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St. Clair County commissioners split on deputy medical director, debate combining health officer roles
Summary
Administrators and commissioners debated whether to create a revenue‑neutral deputy medical director (a physician‑assistant role) and whether to recombine or keep distinct the medical director and health officer roles; commissioners requested job descriptions, funding scenarios and further committee review.
The St. Clair County Board of Commissioners spent a substantial portion of the June 18 meeting debating a proposed deputy medical director position and the broader structure of county public‑health leadership.
Administrator Tom told commissioners he had identified a funded vacancy that could be reclassified as a deputy medical director — described in the discussion as a physician‑assistant‑level post — but said the plan’s revenue neutrality depended on continued Title X funding. "One of those positions is already funded at least 40% by Title 10 dollars," Tom said, explaining how existing grant allocations could be used to support the deputy role. Staff later clarified that if Title X funds were declined, the deputy position would no longer be budget neutral.
Commissioners were sharply divided. Some supported a deputy who would provide day‑to‑day medical coverage while the medical director works reduced hours: "If the medical director continues part‑time, I can certainly see a need for someone that's there all the time," one commissioner said. Others opposed adding a deputy without a job description and warned of the optics of creating an additional managerial position while staffing and service decisions are under debate. A commissioner objected that the county would be the only one in the state with a deputy medical director and asked for clarity on reporting and supervisory lines.
The board also discussed a standing recommendation from the Advisory Board of Health to combine the medical director and health officer roles; commissioners noted the option to keep the positions separate for "checks and balances" and to resolve conflicts through a clear supervisory chain. Several commissioners asked the administrator to prepare contract language, job descriptions, a manning‑table change and funding scenarios for a July agenda. Finance staff said prior RFPs and micro‑grant structures for opioid settlement funds had been set up but that no mini‑grants had been awarded.
No formal vote to create the deputy medical director occurred at the June 18 meeting. The administrator was directed to continue negotiations, provide a complete package (wage scale, job description, funding sources and manning table changes) and return to the board for a future action. Commissioners asked that any deputy position be revenue neutral and that hiring follow standard departmental recruitment procedures with administrator oversight.
