MY TURN: North Idaho deserves answers on the Panhandle Health District crisis

“When public health does its job, it’s invisible.” That’s how Larry Belmont, Panhandle Health District’s first and longtime director, described the work. Its greatest successes are often the ones nobody notices. As a virologist on staff during the COVID-19 pandemic, I saw firsthand how much our community relied on the people working behind the scenes to respond to outbreaks and kept us safe.

So, when I learned that the District Director Erik Ketner, a North Idaho native and 25-year veteran of the health district, along with other members of the executive leadership team and as many as eight additional employees, had abruptly resigned, I knew this could not simply be chalked up to ordinary turnover.

Panhandle Health District’s work goes far beyond vaccines and mask mandates. It protects people across Kootenai, Bonner, Boundary, Shoshone and Benewah counties. While we may not think twice about the Panhandle Health District when we are enjoying a burger at a restaurant, turning on the tap, or sending our kids off to school, we trust that someone is watching to make sure the food on our plate is safe, the water we drink is clean, or the “thing” that is going around at school is being tracked and contained before it reaches our families. Area healthcare providers often seek the district’s expertise on infectious diseases, while residents turn to them for guidance on potential rabies exposure, batproofing their homes, safeguarding their private wells and more.

That makes what happened at the board’s Sept. 3 special meeting especially concerning.

After a two-hour executive session, the board appointed one of its own members, Dr. Thomas Fletcher, as interim director. I understand emergency leadership may sometimes be necessary. But when a sitting board member becomes the administrator he is supposed to oversee, it blurs the line between governance and administration and leaves the public with questions unanswered:

What precipitated the resignations? Why was a sitting board member chosen? Why did Dr. Fletcher not recuse himself from a vote on his own appointment? Why wasn’t his salary independently determined? How will the board provide meaningful oversight when one of its members is now running the agency? Why is there a two-month lag in meeting minutes?

Public health is more than medicine. It is the science and infrastructure that protects communities before someone becomes a patient. What public health qualifications and selection criteria did the board consider?

Three of the district’s five counties were also not represented in the final vote. What does that mean for regional representation and public confidence in a decision affecting the entire district?

With three senior leaders gone, Panhandle Health District has lost experience, relationships and institutional knowledge that cannot be replaced overnight. Combined with concerns about governance and the board’s willingness to legitimize vaccine misinformation, I have serious reservations about it’s capacity to deliver the district’s public health mission.

Over the past five years, health boards like ours have pushed legislation to restructure how Idaho’s public health districts are governed. HB 316 shifted primary responsibility for district personnel and funding to local boards. SB 1031 further restricted public health district authority. Following the governance changes under HB 316, Central District Health in Ada County, which is the most populous health district in Idaho, experienced a significant loss of employees amid reported “worse than toxic” workplace concerns in 2023. The turmoil there should have been an early warning of what can happen when local public health governance loses institutional oversight. Now, this is playing out again in our own district.

If Idaho is going to rely on local boards to govern public health, we the people need meaningful visibility into how those boards operate, how decisions are made and who is accountable when things go wrong.

Public health is critical infrastructure. It is the people, relationships, expertise and institutional knowledge that allow communities to prevent disease, respond to emergencies, protect the environment and keep people healthy. Our health districts cannot be expected to function through volunteerism, temporary leadership or the outsourcing of core functions simply because it costs less. Nor should communities accept the loss of professional expertise as the inevitable price of “local control.”

The choice before us now is not whether we can afford a strong public health system; it is whether we can afford the repercussions of neglecting it.

So, here is what I’d ask you:

Show up. Attend the Healthcare in Kootenai County Town Hall on Tuesday, September 29, at 6 p.m., and make it clear that North Idaho deserves a thriving public health system that serves everyone.

Share your stories. Tell others how Panhandle Health District has helped you and what could be lost. Write a letter to the editor or come in-person to share your story at our community SOS for Health storytelling event [date and location TBA].

Call your county commissioners. They now have a direct role in appointing Panhandle Health District board members. Ask what they know about the leadership departures, what qualifications they expect from district leadership, and how they will ensure transparency and accountability.

Track the legislation. Ask your state legislators and candidates where they stand on restoring meaningful state oversight and strengthening the independence and professional capacity of Idaho’s public-health districts.

Get organized. Join Defend Public Health at defendpublichealth.org. Read, share and endorse its People’s Health Platform, which envisions public health as essential infrastructure: professionally staffed, adequately resourced, transparent, accountable and focused on prevention and the health of entire communities.

North Idaho’s public health belongs to all of us. Its mission is too important to be left to quiet transitions behind closed doors.

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Dr. Karen Bloem, Ph.D. is the State Team Lead for Defend Public Health Idaho