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HEALTH COMMITTEE - PRELIMINARY REPORT
JANUARY 9, 1975
WELD COUNTY GENERAL HOSPITAL
Weld County General Hospital is a body corporate voluntary, non-profit general
hospital governed by a seven-member Board of Trustees (non-paid), serving terms of
five years each under appointment by the Board of County Commissioners. Legislation to
establish such public hospitals originated in Weld County by Weld County citizens and
sponsored in the House of Representatives by the four representatives of Weld County and
in the Senate by its two Senators in 1943.
The•Board of County Commissioners appointed the first Weld County Hospital Board of
Trustees in 1944. This board proceeded in establishing the present hospital by
purchasing approximately 21 acres of farm land from the late Frank Green at a cost of
$500 per acre. The original hospital building at the present location was completed
in 1952 and the north wing was added and ready for service in 1962.
The Board of Trustees employ a hospital administrator as the chief executive of the
hospital. This hospital is an open staff hospital, staffed by practicing physicians in
Weld County, a total of over 100 at the present time. Approximately 66% are board certified
or board eligible specialists, a number well above the national average. The hospital
is open 24 hours a day to meet every need. 15,716 patients were admitted in 1973. With
its 334 beds, 40 bassinets, and its modern facilities, our hospital offers the best
possible medical care to the people of Weld County and its surrounding communities.
Richard Stenner is the Administrator, Wendell Fuller is the Assistant Administrator.
Currently 134 nurses and 70 part time nurses are employed and the total employees
number 800. Approximately 70% of the annual operational budget of $10,215,780 is for
wages and benefits. No mill levy is currently used for operational expenses of the
hospital. One and one-half mills is being levied by the Board of County Commissioners
this year and is used for the construction of the new emergency - ambulatory building
and will be added to money generated by operational gains of the hospital. The south
wing formerly occupied by the Health Department will be used for temporary offices and
other overcrowded departments. Eventually, these facilities will be used for expansion
of the ambulatory department.
Medicaid (a government program providing for indigent patients) reimburses the
hospital through the Department of Social Services, who examine and approve the budget
of the hospital for the medicaid patients. Medicare (a government program providing for
the elderly eligible for Social Security benefits) reimburses the hospital on a cost of
operations basis which included depreciation of equipment and buildings.
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Blue Cross-Blue Shield reimburses the hospital on the basis of 104% of its costs.
The administration depends on the Welfare Department for advise on who is a welfare
patient. State statutes permit the County Commissioners to levy up to 3 mills for
either operational, maintenance and/or buildings.
Effective July 1, 1974, a family practice training program was started by the
hospital to replace the intern program. Dr. David E. Bates is employed by the hospital
to direct this program. Currently, eight family practice residents are under the
program; four in the first year, and four in their second year of training. Effective
July 1, 1975, the final complement of four will be added, making the total of twelve
family practice residents, each serving the program for three years. This facility is
operating under the direction of the Board of Trustees of Weld County General Hospital
and is housed in part of the old Greeley Clinic Building.
Also, the hospital is affiliated with the University of Northern Colorado, which
offers a four year course leading to a Bachelor of Science degree in nursing. About
65 nurses are graduated each year. The hospital provided the clinical facilities in
cooperation with the University of Northern Colorado.
The hospital is serving more and more people from eastern Colorado. Some member
or members of the family often accompany the patient to Greeley, thus the hospital
serves the community with economic benefits.
The Administration states it would be willing to cooperate with other Weld County
agencies in using a County Purchasing Agent if economies can be effected.
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HEALTH COMMITTEE - PRELIMINARY REPORT
JANUARY 9, 1975
PUBLIC HEARING
The Health Committee of the Home Rule Charter Commission held a Public Hearing
on January 6, 1975 at 7:30 P.M. The purpose of the meeting was primarily for Public
input and suggestions to acquaint the committee with prevailing practices and
problems relative to the Weld County Health Deaprtment functions.
The public response was gratifying. There were 13 individuals making responses
on a variety of subjects.
'Frank Anders - representing self.
Mr. Anders was concerned with Environmental Pollution, primarily
Denver pollution that is being passed on into our county. He
cited such examples as Rocky Flats; radio active pollutants; and
the Rocky Mountain Arsenal. He stated that Denver is the sixth
(6th) most polluted city in the United States.
He recommended making stringent government requirements, be it
county, state or federal; with adequate methods of detecting
pollutants.
