Olympia Tyner, clinic assistant for the Women, Infants and Children program at Lawrence-Douglas County Health Department, prepares Wednesday to weigh and measure 18-month-old Arely Lopez-Garcia. Arely’s mother, Maria Alicia Garcia, is pictured at left. The health department has cut 04,840 from its budget and raised fees.

When it comes to lack of funding, Lawrence-Douglas County Health Department is experiencing a triple whammy.

The department, which provides essential public health services to Douglas County residents, depends on funding from the state and federal government, as well as the city and county.

For 2009, it received a $1,000 increase in local funding — a drop in the bucket when dealing with a $3.2 million budget.

Dan Partridge, director, said the department came within in a whisker of losing state funding because it didn’t have the required local dollars to match it.

To make ends meet and prepare for an even grimmer 2010, the health department decided to cut $204,840 from its budget instead of borrow from reserve funds.

“We decided we needed to get ahead of that curve of budget cut, budget cut, budget cut, so that’s when we went through our list of services to see what we could do to reduce our costs,” Partridge said.

Everything was fair game. They cut staff. They cut pay raises. They delayed purchasing new computers. They cut health services. They raised fees.

Dwindling staff

The biggest chunk — about $165,000 — came by reducing staff. Partridge said such cuts are difficult. The department has 42 full-time-equivalent positions.

When compared with other health departments that offer similar services, the staff size is astonishing. Wyandotte County has 6.1 full-time employees for every 10,000 people in the county, and Riley County has eight full-time employees for every 10,000 people.

Douglas County, meanwhile, has 3.7.

“It really shocked me that it was that much disparity,” Partridge said. You can bet that he will be showing those numbers to state legislators.

Partridge said he is proud of the department’s efficiency but added that there needs to be some balance across the state.

Growing need

The local staff cuts come when demand for services is on the rise.

For example, the department didn’t replace two nurses who retired after a combined 53 years of service in the Maternal Child Health program. The program supports and educates teen parents and at-risk childbearing families. Three full-time nurses and one part-time nurse handle 180 caseloads.

“People are out of work. They have no health care. With no health care and no job, the stressors go up, and when the stressors go up, that’s when there’s problems within the family household,” said Carolyn Ball, coordinator of the program.

But there is good news: The department is partnering with the Kansas Children’s Service League. Beginning Monday, KCSL will have three nurses who will pick up some of the work. Each organization will operate under separate regulations and funding but will be reaching out to Douglas County families.

“It’s like someone once told me, ‘We are going down two different roads, but we are ending at the same spot,'” Ball said.

Some happy endings

The department also cut the number of hours it devotes to the Personal Actions Toward Health program, an exercise program for seniors known as PATH. The department coordinated the program but no longer does. Douglas County Senior Services stepped up to fill that role.

The department also nixed the senior health clinics that it provided in Eudora and Lecompton because of the lack of participants. It also no longer provides them at Babcock Place in Lawrence. But Lawrence Memorial Hospital stepped in to fill that void.

“Those are the happy endings out of all of these cuts,” Partridge said of the agencies that stepped in.

The department will go another year without what Partridge considers a key position — community health specialist.

“That’s one of those fundamental things that I think public health should have,” he said. “We are about educating the public on making the right choices, on making the right behavior changes, and so we don’t have that tool in our toolbox.”

Cutting services

To reduce more staffing hours, the department cut in half the number of well-child health assessments it provides to children up to age 5. Before the budget cuts, the department had no restrictions. Now, they only see children who are not covered by private insurance or state programs such as HealthWave.

Kathy Colson, public health nurse, said few people used the program, so making the cuts made sense. Before the cuts, there were 25 openings a month and she was lucky to see 10 children. Now, there are eight openings each month.

Besides cutting staff and services, they no longer offer Gardasil, a vaccine that prevents the types of genital human papillomavirus that cause most cases of cervical cancer and genital warts. The vaccine costs about $145 per dose, and people need to take three doses for it to be effective. About 160 women used it before it was discontinued. Partridge said people were unable to pay for it and the department was left with the bill. The department tried to limit its exposure by only giving it to clients who had paid their bills, but that still didn’t work.

“With all of the controls, we were still losing about $5,000 a year from people who discontinued the series or just never paid for the last shot,” he said.

Increasing fees

The department increased all of its fees this year. For example, vaccines went from $10 to $14 per shot and oral contraceptives went from $5 to $8 for a month’s supply. But that doesn’t necessarily mean it will help the bottom line.

“We cannot deny services on ability to pay, so it’s not a one-for-one — we raise the fee this and get that much back,” he said. “What we are seeing is people’s ability to pay is stressed.”

For example, from Jan. 1 to Jan. 28 last year, the department provided 4,030 clinical services that brought in $26,145 in revenue. During the same period this year, the department has provided 3,443 clinical services and raised only $8,536.

With the revenues from fees added, the department has raised only $14,852 this year compared with $34,366 last year.

“That bottom line is pretty alarming,” Partridge said.

Deeper cuts

Like a lot of companies, the department also is delaying equipment purchases. It saved $30,000 by reducing the staff’s cost-of-living adjustment from 2 percent to a tenth of a percent.

Barbara Schnitker, director of nurses, has worked for the health department for 24 years. She said times are lean and she is adjusting shifts and schedules to fill in gaps left by budget cuts. She said the health department also is reducing the number of health fairs it participates in from 20 to six this year.

“There have been a bunch of issues in the past, but nothing like what we’ve gone through,” she said. “It’s definitely more noticeable.”

And the department is preparing for even deeper cuts in 2010.

County commissioner Charles Jones recently delivered the bad news during a department staff meeting.

“I think I am telling everybody pretty consistently: ‘Buckle your seat belt because it’s going to be a pretty bumpy ride over the next couple of years,'” he said. “What we are seeing is a reduction in our property values, which is pretty troubling because that’s how we kind of made our living.”

Jones said he values what the department does.

“I think they do great stuff, and I am very appreciative of the work they do. I wish we could fund all of our groups to the extent they deserve.”

Partridge said he has noticed earmarks here and there for health in the federal economic stimulus package, but most of it is for treatment.

“It’s going toward fixing things that are broke. It would be refreshing to finally see an investment in prevention at some point,” he said.