JAMES MADISON QUOTE - 1822

"A popular government without popular information, or the means of acquiring it, is but a Prologue to a Farce or a Tragedy; or, perhaps both. Knowledge will forever govern ignorance; and a people who mean to be their own governors must arm themselves with the power knowledge gives."

SCOTTSBORO WEATHER

Click for Scottsboro, Alabama Forecast

Tuesday, August 8, 2017

Jackson County Commission Work Session, August 7, 2017 More on Flat Rock Sewage Sludge - Historical Practice of Intentional Contamination of Water Supply

North entrance of the Jackson County Courthouse Scottsboro, Alabama - photo by G. Morgan

AGENDA
Click on image for an expanded view.
Note item 2 on the agenda - "Fertilizer" that is not what some citizens in Flat Rock call it, they say it smells like "crap." 

There has been a long history of sewage sludge and mining pollution on Sand Mountain. In 1995 time frame there was a massive fish kill in Coon Gulf, off the Tennessee River below Fabious in what citizens demonstrated via photos and documents, intentional violations of law involving the dumping of Sewage into mining pits by the City of Chattanooga in the mid 1990's time frame, under the not so watchful eyes of the Alabama Department of Environmental Management and apparently the TVA according to sources interviewed. More on this situation as documents are received.


Reference item 2 in agenda - States fertilizer spraying in Flat Rock, Alabama on fields. Representatives of Denali Water Solutions, contract holder to spray treated waste water sludge from the City of Chattanooga, Tn. Representatives of Denali Water solutions are contracted by the City of Chattanooga to apply biosolids application to fields

UPDATE - 8-9-17 Letter to Private Citizen Regarding the Application of Biosolids. The folks from Denali Water Solutions nor Lake Majestik Farms indicated they were not aware of this letter. The letter states the City of Chattanooga will not be applying biosolids on farm land owned by Lake Majestik Farms. In conversations and inquiry to representatives of Denali Water Solutions they indicated they were contracted by the City of Chattanooga for the application of biosolids to farmland in Jackson County.

Some farmers have purchased treated sewage sludge from the Chattanooga, Tn. wastewater facility at the Moccasin Bend sewage treatment facility. There have been several citizen complaints about this action from citizens. I have pertinent information regarding this "Biosolids" program, but I'm waiting for historical info and letters from the Mayor of Chattanooga regarding complaints related to the Biosolids program. When I receive the historical documents I will update this blog with the historical and new information.

Dumping of biosolids, sewage sludge had contaminated several wells on Sand Mountain in the mid 1990's. Article from the Huntsville Times in 2008. Over 60% of the wells in the Fabious area were contaminated due to sludge dumping from the City of Chattanooga into mining pits. Article from the Huntsville Times in 2008.

I am in possession of a Health Department document indication over 60% of the wells, of 137 total wells, are contaminated in the Fabious Community due to apparent illegal dumping of sewage waste from Chattanooga, Tn. I will not be posting the document within to protect the privacy, addresses, of contaminated well owners.


VIDEO

Tuesday, July 25, 2017

Scottsboro City Council Meeting, Regular Session July 24, 2017

Scottsboro City Hall, photo by G. Morgan

AGENDA
Council Member Patrick Stewart and City Attorney Steve Kennamer were absent.

VIDEO

Jackson County Commission Regular Session - County Schools, Commission and Sheriffs Agreement for Schools Resource Officer - July 24, 2017

Jackson County Courthouse, south entrance, photo by G. Morgan

AGENDA

Jackson County Schools Resource Officer Agreement between Jackson County Commission, County Schools and Sheriffs Department
(Click on image to expand view.)




VIDEO

Wednesday, July 19, 2017

Scottsboro City Council, Work Session July 17, 2017

Scottsboro City Hall, photo by G. Morgan

AGENDA
Mayors Report - 1) County has provided check to city for the business tax reimbursement. 2) Willow Basin Drainage program bid was rejected as it was $250K over budget. 3) One time Retirement pay raise for retired city employees. All items to be placed on Regular Session agenda.

VIDEO

Tuesday, July 18, 2017

Jackson County Commission Special Session and Work Session - July 17, 2017

Jackson County Courthouse, north entrance, photo by G. Morgan

AGENDA
Discussion regarding Camera and Fingerprint equipment out of date for Sheriff's Department, cost approximately $16,400.

Work Session Discussion
Spreading sewage waste - unknown source for photo, Fair Use for non-profit news reporting and commentary.

Are regulatory requirements being met?
 Work Session discussion over use of human sewage for crop fertilization. Bad smells reported, massive numbers of flies (disease vector problem), runoff witnessed in intermittent streams, sewage sludge-human waste reported on roadway all indicate EPA Regs regarding utilization of human septage and sewer sludge waste products may not be meeting EPA regulatory standards as described in these publications. - https://www.epa.gov/sites/production/files/2015-05/documents/land_application_of_sewage_sludge_december_1994.pdf  and https://www.epa.gov/sites/production/files/2015-05/documents/a_guide_to_the_federal_epa_rule_for_land_application_of_domestic_septage_to_non-public_contact_sites_september_1993.pdf

Chattanooga's sewage sent to Jackson County Alabama
Article from Chattanooga Times Free Press regarding sewage sludge/biosolids issue and amount of tonnage spread on Alabama and Tennessee Fields. "Scientists say many contaminants bioaccumulate -- become concentrated inside the bodies of living things -- and can travel up the food chain."

