The county branch of the Florida Health Department is facing a nearly 8 percent budget shortfall after giving away its fee-generating primary care clinics and getting hit with federal sequester cuts all at once.
Without a rescue from the Health Care District, county Health Department Director Dr. Alina Alonso said she’s looking at closing buildings, consolidating services, and stretching already thin resources to respond to food-borne illness and other disease outbreaks — such as tuberculosis.
Alonso is hoping for an additional $4.6 million grant from the Health Care District in its 2013-2014 fiscal year, to shore up its projected $62 million budget need. But skeptical finance committee members were hesitant to give the green light on Wednesday, asking why the district and the health department hadn’t foreseen the crisis and demanding to see a more detailed breakdown of local spending on public health.
They tabled Alonso’s request and agreed to add a special finance meeting on Sept. 12.
“I think there is an issue here of trust, frankly,” finance committee member Neil Fogel said Wednesday morning’s meeting. “I could see giving you tentative approval, but I think we should monitor this on a monthly basis.”
Alonso said she needs certainty sooner, not later.
“This is a huge deficit we are facing, it’s very difficult to make these cuts,” she said.
Alonso said she had long been relying on clinic revenues to subsidize her public health duties as the Florida Legislature has cut county health departments year after year.
Five years ago, the state sent about $21 million a year in general revenue into Palm Beach County’s branch of the Florida Department of Health. Last year, the state sent about $8 million in general revenue.The health department has cut back on the frequency of beach water quality testing. It has closed a clinic where HIV and sexually transmitted diseases were treated and transferred services to another office. It lost a lab and must contract out for those services.
Amid the belt-tightening, last year, to preserve the county’s web of public clinics, she helped transfer four of them to the Palm Beach County Health Care District, a property-tax funded local government agency that has run trauma programs, school nurses and a public hospital in Belle Glade. But giving up her clinics meant losing about $11 million in revenues. She lost a $3.6 million federal grant, Medicare and Medicaid reimbursements, and part of a Health Care District block grant for the clinics.
She said she had underestimated how much it would cost to shed 87 clinic employees, as she’s still paying for the laid off employees’ accrued time off and severance, she said.
On top of that, the federal budget sequester has lopped off about 5 percent from the grants she gets from agencies like the U.S. Centers for Disease Control and Prevention. She was left with a deficit of about $3 million for 2012-2013, she said. By letting go of the public clinics to ensure their long-term survival, she’s lost one of the “Peters” she robbed when she had to pay “Paul.”
The Health Care District took over primary care services at the clinics, but there are about 12 other health department services that she still provides, she said. Investigating disease outbreaks is a big one.
This summer, for example, a catering company’s food-service worker became ill with tuberculosis. That foreign worker lived in close quarters with co-workers who traveled by bus to multiple communities in West Palm Beach and Boca Raton. Dozens of people were exposed.
Tests are now being conducted on 85 people, to see how many others need treatment. Nurses observe people with tuberculosis taking their medicine, to avoid an outbreak of drug-resistant TB. Those types of outbreaks can be unexpected, and strain the public health agency’s already stretched budget.
Someone exposed to rabies receives shots can cost her agency $1,000, she said. People with sexually transmitted diseases are tested and treated, and their contacts notified and brought in for counseling. People with HIV receive care. Food poisoning outbreaks are investigated.
She said the agency intends to bring on a consultant to help it find new ways to raise money, such as offering large employers wellness education services, becoming an HIV primary care provider to Medicaid HMOs and using technology to ensure TB patients take their medications. But it will take several years to make that transition, whereas these cuts are happening all at once, she said.
“We can get out of this, but it’s too much of an adjustment all at one time,” Alonso said. “I’m optimistic that the district will do the right thing and see that we need this.”