Like every other government agency head in the state, Grays Harbor Public Health Director Joan Brewster was afraid the recently approved state budget would trigger even deeper cuts in her department. Instead, the Legislature and Gov. Chris Gregoire made rural health issues a higher priority, Brewster said, and the county shouldn’t expect to see too many state cuts this year to mental health and substance abuse programs.
On the bright side, in fact, Brewster said that a couple of grants that came in this year for community health planning and nutrition efforts in public schools have helped defray an additional $147,000 in cuts that the county commissioners had imposed on Public Health when their budget went into effect in January.
But the picture isn’t entirely rosy.
Brewster said her office is still learning to cope with about $1 million in state funding cuts her department suffered last year, which resulted in layoffs, the elimination of vacant positions and reduced hours. Altogether, Brewster says her department lost six clerical positions, two registered nurses, one medical social worker, one licensed practical nurse and seven positions reduced to just .8 full-time-equivalent.
“We lost 25 percent of our staff,” Brewster said.
But losing more funding would have exacerbated the problem, she said. The key was keeping Public Health’s flexible spending accounts, which allows Brewster and her staff to divert funds from one public health emergency to another.
County Commissioner Mike Wilson said many non-profits and social service agencies are breathing a sigh of relief after seeing how the Legislature crafted its budget.
“I sit on the Olympic Area Agency on Aging and the Coastal Community Action Program and both are just very happy to be where they are right now,” Wilson said. “We were expecting the worst.”
Responding to the previous budget cuts, Brewster said Grays Harbor County no longer does tuberculosis testing for work sites, instead sending workers to a private contractor. The county also no longer does testing or exams for sexually transmitted diseases, telling patients to contact their private doctors.
Pregnancy testing has also been eliminated, as have children’s immunizations.
One program retained is the popular First Steps program, which helps low-income pregnant women get critical health and social services.
Brewster said she had budgeted to get more than $100,000 from the state, but the state has since changed its formulas for how it gives money on a per patient basis. The result meand that only a small fraction of the expected funds have come in.
“I’m really nervous about the program and it is vulnerable to being eliminated,” Brewster said on Monday.
Last year, the county had assigned the equivalent of 4.13 full-time employees to the First Steps program, but after budget cuts the program was reduced to just the equivalent of 1.34 full-time employees. Monthly visits from prospective mothers dropped from 180 to 109 because eligibility requirements changed and shorter appointments were arranged. The county is also no longer serving east Grays Harbor.
Brewster said she’s not sure how much more the program can be cut if the dollars to keep it don’t show up.
Brewster also praised her staff for keeping the county’s family planning and Women, Infants, Children (WIC) program intact, even though both have been scaled back.
Family planning had the equivalent of 4.76 full-time employees last year, but now just has 2.94 full-time employees, yet monthly visits have dropped from 252 patients to 225. The county was able to keep the program basically intact by reducing its “no show” rate — when patients made appointments, but never showed up — from 23 percent to 17 percent. Brewster said that may sound like it’s still high, but it’s a pretty big gain. Brewster credited the change by having more open “drop in” spots for patients, instead of making appointments weeks ahead of time. Appointment windows were also dropped from 30 minutes to 20 minutes and staff are prepping their own charts.
The WIC program had the equivalent of 5.81 full-time employees last year, which were reduced to the equivalent of 2.42 employees this year yet monthly visits went from 790 patients to 780 patients, which Brewster says is basically the same case load with roughly half the staff time.
Brewster said the county increased group classes, added peer counselors and now has someone at the front counter who can speak Spanish, which all helped reduce the wait time and has made things more efficient.
Dr. John Bausher, the county health officer, said the county is doing a remarkable job for how little its getting from the state to do its programs.
“We had really good communication with mental health and public heath professionals and we tried to get the best outcome we could, given the circumstances,” state Rep. Brian Blake, D-Aberdeen, said Wednesday. “We all know public health is the priority and all aspects of public health effect our lives, and mental health is a huge priority. And having Senator Jim Hargrove in a key position to impact that segment of the budget is helpful.”
Steven Friederich, a Daily World writer, can be reached at 537-3933, or by email at firstname.lastname@example.org