VIDEO

Monday, July 17, 2017

Economic Development Authority Board Selects Shelia Shepard as CEO/President - EDA NEWS RELEASE - July 17, 2017

Shelia Shepard Hired as President and CEO of Jackson County Economic Development Authority 

Scottsboro, Alabama
July 17, 2017

The Jackson County Economic Development Authority (JCEDA) Board announced today that Mrs. Shelia Shepard has been named President/CEO of the organization.  Mrs. Shepard has been serving as Interim President/CEO. (JCEDA Facebook photo, crop by G. Morgan, Fair Use for non-profit news reporting.)

"We are very pleased that Mrs. Shepard has accepted the Board's offer to officially become President/CEO of JCEDA," stated Board Chair Dr. David Campbell.  "She has done an excellent job as Interim and of course has years of experience working in economic development for Jackson County.  We are excited about our county's economic future with Mrs. Shepard leading the way."

The Board conducted a structured process in the selection process.  The job was posted nationally and was open for forty-five days for individuals to apply.  "When it was all said and done, Mrs. Shepard was the unanimous choice of the Board members," Campbell stated.  "With her experience, connections, and passion for Jackson County, she was the perfect choice. We look forward to many achievements in economic development under her leadership."

The Board of Directors, in addition to Campbell includes Tommy Harding, Rudder Williams, Bruce Purdy, Jim Green, Phillip Thompson, and A.J. Buckner.

Shelia
has an A.S. degree with Honors in Business from Northeast AL Community College, a B.S. degree with Honors in Business and Accounting from Athens State University,  the Basic Intensive Economic Development certification, the University of Oklahoma Economic Development Institute certification, TVA Rural Leadership Institute, Leadership Jackson County, as well as numerous training conferences offered through the Economic Development Association of Alabama, Tennessee Valley Authority and the North Alabama Industrial Development Association.

She has helped develop, co-host or serve on the steering committee for various workforce development programs such as, BEST Robotics, CEO Expo Career Fair, CHOICES Program, North Alabama Works Workforce Board, Tri-State Workforce Development Board, and the Impact Learning Center Board.  She also works closely with our existing industry to help offer programs such as Jackson County HR Professionals, Northeast AL Maintenance Managers, Quality Forums, Safety and Environmental Conference, and AIDT Leadership Skills

“I could not be more proud to be named President. CEO of the Jackson County EDA!” said Shepard.  “I have been with the EDA for almost 25 years and it is not just a job for me.  It is something that I truly love and care about.  Jackson County is my home.  I have family, children and grandchildren here and I want to do everything I can to help improve the economic future for them and all of Jackson County.” 
-----------------------------------------------
About Jackson County EDA:   Jackson County Economic Development Authority's mission is to attract new industries to Jackson County, Alabama and help existing industries expand and prosper to provide quality jobs for local citizens.
CONTACT:
shepard@scottsboro.org
Jackson County EDA @ 256-574-1331
www.jacksoncountyeda.org 
GOOD LUCK SHELIA - YOU HAVE EARNED THIS POSITION. Garry Morgan - "In-The-Boro"



Wednesday, July 12, 2017

Jackson County Health Care Authority, Part 2 - July 12, 2017 - Update (7-18-17) - 2015-2017 Financial Chart

This photo was found on JCHCA.ORG, Jackson County Health Care Authority, it was identified as a "coming soon site," the site was not developed. This image is utilized as Fair Use for non-profit news reporting and commentary. The Jackson County Health Care Authority, JCHCA, is a public entity and a separate corporate entity of the Government of Jackson County Alabama. The JCHCA Board of Directors are appointed by the Jackson County Commission. 

The Crisis - A health care facility CEO warns about the financial crisis and the decreasing of Medicaid funding for rural hospitals such as Highlands Medical Center.

Part 1 of this series, Jackson County Health Care Authority, may be found within at: http://arklite.blogspot.com/2017/06/jackson-county-health-care-authority.html 

This chart sums up the citizens hospital, Highlands Medical Center, and the Jackson County Health Care Authority's financial predicament, or should I say pending Financial Disaster.
Jackson County Health Care Authority officials OWE the citizens of Jackson County an explanation as to the financial stability of our hospital.(

I have had 2 meetings with Dr Albin, the CEO of the Jackson County Health Care Authority. One meeting was an in person introductory meeting, the second was a telephone meeting specifically discussing the new ambulances and the purpose of my series on the health care authority. I expressed the importance of the requested video interview. 

Unfortunately, at this time I must conclude it has been denied as to the questions presented in advance of a video interview. I was informed by Public Relations personnel that the attorney for the health care authority advised the CEO to not have a video interview. 

