COLUMBIA, S.C. – South Carolina's public health workers have been tasked with keeping the state safe for 143 years, ever since lawmakers created a health board in 1878 after a yellow fever outbreak killed 20,000 Americans.
Now, as the coronavirus pandemic surges, legislators are trying to break their agency apart.
As in most states, South Carolina's public health agency was underfunded and overworked long before it had to sustain an exhausting defense against a virus humans had never seen before.
Criticism has mounted from all sides since then — over a slow rollout of testing, the agency's refusal to release detailed data on early cases, and for seeming to sideline its top epidemiologist.
Now a new director has stepped into what many see as a leadership vacuum, but lawmakers intent on dismantling the Department of Health and Environmental Control aren't cutting him much slack.
Dr. Edward Simmer is the first medical doctor to helm the agency in nearly four decades — a fact that surprises Simmer himself. He told The Associated Press in an interview that he'll put science at the center of his dealings with the public, the legislature and the governor.
“Obviously, there are political aspects to what DHEC does. My focus is to be as apolitical as we can be,” Simmer said.
Unlike most public health agencies, South Carolina's portfolio has included environmental regulation since the 1970s. It now has nearly 4,000 employees, overseeing everything from water quality, dams and landfills to hospitals and vaccine distribution.
The sprawling agency only indirectly answers to elected officials, through an eight-member board appointed by the governor. State officials have said for years that it has become too powerful and unmanageable.
Lawmakers have accused the agency of failing to advocate forcefully enough for prevention measures or to push back on Republican Gov. Henry McMaster's decisions to reopen businesses. They said DHEC staff shirked responsibility by letting the board decide how to allocate limited vaccines; that the board, comprised mostly of businesspeople and just one doctor, lacks transparency; and that board members moved too slowly to find a new director after the last one quit, mid-pandemic.
Senate President Harvey Peeler is ready to split DHEC apart, bundling public health duties with the state's mental health department and funneling environmental permitting operations to other state agencies. McMaster has said he supports breaking up DHEC as well.
“No one is in control at DHEC and hasn’t been for quite some time,” Peeler declared in December when he announced the bill that would restructure the agency.
Public health agencies have become political scapegoats nationwide after years of inadequate funding, and a lack of federal leadership and coordination has made responding to the pandemic even more difficult, said Simon Haeder, a professor of public policy at Penn State.
In some other states with Republican-controlled legislatures such as Michigan, Montana, Ohio and Oklahoma, lawmakers are looking to curb the powers of proactive state and local health departments.
In South Carolina, the prevailing sentiment is a desire to make the agency more effective, after the response has been hamstrung by a series of politically-appointed directors who didn't last and other staff turnovers.
“You can make all the structural changes you want, but you’ve got to pick people who are really good at this,” said former Gov. Jim Hodges, who served from 1999 to 2003.
Sen. Dick Harpootlian, a Columbia Democrat who has railed against the agency's refusal to shut down businesses flouting public health guidelines, said the plan to split DHEC is a “distraction” and it's the board that ought to be replaced: “They've been useless. Useless is an understatement.”
There are signs that other basic agency functions are falling through the cracks.
Lapsed water pollution permits at three of the state's coal plants had languished for about a decade before environmentalists sued the agency last summer to do its job. The agency finally agreed in January to review the permits.
“Abdicating your responsibility to make sure you're protecting the citizens of the state from pollution is a pretty serious deficiency,” said Amy Armstrong of the South Carolina Environmental Law Project.
More recently, a computer system switchover left families and funeral homes without death certificates, as bodies awaiting cremation stacked up in at least one funeral home, The Post and Courier reported.
Still, people who've worked closely with the agency say splitting up DHEC without adequate funding and staffing will only make problems worse, and that trying to do so during a pandemic is ill-timed.
If anything, the agency's two sides should coordinate even more closely as hazards to human health increase due to climate change and other environmental threats, said John Simkovich, a regional director of public health who left in 2013.
Public health resources were slashed by lawmakers during the Great Recession, and board members' terms lapsed under Gov. Mark Sanford. His successor, Gov. Nikki Haley, remade the board, and Catherine Templeton, previously tapped by Haley to trim jobs at the state's labor department, was named director. Templeton initiated more cuts, centralizing offices and laying off seasoned staffers.
Dr. Robert Ball, one of the state’s top infectious disease epidemiologists until 2012, said morale went downhill after Templeton arrived, prompting an exodus of longtime employees that rapidly drained institutional knowledge.
Salaries remain relatively low for trained health professionals and scientists, so younger staffers quickly move on to earn more elsewhere, former employees say.
Simmer told lawmakers who confirmed him this month that he believes the agency’s environmental and public health halves complement each other. He asked senators to give him a year on the job to figure out reforms before they try to take the agency apart.
So far, he said, no one has promised him that time.