Mississippi State Department of Health leaders are considering what services to scuttle or scale back and which employees to lay off in a massive overhaul of the agency prompted by continuing state budget cuts.
Potentially on the chopping block are services including early childhood health screening and treatment, childhood immunizations and maternity care, which has essentially already been phased out. State Health Officer Dr. Mary Currier in a video statement said, “Pretty much everything is on the table.”
Agency officials, dealing with a 32 percent cut in state funding, say there is less demand for direct, clinical services from the Health Department. Childhood immunizations by the department, for example, have dropped from 207,418 in 2009 to 96,266 in 2015.
This is in large part because more Mississippians have insurance coverage and are receiving primary care elsewhere through the federal Affordable Care Act. Instead, a spokeswoman said, the Health Department will focus on “core services” not being provided elsewhere, such as tracking communicable diseases, testing for tuberculosis and sexually transmitted diseases and inspecting and regulating restaurants, water and sewerage, hospitals and child daycares.
“We have to survive,” said agency spokeswoman Liz Sharlot. “… We are basically working toward a business model, being more efficient, realigning programs. It’s just the way we have to go now, to more of a business model.”
Sharlot said the department is working to ensure any program eliminations or cuts are covered by other agencies, programs or providers.
“We will still assure that childhood immunizations are available, but we may not do them ourselves,” Sharlot said. “… With maternal health, we stopped seeing patients in late ’15 or early ’16, because the numbers were decreasing so much. We helped those clients find other medical homes.”
Unlike after last year’s cuts, Currier and other department leaders are not criticizing the Legislature’s cuts to their budget nor issuing dire warnings about public health consequences. She and Sharlot both expressed thanks to the Legislature that the cuts weren’t worse and that lawmakers allowed the agency more flexibility with the reduced funding. They also offered assurance the agency’s core mission to protect and promote public health wouldn’t be sidetracked.
‘Penny-wise, pound foolish’
But several current and past agency employees said core services have already been hurt by past recent cuts. They said the food service inspection program, in particular, is in shambles after cuts, layoffs and reorganization last year.
Sharlot last week said restaurant inspections are “working out well,” and that “we actually upped our inspections and customer satisfaction.” Sharlot last week said she would try to provide data to back those statements, but had not as of presstime.
But the department’s data available to the public shows the number of restaurant and food-service inspections has nosedived after reorganization in early 2016 cut the number of inspectors roughly in half, to 35 for the entire state. For last year, the department conducted 22,051 food service inspections compared to more than 33,000 a year in the four previous years.
A months-long investigation by the Hechinger Report and The Clarion-Ledger in 2015-16 showed the state’s weakly regulated child care system often perpetuated dangerous conditions for babies and young children by failing to hold centers to minimum standards.
The Health Department announced in January that it would double the number of times a year, to four, that it inspects daycare centers. Less than a month later, it informed child care providers, it was suspending that plan indefinitely to explore other options. Sharlot said last week that the agency in 2015 had 22 child care inspectors but had people depart last year leaving the agency short staffed. She said there are now 23 inspectors — some still in training — and the agency still plans to add five more by July. The state Department of Human Services is providing the Health Department an additional $1 million to improve child care center oversight.
Public health care advocates fear further cuts will dismantle the agency that serves Mississippians from birth certificate to death certificate. It has provided a backstop and in the past helped lead the few health care successes of a poor state that lacks access to care and leads the nation in most categories of chronic illness and mortality. Advocates fear the agency will not have the ability to deal with natural disasters — such as a hurricane — or disease outbreaks. And they fear moves in Congress to repeal the Affordable Care Act will bring increased demand for the public health services the agency is eliminating or scaling back.
“We should be investing in the Health Department, not cutting it,” said Roy Mitchell, director of the Mississippi Health Advocacy Program. “… Study after study shows that public health spending yields a reduction in the mortality rate across all causes — heart disease, diabetes, cancer — and that ultimately helps the economy because we are all paying for these chronic diseases … Mississippi has the most to gain by these programs, and the most to lose by loss of them … Our policy makers are again being penny-wise and pound foolish.”
The agency plans to cut administrative costs and overhead, in part by consolidating state health districts from nine to three. Officials said there are no plans to close more county Health Department clinics. After budget cuts last year, the department closed nine county clinics, laid off 64 clinical employees or contractors and 19 environmentalists who inspected restaurants and/or water and sewerage systems.
