Summit County Health District and Akron Health Department - - PDF document

Summit County Health District and Akron Health Department Consolidation Feasibility Study Presentation

Intr

• duc tion

Re c e ntly e c o no mic , po litic a l a nd le g isla tive stre sse s ha ve le a d to a mo re

• pe n c lima te fo r d isc ussio n a nd e xplo ra to ry initia tive s fo r me rg ing lo c al

public he alth a g e nc ie s. Wha te ve r the mo tiva tio n, the pro c e ss o f me rg ing is a n e xc e ptio na l e xpe rie nc e a nd le nd s itse lf to the ra re o p po rtunity to e ng a g e pub lic he alth with the c o mmunity, e va lua te o rg a niza tio na l value s a nd visio n a nd re c a st the ro le o f yo ur a g e nc y. T he q ue stio n o f me rg ing a g e nc ie s is c o nte ntio us, po la rize s o pinio ns a nd is a so urc e o f g re a t a ng st. L

• c a l c o mmunitie s a nd g o ve rna nc e e ntitie s

must c o nsid e r whe the r to pursue a d ialo g ue to e xplo re fo rmal unio ns with g re a t tho ug htfulne ss a nd re spe c t fo r lo c al value s a nd tra d itio n. T he fo llo wing d o c ume nt is a n a tte mp t to c a p ture the c o nso lida tio n in Summit Co unty, Ohio o f thre e lo c al he alth d istric ts. E a c h c o mmunity is

• b vio usly d iffe re nt a nd e ve ryo ne ’ s e xpe rie nc e in this re g a rd is uniq ue . T

his is ne ithe r a g uid a nc e d o c ume nt o r ho w-to pa mphle t no r d o e s it c ite re fe re nc e s o r is it e vid e nc e b a se d . It is o ne pe rspe c tive with le sso ns le a rne d . T he info rma tio n is pro vid e d in a g e ne ric na rra tive fa shio n fro m the g e rm o f the me rg e r id e a to the c o ntra c t c o mple te ; e ffe c tive d a te o f unio n. I ha ve inc lud e d te xt b o xe s whic h pro vid e insig ht o f ho w we lo c ally a d d re sse d spe c ific issue s re fe re nc e d in the na rra tive . Also inc lud e d a re se ve ra l a ppe nd ixe s o f d o c ume nts we c re a te d d uring o ur me rg e r pro c e ss tha t so me o ne mig ht find use ful. Be st o f luc k to a nyo ne tra ve lling d o wn this ro a d ,

Ge ne Nixon

Pre - Preparations for Preparing 2/09 – 6/09

Assess local resolve to support a merger

DIRECT or even casual overtures can be dangerous The consolidation of public health agencies, no less other government systems requires thoughtful consideration and early on-the-ground preparation to assure that there is sufficient social, political and institutional support for exploring the idea. Initially the water should be tested with trusted confidants that have sufficient political savvy to gauge and provide advice on community capacity for change. Seeking key community player’s guidance, direction and mentorship for moving forward and assessing the feasibility and political climate for a merger will pay dividends. Timing is crucial and to precipitously proceed before cultivating the appropriate community and governance institutional support may initiate fervent opposition stronger than any budding support. This potential backlash can become entrenched, hard to dislodge or reverse once established. The risk of initiating a swell of opposition in the community can immediately stall any dialogue and potentially lead to intense damage control or even; personal career or credibility damage. The consolidation of community institutions is a change and change requires the community capacity and flexibility to consider innovative alternatives. Local politics which is ineffective and mired in inaction may negatively politicize efforts to consolidate. Any discussions regarding a merger may easily be painted as a pointed failure in a depressed political climate that tends towards fault finding rather than solutions building. The appropriate confidants in the community can help provide an honest assessment of local politics and advice on moving forward. Trod carefully It helps to cultivate broad based origin support for the merger concept. The more principals that can claim early ownership of the idea; the more individuals there are with a stake to assure the success of the initiative. Stakeholders may include mayors and other elected officials, hospital leadership, Board of Health members, academic administrators, and other critical community leaders. The willingness of these local idea leaders to promote the merger concept with others broadens the base of original interest in the idea. This expanded base of early interest decreases the opportunity for personalized political attacks and begins to build broad “community support”. Early discussions with these leaders should not be too detailed or prescriptive. Rather, these early exploratory dialogues should be inquisitive of views towards the logic and expediency of a consolidation effort initiative. If it is determined that there is a core progressive capacity willing to carry the merger concept further, details will follow. Absent critical support, the details become irrelevant.