During the telephone interview Dr. Albin expressed concerns regarding the alleged unaccounted for money and other financial problems such as money lost on the "Mamo Bus." It has been reported to me the "bus" cost the health care authority an approximately $300,000 loss. Dr. Albin stated, "This was before my time and I can not answer any questions about this allegation." Referring to the missing/unaccounted for $1.2 million dollars.  He did state that money was lost on the bus.

1 - First, it is my belief that Dr. Albin is seriously concerned about the health care authority and wants to provide the best quality of health care possible to the community. 

Photo by the JCHCA, Fair Use for non-profit news reporting.
There are many excellent services offered by Highlands. One such admirable service is that of the Highlands Medicine on the move bus. The schedule of this service may be found at http://www.highlandsmedcenter.com/services_line/highlands_medicine_on_the_move.aspx

2 - Second, the health care authority has problems, which means Dr. Albin and the Executive Team have problems along with the entire Highlands and Jackson County Health Care Authority have problems which may be detrimental for the continuing operation of our hospital and its various services. Identification of problems may seem simple as to the "big picture," specifically these problems are far reaching and have been expressed by staff, executives and myself as a concerned citizen and retired health care administrator, "sometimes it is difficult to understand folks motivations within the community." 

PROBLEM IDENTIFICATION
There are 4, four, major problem areas which I identified: 1) Communications - (a) internal, professional in-service, team building - morale; (b) external, communications with public as to Highlands and the JCHCA accomplishments, financial status and direction in an ongoing community information program. The JCHCA web site is good, but external broad scale communications to community media is lacking, in my opinion. 

2) Financial development and problem solving: (a) long term/short term planning, commonly called a Capital Expense Procurement Program. Information from the American Hospital Association on Equipment Purchase Analysis and Practices - http://www.hhnmag.com/articles/6278-saving-on-new-equipment How long can Highlands Medical Center continue to operate with a $1.4 million  deficit, March 2017, and decreasing Medicaid payments? The annual report is out of date. It is listed as 2015  http://www.highlandsmedcenter.com/sites/www/Uploads/Annual%20Report/board%20hospital%20report2.pdf  An accurate Highlands and Jackson County Health Care Authority 2016 Annual Report should be listed.

3) LEADERSHIP DEVELOPMENT. There are no so called "natural born leaders." Effective Leaders are educated team players facilitating all within their purview to excel in excellence and professional accomplishment. It is my observation and opinion the cooperation between the board and executive staff is lacking - you do not have the best interest of the community at heart - Ladies and Gentleman you must work together as a team to mange the facility for the continuing benefit of the community. If you can't do the job and are not a team player, get out. We must have a TEAM who will serve the community to build a great Health Care Authority. Yes board, you may hire and fire executives, however you are part of the team. Build cohesion, be a professional, honest leader or resign. CEO, CNO, CFO and the other alphabet executives, if this facility folds it is on you and the Board of Directors. Plan, continue planning, identify and resolve problems, and build the TEAM!

4) Facility Maintenance/Preventive Maintenance Programs - This must be coordinated with the Capital Expense Priorities and Purchase Programs

QUESTIONS
Here are the questions presented to Dr. Albin, CEO, JCHCA, on June 13, 2017; as of  July 12, 2017 the video interview requested has not been granted. As the old saying goes, 'better late than never.'  I have expressed to all concerned that this is an opportunity to communicate to the public at large which should not be passed up or thought of as a negative outcome, this is an opportunity to inform and communicate in a visual manner; to correct misperceptions, facilitate goodwill, and tell OUR and YOUR story about health care in our community.

June 13, 2017
Interview/ Questions with Dr. Lonnie Albin, MD 
CEO of the Jackson County Health Care Authority, Scottsboro, Alabama
Also present: _________________________________________________________________

The following questions are based on interviews with Jackson County Health Care Authority Employees, Citizens of the greater Jackson County Community, Physicians within the community and Board Members of the Health Care Authority.

Questions
Mission-Vision-Goals-Community
1.      Dr. Albin, what do you see as your goal as the CEO for the Jackson County Health Care Authority relating to: 1). Patient care; 2). Employees; 3). Facility?
2.      What do you think about the wellness or health of Jackson County citizens?
3.      Could you please explain about the last Joint Commission Accreditation, how did that turn out for the Highlands Medical Center and associated services and clinics?

Financial Status-Capital Expense Program
1.      Sources within the Jackson County Health Care Authority informed me there was $1.2 million dollars which was unaccounted for/missing approximately 3 years ago, 2013-2015 time frame from the Jackson County Health Care Authority accounts, no specifically named account. Is this claim true, if so how do you explain this loss?
2.      It was reported to me that there was a $6.9 million dollar loss last year, 2016 operations year, for the Jackson County Health Care Authority. Is this true, if there was a loss how do you explain the financial loss; or was there a gain in funds?
3.      Sources within the Jackson County Health Care Authority have stated to me the Reserve Fund of the Health Care Authority was $12 million dollars 3 years ago, currently the reserve fund is approximately $6 to $6.5 million currently. Is this claim factual, if it is factual please explain or if not factual what was the reserve fund 3 years ago and what is it today?
4.      It was reported to me that the Health Care Authority is currently behind in paying their debts to the tune of approximately $300,000 is this true?
5.      Does the Health Care Authority have a policy in writing regarding a Capital Expense Program? Is there a schedule of major equipment purchases, Capital Expense Program – 1 year, 2 year, 5 year, 7 year, 10 year major equipment purchases submitted by sections/divisions/clinics/hospital, etc. approved by the CEO and CFO or Executive Staff and the Board of Directors on an annual basis? If you have a written policy, may I have a copy?

