OTTAWA COUNTY — In less than two months, the new Ottawa Impact-led Ottawa County Board of Commissioners has radically changed how local government works, with most of its scrutiny aimed at health services — sending shockwaves throughout the health community.
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From making allegations the health department “sexualizes” college students to refusing to approve federal grant-funded mental health positions to micromanaging the sitting health officer — which led to a recent lawsuit — commissioners have local health officials worried a lack of understanding and acceptance of marginalized communities will result in widening health disparities.
“They’re imposing their viewpoints on us as employees, who are mandated to provide services to our community,” said one county health employee, who spoke to The Sentinel under condition of anonymity. “Our clients and our community providers are going to be very affected.”
How did we get here?
Ottawa Impact is an upstart far-right political group borne from clashes over the county’s COVID-19 mitigation mandates in 2020. Its founders, Joe Moss and Sylvia Rhodea, were unsuccessful in suing the previous board of commissioners and the county’s former health officer, Lisa Stefanovsky.
In response, they targeted seats on the board in 2022, recruiting like-minded candidates who agreed “traditional Republicans” weren’t enforcing true conservative policies.
They successfully defeated eight incumbent Republicans in the August primary and now hold a majority on the 11-member board.
When the board was sworn in Jan. 3, the new commissioners — most with little or no previous governing experience — began testing every aspect of their authority.
They made sudden, sweeping changes, firing county administrator John Shay and replacing him with unsuccessful GOP congressional candidate John Gibbs; eliminating the county’s Diversity, Equity and Inclusion Office; replacing the county’s corporate counsel to a firm with personal ties to board chair Joe Moss; and changing the county’s vision statement.
In the same meeting, OI commissioners also attempted to replace current health officer Adeline Hambley — an internal candidate with 18 years of experience in the department, hired and approved by the state in December — with Nathaniel Kelly, a local with no public health experience who currently works as a safety manager at a Grand Rapids-area HVAC company.
Commissioners voted to make Hambley the “interim” health officer, instead.
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In the following weeks, the county failed to send Kelly’s credentials to the state for approval, and commissioners continued to rebuke Hambley — demanding she identify the person responsible for placing links to third-party pro-choice websites on the Ottawa County Department of Public Health sexual health page (the links were removed nearly a year ago) and erroneously accusing her of “sponsoring” Grand Valley State University’s Sex Ed Week and “promoting radicalized sexual content.”
On Friday, Feb. 10, Hambley sued in Ottawa County’s 20th Circuit Court, naming seven of the eight Ottawa Impact commissioners as defendants, claiming they’re illegally interfering with her job by micromanaging, attempting to demote her and demanding to have input on how the department runs and behaves.
Hambley said the OI defendants are attempting to “manufacture alleged cause to criticize (her) performance of her duties and/or to manufacture political controversy,” allowing them to more easily remove her and promote their preferred candidate.
Grant-funded mental health positions delayed
Meanwhile, a county board subcommittee refused to approve federally funded positions for the county’s Community Mental Health organization — positions that remain in limbo even now.
During a finance and administration subcommittee meeting Feb. 7, the some commissioners voted to delay approving eight grant-funded positions for CMH. The proposed positions would be funded through grants from Certified Community Behavioral Health Clinics (six) and Medicaid (two).
Positions requested include an autism supports coordinator, wrap-around coordinator, community health worker, substance abuse services program supervisor, customer service aide and supports coordinator aide, as well as positions to support the organization’s senior reach program and multidisciplinary team in Grand Haven.
The total cost of the eight positions would be half a million dollars ($572,307.20) — wholly covered by federal funds. Lynn Doyle, director of Ottawa County CMH, said the organization has entered its second year of a three-year CCBHC grant. If funds aren’t spent, they’ll be returned to the granting agency.
Commissioners, primarily committee chair Gretchen Cosby — a former nurse — asked several questions of Doyle before ultimately delaying a vote. She asked if commissioners typically considered approval for multiple positions at once. Doyle acknowledged the request was unusual, but said it was a matter of moving through the grant process.
“Often, the first year of a grant, we’re sort of working out the bugs and deciding where staff should be, what programming you’re going to continue,” she said earlier this month. “This is a reflection of that second year of CCBHC and making some adjustments (to) where we’re putting staff and how we’re using them.”
Doyle said the positions would be used to alleviate current caseload pressure. She said caseloads are around 50, while industry standard would be “closer to 35 or 40.”
