By Michael Howell
The Ravalli County Commissioners, for the third time this month, have refused to accept Title X funding for the coming fiscal year, basically rejecting about $50,000 in federal funds to operate a clinic for mostly low income women out of the County Public Health Office. Title X money has been used locally and across the state for the last forty years to fund family planning clinics. Ravalli County is the first county ever in Montana to decline the funding.
Acceptance of the funding first failed to pass the Board of Commissioners’ approval on Thursday, September 6, when, in the absence of Commissioner Suzy Foss, the commission split in a 2 to 2 tie vote over accepting the money. Commissioners Greg Chilcott and J.R. Iman voted in favor of accepting the funds and Commissioners Jeff Burrows and Ron Stoltz voted against it. The two in favor noted the overall benefits of the multi tasked program that served many people in need of medical services but unable to afford it, compared to the smaller number of cases involving questionable practices such as counseling and treatment of minors without parental approval. The dissenters claimed to be weighing the benefits and costs as well, but coming up with a different answer. In their calculations the cost of the government coming between a child and a parent over the issue of contraceptives and abortion was too much to offset the good that the program accomplishes.
No one from the public attended this meeting despite the fact that it was properly noticed on the commissioners’ agenda. However, after failing to approve acceptance of the funds that day, it was agreed to continue the meeting to the next day when Commissioner Foss, who previously approved accepting funds for Title X, would be present and able to vote.
Foss did attend the next meeting and on Friday, September 7, the commissioners once again entertained accepting the funds. This time the meeting was attended by about six people, three of whom serve on the Republican Central Committee and two others who are Republican Precinct Captains. All spoke against accepting the funds. The motion to accept the funds was defeated on a 2 to 3 vote as Foss sided with Burrows and Stoltz. As a result, the county’s public health clinic that implements Title X funded programs was slated to close by September 30.
Ordinarily this might have ended the matter. But on September 16, the Ravalli County Board of Health considered the issue. That meeting was packed by a standing room only crowd, most of whom were advocating for accepting the funds and claiming they had been left out of the commissioners’ decision. The Board decided to hold a special meeting on the 19th to consider approving a request to the county commissioners that they reconsider their decision.
The agenda for the special meeting on the 19th, however, stated that it was to consider sending a letter to the county commissioners asking them to reconsider. That drew a series of comments from the standing room only crowd that had showed up a second time. Several members of the public noted that the original decision was to ask for a meeting with the commissioners and not simply send a letter.
After some discussion, Health Board member Kathleen Mauer made the motion for the Health Board to accept the Title X funding since the board’s by-laws state that the board has the authority to accept the funds and state law seems to allow it.
In the public discussion, former county attorney George Corn and local attorney Gail Goheen stated that they had contacted state attorneys from DPHHS and that the state believes that the Board of Health does have the authority to accept the funds, but that authority must be delegated by the Board of County Commissioners. They said that state attorneys were of the opinion that a signature of at least one county commissioner would be needed before the funds are released.
Commissioner Burrows, who sits as chairman of the Board of Health, noted that no single commissioner could sign on behalf of the commission without previous approval by the whole commission.
“It seems like, in either case, the final authority is in the hands of the County Commissioners,” said Burrows.
No one disagreed.
But by approving acceptance of the money, the Health Board was setting up a contradiction to the commissioners’ decision of record, which would have to be settled by an Attorney General’s Opinion or a Court, according to Deputy County Attorney Howard Recht, who was at the meeting.
In response to lengthy public comment in support of the program and the constant refrain that the commissioners had not yet heard from any of them because they were unaware of the previous meetings, Commissioner Burrows first said that he had talked with his fellow board members and that they were not interested in reconsidering their vote. In the end, however, after repeated requests, he agreed to put it on the commissioners’ agenda.
The Board of Health approved accepting the Title X funding on a 3 to 1 vote. Commissioner Burrows voted against it, saying that he could not support the program because he does not believe that the government should be involved in health care at all. He also objects to the counseling and treatment of minors without parental approval, and he does not believe the local government should go on accepting federal funds that have objectionable strings attached.