The principally affected agencies’ standing in the community and their recognized credibility are important predictors of success. The willingness of community leaders to expend political capital on any innovative idea, such as a merger of public agencies which may jeopardize their own public standing depends on their judged risk in the proposition’s success. The perceived risk is directly related to the perceived strength, past performance and credibility of those directly affected agencies. The stronger the

• rganization or health district’s standing in the community, the more likely it will be to

gain local support for advancing new ideas. Unfortunately of course, the inverse holds true as well. The merger of public health districts will face many challenges both administratively and directly; even in the form of personal attacks. Before seeking community support, an honest assessment of the internal agency capacity to carry forward the burden of a formal merger should be conducted and measured. Considerations include: Is the agency’s administration robust enough to manage the tasks associated with transition (personnel, fiscal, IT, legal)? Does the agency harbor enough top leadership capacity to bear the internal and external scrutiny of the process? Do the directors and supervisors have the experience, flexibility and innovative ability to transform and expand their units’ capacity? Is there sufficient Board of Health support? Is the agency fiscally strong enough to weather expected and unanticipated costs associated with a merger? Are there other organization issues, internal conflicts or circumstances that may undermine or limit progress towards consolidation? Why? It will significantly help the process of merging agencies if the question why is answered

• early. Different perspectives drive different assumptions about the need or value of a
• consolidation. Economic savings, greater efficiencies, better positioning for grant

eligibility, stronger public health services are all equally valid priorities depending on the

• perspective. What should and what should not be expected from a union of health

districts must be articulated clearly and often to avoid establishing unrealistic

• expectations. Significant dollar savings may not be possibly nor is it typical with other

merger experiences. Greater public health services may not immediately materialize due to a transition period challenges, declining funds, or administrative limitations. Why then?

Timing is a big thing Despite intuitive indications that a merger is a “good idea”, the incentives for a community or an agency to subject itself to the rigors of a consolidation process generally require mix of internal and external dynamics. The recession of the late 2000’s/early 2010’s was a clear driver for local governments to assess more efficient (read: inexpensive) designs for delivery of local services. Whereas for decades, many local government institutions, including health districts had lumbered along with reliable if not insufficient funding, the sharp decline in local taxation revenues sparked a renaissance in creative budgeting and service delivery modeling. Parochial walls collapsed and mergers in all government sectors became more palatable and attractive. There are other intrinsic triggers for considering agency consolidations. The anticipated retirement or resignation of an agency CEO generally portends an agency’s reassessment

• f values, mission, and management structure. Overtures between entities before an

announced but expected retirement may be met with more readiness to consider the merger concept. The reduction of one CEO also conveniently solves the thorny issue of leadership designation in the combined district. A significant change in other community elected officials or politics can also represent

• pportunities, such as new mayors, county commissioners, city council leadership or a

shift of a political party majority seeking new ideas. Public health events of major impact may demonstrate the value of a robust united public health system. The event recovery phase may include an assessment which includes a proposal or recommendation to merge

• r explore merging agencies to strengthen the current system.

Small careful inclusive steps Once the critical mass of community leadership support has been determined to be adequately achieved the “why” has been articulated sufficiently and the affected agencies It helped us to articulate in writing our expectations for a consolidate health

• district. The established advantages provided a foundation for any discussions

regarding the merger. We focused on three arguments:

• 1. The local health districts already closely collaborate on many

programs.