Concerns
1.      Some folks within the community and the health care authority have expressed concerns about the quality of patient care available at the Highlands Medical Center. What would you like to say to people and possible patients expressing concerns about the quality of health care at Highlands Medical Center or any Clinic or Service associated with the Jackson County Health Care authority?
2.      Concerns have been expressed about the financial stability of the Jackson County Health Care Authority; what would you like to say to those folks expressing concerns regarding the financial stability of the Jackson County Health Care Authority and associated patient care services or clinics?

Future Vision
1.      What is your vision for the future of the Jackson County Health Care Authority, Highlands Medical Center and all the patient care facilities delivering patient care?
2.      Dr. Albin are there any further comments that you would like to make?

Thank you for your time, it is greatly appreciated.

This requested video interview to date has not occurred. I wish the best of all outcomes for the Jackson County Health Care Authority and  Dr. Albin as the CEO. We are very fortunate to have Highlands Medical Center and the professional dedicated team. 

Folks, the problems may be resolved with leadership, teamwork, and professional problem solving.
Organization Effectiveness professionals maybe helpful. Here are some references: 

1) The Profile of an Effective Healthcare Leader http://www.beckershospitalreview.com/hospital-management-administration/the-profile-of-an-effective-healthcare-leader.html  

2) Effective governance: the roles and responsibilities of board members - (from my alma mater, Baylor University) An important article and direction for board members. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1276331/  

3) Developing an Effective Health Care Workforce Planning Model - American Hospital Association  http://www.aha.org/content/13/13wpmwhitepaperfinal.pdf


4) Performance Measures For Health Care Systems  http://www.hret.org/chmr/resources/cp19b.pdf 


Tuesday, July 11, 2017

Jackson County Commission in Bridgeport, Public Hearing on Annexation; Mr. Hodges Seeks Options Regarding Second Job and Commission Chair Position - July 10, 2017

Jackson County Commission Chair Matthew Hodges addresses citizens at the Bridgeport Community Center regarding a request to annex parts of County Road 75 into Bridgeport. Photo by G. Morgan

Jackson County Commission Chair and Second Job - Options
Jackson County Commission Chair seeks options regarding his second job and elected position. Commissioners have mixed emotions about the situation. Will an Attorney Generals opinion be forthcoming? What do the commissioners have to say about Mr. Hodges' actions? One Commissioner did state that he thought Mr. Hodges' actions brings discredit to the commission. The full Jackson County Commission will have to vote on the issue and decide what question(s) to send to the Alabama Attorney General.  Mr. Hodges declined an opportunity for a video interview at his office earlier in the day regarding this issue.



The Special Act creating the Jackson County Commission Chair job, Act 392, approved August 26, 1953 has this to say about the Commission chair's time: "Section 8 ...Chairman of the board shall be required to give his entire time and attention to the business of the board..." A copy of the law and the WAFF News Story may be found at the WAFF site link:July 5, 2017 WAFF News article:  http://www.waff.com/story/35819237/residents-question-jackson-co-commission-chairmans-acceptance-of-2nd-job#.WV6HY5YL-9E.facebook

Alabama Ethics Laws Handbook for Public Officials may be found at -  http://ethics.alabama.gov/docs/GuidelinesPublicOfficialsEmployees7-2012.pdf
The Conflict of Interest law has this to say - Section 36-25-1 states:
"(8) CONFLICT OF INTEREST. "A co
nflict of interest involves any action, inaction, or decision by a public official or public
employee in the discharge of his or her official duties which would materially affect his or her financial interest..." His failing to fulfil his full time commitment as an elected official (
"Section 8 ...Chairman of the board shall be required to give his entire time and attention to the business of the board...") while employed in another full time job, in my opinion, may be a conflict of interest. Mr. Hodges as the Chair of the Commission is the decision maker, him taking off of work for a financial gain at another job reeks of a conflict of interest.

Video of Citizen's Listening Session About Expansion of Bridgeport City Limits

Tuesday, June 27, 2017

Scottsboro City Council Regular Session, Armory Conveyed to Rescue Squad 6-26-17

Scottsboro City Council President Tony Wallingsford, Center; Left - Scottsboro City Clerk Whitney Phillips; Right - City Attorney Steve Kennamer (photo by G. Morgan)

Scottsboro City Hall (photo by G. Morgan)
City of Scottsboro Web Site - http://www.cityofscottsboro.com/

Agenda item 1. Armory conveyed to the Jackson County Rescue Squad. In the words of Councilman, former Police Chief Keith Smith, " They were always there when we needed them."
You Tube - Jackson County Rescue Squad, April 2, 2011 by "Jimbob" - Jackson County Rescue Squad Open House. (Fair Use for non-profit news reporting)

AGENDA

VIDEO

Jackson County Commission, with City-County Business Tax Distribution Agreement, Commission Info Available on the Web, LACKING - June 26, 2017

Jackson County Commission members during the Pledge of Allegiance this week. 
(photo by G. Morgan)
Center- Commissioner Melinda Gilbert, District 3; Right- Commissioner Mike Sisk, District 4; Left- Commissioner Tim Guffey, District 1. Not shown is Commissioner Jason Venable, District 2; Commission Chair Matthew Hodges; see photo below.