On September 20, the commissioners met for the third time to consider the issue of accepting Title X funding. The meeting was packed with every chair filled, people sitting on the floor, standing against the walls and spilling into the hallway.
The commissioners heard much the same testimony that the Board of Health had heard, except that several more people spoke against accepting the funds than did at the previous meetings.
At the beginning of the meeting Deputy County Attorney Howard Recht made it clear that the Board of Health, although it did have the power to accept the funds, could not do so without commissioner approval and the delegation of that power.
Out of roughly 75 people to speak at the meeting, public testimony was 5 to 2 in favor of accepting the funds.
Those in favor of accepting the funds spoke about the tax money saved through prevention, the lives saved through cancer screening, testing for sexually transmitted diseases, and other aspects of the program.
The public testimony was replete with heart rending stories about personal experiences in which the local family planning clinic played a crucial role in people’s lives when they were in a position of not being able to afford any other care. They urged the commissioners not to cut out that help just because of an issue that actually affects only a few.
“You are not the moral compass of our valley, that is not your job description,” Mary Morris told the commissioners.
Public Health Officer Carol Calderwood said, “Title X is a cost effective bi-partisan program that has stood the test of time.” She said it had both direct and indirect benefits and decreased needs for more expensive services later, perhaps at the emergency room.
“As a doctor on the ground in this community I know that asymptomatic STDs, such as chlamydia, will increase by several hundred, STDs will go unchecked.” She said that in the county as a whole the leading cause of drop-out for young girls was unintended pregnancy.
“As a public health officer, a citizen, and a mother, I know if we discontinue these services it will be a tragedy for our county,” said Calderwood.
Former County Attorney George Corn said that federal tax dollars were already allocated for this and that for 60% of women using Title X programs it is their only source for those services. He said the commissioners want to cut a lot of people out based on some principle that affects only a few.
“Do we want to throw these people out because of a principle? There are other principles involved here. Helping those who cannot help themselves cuts through all religions,” he said.
Corn also stated that the county gets many grants with strings attached and yet they chose to cut out the grant that involves women. He called it an act of discrimination.
Concerning the question of parental approval, Russ Lawrence referred to the 1977 Supreme Court case that clarified the constitutional rights of minors to medical help without consent. He said the commissioners were promoting their personal visions over a child’s constitutional rights.
Bruce Weide said that he did not want to see Title X funds cut because it would lead to more sexually transmitted diseases, more unwanted pregnancies and more abortions. He told the commissioners the result of their actions would be the opposite of what they want to achieve.
Dr. William Peters said that there is no infrastructure to take care of the people who get Title X services. He said the ER is expensive and that taxpayers had already paid for the services in Title X. He said in his profession they are told, ‘you wear a white coat, not a black robe’.
“You’ve got to leave your judgment at the door and do what’s right for your patient,” he said. He told the commissioners they should be wearing the same hat since they have to take care of people in this county that need help. “If you can’t leave behind a few things that you are uncomfortable with, you should not be sitting in that chair. And if you think we are going to go away and not fight for the rights of women and families in this county, well, don’t hold your breath because we won’t,” he said.
Many of those speaking against the acceptance of Title X funds mentioned the strings attached to the funding, primarily those that allow minors to receive counseling and treatment without parental approval. Others associated the program with abortion, although the county does not provide abortions or the abortion pill through its clinic. For many it was a moral issue. Others simply did not want their tax money spent on the program.
Tim Day said, “It would be interesting to talk to the children who have been aborted. I don’t see this as anything but the judgment of God. I would not want any tax funds going to support the murder of kids.”
Donna Gibney said it was a financial consideration and she did not want to see any of her tax money go to it. “Hospitals already provide help and financial aid. There is no need for government to reach in our pocket at this point,” she said.
