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story.lead_photo.caption This undated electron microscope image made available by the U.S. National Institutes of Health in February 2020 shows the Novel Coronavirus SARS-CoV-2. Also known as 2019-nCoV, the virus causes COVID-19. The sample was isolated from a patient in the U.S. (NIAID-RML via AP)

A new Missouri proposal meant to keep local health departments from issuing stay-at-home orders could keep them from making any health regulations if it's approved, critics said.

With the end of the legislative session looming, the Missouri General Assembly is gathering bills together into omnibus packages. The House General Laws Committee was doing that Wednesday with a bill that would originally have the state health department issue epinephrine injectors (Epi-Pens) to rural fire departments.

State Rep. Dean Dohrman, R-La Monte, added a paragraph that some local health officials said would eliminate their ability to make any rules to prevent the spread of disease, including stay-at-home orders. The orders are meant to slow the spread of COVID-19 but have also forced businesses to slow or shut down, causing unprecedented layoffs across Missouri.

The amendment would add a paragraph to the section of Missouri law that gives county commissions and health center boards the ability to make rules to prevent the spread of disease, saying the health center boards could only advise county commissions.

Dohrman said his amendment was meant to clarify which local government bodies have the authority to pass stay-at-home orders — county commissions or county health boards. The statute isn't OVERSET FOLLOWS:clear. There needs to be a clear line of authority during a crisis, and any rule and enforcement should go through the county commissions, he said.

"We know this is going to come back around. We could have another serious disease come in. We need somebody who's the authority to speak," Dohrman said. "The health board should do what the health board does, which is keep track of these things and give professional advice."

Dohrman's proposal would affect county health center boards voters have set up as separate entities in 89 Missouri counties, similar to fire protection districts, with elected boards and a property tax levy.

Cole County's health department is one of 17 in the state organized through its county's commission, so it already works with the commission to enact rules.

The proposal would change the same statute the Legislature amended last year to bar county health boards from passing regulations on agriculture — an attempt to stop county-level regulations on concentrated animal feeding operations.

Dohrman's amendment would go further, wiping out elected health boards' ability to make any health regulations, said Miller County Health Center Administrator Mike Herbert, who also serves as legislative committee chair of the Missouri Association of Local Public Health Agencies.

The health departments would still be allowed to issue advisories, encouraging people to limit contact or to wear face masks in public, Dohrman said. They could also advise the county commissions on health-related ordinances they could pass.

Several Democrats on the committee questioned the proposal, saying it would take away authority from local health departments when they need it most, as they fight the spread of COVID-19. Eighty-nine Missouri counties have elected health boards, separate from county commissions. People in those counties voted to set those up and to tax themselves to fund the departments to respond to health crises, state Rep. Tracy McCreery, D-Olivette, said.

"The governor has been really depending on these local elected health boards to make decisions for the community," McCreery said. "So I feel like what this amendment is trying to do is actually kind of go against what I'm seeing the governor do around the state, which is he's respecting local control."

State Rep. Mary Elizabeth Coleman, R-Arnold, said there had been confusion in Jefferson County over if a stay-at-home order could come from the health department or had to come from the county executive. There's precedent for the state health department having the authority to issue a stay-at-home order, but not for local departments, she said. Dohrman's proposal would make it clear local health departments don't share that authority.

Larry Jones, executive director for the Missouri Center for Public Health Excellence, said it's not clear the amendment would keep county health directors from issuing stay-at-home orders, and lawyers disagree on that. Dohrman's amendment would keep county health boards from making regulations on restaurants and grocery stores, sewers and preventing the spread of disease, he said.

"It would be like the county commissioner telling their local superintendent, 'You can tell me what it is you think we have to do for education, but I'll decide for you,'" Jones said.

The proposal is new and wasn't presented to a committee before it was brought up as an amendment Wednesday afternoon, where the committee voted to approve it without hearing testimony.

"It didn't get vetted, and that's a terrible thing to have happen in legislation — because oftentimes, you can improve the bill and come up with something that is really helpful," Jones said.

Since they weren't able to give testimony, Herbert and other health administrators emailed committee members, urging them to vote down the amendment. Herbert argued the amendment goes against the will of voters who established county health boards and elected their members and that it would politicize their health regulations.

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