Reduction in workforce
Agency officials have released few specifics of the reorganization to the public, media or the department’s 1,885 employees, but they plan to have it completed by the start of the new budget year July 1.
Currier has declined media requests, but addressed the reorganization to agency employees in a video on a private Youtube channel. Agency officials said the video was for employees only, not the public or media, but released it to The Clarion-Ledger after it filed a public records request. It can be viewed at clarionledger.com.
“It will require a reduction in workforce, which is not something I wanted to say,” Currier said in the video. She said more details of the reorganization are being worked out and will be provided to employees later. She said, and Sharlot reiterated in an interview, that every effort will be made to ameliorate layoffs through attrition, retirement and not filling vacant positions.
Although details are being kept close to the vest, Sharlot said, “Dr. Currier and our senior leadership has been working with stakeholders.”
During legislative budget hearings earlier this year, officials said further cuts could require eliminating 191 positions, but that was before a final budget was adopted.
Dr. Luke Lampton, chairman of the state Board of Health that oversees the Health Department, said state cuts to the agency “have been down into the bone for probably a year or two” and he is concerned federal funding — which covers 90 percent of the agency’s overall budget — will be drastically cut as well.
“I don’t think the department is in a position to face further cuts without a significant impact on care and delivery,” Lampton said. “I think with the reorganization (Currier) is trying to maximize every dollar and bring the department’s strategy in line with what a 21st century health department should be — and we need to do that — but there is no doubt our emergency response, and our treatment of infectious diseases all will be impacted by this.”
Lampton said the Health Department’s work ensures many of the things a civilized society takes for granted: clean drinking water, safe restaurants and prevention of disease outbreaks.
“The core services of our Department of Health are what keep us from being a Third World country,” Lampton said. “Anyone who thinks we can decimate our Department of Health and not be closer to being like a Third World country, they are wrong.
“… The Department of Health has been operating efficiently and competently and scientifically and very leanly,” Lampton said. “It is one department that should take precedence and priority over most in our state … What it needs to operate is not much money when you look at the overall state budget … Its continued funding is good, conservative policy and cuts are going to cost us in the long run and cause problems that cost more money to fix in future years.”
‘Rural Mississippi is bleeding’
GOP legislative leaders when setting budgets earlier this year said the Health Department will have to “re-brand” itself and operate more like it did in the 1900s than in the 21st century, focusing on education and prevention, monitoring disease rates and regulation rather than providing direct health-care services.
Legislative leaders said they have confidence Currier can revamp and cut the department without endangering public health.
“I have a lot of confidence in Dr. Currier,” said Senate Public Health Chairman Dean Kirby, R-Pearl. “… She’ll do the best she can do with what she has to work with.”
House Public Health Chairman Sam Mims, R-McComb, said he’s been in contact with Health Department leaders as they plan the overhaul.
“They understand the budget, and I think they are going to focus on their changing role,” Mims said. “I think everybody realizes the amount of people going to health clinics for day-to-day primary care is down — with those individuals going to private practices — so the Department of Health has to change and adapt to that and evolve.”
State cuts to health and mental health services have also become a major source of political and partisan debate in Mississippi.
Republican leaders, holding the majority, say they are doing the will of the electorate, cutting taxes and state spending. Democratic leaders accuse the GOP majority of giving away the farm in hundreds of millions of dollars in tax breaks and incentives to corporations while cutting public health care services in the poorest state in the country. As the Health Department ponders further cuts, the Department of Mental Health recently announced it is eliminating 650 positions and reducing services because of state budget cuts.
Former longtime House Public Health Chairman Steve Holland, D-Plantersville, said the loss of public health services will be particularly tough for rural areas that lack other providers.
“Everything you cut in government has the most profound impact in rural areas,” Holland said. “Rural Mississippi is bleeding … I’m beginning to hear from folks on everything from, ‘I can’t get anybody to answer the phone when I call,’ to with restaurant and sewer environmental inspections, ‘I was promised that inspection would be the next week and now it’s been three weeks.’ I was trying to help a family today that’s dealing with Mental Health with a little boy kicked in the head by a horse who needs help. He’s been put on a waiting list.
“… These agencies had to endure all these cuts that are now getting down into the marrow,” Holland said. “These far-right knuckleheads have taken a meat ax to everything, and it’s hurting the least, last and most vulnerable among us.”