John Gibney said that birth control pills were full of toxins. “If you look up these drugs that they want to hand out like candy, you’ll see how evil it is,” he said.
“Peanut” Fleenor said, “There are always strings attached and they are killing our children.” She said they are taking away parental rights and it is getting so that “you can’t adopt babies here anymore because of all the abortions.”
Stark Farley said that she was “against entitlements without personal responsibility.” She said that the program was being abused and that a “means test” should be given to those who receive the services.
Local legislator Nancy Ballance said that the county should create a local program without the federal strings.
Jim Farley said that he was “sick of federal strings and federal regulations.” He said the community could step up and take care of its own like they did when sports were defunded. He said we could put something together locally.
After taking public comment Commissioner Foss asked legal council if the question of discrimination was something they needed to consider.
Recht said he was unaware of any legal notion that declining Title X funding amounts to legal discrimination.
Asked by Public Health Officer Carol Calderwood to clarify the rights to privacy in medical treatment and what laws might be involved related to parental notification, Deputy County Attorney Recht said it was fairly complex. He said under the federal constitution one court case recognized the right of a minor to receive information independent of the parent.
“The Montana Constitution and law would support that and perhaps strengthen it,” said Recht. “But that’s a completely different question as to whether Title X, in the way it is administered, affects communication between parents and information that goes to the children. That’s really a different issue and it’s a completely different issue as to whether there is some sort of right to public funding. Just because someone has the right to receive information, doesn’t mean they have a right to receive it at public expense.”
Commissioner Greg Chilcott said that he’d received a lot of comments and letters saying that the commissioners voting against the funds were doing so based on their religious beliefs.
“I didn’t hear anything that crossed that line,” he said. “There was discussion about faith but there was no comment by anyone on this board upholding their religious beliefs as driving it. They talked about their faith. They talked about their concerns. I just want to make it clear that it seemed like a common thread running through comments attacking this body when there is no factual basis for it.”
Chilcott said Chairman Burrows “should be applauded for his efforts at making this a transparent and open process.” He said the decision depends on how each commissioner weighs the costs and benefits and it is different for everyone.
“But I have a hard time when a community decides they don’t like a decision by one or all the commission and attack it based on inaccurate information. I appreciate the way this body has addressed this issue openly and honestly and I hope you all will recognize that we really worked hard at that,” said Chilcott.
Commissioner J.R. Iman said, “There are people who feel strongly on both sides of this issue, people who have expressed things in their own lives that have made a difference to them. That’s really hard to hear, when someone steps up and tells of things that happened 20, 30 years ago. It is difficult for children to get help at times and we have services that help.”
Commissioner Suzy Foss said, “I’ve been accused of making this decision solely on my religion, which is so patently false. I’ve struggled with this for three years, as everyone knows, not because I don’t recognize all the wonderful things about Title X. I’ve gone forward voting for it because it was my clear understanding based on my information from my health department and from those who come forward, that there was nothing else available for women and that this was the best possible source of health care for them.
“I was a single mom raising four kids. I didn’t avail myself of things and worked hard, I know everyone can’t, but whether that was best in the long run or not I don’t know. I just did the best I could and I emphasize that my heart breaks. I’ve known abuse, I’ve known lots of things that have been shared here and we deal with what happens to us differently… I chose not to be a victim. I also chose to take personal responsibility on how I got out of that situation.”
Foss said that she also had concerns about grants with strings. “Not just Title X. We take a lot of grant dollars and that bothers me. I’ve been doing more and more research about it and there may be other things I’m not going to be comfortable accepting anymore,” said Foss.
She said the federal deficit was at $17 trillion and, “if we only take what the interest is and add the unfunded mandate it’s $1.2 million per individual taxpayer right now. When we are dependent as a community on federal and even state government for our essential services, that really concerns me,” Foss said. “And as a Christian and as a citizen I felt compelled to work within my community to try to find solutions.”
Foss said the community needed to step up and take on the project of meeting this $50,000 shortfall in health funding.
