House Bill 52 of the 1947 Legislative Session established a State Health Department consisting of a State Health Council, a State Health Officer and Division Directors. Until this time, county health officers oversaw most of the hospitals, clinics and related programs. In the populated eastern counties, the cost of running the County Health Office was easier to absorb, but western counties struggled with the load. One important aspect of House Bill 52, was that it allowed the State Health Department to promote local health services as it saw fit, which allowed the combination of less populated counties into one health district funded by the counties as well as the state and federal governments. 

One this date in 1950, the Custer District Health Unit, comprised of the counties of Mercer, Morton, Grant and Sioux Counties, reported on its progress after completing only five months of operations. Working out of Mandan, the Unit boasted twelve full- or part-time employees, including the district health officer, two county health officers, nurses and sanitarians. Dr. Cecil Smith of Mandan was District Health Officer, assisted by Dr. Enders of Hazen and Dr. Salamone of Elgin. The Nursing Division was headed by Irma Smith, assisted by Iryne Berg. Sanitarians were headed by Joe Pratchner, assisted by Frank Gilchrist, Vincent Kavaney and Bert Strothman.