Moss, also on the committee, asked Doyle to speak to trends in requests for services. Doyle said CMH has seen “a steady increase” in both requests and acuity — the amount of support an individual needs.
Doyle said much of the increase stems from the pandemic “and all those issues we went through: heightened stress, isolation.”
Moss asked if that trend might begin to subside, saying it “seems to be related to the government response to the pandemic” — something Doyle didn’t confirm.
“I think stability and predictability often is helpful to people in managing their stress,” Doyle said. “I sure hope, as we’re coming out of the pandemic and those affiliated issues, that we’ll be at a place where we’ll be less stressed out.”
Cosby voiced concerns that using Medicaid dollars for a substance use program supervisor would take financial resources away from other Medicaid uses, such as individuals with intellectual and developmental disabilities.
“I just want to make sure that we’re not taking resources away, financial resources, to fund positions if we have people in our community that are vulnerable and need those,” Cosby said.
Doyle said this wouldn’t be the case, as Medicaid funds come to the county pre-allocated in certain categories, or buckets. Funds for the substance use program supervisor would come from the substance use disorder — SUD — bucket.
“I am going to have to express that I will be voting no on this particular item due to the number of positions and the cost,” Cosby said.
Sylvia Rhodea, also on the subcommittee, asked if the CCBHC grant could be used toward “self-determination” services. Doyle said it can’t.
“CCBHC is a federal grant that’s intended for individuals with severe mental illness and children with emotional disturbances. It does not include, at the moment, federally, individuals with intellectual and developmental disabilities,” Doyle said.
What’s at stake?
Public health officials have expressed deep concerns about OI officials’ unfamiliarity and disdain with the traditional operating structure of local governance, and the lack of trust, refusing to follow recommendations by county staff.
When it comes to sexual health, the OCDPH currently receives federal Title X funding (as a sub-recipient of the Michigan Department of Health and Human Services) to provide services related to contraception and family planning.
Norm Hess, executive director of the Michigan Association for Local Public Health, or MALPH, previously told The Sentinel the county’s three sites — Holland, Hudsonville and Grand Haven — must provide a broad range of medically approved family planning services, including all FDA-approved contraceptive products and natural family planning methods.
“I am not sure what would be the ramifications of the commission deciding to suspend these services without going through proper channels to end their contract with the state,” Hess said.
On the mental health front, lives are affected daily, and health officials say county commissioners should feel a sense of urgency.
“The committee should be leaping at the opportunity to leverage grant funds, Medicaid funds, for these very purposes — and it really doesn’t matter if it’s pandemic-driven or not,” said Mark Witte, executive director for Allegan County Community Mental Health.
Witte said Moss’ assertion of why anxiety spiked during the pandemic is misguided.
“The pandemic exposed needs more than increased needs,” he said. “Certainly there was some increase, but it more so exposed the needs that weren’t well recognized prior to now. We really didn’t see people coming to our door saying, ‘Masks have traumatized us.’ If parents don’t freak out, kids won’t freak out — they tend to follow parent leads.
“The fact that we’re talking about it is wonderful, but let’s not get too wrapped up in how that came to be. I think it’s more student mental-health driven. I think it’s much more about people being willing to talk about it — and stress on families.”
Public health workers can attest to that stress.
“People are overworked. Our acuity is higher than it’s ever been,” said the anonymous Ottawa County employee.
They said the mental health positions currently in limbo are critical.
“It’s not taking away services. It’s increasing services for our community providers. If clients don’t get services, they take up far more community services, like courts, jail, police, ERs. They take up a tremendous amount of time. People are just extremely overworked.”
Dr. Matt Hilton, a primary care doctor at Holland Hospital, is one of the frontline workers who sees mental health cases in real time.
“As a family medicine doctor, when we’re in the primary care setting, we’re on the first line of people who need help,” he said. “The estimate is approximately one-third of our visits deal with mental health in some capacity — and a lot of primary care docs would probably look at that and say that’s an underestimate.”
Hilton has concerns Ottawa Impact officials don’t fully understand community needs.
“Anybody in primary care or healthcare in general — unless you live under a rock or have your head buried in the sand — knows that this affects everybody: rich, poor, regardless of color, gender or anything else — it affects everybody. Anyone can be vulnerable to this,” he said.
Mental health issues and illnesses were increasing before COVID-19, the county employee said — the pandemic merely exacerbated that need.
