To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Nolan Sullivan, 707-565-4774
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Amendment to Agreement with Dr. Karen Smith for Interim Health Officer Services
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services to execute an amendment to the agreement with Dr. Karen Smith to provide interim Health Officer services for a single month term extension, increasing the original contract amount by $13,686, for a revised total not-to-exceed amount of $165,998, and extending the contract term through October 31, 2025.
B) Adopt a Budget Resolution authorizing adjustments to the Department of Health Services Fiscal Year 2025-2026 Adopted Budget to reflect additional revenues and expenditures in the amount of $13,686, associated with costs for the Interim Health Officer during the final month of the service agreement. (4/5th Vote Required)
end
Executive Summary:
The Board of Supervisors appoints the County Health Officer in accordance with California Health and Safety Code Section 101000 <https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=101000.>. Reporting through the Director of the Department of Health Services, the Health Officer provides leadership in protecting public health, enforcing health regulations, and advising County leaders, the medical community, and the public on matters of health and safety. The COVID-19 pandemic underscored the importance of having a highly qualified Health Officer with expertise in infectious disease and strong leadership skills.
Following the resignation of the County Health Officer effective October 28, 2024, the Board appointed Dr. Karen Smith as Interim Health Officer effective the same date. The Board also approved an interim services agreement with Dr. Smith in an amount not to exceed $123,616 for a nine-month term, October 28, 2024, through June 30, 2025, to allow time for a nationwide recruitment of a permanent replacement. On July 8, 2025, the Board authorized an amendment extending the agreement through September 30, 2025, and adding $41,058, bringing the total not-to-exceed amount to $152,312.
The Department now requests Board approval of a final amendment to extend Dr. Smith’s interim agreement for one additional month, October 1 through October 31, 2025, to allow time to finalize either a new Interim Health Officer or a permanent appointment. This amendment would add $13,686, for a total not-to-exceed amount of $165,998. Dr. Smith has indicated she is unable to continue beyond October, and the Department will return to the Board next month with a recommendation for either a permanent Health Officer or a new interim appointment.
Discussion:
The Sonoma County Board of Supervisors appoints the Health Officer in accordance with California Health and Safety Code Section 101000 <https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC§ionNum=101000.>. The Health Officer reports through the Director of the Department of Health Services (hereinafter, “DHS” or “the Department”) and is responsible for protecting public health, enforcing state and local health regulations, and advising elected and appointed officials, the medical profession, and the community on health and safety issues.
Dr. Tanya Phares, who was appointed as County Health Officer on November 14, 2023, resigned effective October 28, 2024. To maintain continuity of leadership and expertise, the Board appointed Dr. Karen Smith as Interim Health Officer effective October 28, 2024, and approved an interim services agreement not to exceed $123,616 through June 30, 2025, while a nationwide recruitment was initiated.
On July 8, 2025, the Board approved an amendment extending Dr. Smith’s contract through September 30, 2025, and increasing the not-to-exceed amount by $41,058, for a total of $152,312. Despite extensive recruitment efforts, no final candidate for the permanent position has yet been secured.
Through this item, DHS requests authorization for a final one-month amendment to Dr. Smith’s agreement, extending services through October 31, 2025. This amendment will add $13,686, bringing the total not-to-exceed amount to $165,998. This extension ensures uninterrupted medical and public health oversight while DHS completes negotiations with another qualified Interim Health Officer or finalizes a permanent appointment. Dr. Smith has indicated she cannot extend beyond October.
The role of the County Health Officer is essential to the Department’s operations and the community’s health. Responsibilities include:
• Developing and overseeing medical protocols for DHS programs.
• Providing expert guidance to County officials, the medical community, and the public.
• Ensuring compliance with public health laws, regulations, and ordinances.
• Leading public health initiatives aligned with the DHS Strategic Plan and Board priorities.
• Collaborating with community partners on issues such as food systems, environmental health, children’s dental care, and integrated health delivery systems that advance the “Triple Aim” of improved care, reduced cost, and expanded access.
The COVID-19 pandemic underscored the importance of strong, knowledgeable leadership in this role. Approval of this amendment ensures the County continues to have experienced medical oversight during the transition to a new Health Officer.
Strategic Plan:
None
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
On July 8, 2025, the Board authorized the Director of Health Services to execute an amendment to the agreement with Dr. Karen Smith to provide Interim Health Officer services, increasing the original contract amount by $28,696 for a new total not-to-exceed amount of $152,312, and extending the contract term through September 30,2025.
On October 22, 2024, the Board adopted a resolution appointing Dr. Karen Smith to the position of Interim Health Officer for the County of Sonoma effective October 28,2024; and authorized DHS Director to execute a professional services agreement with Dr. Karen Smith to provide Interim Health Officer services in an amount not to exceed $123,616 through July 28, 2025.
On November 7, 2023, the Board appointed Dr Tanya Phares to the position of Health Officer effective November 14, 2023.
On August 1, 2023, the Board appointed Dr. Karen Smith to the position of Interim Health Officer effective August 5, 2023.
Fiscal Summary
|
Expenditures |
FY 25-26 Adopted |
FY26-27 Projected |
FY27-28 Projected |
|
Budgeted Expenses |
$28,696 |
|
|
|
Additional Appropriation Requested |
$13,686 |
|
|
|
Total Expenditures |
$42,382 |
0 |
0 |
|
Funding Sources |
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General Fund/WA GF |
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State/Federal |
$42,382 |
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Fees/Other |
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Use of Fund Balance |
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General Fund Contingencies |
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|
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Total Sources |
$42,382 |
0 |
0 |
Narrative Explanation of Fiscal Impacts:
The Department’s Fiscal Year 2025-2026 Adopted Budget was previously increased by $28,696 through a Board-approved item to cover salaries and benefits for the remainder of the original contract. The Department now requests an additional $13,686 in appropriations to support costs associated with the Interim Health Officer for the final month of the extended service agreement. Funding will primarily come from Public Health Realignment and may be supplemented by other sources, depending on the scope of work completed and the availability of additional funds.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
None
Attachments:
Attachment 1 - Budget Resolution
Attachment 2 - Draft Amendment
Related Items “On File” with the Clerk of the Board:
None