunity. Sayer said the county does not currently have capacity for titer testing but will work with hospitals; she noted one hospital quoted about $34 for a titer test. Dr. Fountain recommended the county run a tabletop exercise that includes commissioners, the county attorney, local clinicians and public-health staff to clarify roles and communications in an outbreak.

The board concluded by directing Sayer to continue outreach to potential medical directors and clinicians, forward the recommendation to the commissioners, and keep the board informed of any contracts or commitments. The special meeting then adjourned.

Emily Sayer, Margaret and other board members said they would follow up with commissioners and local clinicians in the coming days.