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Emily Varner, chief of the department’s health data team, said in a letter to department leaders that Director Dr. Kanika Cunningham’s mismanagement has prompted seven top managers, including Varner, to step down in as many months.

Moreover, Varner said in an interview Thursday, the department is inflating numbers in the county’s application for federal money for clinical services.

Together, the problems pose a risk to public health and clinical services the department offers to some of the county’s most vulnerable people, said Varner, who’s still employed for the next two weeks. She was placed on administrative leave after she gave her resignation notice.

“To see what’s happening internally, the community is going to suffer,� said Varner, who has worked at the department for more than eight years. “It’s the exact opposite of why we get into the field.�

Cunningham sent an email to employees Wednesday in response to Varner’s letter, which was circulating among department staff.

“Please know that the county takes allegations of discriminatory or harassing conduct very seriously and will not tolerate inappropriate behavior in the workplace,� Cunningham wrote. “Employees are encouraged to bring such matters to my attention at any time, without fear of any retaliation being taken against them for doing so.�

She asked employees to treat Varner’s letter as a “confidential personnel matter.�

Doug Moore, a spokesman for County Executive Sam Page, who appointed Cunningham in 2023, declined to comment.

Varner said the six other senior leaders who have left their positions in recent months had similar concerns.

The Post-Dispatch confirmed the departures of the communicable disease response director, the change management officer, the strategy and quality management director, the health center administrator and the deputy director. The chief medical officer quit her position but remains employed by the county, Varner said.

At least four of them wrote letters to department leadership, Varner said.

Laura Klaesner, the strategy and management director, wrote in a Nov. 15 letter that she was resigning because of retaliation and because she no longer felt like “a valued senior leader in this organization.�

“I am not leaving due to pay,� wrote Klaesner, who started working for the county in 1995. “I am leaving because I am no longer empowered to do my job.�

Klaesner declined to comment for this story.

Varner ran the health department’s data team, which manages health records, produces public health reports and helps track infectious diseases.

Varner said her problems started after she lost five staffers, almost half her team, to layoffs in December 2023, she wrote in her letter, dated Tuesday. She lost another to a change to the county’s remote work policy, and another who left for a new job.

Varner tried to work with Cunningham and other department leaders to find ways to reduce costs without laying people off. Varner offered to cut vacant positions, among other things, but Cunningham didn’t agree. Cunningham told her, and the County Council, that the layoffs were due to “a reorganization.�

But the reorganization never materialized in the year that followed, Varner said. She said she never saw a plan, though she asked for details and for guidance about how to talk with her staff about the layoffs.

“I would anticipate that, as the division director, I would be included in conversations/plans as has been done in the past,� Varner wrote.

The team’s workload doubled with only six employees left of the original 13, Varner said.

In May 2024, Varner was placed on a “performance improvement plan� after health department leadership expressed concerns about her work, Varner’s letter says, and Cunningham called her a “poor leader.� Prior to 2024, she had satisfactory performance reviews, Varner wrote.

The same month, attorneys with an outside law firm questioned Varner as part of a human resources investigation connected to the layoffs. Attorneys asked for her opinions of Cunningham and the county executive. They also asked if she had ever heard anyone say Page was “evil� or called him “a robot.�

After that, Varner said she was left out of decisions for key projects, such as choosing a new vendor for electronic health records. She said her boss, a senior health director, stalked her outside of the bathroom, yelled during meetings and screamed at her in front of other colleagues. She complained to HR, but nothing happened, she said.

Varner filed two grievances that summer with county HR, alleging her treatment was retaliation for questioning the layoffs. She never heard back, she said. She also never received reviews from her performance plan, and nothing was done in response to her complaints about her boss, she said.

Varner told the Post-Dispatch the public health department overall is suffering because of mismanagement. She witnessed some problems first-hand: The department’s clinical services provide primary care to people who either don’t have insurance or are underinsured, but the department hasn’t been able to modernize its digital patient portal where patients can look up information about their visits and health — leading to frustration for patients and doctors.

Varner doesn’t work on the clinical side, but she has heard directors in meetings discuss delays in patient care, a lack of providers and a lack of services. Some contracts have lapsed, she said.

And the department inflated numbers in an effort to get higher Medicaid reimbursements and discounted prescription drugs from the federal government, Varner said: The department reported in its application to the federal government that it had over 2,000 patients in a month last year.

But the clinics saw a little over 6,000 patients all year last year, she said.

“The numbers in the application are a lot different than what we’re seeing,� Varner said.