• 2. The consolidation will create more efficiency.
• 3. Local services/county voice.

For each of these central principles we provided further explanation and examples to clarify the message. These issues ultimately formed the nexus for reports and dialogue throughout the process (See Appendix A.).

have assessed and determined that they indeed have the necessary internal capacity to cope with the rigors of a consolidation, it is time to begin the formal community-based exploratory process. It may be important to register initial endorsement or support under a formal mechanism. Steps moving forward need a reference document as a foundation that spells out who, what, where, why and how the process should move forward. This documentation provides clarity on who initially supports the merger concept, why they support the concept and provides the consent and encouragement to move the process forward. Careful thought should be given to who is represented in this consent document to avoid unintended offense through exclusion. Early in the process it may not be appropriate to seek direct support to merge but may be more palatable for individuals to sign on to support study of the idea. Conceptual support provides flexibility and will generate greater willingness for broader consensus on the idea of merging or to study a merger. It is also advisable and prudent to seek a commitment from the affected agencies governance structure through a resolution to support the process. This document which will provide the cornerstone of institutional support can take many forms: proclamation, jointly signed letter, contract or combination of these can serve to institutionalize the community confirmation. A Board of Health resolution supporting an exploratory process to merge agencies is strongly encourage as both a demonstration of commitment to staff and as a good faith signal to the other agency(s) that the intent is sincere.

Preparations for Preparing 6/09 – 2/10

Existing guidance documents that provide recommendations for merging agencies often encourage convening a study group or steering committee. These community based teams identify the issues, explore options for resolving identified concern and make recommendations for resolution. The group may also conceivably identify significant

• bstacles and advise to not proceed with the union. This phase further demonstrates the

transparency of the process and spreads the burden of decision making on a representative community. Convening this feasibility group becomes inexorably simpler with the designation of a Chair with sufficient recognition, respect and leadership to carry the process forward. Other committee participants will be more inclined to participate under the headship of this local leader and that leader’s intention of support for this course of action. Commitment to the process will be reflected by the dedication and participation of agency and local institution directors, presidents or CEOs rather than their designees. The process and subsequent conclusions will bear more weight with weightier names if possible. The identification of key stakeholders in the process is important. The committee should be robust enough to encompass those critical local institutions, be inclusive not exclusive,

yet be manageable and able to move the agenda forward without being too large and

• cumbersome. Once the committee meets, it is helpful, as a first order of business to

evaluate the list of participants and engage in a discussion regarding who else might, by being a member, facilitate or add to the process. The use of a facilitator or contractor to guide the process may also provide further confirmation that the process was nonbiased or had predetermined conclusions. A nonaligned consultant can serve a much broader role by organizing notes, gathering supporting research, issuing reports or even conducting community focus group

• meetings. The consultant can often bring facilitating experience and organization depth of

expertise to significantly stream-line the process and assure a definitive and timely conclusion including a summary of findings and recommendations. What should be the role of the Committee? Much debate and consternation can be avoided if the Committee decides at the onset what they are convening to decide and how those decisions will be made or by what criteria conclusions will be drawn. Although it seems self evident that the question being explored is whether to merge or not to merge,

• ther considerations may limit the ability of the committee to tender that summary
• conclusion. Namely the depth of detail that needs refining probably exceeds the capacity
• f a time limited ad hoc committee. Issues like ultimate contract costs between the

subdivisions, the separation agreement for transitioning employees, building lease agreements, etc are issues requiring extended study and agreement negotiations. More fundamentally as indicated, the decision to merge two government agencies is the responsibility of the governance body(s) defined in statute. The Committee may decide to recommend a merger as long as the authority and responsibility of the respecting Boards

• r Commissions are respected.