In 2019, approximately 1 in 10 adults in the U.S. reported symptoms of anxiety and/or depressive disorder, according to the Centers for Disease Control. After the COVID-19 pandemic, that jumped to 3 in 10 adults since May 2020.
Doyle told the health and human services committee on Feb. 21 that mental health services in Ottawa County have increased 11 percent since 2018, “and I expect those numbers will continue to increase over the next couple of years.
Hilton said government officials have an obligation to serve all citizens.
“When we have someone sitting in front of us — face to face — who needs help and they can’t get help because of whatever their challenge is — their insurance isn’t good enough, they have Medicaid, they don’t have insurance, they can’t afford the co-pays to get to a therapist or whatever — that is heartbreaking to us,” he said.
He said the vulnerable populations, in particular, need this care.
“If you care about kids, you care about health … or the homeless, the jobless. All those people get hit by this, the access issue, more than other people,” Hilton said. “The prospect of having more employees to take care of this stuff and give more time to the people who need it, that’s awesome. And I guarantee you that every primary care doc in this county would say, ‘Yeah, there’s a need for that.'”
As for Rhodea and Moss pushing “self-determined” care?
“This is something that needs to be as easy to access as possible,” Hilton said. “Complicated systems are what further prevent people from getting help (and) leading healthy and productive lives. We can’t make this harder for people that already are having a hard time doing things for themselves.
“Ottawa County is a beautiful, wonderful place and even though it’s rated as one of the best places to live, we’re not immune to mental health issues,” he said. “And anyone who doesn’t get that is ignorant to the realities of the world.”
Helping those who need it
Over in Ingham County, outgoing health officer Linda Vail said public health workers have a duty and obligation to help the community — especially vulnerable populations.
“My job as a public health officer is to be where these people have barriers to access. Because, otherwise, we have this lopsided health and health outcomes in the United States,” said Vail, who retired Feb. 17 after 16 years in her role. “Morbidity and mortality across the board — we have an overburden of disease, overburden of death from disease in our African-American population, in our Latino population, and that’s not because of genetics.”
Ottawa Impact doesn’t endorse diversity, equity, and inclusion programming or implicit bias training, arguing the concept is divisive. But according to Vail, the concept of public health is rooted in care for all.
“They were all parts of movements of public health to create safe and healthy workplaces for people who were just being used — and how it affected their health and well-being,” Vail said. “It was public health that advocated for these things way back in the 1900s. That is really the very roots for public health — to advocate for people who tend to not have a voice.”
Those roots led to progress in the decades to come, narrowing the gap of health outcomes between white people and people of color.
“The work of public health — one of the big pieces — is to narrow that gap and to ensure we provide adequate resources across the board. Not based on who has the most ability to pay for something. We are basically serving the public, protecting the public — and that means everybody — and protecting people’s lives. It’s going to be a sad day if public health gets taken over by people who have no concept of the roots of public health.”
Witte has similar concerns.
“Sixty years ago, there was no mental health system,” he said. “There were state hospitals and institutions where people with mental illnesses and developmental and intellectual disabilities lived their entire lives — and people died there. They were uprooted from their communities, separated from their families and friends.”
Witte said all communities need to ensure they don’t regress to outdated strategies.
“This is what this (current) system is built around and it’s clawing to move forward,” he said. “Now it’s more people being served — more people who have the right to those services.”
In part, that means assessing the needs of the community — another piece of the puzzle Ottawa Impact commissioners have delayed.
Hambley told the health and human services committee Feb. 21 that questions on a Community Health Needs Assessment related to sexual orientation and gender identity — which she believed to be sources of concern for commissioners — are necessary for hospitals to understand healthcare needs and health disparities for those populations.
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“It’s a requirement for hospitals that this process continues to move forward, and it will do so with or without us at the table,” she said. “However, we will be in breach of contract that I believe will do damage to the credibility of Ottawa County moving forward by failing to pass and continuing this on. That needs to be approved and done.”
Commissioners didn’t comment or ask any follow-up questions.
Witte said assessments are critical to understanding all types of health, with mental health at the forefront.
“We don’t want people spending years being depressed because we never checked that they were,” he told The Sentinel. “We want to have screening. We’ll give families the option to opt out, but most people won’t, because it’s about their health.
“It’s not like the government is going to tell you what to do — it’s not a requirement. It’s just another avenue of opportunity for people who are concerned about making sure everyone is as healthy as possible.”
