A planned 17 percent cut by the Alaska Legislature to the state public health nurse program will change services and close some offices, but it’s not yet clear how the reduction would play out in Haines.
“The proposed reduction would necessitate an unprecedented decrease in service groups; the age range for provision of services will focus more on the youth and children of Alaska,” said Dawnell Smith, spokesperson of the Department of Health and Social Services.
There are 22 state public health offices statewide, including one in Haines.
A 6 percent cut last year resulted in the elimination of 10 positions – including seven that were vacant – closure of the longtime public health nurse office in Seward, and reduced public health grants to communities and tribal health care providers.
The 16.7 percent cut to personnel – about $3.75 million – has been designated by both the state House and Senate in the coming year’s budget “and is expected to stand at this time,” Smith said in an email.
The public health nurse office based in Haines serves Klukwan and Skagway additionally and includes a full-time nurse and a full-time clerk position.
Linda Worman, chief of the department’s Public Health Nursing section, said this week she couldn’t say which or how many offices would be closed by the cut. But she said she would try to maintain services by using itinerant nurses and partnering with other health-care providers in communities.
“We’re looking for ways to still provide what communities need, but delivering them in a different way. There are other ways we could partner with other providers in the community, but (our service) would look different,” Worman said.
Prioritization of programs serving youths and children doesn’t mean a nurse wouldn’t see patients over a certain age, but it may limit immunizations such as for the flu vaccine, or cause the agency to find a different way to provide flu shots, she said.
The decision to close an office would include several factors, including agency internal information, county health ranking figures, the local poverty rate, and the availability of other health-care providers, including a school nurse. The relative isolation of the Haines office also would factor in, Worman said.
“We don’t have fluff but I don’t want to give up being geographically dispersed throughout the state. I’d like to remain present in all the communities but in some places we may not have a physical office and somebody living in the community,” Worman said.
Spokesperson Smith said the public health nurse office is “a safety net provider” and that it would “continue to partner with all tribal, private, and public health care providers to collectively develop the strongest health care delivery system in Alaska.” Besides immunizations, public health nurse offices work on control of diseases, including sexually transmitted diseases and tuberculosis, and conduct developmental assessments of young children.
The offices use a sliding scale for payments and can help clients apply for Medicaid.
If budget cuts eliminate some offerings, the agency would work with clients to identify other providers, but those may be more expensive, Worman said. “We accept what a person can pay us. That’s understandably not something a private practice can provide on a regular basis.”
Michelle Rountree, who is serving as interim public health nurse in Haines, said many smaller public health nurse offices are concerned about the proposed cut, particularly because the closed Seward office was a busy one and was the sole provider of some services not offered by a hospital there.
“A busier office was closed, and that is a cause for concern. Every health center is on pins and needles right now. Nobody knows what to expect. There’s a lot of speculation and people are going home at night not knowing the future of their jobs,” Rountree said.
(Agency chief Worman said the Seward closure was made in part because clients could be served by another office in Kenai, a two-hour drive away.)
Rountree said people she has spoken to about the proposed cut are surprised. “People rely on public health. They may not always use us, but they’re glad we’re here. They understand what we do here is important.”
Figures provided by the agency show that during the nine months beginning July 2014, services by the Haines office included 673 individual visits, 208 immunizations, 264 visits by children (including ones not able to access other care), 58 visits related to sexually transmitted diseases and 47 individual visits to address tuberculosis. (There is no active tuberculosis in Haines.)
Broad-based work included participating in 15 community events to promote health and prevent disease, and responding to 22 referrals from community providers. The office also assists schools with TB testing, vision and hearing screening.