Tuesday, Oct. 14, 2008

Benton-Franklin Health District cutbacks looming

Laura Kate Zaichkin, Herald staff writer

The Benton-Franklin Health District faces "catastrophic" cuts to programs and staff if Benton and Franklin counties don't contribute at least $745,000 more to the district annually, the district's health officer said.

The district provides preventive health care services ranging from vaccinations to well water testing to nutrition programs for mothers and babies to restaurant inspections.

Last month the district announced it was facing a nearly $1.6 million budget deficit. The Board of Health, made up of Benton and Franklin county commissioners, asked the district where it could cut costs without cutting services.

"We've done that and we're still short," Dr. Larry Jecha, the district's health officer, said of the nearly $745,000 shortfall now projected. "This budget will keep us doing what we're doing now."

The district now proposes to increase service fees, charge for tuberculosis tests and administrative fees for vaccinations, and reassign public health nurses to more revenue-producing work.

If the district receives the $745,000 in additional county money, its 2009 budget would total about $9 million, up nearly 1 percent from this year, Jecha said.

Health district payments from state and federal agencies depend on services provided. So if the counties don't contribute more, the district would have to cut services and staff and the budget would be about $6 million, he said.

Fees to increase

The district's director of preventive health services, Sandy Owen, calls the reassignment of nurses "robbing Peter to pay Paul." She has been asked to put more resources into First Steps, which helps Medicaid-eligible women who are pregnant or who just gave birth and their babies.

Owen has been forced to reduce the district's child care program, which serves licensed child care providers. She is cutting the Children with Special Health Care Needs program by about half. It helps children with birth defects, who have been injured in car wrecks or other accidents or require a lot of medical care.

Nancy Klotz, a public health nurse who has been with the district for eight years, said some of her 50 to 100 clients could be left behind.

Her clients include premature twins born to a 16-year-old mother who is trying to graduate from high school. "It takes a lot of gumption and a lot of support," she said. "And we're going to pull out the support from under them?"

Layoffs possible

But these cuts are better than what will happen should the counties not give the district additional money, Jecha said.

The district would have to cut most of its programs and "a lot" of its 100 employees -- Jecha declined to say how many -- and put nearly all its budget toward mandated programs. That essentially would leave only communicable disease and environmental health programs, Jecha said.

If that happens, programs for women with a recent history of alcohol or drug abuse who have children younger than 3; a nutrition program for pregnant, breast-feeding and post-partum women and their children; programs that promote healthy families and children; well-water testing, and food safety education for schools and other public venues would be eliminated.

"If we cut down to mandated services, there are going to be these huge gaps," Klotz said. "If we go away, the problems and the needs that the clients have don't go away."

Thousands served by the district would be affected by major cuts. For example, more than 15,000 women, infants and children in both counties were served in 2007 by the nutrition program, called WIC, while the Children with Special Health Care Needs served about 1,500 people last year, according to the district's 2007 annual report.

Widespread impacts

Jecha said it's impossible to count how many clients and community members would be affected by these cuts. "Everybody in the county would be affected, whether directly or indirectly," he said.

Jecha said the community wouldn't just see the effect of significant health district cuts now, but also in 10 to 15 years. Prevention programs help children be more prepared for school, reduce health costs, decrease criminal behavior and create a healthier community, district officials say.

The counties have not increased the amount they provide the health district in nearly 30 years, Jecha said. Service fees and state and federal money the district receives also have declined.

Should both counties contribute the additional funding, total county contributions will rise from almost $582,000 to nearly $1.3 million annually.

Currently, the health district gets 7 percent of its funding from the counties, the fourth-lowest amount in the state contributed by local government agencies, according to state Department of Health data.

"It's time that the counties have to step up to the plate and give them more money," said Franklin County Commissioner Neva Corkrum. "For us to gut the public health, I just don't think it's fair. They have been down to the bare bones."

Corkrum and Commissioner Rick Miller said Franklin County's budget looks sound enough to allow it to contribute more. It has given the district nearly $217,000 in years past and has been asked for almost $178,000 more.

Up to Benton County

But Miller said the district's fate is more in the hands of Benton County, which contributes more money because of population. "In some ways a lot depends on what they end up doing," he said.

Benton County has contributed about $364,000 to the district yearly -- though both counties paid more in 2008 to balance the budget. It has been asked for nearly $567,000 more annually.

Benton County Commissioner Max Benitz said, "I believe we're going to look favorably at the necessary funding for public health."

All three Benton commissioners said the health district is a priority, but not their only one.

"It is a priority for me, but so is mental health, so is public safety and, in fact, so is economic development," said Commissioner Leo Bowman. "I'm not looking to cut 'em (but the current economy) may require it."

Commissioner Claude Oliver said, "It's not like, 'Do we solve it for the health district?', it's 'Do we solve it for everybody?' "

The Benton-Franklin Health District is not alone in what public health advocacy groups are calling a funding crisis.

The Spokane Regional Health District began laying off staff and cutting programs a few years ago. Public Health-Seattle and King County is facing a $12 million budget cut, and the Snohomish Health District is expecting layoffs and discontinuing programs.

The budget will be discussed at Wednesday's Board of Health meeting at the health district, but the counties don't expect to make decisions about additional health district contributions until the end of the month.

w Herald staff writer Franny White contributed to this report.

w Laura Kate Zaichkin: 582-1521; lzaichkin@tricityherald.com