At a time when public health programs are crucial in order to protect, advise and educate state governments and the people they serve, the Nebraska Department of Health and Human Services is in the middle of a weighty reorganization.
Under the leadership of CEO Dannette Smith and advice of a hired consultant, it is shuffling employees and filling new positions.
Tom Safranek, who had been the state epidemiologist for 30 years, was removed last month from that position and given a new role: special assistant to CEO Smith.
According to HHS spokeswoman Khalilah LeGrand, "Dr. Safranek’s epidemiological knowledge and infectious disease expertise are still being utilized, and he continues to serve in the capacity of state epidemiologist."
But she did not answer a question on whether Safranek, who has been referred to by some as Nebraska's Dr. Fauci, was now considered a classified or discretionary employee. A discretionary employee serves at the pleasure of the agency head and does not have the same employment protections as a classified employee, which he was as epidemiologist.
Safranek has been unseen in the many coronavirus briefings Gov. Pete Ricketts has held with the media since March. Dr. Gary Anthone, Nebraska chief medical officer, is frequently at the briefings. Anthone has no public health experience.
LeGrand said Safranek's expertise, long-standing knowledge and established relationships with agencies across the country "made him the perfect candidate to advance in the department and take on this new role of advising and working closely with the CEO."
The department consulted with the Association of State and Territorial Health Officials and hired Stephen Martin with EKI-Digital Consulting to evaluate the public health division, she said. So far, it has spent about $75,000 on the consultant contract and could spend up to $125,000 by June 30, 2021, she said.
The state epidemiologist position has been vacant since Sept. 8.
'Strange to reorganize'
Omaha Sen. Sara Howard, chairwoman of the Legislature's Health and Human Services Committee, which helps provide oversight of the state department, said it was "strange to reorganize our public health agency in the middle of a pandemic. And it's even more strange to remove most of the direct reports from the chief medical officer, who is meant to be in charge of that agency."
It's also "curious," she said, that the department would change the role of the state epidemiologist during a pandemic.
"It appears they have taken him out of the data management and out of the direction of the disease in the state, which is truly his role and his expertise," she said. "This is not the time for the state to not have an epidemiologist."
The epidemiologist would be the person to help with the logistics of laboratories and coordinate with public health departments when it's time for vaccine distribution, she said.
The organizational chart for the public health division shows 17 positions in what is called Phase 1. Those include new and unfilled jobs of public health director of operations, epidemiologist, lead public health attorney and operational division support.
Most of the epidemiology team would be under the new director of operations, who will serve under Smith.
Anthone, who also serves under Smith, is a surgeon by profession and has no apparent public health or organizational policy experience. He was appointed to his position about a year ago. As it happens, he is a close neighbor to the governor in their Omaha neighborhood.
Anthone said in a recent publication of the Nebraska Hospital Association that his biggest surprise was how much he needed to learn about a public health system and how it operates.
New organizational structure
Smith and Anthone in August sent a memorandum to "community stakeholders" saying the public health division had "played a significant role in the state’s response" to the pandemic.
COVID-19 also gave it an opportunity to review the system and implement changes to the organizational structure, they said.
In his new role, Safranek will keep Smith's office current on developing infectious disease processes or outbreaks in Nebraska, the U.S. and globally, according to the memo. He will maintain relationships with local public health departments, the University of Nebraska Medical Center, regional task forces, the Centers for Disease Control, local and state laboratories and the State Board of Health. And he will "continue to function as a subject matter expert on epidemiological issues for Nebraska."
So what does that leave for a state epidemiologist?
According to the description, the person would coordinate epidemiology services and disease investigation, consult, plan for and monitor disease detection, and other prevention, control and policy matters.
Other positions on the new organizational chart include an incident commander, research liaison, laboratory and information services administrator, data strategist and informatics administrator, and an interim position to lead all surveillance and epidemiological work for the public health team.
With the reorganization, six people will form the Governor’s Public Health Team — Anthone, DHHS incident commander Angie Ling and other members of the epidemiology staff, but not the epidemiologist or Safranek.
Howard also questioned where the department is getting the money for the new positions and consultant.
"I have a lot of concern about them creating new positions in the middle of a pandemic, when they don't know what the fiscal forecast is for the state," she said.