County supervisors agreed Tuesday to hire 23 new employees--nurses, analysts, and health educators--to determine how more than $14 million in tobacco settlement money will be distributed to hospitals, clinics and health programs.

The decision to create the positions comes two weeks after the board voted to keep its promise to split $28.4 million in tobacco money between paying down the county's bankruptcy debt and health care. Some supervisors had earlier angered health care advocates by saying they were inclined to rethink that promise and possibly spend most of the money on debt reduction instead. Last year, when the county's first cut from the federal tobacco settlement rolled in, supervisors decided to spend the entire $37.7-million allocation on paying down the lingering debt. That decision so unsettled health care leaders, who believe the money should be used solely for health care, that a measure was placed on the Nov. 7 ballot to force supervisors to spend all future tobacco allocations on health care. The ballot measure, Measure H, was overwhelmingly approved by voters, and the county has since filed a lawsuit in an effort to overturn that vote. But with half of this year's chunk of tobacco money going to health care, the county needed help determining how best to spend it. Juliette A. Poulson, interim director of the county Health Care Agency, said the new employees will review existing and new programs that target health needs. Under the plan, 14 positions will provide outreach services to older adults and those in the county who lack basic health care. Employees, including public-health nurses and social workers, will visit homes, family resource centers and senior centers to conduct health assessments, education, screenings, referrals and case management. Other positions will be used to provide planning support and monitoring of health education campaigns, alcohol and drug treatment and anti-tobacco programs. In addition, funds were approved to hire two staff analysts to support additional contract services and one to serve as the project manager for tobacco-settlement services.

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