Cambridge Health Alliance CEO Assaad Sayah, left, at a Tuesday hearing with City Manager Yi-An Huang, center, and Derrick Neal, Cambridge’s chief public health officer. The image is taken from city video.

City councillors who were shocked to learn this year that the city did not control its own public health department are exploring whether to change the relationship. Two council committees met jointly Tuesday to start examining the 27-year-old legal framework that ended the agency’s status as a city department and made it part of the Cambridge Health Alliance.

A 1996 state law established the Alliance, ending the city’s operation of then Cambridge Hospital. The Alliance became the city’s public health commission; its chief executive became the health commissioner. CHA also gained the right to acquire Somerville Hospital and other health entities. The city agreed to pay it to operate a public health department, and the Alliance agreed to provide a long list of health care services that included public health and medical care.

As the years went by, only the amount the city paid changed, and councillors routinely approved a health department budget that included few details. No one questioned the arrangement. Meanwhile, CHA acquired Whidden Hospital in Everett, ended Somerville Hospital’s role as an acute care hospital and replaced its emergency room with an urgent care center, and expanded into several communities west and north of Cambridge, including providing some public health services there, among other changes.

That lack of attention changed this year after CHA decided to lay off seven health department workers as part of a larger layoff of 83 employees at the Alliance to cope with big expected financial losses. Councillors found out during hearings for this year’s city budget that they had no say over the decision. They then did the only thing they did have power over: They refused to approve the city’s budgeted allocation to the Alliance.

That conflict is over. The city offered to pay CHA more money to save the seven jobs. Alliance chief executive Assaad Sayah agreed to preserve all but two, saying that the health department needed to share the pain.

And now, the council’s health and environment committee and its government operations, rules and claims committee are examining “whether the current structure is serving us well,” said councillor Patty Nolan, head of the Health & Environment Committee, at the Tuesday meeting.

“The current structure is now over 25 years old, and the health care landscape is drastically different now than it was then. Even our understanding of public health has drastically changed over the years,” Nolan said.

Serving several communities

Vice mayor Alana Mallon, chair of the Government Operations, Rules & Claims Committee, explored CHA’s serving communities besides Cambridge. “One of the things we noticed during the public health crisis and the Covid pandemic was that the CEO of CHA was our public health commissioner, which oversaw four other communities and that the public health needs of the city of Cambridge varied from some of those other communities.”

“And, you know, one of the things we started thinking about was, does Cambridge need a public health commissioner that’s based here in Cambridge to … be empowered to meet our community’s unique public health needs?” Mallon asked.

The idea of changing the relationship elicited pushback from Sayah, that chief executive (and health commissioner). “I think it’s less a secret that our model was absolutely effective during the largest public health crisis of the century, and that’s Covid. And the relationship between the city and the Alliance and the Public Health Department was absolutely evident in really pivoting in a very short order, and responding to the public health crisis in a way that I don’t think any other municipality in the state or maybe in New England responded to,” he said.

Sayah also said CHA fulfilled requests for clinical services from Cambridge “seamlessly,” while people in other communities had to make a phone call to ask for help. CHA spends more on public health than the city gives – about $1.4 million more this fiscal year, according to a budget document. It said the city is contributing almost $8.5 million to help fill a $9.8 million gap between revenues and expenses. The expenses include $1.5 million in “overhead” expenses such as administration.

A closer look at finances

Councillors want a lot more details. “We have been asking for that expanded budget” since the fiscal year 2024 budget hearings, “so that I think the sooner the better on some of those past budgets and when we talk about upcoming contracts, and how they will be structured. I think that should be the expectation – that we receive an expanded detailed budget,” Mallon said. “I mean,  that’s what we get in the budget book for other departments.”

Sayah said councillors will get the information addition to the audited financial report the city gets for the Alliance every year. It wasn’t clear if that report included a breakdown for the health department; CHA’s budget approved by its trustees every year and its monthly financial reports don’t break out figures for the health department.

The Tuesday meeting is just the first, Nolan made clear. “I look forward to working with the vice mayor and the city manager and CHA on some next steps,” including asking for an opinion from the city’s legal department “how it is that we can move forward,” Nolan said. Mallon suggested that the council might want to hire a consultant to provide “the best advice on how to move forward, because it seems like there are a lot of opinions in this room about the best way to structure this relationship.”

That might be an easy way for us to have the conversation without a lot of the history and feelings that are happening,” she said.