Regarding Commission Information Available on the World Wide Web
This is not good! Utilizing the Google Search this is what I found, information available on the web, at this time, is lacking regarding the county commission: https://www.jacksoncountyal.com/#
Lets look elsewhere... 
Chamber of Commerce, looks good for Chamber info, seriously lacking regarding commission info:  http://business.jacksoncountychamber.com/list/member/jackson-county-commission-scottsboro-2017  
Facebook, not bad, but not current in all aspects, no info on current commissioners:  https://www.facebook.com/JacksonCountyCommission/
Other sites, such as the ACLU and others had this erroneous information:  https://ssl.capwiz.com/aclu/officials/locality/?entity_id=1068&state=AL
One of the best sites is the Revenue Commissioner's Office, looks good, informative and thorough: 
Another excellent resource from the Revenue Commission is this site:
County Court Clerk
Another informative, excellent site is the Jackson County Economic Development Authority, EDA:
Jackson County School Board is another excellent, informative site.

New Website Development, Old Web Site Taken Down
In all fairness to the commission, they announced they will be updating their web site, this plan was announced and approved at the  February 13, 2017 Commission Meeting.  http://whnt.com/2017/02/13/jackson-county-commission-plans-to-develop-an-official-website/
It was stated the development will take 5 months to complete. The old website was taken down leaving a huge void. 


Seated left to right: Commission Chair Matthew Hodges; Commissioner Tim Guffey, District 1; Commissioner Jason Venable, District 2; County Administrator Bob Manning, Center; Commissioner Mike Sisk, District 4; Commissioner Melinda Gilbert, District 3. (photo by G. Morgan)

AGENDA
Click on image to expand view.

City County Business Tax Agreement, Agenda Item 4, Approved by County Commission


VIDEO

Monday, June 19, 2017

Jackson County Health Care Authority, UPDATED June 20, 2017, Part 1 of 3 parts, June 19, 2017 - Dilemma of Rural Health Care Facilities.

                             PART 1 BACKGROUND

Three months ago I decided to write this three part series about the Jackson County Health Care Authority. Several people within the community have commented and asked me about the layoffs and terminations of health care employees along with ambulance purchases, health care quality and financial stability of our hospital and its various clinical and health care organizations.
Highlands Medical Center (photo by G. Morgan)


We are fortunate in Jackson County Alabama to have a functioning rural community hospital with its clinics and supporting organizations in Jackson County Alabama. In part 1 of this 3 part series I'll discuss history and issues of health care in Jackson County Alabama with links about the rural health care crisis in the U.S. and Alabama.  Part 2 of this series is available within at this link:  http://arklite.blogspot.com/2017/07/jackson-county-health-care-authority.html

Many thanks to Mrs. Jessica Butler, Director of Marketing/Media Relations for providing me with the basic information regarding the organizational chart and basic staff information. Interviews were conducted with concerned citizens, health care authority board members, local physicians, current and former employees of the health care authority.

The Health Care Crisis in Jackson County Alabama is not a standalone problem; and yes we do have a crisis as Federal Aid for Medicaid recipients is decreasing and insurance payers reduce payments to health care facilities and care providers. Many times insurance carriers are deciding on patient treatment outside of what physicians may recommend.