Manuel Pineda - Director of Loveland Local Beet Growers.
Adolph Bohlander - Weld County Livestock Association.
Carl Felte - Weld County Farm Bureau.
Alex 0. Hoffner - N. F. 0. member.
J. C. Lang - Potato Administrative Committee
Were all concerned about E.P.A. regulations curbing their farming
and feeding activities. They were particularly concerned with
the use of pesticides, fungicides, nitrates, etc. They recommended
avoiding all government controls possible. The Health Department
should not allow themselves to become controller of Federal
regulations. They also recommended better relations between the
Health Department and the Milk and Meat Producers.
Sherman W. Neilson - Older Americans.
Joe MacKinnon - Weld County Council on Aging.
They expressed concern for health, nutrition, transportation,
nursing care, hospital care, home environment and all other
needs of our senior citizens and older people on fixed incomes.
They commented that Dr. Yoder has been very cooperative.
They recommended a committee to represent older people and to
determine their needs. This committee should also find help
they need - without duplication. Also, consolidating agencies
for more efficiency.
Mel Bush - Fort Lupton City Administrator.
He recommended consolidating health services as much as possible.
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Patricia Fay - East Side Health Center.
Leslie Leppla, M.D. - East Side Health Center.
They were concerned with gaps in the health services to individuals
who were unable to pay and yet ineligible for help. Not the welfare
cases, but the working_ people with low incomes who cannot afford
the proper medical care or proper medicines.
They recommended that the County Commissioners be on the Board, as well
as a licensed physician. Also, more county involvement with some
county financing.
Bernard Schmansky -
Jack Ailnut -
They spoke on the County Coroner appointment.
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HEALTH COMMITTEE - PRELIMINARY REPORT
JANUARY 9, 1975
WELD COUNTY HEALTH DEPARTMENT
ESTABLISHMENT
County Health Departments were established by enabling legislation that allowed
counties to form a county health department or join with other counties into a
health district. County health departments may also be dissolved by resolution of
the County Commissioners.
FUNCTION
Their function is to protect the health of the public.
DUTIES
A. To administer and enforce the laws pertaining to public health and vital
statistics and water pollution control; and the orders, rules and regulations and
standards of the State Board of Health and the State Water Pollution Control
Commission; to enforce the orders of the division of administration of the State
Department of Public Health, with respect to air pollution control.
B. To investigate and control causes of epidemic and communicable diseases.
C. To establish, maintain and enforce isolation and quarantine and close
public places, when necessary to protect public health.
D. To establish, maintain and make available chemical, bacteriological and
biological laboratories.
E. In emergencies, to buy and distribute to physicians or veterinarians
vaccines, serums, toxoids or other approved products for their use.
F. To initiate and carry out health programs that may be desirable for
protection of the public health.
G. To collect, compile and tabulate reports of marriages, divorces and
annulments, birth,and deaths.
H. To make any necessary sanitary and health investigations on its own
initiative or in cooperation with the State Department of Public Health.
I. To cooperate with the State Department of Public Health, State Water
Pollution Control Commission, and the Air Pollution Variance Board in all
matters pertaining to their jurisdictions.
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The Health Committee met with the Weld County Health Director, Dr. Yoder,
his Board Chairman, Mr. Sitzman and his department heads. Dr. Yoder and Mr.
Glen Paul, Director of Environmental Health Services and Mr. Sitzman have also
made presentations to the entire Charter Commission. A summary of programs being
carried are:
A. Home health care by public nurses - mostly concerned with senior citizens
who need minimal care but have no one to help them, and can't afford nursing
homes or hospitalization. Program helps free these institutions for care of
more critical patients.
B. Immunization program for the needy.
C. Family planning service.
D. Supplemental food program for the needy.
E. Dental program, to be directed toward control of dental diseases.
F. Tuberculosis and venereal disease control programs.
G. Work with migrant programs and health centers.
H. County clinics in areas outside Greeley to cover all of Weld County.
I. Doctor referral programs.
J. Health education programs.
K. Environmental health services.
L. Laboratory services.
M. Family planning.
N. Therapy programs.
The 1974 budget was $530,000.00. The County's share was given as approximately
65%. In figures furnished the committee, the department in 1973 received its funds
as follows:
1. Weld County 48.64%
2. Federal and state 21.53%
3. Fees for services 29.84%
The department spent its funds on these services:
1. General health 64.94%
2. Home health care 12.43%
3. Homemaker aide service 9.83%
4. Family planning 8.29%
5. TBC control 2.20%
6. Regional Greeley 1.41%
7. Regional Sterling .90%
The board is an advisory board consisting of five members who serve five year
terms. They are Mr. Clarence Sitzman, Chairman; Mr. Anthony Lembach, Mr. Ralph MO,
Mrs. Nels Benson and Dr. Werking.
