State budget cuts fall on nurses, moms and infants

Jan 13, 2011

If those cuts don't sound harsh enough, you can add "low-income" and "people of color" to the headline. 

Last month, the Washington legislature met for one day to approve $488 million in immediate budget cuts, to cope with a shortfall in tax revenues.  One of those budget items, barely mentioned at the time, was a public health program called "maternity support services."  This pays for nursing and counseling for pregnant women, and it continues in the early months after a baby is born.  The goal is to have a higher percentage of healthy babies, and prevent hospitalizations and other complications. 

It's the type of program aid groups are trying to export to developing countries.

More than one-third of all babies born Washington

The maternity program covers so many pregnant mothers, its reach is far and wide, according to Public Health Seattle & King County. 

Now, half the staff for the program is facing lay-offs in King County. That's 123 employees, and half of these are licensed nurses.  Here's the breakdown from Public Health Seattle & King County:

  • 87  Nurses, social workers, dentists, dental assistants, interpreters, and education specialists.
  • 24  Clinic support staff.
  • 12  Central administrative staff and program management (includes nurse supervisors, administrative supervisors and assistants, program administrators and managers, a finance officer, and an IT system engineer.)

The layoffs are effective March 1st, 2011.

More low birth weight babies

The maternity program has been proven to reduce the rate of "low birth-weight" babies, says David Fleming, Director of Public Health Seattle & King County. Those babies often end up in Intensive Care Units "and cost tens, if not hundreds, of thousands of dollars to care for," he says.

"So, it's kind of crazy to reduce investment in a program that saves money," says Fleming.

Snohomish County is preserving its version of the program by laying off nurses in other areas. In Pierce County, the program is mostly administered by private medical providers at Multicare and Franciscan health systems.  The portion run by Tacoma-Pierce County Public Health has been trimmed down to just three remaining nurses.

Tina Maestas, a public health nurse for 22 years, is one of those losing her job.  She makes home visits to new mothers -- which she says can catch all kinds of problems.

"Often when woman comes into a clinic, she may be well dressed and she may be smiling," says Maestas. "But when you go into the home, you can see maybe she doesn’t have furniture, maybe there's no food in the cupboard, maybe there's signs there's problems in the home with alcohol, with domestic violence, or with child abuse. "

Second round of dramatic cuts: Community clinics are next

The legislature also mandated a reduced payment for basic medical services at community clinics that specialize in serving low-income Medicaid patients.  Fleming says, if those cuts are not amended, soon, many clinics will simply need to close. They won't be able to pay their staffs.

To fend this off, public health agencies, along with others involved with the medical system, are lobbying the legislature for a radical change in how we pay for health care. Currently, every service provided must be billed separately. Under the proposal, doctors and hospitals would get paid for each overall treatment.  Fleming says this would save money because medical providers would use cheaper procedures and cheaper drugs, and avoid costly surgeries.

Such a change might seem straightforward, but it would represent a radical shift for the medical system. It's being discussed all over the country, as part of a trend toward making medical providers into  "Accountable Care Organizations."