Alternative conclusions may be less definitive, less political and more palatable than a clear recommendation and reflect standards of practicability, desirability, or feasibility of a merger or other agreed upon tentative verbiage. The “desirability” of a merger is less prescriptive than encouraging or supportive and yet can still be based on tightly defined

• criteria. Depending on their preference, the committee’s defined goal should be to

determine whether a merger is feasible or unfeasible; practical or unpractical, or desirable

• r undesirable.

We funded the contractor though the combined financial support of several agencies and a local foundation. Though not an intended strategy, this “investment” in the process helped further bolster community commitment to exploratory process and the union of these agencies. Our consultant provided a valuable independent perspective and their positive summarization also represented further validation of the process outcomes. (See Appendix B. summarizing our process facilitation process and consultant arrangements.)

The criteria which are applied to determine whether or not the standard has been reach to tender a conclusion on the merger prospect should also be predetermined. What are the issues that need to be explored and what benchmarks need to be set to determine whether the merger can be successful? Exploring these issues will be the primary tasks of the committee. The circumstances and their relative values that may contribute to a merger success vary in every community. The variety of criteria may contract or expand and be given differing weight depending on the pleasure of the committee. Examples of critical criteria include; Facilities: Is there adequate exiting or available facility or building capacity available for the consolidation of staff from the uniting agencies? Is the facilities consumer convenient, friendly and economical? Staffing: Can a reasonable organization chart be designed to accommodate staff with adequate (but not inflated) management capacity? Is the reasonable potential for salary parity and existing similarity in job classifications? Finances: Are there funds in the public health system to support a consolidated system adequate to meet the required needs of the district. What would be the estimated financial needs of the combined entity?

Governance: Can the existing governance structure be expanded or restructured to accommodate the district expansion. Is this politically tolerable? Community Support: Is there sufficient community understanding and support to initiate a merger? What are the community expectations for a merger of services? What is the community fears regarding a union? Programmatic Compatibility: Are the respective programs delivered by each agency similar in scope to allow for ease in expansion? If, as a sum of discussions or research indicates for each of these critical areas, the conclusions are positive, that is: each question yields a possible, practical or feasible

• utcome; the committee should recommend moving forward with some quantifiable
• assurance. If alternatively, the committee identifies one or more significant issues of

concern, either political, pragmatic or economical, they may choose to support with concerns, or recommend against further efforts to consolidate. The study committee provides a thoughtful informed community report on the concept of a merger; the risks, advantages and likely challenges. The identification of serious issues that will need to be addressed should be expected. The discussion among this group will Our Committee considered three Board of Health governance structure alternatives and a fourth option unique to Summit County and meeting the requirements under Ohio Revised Code. (See Appendix C.) 1. maintain the current structure and add one additional representative from Akron. Currently, by contract, each of our cities appoints a representative in addition to the DAC general health district appointments and the licensing council rep (17 member BOH). 2. establish a new five member Board with four representatives from the general health district and one from the licensing council. 3. restructure the Board of Health completely basing the representation on population, funding or other factors. 4. because of the unique charter form of county government, Summit County, per Ohio Revised Code could choose to place a charter amendment on the ballot that would permit the establishment of a county “department” of health. The Subcommittee which reviewed these options recommended maintaining the current Board of Health governance structure. The deciding factors including the preference to expedite the process rather then take the extended time to restructure and, the recognition that redesigning the Board structure would require renegotiating each of the other eleven city contracts in the district.

likely raised concerns that will haunt the process and presage impending roadblocks and process hurdles. Go forth! A practical, desirous or feasible conclusion by the committee for the merging of two or more districts serves as a solid confirmation by the collective community to initiate the merger process. It also creates an expectation that the process will proceed to its obvious

• conclusion. The final report and the positive determination by the committee provide a

broad assessment of the critically identified issues and may include some specific estimates regarding finance, personnel or spacing needs. Most likely though, the details and hard work begins after the issuance of the group conclusions.