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This is a very large and complex operation, as the functions would
indicate, public health can cover almost anything. There are probably several
other activities that are carried on not covered in this report. A two hour
meeting can only hit the high spots.
The environmental health field headed by Mr. Glen Paul is an area that
will have a large growth under newly promulgated regulations being handed down
from the federal and state level. The committee has been unable to receive
any estimate as to the number of technicians that will be required to enforce
new water pollution, air pollution, and chemical and pesticide regulations.
The Weld County Health Department Laboratory has contracts with Larimer
County and a northeastern regional contract. They are involved in COG
(Council of Governments) planning. This could be a big growth area.
They purchase some medical supplies from Weld County General Hospital.
They felt that a central medical purchasing program for the county could save
money. Other supplies are purchased both thru the county and independently
and could be consolidated.
In general, the feeling was expressed that good communications were
maintained with the other health agencies and the medical groups. The area
where improvement could be made was with the Welfare Department.
A big handicap to the department is the difference in fiscal years for
the county, state and federal governments. This makes budget planning very
difficult. This was the area they expressed a desire to see home rule action.
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HEALTH COMMITTEE - PRELIMINARY REPORT
JANUARY 9, 1975
CORONER
The Charter Commission heard Mr. Ross Adamson on December 19, 1974. For the
benefit of records a brief summary follows:
The Coroner is a constitutional officer who is elected for a term of four years.
The principal duty of the Coroner is to investigate the causes of deaths, for
reasons for which are not known. The Coroner, District Attorney's office or a
Coroner's Jury can call for an autopsy to determine cause of death.
The 1975 budget will be $20,400. , to be spent largely on autopsies conducted by
any of the three physician-pathologists available at Weld County Hospital. Pathologists
fees for an autopsy averages $200. Adamson receives a fee of $15. for each case he
investigates.
Mr. Adamson has four deputies who are also his employees as morticians. He believes
the office should remain elective and that to have a medical examiner or physician as
coroner would be more expensive that the present budget.
At the public meeting there were four morticians present. Mr. Bernard T. Schmanski,
a funeral director in Ft. Lupton, said the Coroners office was an antiquated system.
Sixteen counties in Colorado have a coroner-funeral director and three are under
law-suit now. Sixteen states have adopted a law that states a coroner cannot serve as
funeral director on coroner cases. In Weld County there are six licensed funeral
establishments. Mr. Adamson does 43% of the business in Weld County, but 80% of the
coroner deaths are handled by Adamson Funeral Home. Mr. Schmanski feels that there is
definitely a conflict of interest.
Mr. Schmanski recommends that a county morgue is available in Weld County Hospital
and that someone trained in forensic medicine serve as medical examiner.
Mr. Jack Allnutt also spoke at the Public Hearing and made the following random
thoughts :
Attorney General Moore has spoken very heatedly for a medical examiner system in
the state on a county basis.
Need to take a better look at the budget breakdown of the Coroner's office; that it
might already be adequate for a medical examiner on a fee for service basis.
Mr. Allnutt also believes that there is a need for someone qualified medically
and legally.
The duties of the Coroner should be more completely outlined.
An informal discussion was held with a pathologist from Weld County Hospital.
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While not a perfect system, the working relationship between the pathologists and
the Coroner's office in Weld County has been very good. He agrees that the Coroner's
office is antiquated, probably having a medical examiner would be better. The three
pathologists at this time are very busy and would not be able to assume further
responsibilities. The present arrangement of cooperation with the Coroner's office on
a consultation basis, better fits their time limitations.
To the question of having an M.D. , he responded by saying, "It would probably be
difficult to find a knowledgeable, conscientious, willing physician for the job of
medical examiner." He encouraged seeking other opinions.
In delving deeper into the aspects of the office of Coroner, some insights were
gained from a pathologists reference book, Medicolegal Investigation of Death.
"The first statewide Medical examiner system was established in 1939 in Maryland.
