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Guest Column: Fixing South Carolina’s ‘Out Of Control’ Health Bureaucracy

Jennifer Black: State representatives need to get serious about reforming broken, unaccountable agency.

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Three years ago, this past month, the lives of all South Carolinians were forever changed.  In many ways, many of us are still affected by the responses of our government officials to the COVID pandemic.  How our kids attend school, how we think about our neighbors, and how we look at disease has forever been shaped by what we were told and what we were required to do.

Incidentally, much of the decision making on South Carolina’s response came from one agency.  The S.C. Department of Health and Environmental Control (DHEC). A somewhat sleepy, yet expensive, agency – DHEC was thrust into a leadership position, “guiding” South Carolina and its government officials on what the state was going to do about COVID.  Although South Carolina has typically been known as a “legislative” state, when DHEC was formed in the 1970s the legislature chose to abdicate its authority to this agency via broad language regulation. 

What makes this worse is that this is not a cabinet agency, so the Governor has no direct power either. 

Ultimately, during the pandemic DHEC became the most important game in town.  Without really any accountability, they wielded that self-important control.  Because of their position, their “guidance” was interpreted as requirements, because going against their recommendations put businesses and other government entities in a potentially liable position.  The Governor, Department of Education, local school boards and businesses were at odds with not only the practicalities of their recommendations, but also with their narrow thinking of solving a disease without addressing the consequences of such decisions. 



Since DHEC did not answer to anyone, there was no way of reigning in its bureaucrats’ power. In the wake of leadership being centered under several government officials that were not working together and at times responding to an agency led by unelected officials, the citizens of South Carolina were caught up in chaos and suffered. 

What became apparent throughout the pandemic is DHEC’s authority is out of control. Yet, three years later, our legislature continues to struggle with how to deal with DHEC.  Despite seeing how other states were able to respond to the pandemic and get laser focused on addressing state citizen specific needs, there doesn’t seem to be any desire to make some real impactful changes coming from leadership from at least one side of the General Assembly.

On the issue of Certificate of Need, which the Governor temporarily repealed during the pandemic so that the market could respond appropriately, the House waited until the last minute of the last legislative session to deal with the request for permanent repeal by the Senate, thereby failing to pass legislation in time.

In consideration of restructuring DHEC, the House again is the issue and doesn’t seem interested in solving DHEC’s lack of accountability.  Their solution is to split the agency into two different factions, blowing up the budget to do so and leaving the leadership structure not only in place, but also under a board that has been ineffective since its inception.

(Click to View)

Sen. Shane Martin, right, and Sen. Harvey Peeler, far left, during a Senate Finance Committee meeting on Monday, April 3, 2023 in Columbia, S.C. (Travis Bell/STATEHOUSE CAROLINA)

Fortunately, the Senate held extensive hearings to explore these issues and how other states operate, specifically Iowa. In recent news, Iowa re-aligned their structure to put 16 cabinet positions under the Governor, including their Department of Health being put under their Department of Health and Human Services as an aftermath of the pandemic, addressing inefficiencies and a need for shared direction. Meanwhile, Florida seemed to manage the pandemic effectively and was an example that America learned from. It worked because their accountability solution was a reporting structure to the Governor via a Surgeon General.

We are approaching the end of the legislative year, and while we hear rumblings of other diseases across the world, South Carolina is bound to repeat what it has done before.  Not because adjustments haven’t been made and lessons learned – but because without DHEC’s structure and accountability being addressed, the system is ripe to produce yet another episode of chaos, egos, government inefficiencies and South Carolina citizens suffering, with very little recourse.

As an aside, I often think about one legislator’s infamous “efficacy bar” for making decisions and laugh when I see these two issues drag on, unresolved.  As if addressing problems with the structure of government before it becomes a problem is ignorant or a waste of everyone’s time. It is worth noting that both aforementioned issues have been brought up to the General Assembly many times and long before the pandemic.  I think everyone can agree that post-pandemic, the need to address these two issues is very clear and efficacious.

Oh well. The citizens must suffer first, I guess.



Jennifer Black (Provided)

Jennifer Black is a Christian mother, accountant and conservative activist from Greenville, South Carolina.



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mysonsdad Top fan April 8, 2023 at 3:10 pm

The DHEC Board is appointed by the Governor with the consent of the Senate. If they felt like DHEC was doing an inadequate job they could’ve asserted their authority for change to occur. Putting DHEC in the cabinet and combining it with other agencies to make a mega-agency larger than the current DHEC is a solution to a problem that doesn’t exist.

schealth April 8, 2023 at 5:38 pm

Unfortunately in practicality, the power of the Board is not that powerful either. They do not get into policy or practice of DHEC, they only hire and fire the Director. And when you are missing leadership in real time, having a spread out board, coupled with their only threat of firing the Director of DHEC, no action happens. I am not sure how putting DHEC into a cabinet agency makes a “mega-agency larger”. It merely puts the focus of accountability clear, to an elected position that is ultimately beholden to his/her vote.

RC April 10, 2023 at 11:53 am

The only restrictions that were made at the state level were via executive order of the governor. The governor likewise included DHEC in his regular public addresses and stood behind them in their recommendations. Whether there was any issue with DHEC or not (and I’m certainly not conceding that there was), the governor was most responsible for the state’s pandemic response (again without giving any opinion on whether it was good or bad).


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