“We have a $10 million bond to buy open space when we live in the middle of the largest wilderness in the United States,” she said.
“We can raise money for the NRA, the Rocky Mountain Elk Foundation. We do a lot to raise money for medical situations. We have all the ‘Runs’ for cancer research and all these things because we are a caring community and we embrace all of our interests,” said Foss. She said she recently attended a meeting that included doctors, attorneys, and people in education and other professionals, all trying to help figure out an answer.
“To say that there are no services available, period, for these women is patently not true,” said Foss. “That’s the part I really needed to understand.” She said doctors who work at Marcus Daly Memorial Hospital told her that there are 10 clinics in the valley.
“The main thing driving me on this,” said Foss, “is that the financing is available. At the hospital they work with you and see what might apply to you, and if you don’t, they will take you anyway. And if they don’t we ought to be getting on their case about it, because it’s not right. Our community hospital is here to serve our community, all of our community, and that’s what they should serve.”
Foss said her big concern was that doctors had come to her who are not satisfied with the health care being provided to those who have limited or no means to pay.
“When you go to a nurse practitioner or a physicians assistant,” she said, “you are not getting connected to a primary health care provider who will follow you through and develop and give to you a complete picture of your physical health. This is a hole in how the system works. I’m struggling with how to provide for the health care needs of our citizens. Our community needs better and this conversation is a wonderful start.”
“A lot of things we heard today were historical,” said Foss. “They are painful for people, but we have moved forward and there are protections in place for our youth.”
Foss said that the 1% that benefit from Title X funding are still an essential part of the population and that the commissioners were trying hard to bring economic development to the county. She said the county has suffered from poverty for a long time.
“So we are not saying we don’t care,” said Foss. “We care passionately. But I want to make sure that the decisions I make are moving us in a direction that will provide the best possible health care for all our citizens, that will bring the economic vitality of our community up and get us more reliant upon ourselves and less reliant on both state and federal government which are all in a mess.
“To depend on our federal government to do things we need to do as a community is not going to work. We are going broke and we’re putting it on the backs of all of us again. You say your taxes pay for this, true. But you’ve got a debt rising every minute. To say I don’t care for everybody, I’m sorry, but I have a lot of things I look at.
“I want a better community, not one that is staying stagnant,” said Foss. She said Title X has been running for forty years and called it “a stagnant program.”
“It was designed to be a short term fix and it’s just become one more entitlement program. That isn’t fixing a problem, it’s just continuing it,” said Foss.
Commissioner Ron Stoltz said, “I do a lot of investigating. I look into a lot of things before I make a decision. And my decision is what I believe is the best for my community. Now we may agree to disagree on a lot of issues, but on this one, some of us will and some of us won’t. But I did read Title X more than once. So I will stand by my vote.”
Commission Chairman Jeff Burrows thanked everyone and said his decision is in no way a shot at the public health office. He said they give excellent service. He also complimented the public for being respectful despite all the emotion and tension.
“No matter what side you are on on this issue, we all want a better community. We want a better place for our kids,” said Burrows. He said he took a little heat for even scheduling the meeting but he felt it was necessary because the decision was made at a poorly attended meeting.
Burrows said that he had not read all of Title X but had gotten legal opinions and read enough to see that it contained some strings that he found unacceptable.
“I don’t make this decision lightly,” he said. “I was applauded for sitting up here and taking a few shots, but the stories I heard today, I could never get up and say those things at a public meeting. My heart sank. It’s heart wrenching to hear. So, I thank those ladies.”
Moving on with business then, Burrows said that, according to the commission’s by-laws, a vote to re-open a previous vote has to begin with a motion to reconsider from a commissioner on the majority side of the original vote. Burrows said in this case it would have to be Stoltz, Foss or himself to make the motion.
Failing to get a motion, Burrows gaveled the meeting closed. Without a motion the original rejection of the funding stands and no money will be accepted by either the Board of Health or the County, he said.
The county’s family planning clinic is set to close on September 30.