On behalf of the Montana Department of Public Health and Human Services, I wish to sincerely thank the federal government for the assistance which they have provided to our department on numerous occasions over the years.
As you might suspect, health care resources in this state are rather limited. Public health workers with the highly-specialized training and expertise needed in Libby are not available in this state. Thus, in these situations it becomes necessary for our department to appeal for help from federal health authorities in order for our residents to be properly served.
Our department has enjoyed a long history of good working relationships in Montana with federal health experts from the Agency for Toxic Substances and Disease Registry (ATSDR). Examples include health effect studies of environmental contamination in Livingston, Phillipsburg, Billings, Bozeman and communities along the Clark-Fork River Operable Unit, our nation's largest superfund site complex. Most recently, ATSDR workers provided invaluable assistance to local and state health workers in response to the train derailment and subsequent chlorine spill near Alberton.
The responsiveness of ATSDR to public health needs in Montana continues to this day, as evidenced by the strong showing of federal health workers on-site in Libby. We are most appreciative for assistance in providing the residents of Libby with the care they expect and deserve.
Our department is currently involved in response activities in Libby in several different ways.
First, the State Medical Officer and the State Epidemiologist have been working closely together with local health officials to assist them in decisionmaking when requested.
Since the public health system in Montana is set up by statute such that local/county health agencies have primacy over health matters in their jurisdiction, the Lincoln County Health Department ultimately has the final decisionmaking authority with respect to public health actions in Libby. State and federal health officials are careful to respect this right of the counties. Just as federal health authorities are here at the request of the state, so state health workers are here at the request of the county.
It has been our experience that county health departments appreciate DPHHS's assistance in decisionmaking, especially when dealing with large federal agencies such as EPA and ATSDR. County health departments are quite understandably nervous about becoming "out on a limb alone" by making decisions in isolation. They recognize the state's experience working with these agencies, and they value our input because of insight obtained from past situations in Montana. We are working closely with the Lincoln County Health Department to help ensure that the decisions made are logical, scientifically defensible, and cost effective.
Close cooperation between state and county health agencies is the norm in Montana. DPHHS has worked hard over the years to successfully establish good, collegial working relations with all of our county health departments, including Lincoln County.
Secondly, the Montana Department of Public Health & Human Services is working closely together with health officials from EPA and ATSDR to assist them in accomplishing their mission in Montana.
Since public health infrastructures and resources vary considerably among states in the nation, federal health workers rely upon state health workers to help them transition to work in the locale. State health department workers are helping to facilitate their work here in every manner possible. We stand firmly united with EPA and ATSDR in efforts to protect the health of the public in Libby.
Thirdly, DPHHS has engaged all personnel and resources within the agency that are able to bear on the situation in Libby. Workers in the department's Bureau of Vital Statistics have provided death certificate data for analysis by state and federal epidemiologists. Similarly, workers with the Montana Central Tumor Registry have supplied cancer incidence data on Libby area residents, and on residents in other areas of the state for comparison purposes.
In an unprecedented action, departmental administrators accessed medicaid claim databases for medical utilization review of current and former residents of Libby that have received medicaid benefits. This action was undertaken in effort to help the federal health workers in their assessment of the current state of the health of the public in Libby.
Lastly, DPHHS has created new partnerships and strengthened old partnerships with other state agencies in response to the incident in Libby.
Health professionals with DPHHS are currently 'on call' to meet with the DEQ incident managers as developments unfold. Face-to-face meetings of workers in DPHHS and DEQ are occurring on a frequent basis to help ensure that state response actions are coordinated and comprehensive.
The Montana Department of Public Health and Human Services is also collaborating with the Montana Office of Rural Health in Bozeman to evaluate and redress unmet needs regarding health care delivery in Libby.
The Montana Office is part of a national network of 50 state offices funded through the Federal Office of Rural Health Policy, under the Health Resources and Services Administration (HRSA). The office in Bozeman serves as the state single point of contact for the Federal Office of Rural Health Policy and HRSA.
The Montana Office of Rural Health and DPHHS gratefully acknowledge the efforts of Senator Baucus in getting the "Medicare Rural Hospital Flexibility Program", Section 4201 of the Balanced Budget Act of 1997 (PL 105-33), through the U.S. Congress.
In Libby, the Montana Office of Rural Health has been working with the County Health Officer, the Administrator of St. John's Lutheran Hospital, and with DPHHS in attempts to secure funding for two very critical unmet needs:
1). a clinical coordinator, locally-hired, to work out of the hospital to assist the County Health Officer with medical screening and follow-up of patients in Libby
2). telemedicine capabilities for the hospital to allow for teleradiology, pulmonary function telemetry and consulting on patient evaluations and follow-up care.
In closing, the Montana Department of Public Health and Human Services is committed to working closely together with local, state and federal colleagues to ensure that the public health response to the situation is Libby is the best available anywhere.
Thank you Senator Baucus for the opportunity to present this testimony.