CHARLESTON -- As their own and government funding sources continue to dry up, area health departments are hard pressed to retain staff and perform legally mandated services.
Health departments have had to cope with a major loss of federal grants, as well as competition from private health clinics in revenue generating services such as home health care. County and local governments are strapped for money themselves and offer little help. The state Legislature has contributed $3 million in supplemental funds to health departments in the last two or three years, which "keeps them afloat," said Del. Mary Pearl Compton, D-Monroe, who chairs the House Health and Human Resources Committee.
The problem became acute in 1997, when Congress passed the Balanced Budget Act, said John Frederick, director of the Lewis County Health Department.
"We went from having 45 employees to 11 employees in three years," Frederick said. "The Balanced Budget Act killed home health care, where we earned a lot of our money."
Frederick said state and federal funds cover 60 to 70 percent of what the Lewis department needs to perform legally mandated services such as immunization, food service inspections and septic system inspections.
The department has to come up with the rest through profit-generating services and contributions from organizations such as the Board of Education and the county commission.
"The commission wants us to earn the money ourselves," Frederick added. "They have a small amount of funds to distribute among various agencies. They have not had it easy in the last several years after county and local governments lost revenue sharing money."
Kathy Canterbury, director of the Upshur County Health Department, said she faces a similar situation -- revenue loss combined with a high demand for services.
"Last year we performed about 90 percent of the immunizations in the county. We make about 20,000 referrals a year and provide other public health services like family planning, mammograms and pap smears," Canterbury said. "There's definitely a need for our services. In small, rural counties, sometimes health departments provide the only health care people get."
Canterbury added that in order to "do everything that needs to be done," her department would need four nurses and two sanitarians. Currently, the Upshur County Health Department employs two nurses and one sanitarian.
"The lost grants hurt because we need part time help," she said. "When we aren't able to call people or send reminders about immunizations, many times they won't show up. Immunizations go way down."
The Harrison County Health Department is also "under the gun," said Director Randy Moodispaugh. Moodispaugh said while the Harrison Health Department does receive $65, 000 a year in levy funds, it only covers about 4r percent of the total budget.
"We're still surviving but we've had to lay off people. We're better off than some others because we still have viable income from home health services and clinics," Moodispaugh said. "The state supplements have been helpful but they won't solve the problem. We need more funding."
Moodispaugh said fees from environmental health services such as inspections generate some money, but not much.
Compton said the Legislature has been reluctant to raise fees for environmental health services, in part because of political pressure exerted by business interests. Frederick said fee increases proposed this year would add about $10,000 to the Lewis department's revenue pool -- an amount he said will not even cover annual benefits for a state employee.
Moodispaugh also said he expects no substantial relief through environmental services fees.
"I can't imagine any increase that would save us from financial trouble," he said.
Compton said she believes health departments should be allowed to pass on more of their costs. However, she added that they will likely have to continue to fend for themselves to a large extent.
"Local health departments, at one time, played a very large role," she said. "But in recent years, private health centers have sprung up and put them at a disadvantage by providing many of the same services. Health departments will have to be more creative because the competition is very stiff.
"In the present dog-eat-dog health care climate, it is very difficult for health departments," Compton added. "I've suggested they look into joining forces with other health care agencies and share costs."
Moodispaugh said he has looked into trying to generate revenue through nursing services but added it is difficult because of the overhead cost of nurses' salaries.
Moodispaugh, Frederick and Canterbury all said they really need more help from state government if it is possible for them to provide it.
"We provide a vital public service," Frederick said. "My belief is that if the state mandates it, they ought to fully fund it."