RURAL HEALTH CARE ACROSS THE U.S. AT A GLANCE: ( "Excerpt from Health Affairs Blog" ) "Over the past several decades, rural hospitals have closed at alarming rates. A 2016 study identified over 650 rural hospitals vulnerable to closure in 42 states with 38 percent of 1,332 Critical Access Hospitals (CAH) operating at a financial loss. CAHs are rural hospitals that meet specified criteria (size/rurality) and have applied to the federal government for CAH designation and subsidy support. The Centers for Medicare and Medicaid Services (CMS) reimburses CAHs for Medicare patients at 101 percent of costs; however, this support is frequently insufficient to maintain solvency. The reasons for closure can be partially attributed to low admission volumes—some hospitals achieve an average daily census of four inpatients, and many intake fewer than one per day—and decreasing reimbursement from third party payers and CMS, which cannot sustain hospital operating costs." 
"Hospital closures create an economic and health care access void, which is magnified in rural communities that typically have few other employment and health care service options. Job losses directly impact medical and ancillary staff, and the community tax base is diminished when a large employer like a hospital closes, forcing people to move away from communities where they want to live or to retire. When hospitals close, so do their Emergency Departments (EDs) and the life-saving care they provide. When an ED closes, patients are forced to seek care elsewhere, introducing long travel times to other EDs, which can increase mortality for time-sensitive diseases such as trauma, stroke, sepsis, and acute myocardial infarction. This has become a crisis for a large portion of rural communities: 77 percent of 2,050 rural counties are designated Health Professional Shortage Areas (HPSAs) by the U.S. Department of Health and Human Services."  Other important articles on rural health care may also be found on this blog. http://healthaffairs.org/blog/2017/02/21/solving-the-rural-health-care-access-crisis-with-the-freestanding-emergency-center-care-model/
The National Rural Health Association Points at these issues: "The obstacles faced by health care providers and patients in rural areas are vastly different than those in urban areas."
Health Inequity
More than 50 percent of vehicle crash-related fatalities happen in rural areas, even though less than one-third of miles traveled in a vehicle occur there.[9]
In rural areas there is an additional 22 percent risk of injury-related death.[10] 
Rural areas have more frequent occurrences of diabetes and coronary heart disease than non-rural areas.[11]
Mental health creates new challenges in rural areas, such as:
    • -Accessibility: Rural residents often travel long distances to receive services, are less likely to be insured for mental health services, and less likely to recognize the illness.
    • -Availability: Chronic shortages of mental health professionals exist, as mental health providers are more likely to live in urban centers.
    • -Acceptability: The stigma of needing or receiving mental health care and fewer choices of trained professionals create barriers to care.[12]
  •   -Rural youth are twice as likely to commit suicide.[13

Socioeconomic Factors

  • Rural residents tend to be poorer. On average, per capita income in rural areas is $9,242[4] lower than the average per capita income in the United States, and rural Americans are more likely to live below the poverty level. The disparity in incomes is even greater for minorities living in rural areas. 

  • About 25 percent of rural children live in poverty.[5]

  • People who live in rural America rely more heavily on the Supplemental Nutrition Assistance Program (SNAP) benefits program. According to the Center for Rural Affairs, 14.6 percent of rural households receive SNAP benefits, while 10.9 percent of metropolitan households receive assistance. In all, 1.1 million households receive SNAP benefits.[6]

  • Rural residents have greater transportation difficulties reaching health care providers, often traveling great distances to reach a doctor or hospital.

  • Tobacco use is a significant problem among rural youth. Rural youths over the age of 12 are more likely to smoke cigarettes (26.6 percent versus 19 percent in large metro areas). They are also far more likely to use smokeless tobacco, with usage rates of 6.7 percent in rural areas and 2.1 percent in metropolitan areas.[7]

  • Rural communities have more uninsured residents, as well as higher rates of unemployment, leading to less access to care.  https://www.ruralhealthweb.org/about-nrha/about-rural-health-care


RURAL HEALTH CARE IN ALABAMA, POOR FOLK IN CRISIS:

Life expectancy at birth for rural Alabamians is one-half of a year lower than that for urban Alabama residents and 3 ½ years lower than that for the nation.  Life expectancy for residents of Wilcox County is 9 years lower than that for the nation. 

More than one in every five rural residents is eligible for Medicaid. Nearly one half (47%) of all rural children are eligible for Medicaid.

14 rural counties have between 10 and 16 percent of all households with no vehicle.
Only two of Alabama’s 54 rural counties (Coffee and Pike) are not entirely or partially classified as primary care shortage areas.  There are 4.1 primary care physicians per 10,000 population in Alabama’s rural counties compared to 7.9 for urban residents. 

All of Alabama’s 54 rural counties are classified as dental shortage areas for the delivery of service to the low-income population.  Only Shelby County and a portion of Madison County are not currently classified as dental care shortage areas.  There are 2.7 dentists per 10,000 population in Alabama’s rural counties compared to 5.5 for urban residents.

Alabama currently has three counties (Coosa, Greene, and Lowndes) with no full-time dentists in the entire county.  Coosa does not have a physician in the entire county.
All of Alabama’s 54 rural counties are classified as mental health care shortage areas for providing mental health care to the entire or low-income populations.  Only Madison County is not currently classified as mental health care shortage areas. 

In 1980, 45 of Alabama’s 54 rural counties had hospitals providing obstetrical service.  Today only 16 of the 54 counties offer this basic service.  In 1980, 10 of the 12 Black Belt Region counties had hospitals providing obstetrical service.  Today only one still offers this service.
More than ¼ of all births to rural Alabama women involve mothers who received less than adequate prenatal care during their pregnancy.

13 rural Alabama counties do not have a dialysis clinic.

7 rural counties (Cleburne, Coosa, Henry, Lamar, Lowndes, Macon, and Perry) do not have a hospital.

Having healthy population growth is a basic requirement for attracting and keeping adequate health care services.  Between 1910 and 2010, 24 of Alabama’s 54 rural counties actually lost population.  39 of the 54 rural counties and 2 of the 13 urban counties are projected to lose population between 2010 and 2040.

Obesity is a major risk factor for numerous serious health conditions.  There are 10 rural Alabama counties with between 40 and 49% of the adult population being obese. 

The mortality rate for rural Alabama residents is over 10% higher than that for urban residents.

The chronic lower respiratory diseases mortality rate for rural Alabama residents is nearly 38% higher than that for urban residents and nearly 57% higher than that for the nation.