Preparing 2/10 – 8/10

The size of the corresponding districts in the merger should provide a thumbnail gauge on the expected difficulty to be faced sorting through the administrative details to prepare and conclude the merger. The larger the organizations, the more hurdles should naturally be expected. Unfortunately, assessing “feasibility” of a union does not begin to confront the myriad of details necessary to conclude a contract, prepare for the transfer of employee or align divergent fiscal management systems. Although a larger health district absorbing a small district may pose significant political intrigue, the administrative details can be addressed fairly easily. Whereas, merging of two large districts will require considerable fiscal, legal, personnel and organizational management skills and support. The central binding element of the merger is the agreed upon contract between the uniting entities. Following the recommendation of the Committee but prior to a significant commitment of time and resources by the interested health districts, we created a memorandum of understand to demonstrate a formal good faith commitment by both parties. The stated goal in the memorandum was to allow a seamless transition of responsibility (See Appendix D.). The priority issues in the document included:

• 1. Facilities will be maintained and operated in the City of Akron to

assure continued convenience of public health services and access to area residents.

• 2. There will be continued employment for Akron Health Department

stall in good standing.

• 3. The City of Akron will reconcile all city specific employee

employment obligations prior to their transfer to the County Health District.

Implementing 8/10 – 1/11 -

Once the contract has been executed, tangible transition actions can begin. A significant change like the union of two agencies leads to unavoidable angst, anxiety speculative rumors and other bad things. It might not be entirely avoided but purposeful efforts should be applied to lessen concerns and heighten acceptance by employees of the pending merger. Engaging employees in the process through regular meetings, newsletters or other updates can help decrease rumors and increase credibility. Providing

• pportunities for employees of all agencies to submit or ask questions of concerns also

helps to lessen stress and increases transparency in the process.

New Beginnings 1/11 –

Once the consolidation of two districts becomes effective; political, administrative and coordination details will naturally continue; but the heavy lifting has been accomplished. A great opportunity has been entrusted to the combined district, the Board of Health and the leadership of the new organizations. This also represents a great burden, not to be

• squandered. Make the time to take a step back from the paperwork, policies, and

personnel issues to consider what might be; to develop a shared fresh vision for your agency and begin the task of molding a new local history of public health.

Public Health – Oh Yeah!

Appendix A

Strong Advantages of Uniting the Summit County Health Districts

The Consolidation Feasibility Study Group (CFSG) chaired by Bill Considine, President and CEO of Akron Children’s Hospital met for 6 months to consider the opportunity to consolidate community public health services. The Group considered eight critical issues and based their recommendation to unite the Akron City Health Department and the Summit County General Health District on the degree to which each issue could be successfully addressed. The Group thoughtfully considered the pragmatic issues associated with uniting two large government agencies including fiscal, personnel, governance and facilities needs. More importantly the CFSG believed that merging these agencies would better serve community needs and position the local public health system as a local leader and

• advocate. The consideration of a proposed merger of local health districts focused

foremost on the community’s best interest and only secondarily on the mechanics of consolidating agencies. In considering the merger the following should be emphasized:

• 1. The local health districts already closely collaborate on many programs. This

feasibility study culminates many years of program integration and closer functionality between the two agencies. Funding streams, training and planning, and disease tracking and response have necessitated linkages which have blurred the unique distinction between health districts. Examples include: Emergency Response: Since 2001, significant federal support for public health emergency planning and response has required an alignment of local and regional capacity. Summit County public health system is stronger because of this united front to address epidemics, bioterrorism or natural

• disasters. The recent coordinated H1N1 mass vaccine campaign reflects this

close working relationship. Communicable Disease: The local public health communicable disease tracking and response team is a de facto single operating unit despite staff representing different employers.

• 2. The consolidation will create more efficiency. The precipitous decline in

federal and state funding streams necessitates the need for local governments to seek greater efficiency in program delivery, to challenge existing canons and assumptions and consider alternative means of service delivery. The consolidation will eliminate confusion over health districts’ geographic and programmatic authority and clarify points of contact.

