Cochise County health officials outline budget pressures, request two staff and warn grants fund nearly half of public health operations

Cochise County health officials told the Board of Supervisors on Wednesday that nearly half of the Health Department’s budget comes from grants, that the county pays outside agencies for medical examiner services, and that staff are seeking two additional positions to address inspection backlogs and administrative workload.

"48% of public health is paid for through grants. 52% general fund," Barb Lang, director of the Cochise County Health Department, told the supervisors during a work session April 30. Lang said the department is asking the board to approve one environmental health specialist to increase inspections and one administrative aide to support the public fiduciary office.

The request is part of a larger presentation on the department’s general fund pages (identified to the board as pages 1–8). Lang described several budget drivers the board should consider: payment to an out-of-county medical examiner, a contracted medical director, maintenance-of-effort transfers to the jail district for jail medical and mental-health services, and a broad portfolio of grant-funded programs.

Why it matters: supervisors pressed staff on recurring costs and how grant accounting appears across county funds. Supervisor questions highlighted constituents’ concerns about restaurant and septic inspections, well permitting, and use of grant funds for programs such as WIC, overdose prevention and public-health emergency preparedness.

Key details from the presentation

- Staffing requests: Lang said environmental health currently has eight specialists and the department is requesting one additional environmental health specialist (to bring the total to nine) to address inspection backlogs for restaurants, septic systems and other regulated operations. The department is also asking for an administrative aide for the public fiduciary office to handle court paperwork and intergovernmental coordination.

- Grants vs. general fund: Lang told the board that approximately 48% of the Health Department’s funding comes from grants and 52% from the general fund. Many program lines after page 9 of the packet were grant-funded, she said.

- Medical examiner and medical director: Lang said Cochise County does not have its own medical examiner and uses Tucson for those services, which contributes materially to expenses. She also described the department’s contracted medical director: "42000 is very, very generous. Medical directors cost quite a large amount of money for an MD, so he contracts with us and talks us through, any complications..." Lang said the contracted physician is on call for the department: "he's on call whenever we call at any time for whatever reason." The presentation identified the $42,000 figure in the professional-services line as the amount budgeted for the medical director contract.

- Jail mental-health and medical services: Lang explained that the budget includes a maintenance-of-effort transfer for jail mental-health services. She said the transfer to the jail district to cover jail medical/mental-health services is budgeted at $226,098 for the year and noted there are grant lines that flow to jail medical services as well. Staff described the county’s accounting codes (activity codes such as 5220) and the county financial system (New World) as the reason similar activity names can appear in multiple funds, which can make fund sources look duplicated on a high-level summary.

- Environmental health work and permitting: Lang and staff outlined the department’s responsibilities: annual restaurant inspections (statutorily required to occur at least annually, the department said), septic permitting and inspections, plan review for new wells and septic systems, and technical assistance for cottage-food operators and other small food businesses. Lang said the environmental health program produces significant fee revenue and that additional inspection capacity would reduce the current backlog.

- Vital records, clinics and community programs: Lang described vital records work (birth and death certificates, indigent burials), and noted five county clinics in Douglas, Benson, Bisbee, Wilcox and Sierra Vista. She reviewed grant-funded programs including WIC, suicide (mortality) review, public-health emergency preparedness, overdose prevention (Narcan distribution) and smoking-cessation outreach.

Supervisor concerns and board context

Supervisors repeatedly questioned the scale and purpose of some grant-funded programs and sought clarity on where money shows up in county reports and warrants. One supervisor said the packet contained roughly nine pages of general-fund items and about 59–60 pages of grant-funded programs and voiced concern about taxpayer dollars and program scope. Board members asked staff to confirm that warrant-and-demand reports and interfund-transfer forms make clear the fund source for payments and transfers.

No formal action taken

The session was a budget work session for information and discussion; the board did not vote on the requested positions or adopt budget changes during the meeting. Lang asked the supervisors to "consider" the two positions and said grant-funded programs are essential for the communities the department serves.

What’s next

Lang and department staff told the board they will provide additional detail if the supervisors request it during the budget process. The board also scheduled a subsequent budget work session on development services following the meeting.

Ending note: the presentation emphasized the Health Department’s reliance on grants for many community services and asked the Board of Supervisors to weigh two modest staffing additions against inspection backlogs and court-related administrative needs.