Medical community praises Brereton in confirmation hearing, lawmakers ask questions

By: - February 9, 2023 4:39 pm

The Montana Department of Public Health and Human Services (Photo by Eric Seidle/ For the Daily Montanan).

Legislators quizzed health department director Charlie Brereton this week about the troubled state hospital in Warm Springs and one asked about his tepid interactions with the legislative branch — but not before Lt. Gov. Kristen Juras and members of the Montana medical community sang his praises.

Charlie Brereton, Montana’s Director of the Department of Public Health and Human Services (Photo screenshot from Montana Public Affairs Network).

Wednesday, the Senate Public Health, Welfare and Safety Committee held a hearing on the confirmation of Brereton, who has led the Department of Public Health and Human Services since August 2022. Adam Meier, the previous director, said last summer he was stepping down due to “an ongoing family health issue.”

Joel Peden, who advocates for people who have disabilities, said oftentimes, people talk down to those who are disabled, but Brereton does not. Peden joined a chorus of health care representatives who requested the committee forward Brereton’s confirmation onto the full Senate.

“He is open and willing to listen,” Peden said. “We don’t always agree, right? Which is actually a good thing because sometimes, through those disagreements, we churn out a great solution.”

Craig Lambrecht, who said he has worked as an emergency physician, chief medical officer and done three military tours, said Brereton has done an “outstanding job” in a difficult situation. He described Brereton as a trustworthy “battle buddy” and said he will elevate DPHHS.

“I have the utmost confidence in this young man,” said Lambrecht, head of Kalispell Regional Healthcare.

Brereton, former health policy advisor to Republican Gov. Greg Gianforte and then chief of staff at DPHHS, also requested approval to lead the state’s largest public agency. He said he was proud to help Gianforte launch his “Montana Comeback” plan.

DPHHS had a total budget of $6 billion for the 2021 biennium including federal funds and counted 2,852 full time employees who work across Montana, according to the Legislative Fiscal Division.

“I’m eager to think past the mantra of ‘This is the way that we’ve always done it,’” Brereton said.

The state health department has faced difficulties, including in the wake of the COVID-19 pandemic.

Last year, the state mental health hospital lost its federal accreditation, which cost the health department $7 million. Also, 10 nursing homes in Montana have closed since the end of 2021, pointing to low Medicaid reimbursement rates in part as a culprit. 

In his presentation, Brereton said he is prepared to take on those challenges and already has made headway.

He described a career path in which he has demonstrated an “intense work ethic,” “seizure of opportunity at every turn” to develop policy matter expertise, and an aptitude for leadership. Brereton noted nearly 10 years of health and human services experience in federal and state government and the private sector.

He noted he worked with U.S. Sen. Richard Burr, R-North Carolina, former ranking member of the U.S. Health, Education, Labor and Pensions Committee.

His LinkedIn profile notes he was an intern for Burr in 2016, and after serving as an intern in 2017 at the law and lobbying firm Squire Patton Boggs, worked there as a public policy specialist and advisor.

He joined Gianforte in January 2021, at the height of the pandemic and after nearly two years with the U.S. Senate HELP Committee of U.S. Sen. Lamar Alexander, R-Tennessee, his LinkedIn says. Right away in Montana, Brereton said the new administration notched successes.

“These immediate successes included re-engineering our COVID-19 response and lifting statewide mandates to return Montanans’ freedoms, of which I was intimately involved,” Brereton said.

At the hearing, no one opposed his confirmation, but committee members asked him questions including about the way the department has handled nursing homes and its relationship with the legislative branch. The committee did not take immediate action Wednesday evening.

Sen. Jen Gross, D-Billings, grilled Brereton on numerous topics.

“Why did you not participate with the criminal justice oversight council when they repeatedly requested that you do so?” said Gross.

Brereton said he was typically copied on emails and his staff had presented multiple times. He said from his perspective, the agency had worked with the council.

“Perhaps there’s more collaboration that needs to occur, and I’m happy to do that,” Brereton said.

Gross also asked Brereton for the amount of money going to out-of-state consultants the last two years — information he said he did not have handy but would provide.

Among other questions, she asked whether he himself knew about the agency’s decision to circumvent a court order on birth certificates.

“I can’t speak to which order if I don’t know the specific order that you are referring to,” Brereton said.

In an ongoing and complicated legal dispute affecting people who are transgender, the ACLU of Montana sued the state of Montana over a restriction in how DPHHS allowed people to change their gender on a birth certificate.

In response to a temporary injunction, DPHHS modified its administrative rules. DPHHS argued the action was necessary, but the ACLU and the Montana Supreme Court found it questionable.

Gross also said she wanted to know the reason DPHHS, after initially participating with an interim committee, had later not responded to multiple requests from legislators for input on child and family services draft bills — and now was testifying in opposition to bipartisan legislation.

In response, Brereton said DPHHS has consistently provided feedback, and he and his colleagues have been transparent about their lack of ability to support proposals if the committee didn’t accept the agency’s position. But he said perception is reality, and he wanted to change that perception.

“Collaboration with you and your colleagues is extremely important to me,” Brereton said.

Following the positive testimony for Brereton, Sen. Becky Beard, R-Elliston, said it sounds like DPHHS is on the right track. She asked him and his staff to be a familiar and more frequent presence at the legislature, and she asked about nursing homes. 

On one hand, Beard said the executive and some legislators talk about a decline in demand for nursing homes, but on the other hand, the state is still talking about how to come up with an adequate increase in Medicaid rates.

Beard said a sizeable amount of money was appropriated for nursing homes that was then transferred elsewhere – she wasn’t sure where – and she wanted to know how legislators could be sure funds for nursing homes were restricted to nursing homes.

“Do you have any ideas?” Beard asked.

Brereton said he had many, and he also said the administration has been clear that it does not want to see closures. At the same time, he said data show a “soaring demand” in Montana and across the U.S. for home- and community-based care. 

As for the dollars, he said DPHHS projects utilization of services, and if its estimates end up being low in one area but high elsewhere, the department can make adjustments in reimbursements.

Others who testified in support of Brereton included representatives from Shodair Children’s Hospital, the Billings Clinic and Intermountain Healthcare in Montana.

With the Behavioral Health Alliance of Montana, Mary Windecker said Brereton has produced a needed “paradigm shift” that means the alliance and DPHHS are working in partnership on behalf of clients.

Lt. Gov. Juras, the first to testify, said she worked side by side with Brereton in the Governor’s Office prior to his appointment as head of the health department. In 2021, in the midst of the pandemic, she said he brought practical experience from a variety of perspectives.

Juras said he helped promote telehealth as a way to address workforce shortages, helped prioritize vaccinations, and took many phone calls at 10 p.m. or 11 p.m. She and others noted former U.S. Attorney for the District of Montana and former Gianforte budget director Kurt Alme also expressed support for Brereton. 

“I’m here to say that this man knows how to step up to a challenge — and he does have challenges at the department — and how to bring collaboration and innovative problem-solving solutions to those challenges,” Juras said.

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Keila Szpaller
Keila Szpaller

Keila Szpaller is deputy editor of the Daily Montanan and covers education. Before joining States Newsroom Montana, she served as city editor of the Missoulian, the largest news outlet in western Montana.