Meanwhile, a number of large cities, the District of Columbia, as well as twenty
states, have amended their antiquated Coroner's laws or adopted legislation providing
for a medical examiner system. Several of these are in the position of having
adopted enabling legislation, but due to the shortage of forensic pathologists or the
failure of the legislature to provide funding, implementation of the revised coroner's
laws is yet to be accomplished. In 21 other states there are either coroner's and
medical examiner's systems in co-existence or legislature requires that the individual
carrying out medicolegal investigations shall be a physician or otherwise
have special knowledge. In the remaining nine states there are no such requirements,
and the individual responsible for the investigation of death is still the corner or
justice of the peace; generally an elected official whose principal qualification for
the job is the ability to win the election. "
Letters have been sent to Dr. Patrick Sullivan, Chief of Staff at Weld County General
Hospital and Dr. Fred Groves, President of Weld County Medical Society, asking for
statements from their organizations regarding the office of Coroner.
The committee felt that the Public Hearing helped to` expose other opinions.
There doesn't seem to be any personal vendetta with Mr. Adamson, just interest in
giving further consideration to alternatives for the office of Coroner.
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AMBULANCE SERVICE
The Weld County Ambulance Service Director Richard Gazlay, spoke to the Charter
Commission on December 20, 1974.
The three month old ambulance service is subsidized by the county and the city of
Greeley. Bill collecting is the number one problem.
Mr. Stenner, Administrator of Weld County General Hospital expressed satisfaction
with the ambulance service and their cooperative effort in utilizing the employees in
the hospital when not being used on calls.
We received no public in-put or information from other county ambulance services.
The high cost of the director and ambulance service was the only expressed concern.
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HEALTH COMMITTEE - PRELIMINARY REPORT •
JANUARY 9, 1975
WELD MENTAL HEALTH CENTER, INC.
A two hour meeting of the Health Committee and Dr. Richard Cripe, Director, and
Charles Smith, Chairman of the Board was held December 17, 1974 at the Mental Health
facility on 11th Avenue.
The standards for licensure of Community Mental Health Centers in the State of
Colorado are the guidelines used by the center.
The following excerpts of standards are pertinent to the study:
Standard 1. A community Mental Health Center (CMHC) shall include:
a. in-care services
b. out-care services
c. partial-care services
d. emergency services
e. consultative and educational services
Standard 2. A CMHC shall :
a. be owned and operated by one or more nonprofit corporations or
associations.
Standard 3. The corporation owning and operating a center shall organize by
suitable election or appointment, a board whose membership is broadly
representative of the community served to govern the center. "Broadly
representative" shall mean "representative of the socio-economic,
ethnic, and geographic characteristics of the population served."
The Weld Mental Health Board is a self-perpetuating, 15-member, governing board.
The Executive Director is appointed by the board and has a one year contract.
The organization, staff and services are described on additional papers provided
by Dr. Gripe.
The 1974 budget is $810,000.00. 50% Federal, 33% State and 17% Greeley, fees,
insurance and contracts. Approximately 30% of the patients are county. Of the 14
comprehensive Mental Health Centers in the state, all but one (Denver General Hospitals
program) are private, nonprofit corporations; and Weld County is the only one presently
receiving no county monies.
The committee received copies of a letter sent by Dr. Cripe to the County
Commissioners suggesting county support. "In the past, one of the issues the
Commissioners have had with the center is the legality of appropriating tax money to
a private corporation. It is our understanding that Colorado Law, 3-11-13 CRS, allows
for the local government to purchase services from private corporations." (See page
37 - Duties and Functions of Colorado County Officials. )
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When the committee asked for suggestions, Dr. Cripe stated that personally he
would like to have the governing board remain, but felt that compromises could be
worked out on board appointments in order to receive the 25% county funding that
might be needed when the Federal Government ends in October of 1975. He said that
a formal statement would be needed from the board and he could only express personal
opinions.
Dr. Cripe feels that the Mental Health Center has an excellent working relationship
with the hospital. Improvement is being made in the areas of social service, probation
and law enforcement.
The committee felt that the interview session was very beneficial and that Dr. Cripe
was candid, and easy to communicate with in all areas. Mr. Smith had to leave so we
did not have much opportunity for exchange of information.
The committee has available the Annual Report 1973-74, the State Standards and the
three page letter to the County Commissioners requesting financial support.
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