The health districts share a common mission and are similarly structured to deliver a uniform set of state mandated programs. The expectations are that given time, there will be a leaner budget with no loss in services or immediate loss

• f staff positions. Example include:

Vital Statistics: Uniting the cumbersome administrative functions by eliminating multiple sites will result in an overall decrease in staff engaged in these functions. Significant staff reductions over the past year have resulted in the

• pportunity to merge in complimentary ways rather than having a merger

result in duplicative positions. Creating a single administrative office and eliminating administrative duplicity allows for a redirection of dollars otherwise necessary to cover administrative costs to programs that more directly serve the public. 3. Local services/county voice. Planning for proposed merging of the two health districts includes organizing staff and functions to be better suited to meet local/ neighborhood needs while maintaining a strong county level presence. The Board

• f Health governance authority is designed to assure representation across all

involved districts. Appropriate program staffing levels and facility locations will assure convenient access for all residents.

Appendix B

He Healt lth Di Distric ict Me Merger ger

Process Facilitation

The consultant for this project will be an integral contributor in the process and is expected to participate in most proceedings of the group. The successful candidate will facilitate meetings by providing data evidence and regular reports on ongoing activities The Center for Community Solutions successfully responded to a request for consulting services to conduct a consolidation feasibility study for the Summit County Health District and Akron City Health Department. CCS committed to providing the following services/deliverables:

• 1. Conduct interviews with key individuals to determine views and expectations of

the study, concerns regarding the proposed consolidation, key issues to be addressed, and other relevant information.

• 2. Conduct a thorough examination and analysis of the critical issues relevant to

health department consolidation including: (a) governance and organizational structure, (b) capacity assessment, (c) facilities and space, (d) funding, resources, and costs, (e) legal issues, and (f) implementation timetables.

• 3. Facilitate at least (3) three community and stakeholder meetings and provide a

written summary of comments.

• 4. Produce a written report that includes the findings, data, and other relevant

information from the interviews, analysis, and community meetings. The report will serve as a guide for consolidating the health departments. The CCS consulting team will be led by Ken Slenkovich, W.M. & E.C. Treuhaft Chair in Health Planning, and will include Susan Ackerman (senior budget analyst), Wendy Feinn (program analyst), and John Begala (executive director). It is expected that the team will receive data and information from the appropriate Summit County officials including:

• Applicable local ordinances and regulations.
• Staff listings, position descriptions, job classifications and pay grades, benefit

schedules.

• Labor agreements and personnel policies and procedures.
• Vendor contracts and lease agreements.
• Equipment inventories.
• Facilities descriptions and maintenance agreements.
• Program listings and descriptions.
• Board composition, policies and procedures, bylaws.
• Organizational charts, budgets, and financial statements

The length of the engagement is expected to require approximately four (4) months. The cost for the engagement will not exceed $50,000 at $75.00 per hour. The CCS team is available to begin the engagement immediately.

Appendix C

Summit County Health District Merger Feasibility Study Committee Governance Subcommittee

There are four relevant statutes: R.C. 3709.01, 3709.07, 3709.071 , and 3709.10.

• A. R.C. 3709.01 creates the various health districts and then allows for

the "union of two or more contiguous general health districts, not to exceed five, a union of two or more contiguous city health districts to form a city health district, or a union of a general health district and one

• r more city health districts located with or partially within such general

health district." B) R.C. 3709.07 sets forth the process for combining a general health distinct and a city health districts or districts. The statute requires an affirmative vote to combine by a majority of the district advisory council

• f the general health district and the legislative authority of each city to
• combined. When approved, the chair of the district advisory council and

the chief executive of each city shall negotiation and enter into a contract for the administration of health affairs in the combined district; including: 1) the proportion of the expenses to be paid by the city or cities and by the original general health district; 2) the administration of the combined district; and 3) the date on which such change of administration shall be made. 4) the administration changes shall spell out any changes to the composition and governance of the Board of Health for the combined district. a) One of the members of such combined board of health shall be a physician, and one member shall be an individual appointed by the health district licensing council established under section 3709.41 of the Revised Code.