The motor vehicle accident mortality rate for rural Alabama residents is nearly 67% higher than that for urban residents and more than 120% higher than the national rate.

 JACKSON COUNTY ALABAMA and THE JACKSON COUNTY HEALTH CARE AUTHORITY (JCHCA) 2016 HEALTH NEEDS ASSESSMENT, PRIORITY OF NEEDS

JCHCA operates Highlands Medical Center (HMC), a 170-bed acute care hospital located in Scottsboro, Alabama. HMC provides a broad range of services and is the only hospital in Jackson County, a county with more than 1,077 square miles in northeast Alabama. In addition to the wide range of typical acute care services provided by HMC, JCHCA operates: 
Highlands Health & Rehab is a 50-bed short-term rehabilitation and long-term care facility located on the HMC campus in Scottsboro; 
Cumberland Health & Rehab, a 100-bed short-term rehabilitation and long-term care facility located in Bridgeport, in the northern portion of Jackson County; and 
Highlands Home Health, a Medicare-certified home health agency serving residents of Jackson, DeKalb, Madison and Marshall Counties.

Summary Findings, PRIORITY OF NEEDS 
Community health needs were identified through primary and secondary data collection and analysis, and were grouped into eight major categories. These areas were prioritized by the CHNA Advisory Committee by utilizing criteria related to the estimated feasibility and effectiveness of possible interventions; whether addressing the need builds on existing organizational competencies; the number or proportion of people effected by the health need; the importance the community places on addressing the health need; the opportunity to intervene at the prevention level; and the relationship to existing partnership, community, or other JCHCA initiatives. 

This process resulted in the prioritized health needs list shown below: 1) Cancer 2) Diabetes 3) Obesity 4) Heart Disease 5) Access to Services/Care 6) Lung Disease 7) Continuity of Care 8) Substance Abuse/Mental Health 

Demographics, findings and other information may be found at the Jackson County Health Care authorities assessment report pages.  http://www.highlandsmedcenter.com/sites/www/Uploads/Jackson%20County%20Health%20Assessment%202016%20JCHCA%20CHNA%20Report%20(9%2028%2016).pdf

UPDATE June 20, 2017
Patients with cancer is priority #1 on the above list for a reason, the cancer death rate is  high for Jackson County Alabama as reflected on the latest map from the National Cancer Institute.
(Click on image for an expanded view.)
Jackson County is # 2 in the state for deaths from Ovarian Cancer; Jackson County men have the highest death rate in the state for Brain Cancer. There are several other cancer sites listed pertaining to Jackson County which show cause for alarm.

                           JCHCA ORGANIZATIONAL CHART
                      (Click on image for an expanded view)

MEDICARE.GOV SURVEYS FOR THE JACKSON COUNTY HEALTH CARE AUTHORITY'S HIGHLANDS MEDICAL CENTER AND CLINICS MAY BE FOUND AT  https://www.medicare.gov/hospitalcompare/profile.html#profTab=1&ID=010061&loc=35768&lat=34.733095&lng=-86.0733498&name=Highlands%20Medical%20Center&Distn=6.5 

JACKSON COUNTY HEALTH CARE AUTHORITY MISSION, BOARD of DIRECTORS
and ADMINISTRATIVE STAFF
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The Highlands Medical Center and Clinics are Accredited by the Joint Commission on Hospitals Accreditation - Link: https://www.jointcommission.org/accreditation/accreditation_main.aspx

FINANCIAL STATEMENT ( March 31, 2017)
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 Jackson County Health Care Authority total as reported for the time frame is $444,358.44 in the red, negative balance; while the Highlands Medical Center Reports $1,401,101.24 in the red, negative balance; all other services report a positive cash flow. 

FINANCIAL STATEMENT UPDATE June 22, 2017 (April 15, 2017 statement)
JCHCA LLC's 
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Note: $359,453 improvement over last year. With the improvement, the indicators demonstrate a $931,093 financial loss year to date as of the end of March 2017, end of first calendar year quarter for 2017.

UPDATE June 20, 2017
Highlands Medical Center financial difficulties reflect a serious management problem which must be dealt with sooner, rather than later. More will be provided in the Part 2 segment regarding finances, missing funds questions, "mamo bus" waste ($300K loss?); large population unable to afford health care payments - 63% unable to pay, air conditioner problems, capital expense program failures (lack of planning); financial concerns over the past 3-4 years and a decrease in reserve account. 

Still no word on CEO interview regarding the time and date; however, I received word late on June 19th the Jackson County Health Care Authority attorney has advised the CEO not to do an interview. Is there something to hide about this public hospital??

UPDATE June 20, 2017 6 PM - Dr. Albin assured me telephonically this evening, "there is nothing to hide," 
 He pointed out to me this evening his commitment, "The financial problems occurring 10 years or 3-4 years ago are out of  my control at this time. My goal now is to facilitate the best patient care environment possible and offer forth responsible management of the Jackson County Health Care Authority for the people of Jackson County." Dr Albin further stated, "I care and it is my goal to do the best job possible to ensure this health care facility delivers quality medical care to all the people who enter our facility and insure its future financial stability." Dr. Albin also commented he would schedule a sit down discussion with me soon.