Why the disconnect?
“It makes us feel like we’re not valued. Staff are tired. Morale is very low — and it’s usually not this low.”
That’s how the anonymous Ottawa County employee characterized how other employees are dealing with Ottawa Impact’s interference with what was previously standard operating procedure.
Ottawa Impact campaigned in 2022 as champions of freedom — going so far as to change the county motto from “Where You Belong” to “Where Freedom Rings.”
More:Ottawa Impact campaigned on transparency. In their first meeting, they blindsided the community.
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But who is freedom ringing for? The board continues to get hammered during public commenting periods on exclusionary tactics.
Kristen Kobes du Mez isn’t surprised.
A professional, historian and author at Calvin University, de Mez is also an expert on Christian nationalism and its ideology.
“This is really the conversation inside Christian spaces — this just utter disconnect,” du Mez said. “There are many people in churches and families saying, ‘Wait a minute, this is not what I thought our faith was directing us to do. This is not what we believed all along.’ There are parishioners staring at each other across the aisle, saying, ‘Who are you?'”
Hilton, the Holland Hospital doctor and a Christian, said he also takes issue with OI ideology and how it has translates into their decision-making.
“This Ottawa Impact groups touts itself as followers of Jesus and that’s a little bit offensive to me, because I am, too, and there’s no mistake about Jesus telling us that we need to take care of the poor and the hungry and the people who need help. This is completely contradictory to what these people apparently stand for,” Hilton said.
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Du Mez explained there are many contradictions in Christian nationalism — parental rights in particular.
“It’s been a rallying cry for conservatives,” she said. “It’s important to go back historically there and remember that some of the initial reasons behind ‘parental rights’ in modern conservatism were the rights of white parents to send their kids to segregated schools.”
Du Mez said the concept advocates the “rights” of some, while seemingly limiting the rights of others.
The parental rights argument has always been selective, she said. Now, the focus is on transgender people “threatening the innocence of children” and book banning in schools — and protecting the community from intrusive health questions.
“It’s the right of good, Christian parents to dictate what their kids are exposed to, but that right doesn’t seem to extend to those who they believe are promoting ideas that go against Christian America,” du Mez said. “That ultimately will harm their own children and harm our country, so even though they’ll speak in the language of rights … how they interpret that within a Christian nationalist framework is always Christian privilege.”
The anonymous county employee said the micromanaging of the board is already negatively affecting those they need to serve.
“We’re mandated to provide services to vulnerable people — people with Medicaid or no insurance. That is our role,” the employee said. “A lot of people don’t see people like this as worthy. They look at people with developmental disabilities as ‘they were born that way,’ but there also are people who are born with mental health disorders, or who have had terribly traumatic things happen to them. And many of them use substances as self-medication — and you can’t pray away substance abuse.”
Du Mez said much of Christian nationalism is based on the idea that God has designed rigid structures for humanity and those who are obedient will be rewarded.
“I find it interesting how relatively infrequently Jesus Christ is drawn upon in these conversations. There’s a lot of talk about what is right, what is God’s order for society. … It’s not one primarily motivated by following Christ — loving your neighbor as you would yourself.”
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She said churches play a large role in fostering the continuance of the “obedience” theory, pushing through unpopular policies by any means necessary to achieve a greater good.
“They’re convinced that what they’re doing is for everyone’s good — that if you disobey you won’t be blessed by God and you will only experience suffering,” du Mez said.
“So for outsiders, it seems like coercion — which it is — but for them, it seems like: ‘We know what’s best for you and we’re going to make sure — even if you don’t want it — we’re going to do ultimately what’s for your own good and the good of our country and the good of your children.’”
If nothing else, Vail hopes the situation forces citizens to recognize the gravity of local elections.
“I hope people are watching in Ottawa County, because I bet many of them are reading these stories and going, ‘What is happening right now?’ They need to understand the importance of county commissioners. It’s important to know your county commissioners, to know who they are, to know what they can do and can’t do.”
Vail said she hopes logic, reason and — most of all, science — will prevail.
“Ottawa County is known as a really, really good health department. Why would you throw all that away?”
— Reporter Mitchell Boatman contributed to this article. Sarah Leach is executive editor of The Holland Sentinel. Contact her at sarah.leach@hollandsentinel.com. Follow her on Twitter @SentinelLeach.