b) The contract may also provide for the representation of areas by one or more members and shall, in such event, specify the territory to be included in each such area. c) The appointment of any member of the combined board who is designated by the provisions of the contract to represent a city shall be made by the chief executive and approved by the legislative authority of such city. i) If a member is designated by the contract to represent more than one city, the member shall be appointed by majority vote of the chief executives of all cities included in any such area. ii) Except for the member appointed by the health district licensing council, the appointment of all members of the combined board who are designated to represent the balance of the district shall be made by the district advisory council. 5) The combined district shall constitute a general health district with all the powers granted to, and perform all the duties required

• f, the board of health of a general health district.

6) The district advisory council of the combined general health district shall consist of the members of the district advisory council

• f the original general health district and the chief executive of

each city constituting a city health district, each member having

• ne vote.

7) A copy of such contract shall be filed with the director of health. 8) The service status of any person employed by a city or general health district shall not be affected by the creation of a combined district.

• C. R.C. 3709.10 sets forth the process when two or more contiguous

general health districts, not to exceed five, unite in the formation of one general health district. In such situations, a majority of the district advisory council of each general health district wishing to combine must vote in favor of the union. 1) When the district advisory councils have voted to combine, they shall meet in joint session and shall elect a board of health for the combined districts.

2) Each original general health district shall be entitled to at least

• ne member on the board of health of the combined districts.

3) When such union is completed, such district shall constitute a general health district and shall be governed in the manner provided for general health districts. 4) When two or more general health districts unite to form one district, the office of the board of health shall be located at the county seat of the county selected by the joint board of district advisory councils. 5) When two or more general health districts have been combined into a single district, the county auditor of the county selected by the joint board of district advisory councils as the location of the central office of the board of health shall be the auditor of such district and the county treasurer of such county shall be the custodian of the health funds of such district. 6) When the budget of such combined general health district is a matter for consideration, the members of the budget commissions

• f the counties constituting the district shall sit as a joint board for

considering and acting on such budget.

• D. R.C. 3709.071 is an odd statute in that provides the method by

which the question of combining or forming a combined health district between a general and one or more city health districts can be put on the

• ballot. To date, there has only been one use of this statute. Without

elaborating on the ballot process (outside the scope of the question presented), if the electorate votes to combine, then the combination will follow the process set forth in R.C. 3701.07.

Appendix D

February, 2010

Memorandum of Understanding

Initiating the Union of the City of Akron Health Department With the Summit County Health Combined District

This Memorandum of Understanding (MoU) is made on this 10th day of February, two thousand ten between the City of Akron, Ohio and the Summit County Combined General Health District. The purpose of this Memorandum of Understanding is to demonstrate good faith commitment and intent by both parties to consolidate their respective public health districts. The anticipated date of a formal union of the health districts will be January 1, 2011. This Memorandum of Understanding follows the recommendation of the Consolidation Merger Feasibility Study Group to create a union of the Akron Health Department and the Summit County Health District. It comes with the concurrent support of the Akron Health Commission and the Summit County Board of Health. The goal of this agreement is to allow a seamless transition of responsibility for federal, state and local public health services from the city health district to the county combined health district. The transition plan will depend on assuring quality, accessibility and accountable of those services to all residents of Summit County. In order to complete a contract with the Summit County Health District as the provider of public health services and in order to assure the continued delivery of quality service to residents of Akron, the following are priority issues and/or deliverables the parties mutually agree should guide the transition process:

• Facilities will be maintained and operated in the City of Akron to assure

continued convenience of public health services and access to area residents.

• There will be continued employment for Akron Health Department staff in good

standing.

• The City of Akron will reconcile all city specific employee employment
• bligations prior to their transfer to the County Health District.

_________________________________________________________________ Honorable Don Plusquellic, Mayor, City of Akron Date _________________________________________________________________ Gene Nixon, Health Commissioner, SCHD Date