Suwannee Democrat


October 17, 2013

HamCo health department on road to accreditation

Jasper — Surgeon General

State Surgeon General John H. Armstrong M.D. visited the Florida Department of Health-Hamilton County on Thursday, Oct. 3, to assist in helping the health department become accredited, which is a voluntary program.

Armstrong is a trauma surgeon, public health professional, educator and military veteran, and was appointed by Governor Rick Scott to serve as State Surgeon General and Secretary of the Florida Department of Health on May 23, 2012.

Scott said, “Dr. Armstrong is recognized as a national expert in medical team training and public health preparedness for disasters, and his leadership will be a great asset to the citizens of Florida.”

Accreditation Coordinator

In preparation for the accreditation process, Hamilton/Columbia County Health Department Administrator Mark Lander approached Hamilton County resident Johnny Bullard in August and asked if he’d like to apply for a position as Accreditation Coordinator since he had experience in accreditation for the school system, and also has the ability to express himself well in written language. He also recruited Rel Perea for the health department in Columbia County.

Lander said, “You need someone who is detailed and someone who is not afraid to ask for what they need. Johnny and Rel are not afraid to ask and they’re not afraid to ask again if they don’t get answers the first time,” he added, grinning.

Bullard applied and got the job under the health department’s “Other Personnel Services” through a one-year grant program and is contracted by the hour. His first day on the job was Aug. 9 and he has been busy learning the standards and measures of the Public Health Accreditation Board (PHAB), a non-profit organization funded by the federal government.

Accreditation process

There are 12 measurement domains, Bullard explained, which are part of the accreditation process; conduct and disseminate information,  expectations, inform and educate the public, engage with the community and interact with their needs, planning and development of policies, enforcement of public health laws, provide access to healthcare standards, maintain a competent workforce, work on continuous improvement, contribute and apply the evaluative base of public health, address management and capacity with human resources and management information systems, and the capacity to engage the public health governing entity.

“Under those domains there are a number of different standards and measures, which have to be met,” said Bullard. “My job is to gather the information that documents the fact that we are working to meet or have met those standards and measures, and to write a report into a template that will be provided by our Department of Health at the state level, and to work within that framework to write a narrative that is unique to the population we serve here.”

A community health assessment and a community health improvement plan for the county have already been completed, Bullard explained, which is the first step in the accreditation process.

More than 20 states across the nation have already signed up and Florida is one of them.

“I’m enjoying my work here,” said Bullard. “There’s a lot of challenges. There’s a lot of meticulous, technical writing that goes along with it, because it is the jargon that bureaucrats want to see as far as documentation is concerned.”

The community

Bullard said he not only enjoys his job, but has learned a lot, including how vital the health department is to the community and all the services they offer. He also said a lot of the challenges residents are faced with are of a cultural nature, such as obesity.

“Here, people eat,” he said. “When people get together they eat. They eat southern food and it tastes great. It’s wonderful, but it’s not necessarily the best for you in some instances.”

Bullard said the school system has taken a big step forward in combatting obesity since Ida Daniels took over implementation of the free breakfast and lunch program with nutritionally balanced meals and proper portions.

“We all need to be eating more fresh fruits and vegetables,” said Bullard. “We all need to be walking more, exercising more, and drinking more water and less carbonated beverages.

Bullard told Armstrong the health department in Jasper does a great job, to which Armstrong responded, “I already know.”

“In this county, it really is the city set on a hill for healthcare,” Bullard said. “It reaches out to a large section of our citizens who don’t have anyplace else to go.”

“As I go around the state I do see some places like Hamilton where, clearly, there is a lot of synergy,” said Armstrong. “There’s a lot of mutual respect and trust. That’s how you ultimately elevate health in the communities by knowing who's in the community and building that trust and figuring out how to combine resources to make a difference.”

The accreditation process, Armstrong said, is moving forward.

“As you probably know, we got the state health office application in, so now we’re working to collect applications across 67 counties.”

The applications from all the Florida counties will go into one master database, Armstrong explained.

Hamilton County High School, it was noted by Bullard, has a full service clinic on campus, as well, that serves all the students in the county. Additionally, each school has a resident LPN on staff. Lander told Armstrong that Nursing Director Nancy Sult, RN is the heart of the health department.

“Hamilton is a very poor county with a high rate of poverty, but it’s a good county with very good people,” said Sult. “The resources here are small, but in a disaster situation everyone pulls together.”

Sult said the Hamilton County CERT team, along with the volunteer firefighters and the National Guard, recently held a search and rescue disaster exercise on the river. The county, she said, is surrounded by rivers on three sides.

“We’re the only county that isn’t connected to the state of Florida by land, and in an emergency, we’re not going to get the resources by land,” Sult continued. “It’s going to have to come from Georgia. When there is a need in the county, the people “come out of the woodwork.”

Sult explained to Armstrong that Hamilton is a big agricultural county with a large population of migrant workers.

“Recently, some of the farms have been bought out by a corporation that is being funded through the Gates Foundation,” she said. “They do row cropping in some places and right now they’re harvesting peanuts. “They’ve harvested corn and tobacco, and we have a lot of cattle.”

Florida is one of the nation’s largest cattle states, and Sult said her neighbor just shipped out a bunch of cattle to Texas.

“It’s small, it’s rural, but it’s proud people,” Sult said.


Over the last eight years, Sult said they went through 10 different physicians and explained how difficult it is to keep a doctor on staff because the county is so rural. The health department now has a full time nurse practitioner, whom she raved about, as well as a part time nurse practitioner. They are also covered by a physician in Columbia County. Sult is a credentialed nurse who does family planning.

“I have two RN’s and that’s it,” said Sult.

Lander said he is anxious to see the rural health clinic open for business so that the health department can get some relief and get back to the primary business of focusing on disease transmission.

“We’re turning people away right now for primary care because we’re so slammed,” said Lander. “We’re sending them down to Columbia to qualified health centers. We can’t support it. We’re just overwhelmed.”

Lander said once the rural health clinic opens, the health department will work hand-in-hand with them on a lot of joint ventures.

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