From Health Care Authority Source, on June 19, 2017 (including ambulance photo below). - $600,000 spent on New Ambulances Not Utilized, unequipped, were/are stored at the National Guard Armory on Cedar Hill Dr..

UPDATE: 6 PM June 20, 2017 - Lets talk ambulances: I had a discussion with Dr. Albin, CEO, Jackson County Health Care Authority about the ambulances this evening. Dr. Albin wants citizens to know that these are the best ambulances and equipment money can buy. "They are state of the art, and the first NEW ambulances that the authority has purchased since 1995," said Dr Albin. Currently there is a problem, the state must inspect the ambulances prior to placing them on the road. Dr. Albin stated, "We are in contact with the state daily, and today multiple times," regarding the state's inspection of the ambulances. Before each ambulance becomes operational, some equipment must be transferred from the old ambulances to the new vehicles, particularly communications equipment, Dr. Albin mentioned. 

Before the conversation ended it became obvious the good Doctor and Chief Administrator of our hospital was concerned about my writing regarding the ambulances. He wanted the citizens of our community and me to know that he has the citizens best interest at heart. The new ambulances are stored with their state of the art equipment in the most secure location possible until the state inspects our emergency vehicles so they may be utilized as they were purchased to be utilized, emergency patient care transport vehicles. Many thanks to Dr. Albin for his phone call.
Photo provided by unnamed source at the Jackson County Health Care Authority, cropped by G. Morgan. 

AMBULANCE UPDATE, JUNE 22, 2017 

video

Highlands Medical Center Receives Awards From Vizient Hospital Engagement Network

Highlands Medical Center received three awards for their active participation in this program.
One award is for Highlands Medical Center’s outstanding commitment to the goals of reducing patient harm. The second award is for Highlands meeting or exceeding their goal in all ten of the above initiatives. The third award, Outstanding Performer award,  is for Highlands achieving the highest level of performance in the Vizient Hospital Engagement Network, which is made up of 243 hospitals across the nation.  Highlands is ranked within the top 18% of the Vizient HEN hospitals.
“The success of this program at Highlands is due to the hard work and commitment of many, many staff members, including all nursing staff members from all of the inpatient departments, our Infection Preventionist, Mr. Craig Lacey, members of the Information Systems team Deva Allen and Kelly Jones, reports generated and submitted by Terri Wright, and many, many more staff members who assisted in one way or another.  These initiatives required input and teamwork from all of the staff in order for us to meet our goals.  We are very pleased to have received these awards, but the work is not over.  We will continue to work on these initiatives, as well as others, to improve care and reduce the chance of harm to all of our patients,” were comments from Debra Brickley, Director of Quality Management at Highlands.  http://www.highlandsmedcenter.com/Articles/highlands_medical_center_recives_awards_from_vizient_hospital_engagement_network.aspx  About the Vezient survey - https://www.vizientinc.com/what-we-do


Interviews and Parts 1 and 2

I met with Dr. Albin in an initial introduction interview on June 5, 2017, which went very well. Dr. Albin related to me that he wanted to provide the best health care possible to the people of this area. I found Dr. Albin to be a cordial and friendly physician whom I believe truly cares about providing the best health care possible.


PART 2 WILL BE SIGNIFICANT PROBLEMS DISCOVERED UPON INTERVIEWS WITH JCHCA BOARD MEMBERS AND EMPLOYEES. THERE WERE 12 QUESTIONS PROVIDED PRIOR TO A REQUESTED INTERVIEW WITH DR. ALBIN, CEO JCHCA RELATED TO THE INITIAL INTERVIEWS. THE CEO INTERVIEW WAS ORIGINALLY SCHEDULED FOR JUNE 13 AT 2PM. THE QUESTIONS WERE PROVIDED TO MRS. JESSICA BUTLER, DIRECTOR OF PUBLIC RELATIONS AND MARKETING, AT 10AM ON THE 13TH. LATER THAT MORNING I WAS CONTACTED BY MRS BUTLER AND ASKED FOR THE AFTERNOON APPOINTMENT TO BE RESCHEDULED AS DR. ALBIN WAS NOT THE CEO DURING THE TIME FRAME REGARDING SOME OF THE QUESTIONS SUBJECT MATTER AND WANTED TO GATHER INFO REGARDING THE QUESTIONS. I AM STILL AWAITING THE APPOINTMENT FOR THE INTERVIEW WITH DR. ALBIN.  Part 2 is available within at this link: http://arklite.blogspot.com/2017/07/jackson-county-health-care-authority.html

PART 3 WILL BE THE VIDEO PORTION OF THE INTERVIEWS. IF THE INTERVIEW WITH THE CEO IS NOT PROVIDED I WILL GO AHEAD AND LIST THE QUESTIONS AND AREAS OF CONCERN WITHIN THE HEALTH CARE AUTHORITY PREVIOUSLY PROVIDED TO ME ALONG WITH ALL QUESTIONS PROVIDED TO DR. ALBIN.