THE MISSISSIPPI LEGISLATURE

A Review of the Mississippi State Department of Health

Executive Summary

Protecting and promoting public health in Mississippi is challenging given the state’s demographics (e.g., a high percentage of the population which is low-income, rural, and undereducated). These demographics are associated with behaviors linked to greater risk of disease, high incidences of disease, and poor access to healthcare.

In FY 1999, the State Department of Health expended $175.4 million on public health programs. The majority of revenues (51.2%) consisted of federal funds and the sub-program receiving the greatest total funding ($53.3 million) was the supplemental food program for Women, Infants, and Children (WIC). Between FY 1990 and FY 1999, state funds expended by MSDH nearly doubled, from $20.3 million to $37.5 million.

In addition to the State Department of Health, hundreds of entities in both the public and private sectors carry out activities that directly impact the protection and promotion of public health in Mississippi. In terms of broad health indicators, while Mississippi continues to rank poorly on several major public health indicators in comparison to the rest of the country (e.g., years lost by premature death, infant mortality rate, death rates by motor vehicle accidents, incidence of sexually transmitted diseases, teenage birth rate), the state has made progress on a few indicators during the decade of the 1990s (e.g., reduction in syphilis and infant mortality rates) and ranks well on other important public health measures, such as the percentage of children who are immunized.

PEER reviewed three MSDH regulatory programs and found deficiencies in enforcement which compromise the ability of these programs to protect the public from associated health risks. Also, PEER determined that MSDH could improve the timeliness and comprehensiveness of its data collection efforts.

Collection and Analysis of Public Health Data

1. To improve accuracy and timeliness in the reporting of communicable disease data, MSDH should:

--facilitate reporting by printing the phone number, fax number, and MSDH’s mailing address on Form 135, the form used to report communicable diseases;

--investigate the possibility of online reporting of data;

--add to Form 135 the date that the laboratory results were available, as this is a more accurate date to assess timeliness;

--track, document, and send educational material to every physician who reports more than seven days after the stated deadline for all classes of communicable diseases to encourage more timely reporting; and,

--identify physicians who rarely report communicable diseases and pro-actively contact a specified number per month to inform them of the reportable diseases and proper reporting procedures.

2. The Legislature should consider amending MISS. CODE ANN. § 41-23-1 to provide for several levels of penalties for late reporting and failure to report communicable diseases (e.g., suspension of license, revocation of license, $100 for the first violation, $500 for the second violation).


3. MSDH should add streptococcus disease and toxic-shock syndrome to its list of reportable diseases, since these diseases are on the Centers for Disease Control’s nationally notifiable list and are not regional diseases.


4. To address the problem of MSDH not having comprehensive chronic disease data, the Legislature should consider mandating hospitals to report discharge data to MSDH.


5. MSDH should explore ways of improving the accuracy of reporting causes of death. For example, the department might consider changing the death report form to allow for more than one cause of death and should train doctors, funeral home directors, hospitals, and coroners in the importance of accurate reporting.


6. In order to improve the timeliness of vital statistics reporting, the Legislature should consider imposing penalties parallel to those established for the reporting of communicable diseases (see recommendation 2).

Food Protection

7. MSDH should establish a maximum number of inspections a food establishment can fail within a given time frame, regardless of whether it passes follow-up inspections, before suspending its permit for a specified period.


8. MSDH should inspect food establishments with the frequency required by regulation and more strictly enforce policies governing the Certified Food Manager Program.


9. When conducting internal audits of the food protection sub-program, MSDH internal auditors, not the district, should select the counties to be evaluated and the files within the county offices to be reviewed.


10. MSDH internal auditors should ensure correction of deficiencies cited in internal audit reports by continuing to follow up until the deficiencies are corrected.

Milk Sanitation

11. MSDH should update its milk plant inspection form to correspond with the Grade A Pasteurized Milk Ordinance.

Child Care Facility Licensure

12. MSDH should reallocate staffing resources in order to meet the National Association for the Education of Young Children’s staffing standard for child care facility inspectors of a maximum of seventy-five facilities per inspector.


13. MSDH should formalize its hearing process for violations of child care facility licensure regulations and make a record in all child care cases, including all findings and conclusions.


14. MSDH should implement its planned quality assurance function in order to ensure that child care facility inspectors uniformly enforce regulations.

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