Yhea... the states basically owned by East PA (Philly, Allentown, Scranton). So any state power they've all wrapped up. Health Director, and a whole bunch of stuff or most 'departments', is/are governor appointed.

Heck, on unrelated related stuff... Philly has basically special exemption from the state constitution for guns and the usual shit. Pittsburgh's tried to copy them a few times but had usually been ruled against.