STANTON — Over the past 12 years, the Mid-Michigan District Health Department (MMDHD) has taken pride in exceeding the expectations of clients, according to Health Officer Kim Singh.
These days, Singh says the MMDHD is struggling to provide adequate services, at best.
The MMDHD — which services Clinton, Gratiot and Montcalm counties — was hit with budget cuts from the state and the county last autumn. A nonprofit organization, the MMDHD receives approximately 43 percent of its funding from the state and federal level, 21 percent from appropriations and county funding, 19 percent from Medicare and Medicaid, 9 percent from fees and collections and 8 percent from other sources.
The MMDHD operated on a budget of $6.5 million in 2010. Personnel costs comprised 64 percent of that budget. Last October, the MMDHD received a 10 percent decrease in funding from Montcalm County, as well cuts from the state and federal level.
At the direction of the MMDHD Board of Health, Singh recently presented a detailed summary to the Montcalm County Board of Commissioners about how budget cuts have affected her department.
Community Health and Education Division
Singh said state funding to the MMDHD’s essential local public health services was cut effective Oct. 1. The cuts primarily affected the communicable disease program. A public health nurse’s position was not filled, reducing public health nurse services for communicable diseases, sexually transmitted diseases (STDs), human immunodeficiency virus (HIV) and tuberculosis programs.
“This has led to poorer performance in the communicable disease program,” Singh said. “Public health nurses are scheduled to work in clinics and therefore are not able to check incoming electronic communications as quickly as they previously did. This, in turn, leads to delays in communication to our clients and community partners. Clients have complained about delays in nurses returning calls. On low-priority cases, calls may not be returned for 24 hours. Weekends and holidays may extend this time period. In the past, every effort was made to return calls on the same day.”
Chronic Hepatitis C cases have now been moved to a low-priority status and remain pending for up to six months or more, while in the past they were addressed and closed out in three months.
Temporary (contingency) positions also were eliminated, so if staff is absent due to illness or leave requests, their position is not filled in the clinics and clinics are canceled or staff work shorthanded, leading to delays in services, overworked staff, lower morale and poorer customer service, according to Singh.
“Since Oct. 1, 2011, we have seen an increase in dissatisfaction with phone services per client satisfaction surveys,” she said.
Due to Montcalm County budget cuts, work hours were reduced by 2.5 hours per week for MMDHD staff in Montcalm County from Nov. 1 through March 2.
Back-up coverage to answer telephone calls after 4 p.m. each day was discontinued. Montcalm County staff assigned to work in other counties were required to leave their work site a half hour early, slowing down clinics and limiting appointments. The communicable disease nurse in Montcalm County (which has the highest caseload of communicable diseases in the three-county coverage area) was limited.
Appointment availability for the Women, Infant & Children (WIC) program was decreased by eight to 10 families per week. As of Feb. 1, 34 newborns and pregnant women in the Stanton WIC clinic did not receive an appointment within the 10-day federal WIC appointment rule. Most of these families had to wait up to three to four weeks for an appointment. In Clinton County, 27 newborns and pregnant women averaged a two-week wait time, as did 42 newborns and pregnant women in Gratiot County.
Family planning appointments in Montcalm County are currently booked out more than a month into the future and staff are struggling to meet program guidelines for making necessary referrals for follow-up appointments on abnormal PAP tests, according to Singh.
“Women requesting family planning services need to be able to access them quickly,” Singh said. “An unintended pregnancy is likely to occur if clients are required to wait four to six weeks for an appointment.”
Singh said local students in particular have shared with MMDHD staff the challenges of coming in for services on a shortened MMDHD work day — one student saying, “I can’t get a ride after school to be here by 4 p.m.”
Environmental Health Division
The MMDHD also saw a reduction in state funding for essential local public health services.
An environmental health specialist was eliminated and the district’s food service establishment inspection schedule was realigned and reclassified with assistance from the Michigan Department of Agriculture & Rural Development.
All 495 fixed food establishment files were reviewed for the three-county area (each file encompassing five years of compliance history) and each of the 495 facilities was ranked according to risk. The result — more than 160 food service inspections were eliminated due to a 17 percent decrease in inspection activity.
“This decreased presence in the community jeopardizes the public’s health with regard to food safety,” Singh said.
Temporary clerical support was eliminated, meaning no one is available to cover illnesses, medical appointments or vacations for public health representatives. Professional staff are now helping cover clerical duties. Incoming phone calls are either routed to another county or simply go unanswered when the reception desk is closed due reduced staff.
Wait times for services such as permits, inspections and water samples have been extended from a typical five-day turnaround to an eight-day turnaround and nuisance complaint response time has significantly increased. Singh said 14 complaints dating back to October are still without a follow-up visit, including trash and blight, vector control for fungus or viruses and substandard housing issues. Water well inspections are delayed too — 21 well owners have not received inspections since October.
“Should present resource levels continue, it can be expected that service quality and delivery will continue to erode,” Singh said. “The communities in which we live and work will continue to realize the negative impacts of a reduced public health presence.”
MMDHD Director of the Environmental Health Division Bob Gouin agreed, calling the budget cuts and results “unfortunate.”
“The impact of the budget cuts really affect the public,” Gouin said. “We certainly wish there was a way to address these issues. Our culture here has been excellent customer service over the last 12 years. We’re very uncomfortable with the possible risk to the public. It’s a tread water approach right now, which we do not like.”