What are the powers and duties of a local health director?
All local health directors have powers and duties that come from multiple sources of law.[1] A local health director’s powers and duties fall into five general categories:
Administration: The local health director administers programs under the direction of the board of health.[2] All types of local health directors have the authority to employ and dismiss health department staff, but the employment decisions of a director of a consolidated human services agency must be approved by the county manager.[3] In addition, the director of a county health department, a district health department, or a consolidated human services agency may enter contracts on behalf of the department, but the law that gives local health directors this authority also states that it shall not “be construed to abrogate the authority of the county commissioners.”[4] Thus, it is a common practice to have county managers involved in the approval or execution of health department contracts.
Other administrative functions include serving as secretary to the board of health;[5] explaining the department’s activities to the board, local officials, and the public; preparing the agency’s budget; and preparing the department for accreditation. While these activities are the local health director’s responsibility, some of them may be delegated to other department staff and the way particular functions are handled may differ from place to place.
Remedies: The local health director is responsible for enforcing public health laws within his or her jurisdiction and may employ a number of legal remedies when public health laws are violated. The director may:
- Initiate civil or criminal proceedings against a public health law violator[6]
- Abate public health nuisances or imminent hazards[7]
- Impose administrative penalties (fines) for violations of state or local laws regulating smoking in public places[8]
- Embargo food or drink in some circumstances[9]
- Impose administrative penalties for violations of local on-site wastewater rules, or conditions imposed on permits issued under such rules[10]
The local health director may also play a role in actions taken by local public health employees to suspend or revoke permits, such as a permit to operate a restaurant.[11]
Communicable disease control: The local health director must investigate cases and outbreaks of communicable diseases and ensure that communicable disease control measures are given.[12] The director may order isolation or quarantine if the legal conditions for exercising the isolation or quarantine authority are met.[13] The local health director also has the duty to enforce the North Carolina laws requiring the immunization of children.[14]
Other disease control: The local health director must examine, investigate and control rabies in accordance with state public health laws.[15] The director must also investigate the causes of other diseases in the jurisdiction, whether or not they are communicable.[16]
Educate and advise: The local health director must disseminate public health information, promote the benefits of good health, and advise local officials about public health matters.[17]
This list is not exhaustive. Local health directors are responsible for the overall operation of the local public health agency, which makes the director ultimately accountable for administrative activities associated with the agency’s performance of local public health services and functions. A consolidated human services director also has duties that go beyond those of a traditional local health director, largely reflecting the consolidated human services director’s role as the chief administrator for human services programs other than public health. More information on the services and activities of local public health agencies is available here.
[1] The main statute setting forth the powers and duties of local health directors is G.S. 130A-41. See also G.S. 153A-77(e) (consolidated human services directors); 130A-45.5(c) (public health authority directors). However, other powers and duties appear in elsewhere in Chapter 130A or in other laws.
[2] G.S. 130A-41(b)(1) (county and district health directors); 130A-45.5(c)(1) (public health authority directors).
[3] G.S. 130A-41(b)(12) (giving local health director the power to employ and dismiss health department employees in accordance with the State Personnel Act); 130A-45.5(c)(12) (giving public health authority director the power to employ, discipline, and dismiss authority employees); 153-77(e)(1) (authorizing consolidated human services director to appoint agency staff with the approval of the county manager).
[4] G.S. 130A-41(b)(13). In public health authorities, the board has the power to enter contracts, not the director. G.S. 130A-45(a)(12). However, the board could delegate this power to the director. G.S. 130A-45(a)(9) (authorizing a public health authority board to “delegate to its employees or agents any powers or duties as it may deem appropriate”).
[5] G.S. 130A-35(e) (local health director serves as secretary to county board of health); 130A-37(f) (local health director serves as secretary to district board of health); 130A-45.1(h) (public health authority director serves as secretary to public health authority board); G.S. 153A-77(e)(4) (consolidated human services director serves as secretary and staff to consolidated human services board under the direction of the county manager).
[6] G.S. 130A-18 authorizes the local health director to institute an action for injunctive relief in superior court. G.S. 130A-25 makes violation of most state and local public health laws or rules a class 1 misdemeanor (see also G.S. 14-3, providing for the classification of misdemeanors). However, violations of laws and rules pertaining to smoking in public places may not be prosecuted as misdemeanors. G.S. 130A-497(d). Further, in counties in which the county commissioners have assumed the role of the local board of health, the commissioners are authorized to enforce local rules through civil penalties--an option that is not available in counties with other forms of public health governance. G.S. 153A-77(a). However, if the commissioners exercise the option to impose a civil penalty, violation of the local rule subject to the penalty is not a misdemeanor unless the rule specifically states that it is. Although G.S. 130A-25 does not specify a role for a local health director, in practice the director is likely to be the person who asks the district attorney to bring the misdemeanor charge.
[7] G.S. 130A-19 (public health nuisance); 130A-20 (imminent hazard).
[8] G.S. 130A-22(h1).
[9] G.S. 130A-21.
[10] G.S. 130A-22(h). Very few counties have local on-site wastewater rules. In most counties, the state on-site wastewater laws apply and different remedies are available.
[11] See G.S. 130A-23, authorizing the Secretary of Health and Human Services to revoke or suspend permits upon finding a violation of state environmental health laws. Although the power to exercise this remedy is given to a state official, in practice violations are discovered and permit actions are taken by local environmental health specialists acting under the supervision of the local health director.
[12] G.S. 130A-144.
[13] G.S. 130A-145.
[14] G.S. 130A-41(b)(7).
[15] G.S. 130A-41(b)(10).
[16] G.S. 130A-41(b)(3).
[17] G.S. 130A-41(b).
