Nevada County: big challenges for new county health chief
Sun News Service
GRASS VALLEY, Calif. and#8212; Dr. Karen Milman is less than two months into her new position as Nevada County’s Public Health Officer and already has weathered a storm of controversy over budget cuts that forced the elimination of a popular teen clinic.
But Milman is forging ahead, working to create viable collaborations with other county providers to eliminate gaps in coverage and safeguard other programs that are in limbo.
The closure of the teen clinic and#8212; a decision that was made before Milman came on board and#8212; is a good example of how the county is working to ameliorate its budgetary constraints, she said.
and#8220;We’re unable to provide those services, but other providers came forward to say they would help,and#8221; she said. and#8220;It’s not the same, we know that … But the effort by the community and other providers is really quite remarkable. They’re continuing to improve that access; in June, Miners (Family Health Center) opened extra hours just for teens. We walked them through how we did things and had several transition meetings. It’s a great collaborative. They really put in a lot of time and effort.and#8221;
Milman gives a huge amount of credit to county staff as well.
and#8220;The people who work here are very dedicated and want to do what’s best for the community,and#8221; she said.
Milman received her medical degree from the University of Maryland School of Medicine and her Master’s in Public Health from the Johns Hopkins University Bloomberg School of Medicine. She completed residencies in both emergency and preventive medicine and received a certificate in health care finance and management.
Although she has spent much of her career in Maryland, Milman is a California native.
and#8220;It’s always been a goal of mine to get back here,and#8221; she said.
And it always was her goal to work in the public sector, she said.
and#8220;That’s where you can make a difference,and#8221; she said.
Milman is board-certified in both preventive medicine and public health, which she said teaches you to look at the whole community and their health needs.
and#8220;This is a really interesting community,and#8221; she said. and#8220;When you start getting into it, it’s a very diverse community. There are a lot of different points of view and you have to try to put it all together.
and#8220;I think that’s the fun part,and#8221; she continued. and#8220;There are so many different personal beliefs here. How do you balance those with the public need?and#8221;
Perhaps because of the popularity of alternative medicine, immunizations remain a problem in the county, Milman said.
and#8220;Immunizations are for both the individual and the public good,and#8221; Milman said.
and#8220;Explaining the concept of herd immunity to people is not easy. The national goal is 90 percent to 95 percent and we’re not anywhere near that. Some counties won’t let kids go to school if they’re not immunized, but we don’t do that. That’s the challenge. I have to respect other beliefs, but still protect everyone,and#8221; she said.
The other big challenge, she said, is the state budget crisis.
and#8220;We know some programs will be fine,and#8221; she said.
But others and#8212; such as HIV testing and prevention and#8212; are almost entirely state- and federally funded. Maternal, child and adolescent health education programs also are in limbo, she said.
Milman has inherited a position with a fair amount of baggage and#8212; and turnover.
Dr. Joseph Iser, a physician who spent 24 years with the United States Public Health Service, resigned in January after two years to accept a similar position in Yolo County.
Dr. Brent Packer stormed out of office in May 2006, blasting county hierarchy for allegedly badgering him and undermining his authority. CEO Rick Haffey said Packer had problems following directions.
Dr. Kent Cutler left on good terms in 2004 after one year to spend more time with his family.
Milman is undaunted, saying with a laugh, and#8220;I hope to be the first to change the turnover.
and#8220;It’s a very tough job,and#8221; she continued. and#8220;It does require balancing what you want and what the community needs with what resources are available and what there is political willpower for and#8212; both from the supervisors and the community. I specifically chose this specialty, so I may be accustomed to and willing to work with that aspect of the job. I’m not going in with my eyes closed.and#8221;
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With the support of local residents and community leaders, the Nevada County Relief Fund raised $287,500 in the last four weeks, which will be awarded to 73 small businesses countywide, according to a press release.