Could local health departments disappear?
There’s a good chance that local taxes will jump if Connecticut Health Commissioner Raul Pino’s proposal to consolidate the state’s 73 health departments into county or council of government-sized health districts is approved, Nancy Brault, the director of Monroe’s health department, said. Trumbull and Monroe shared a health district until 2015.
Health directors and politicians have voiced concerns about the proposal and whether the plan would be beneficial to residents.
Pino’s plan is summarized as “integrating 73 local health departments and districts into regional health districts. The proposal will incorporate changes to the municipal payment structure along with standardizing the operations of the departments and services they provide to members of the community.”
The state currently offers three different models of public health service providers. There are full-time local health departments, part-time local health departments, and local health districts. Pino’s plan calls for one regionalized model that would merge local departments into a regional health district.
“Local health department and district staffing also varies across the state and ranges from less than one full-time employee to 60 full-time employees. Regionalization of local health departments and districts will pool resources, therefore improving staffing numbers, the delivery of public health services and the capacity to respond to public health threats in the event of an emergency,” the proposal states. “Regionalization will also provide governmental efficiencies. The Department of Public Health (DPH) will be able to provide better oversight and technical assistance to fewer local health departments and districts. The DPH will be able to save time and money, reducing the number of contracts and payments to local health departments and districts.”
Pino’s plan intends to ensure that every municipality receives uniform health services. However, many health directors across the state are less than supportive of his proposal, as it would require each town and city to put aside 1.5% of the previous year’s operating budget to fund the potential health districts.
Monroe designated $153,365 for the Monroe Health Department in last year’s budget. Under Pino’s plan the town would be required to kick in an estimated $1.27 million to the health district, which would be used to provide health services throughout Fairfield County.
“That’s a tremendous amount of money,” Brault said.
If the proposal is approved, the state health department will determine the map of the health districts on July 1. At that point the departments will begin the three-year transition from local departments to the larger health districts.
Brault said Pino’s plan is “tricky” because, while the state should certainly work to ensure that everyone receives health services, consolidating the districts is not the best way to go about it.
Having with one system, Brault said, would make it easier to assess the services being provided, but it would no longer allow health departments to focus on what is important to their individual towns.
Stratford Health Director Andrea Boissevain said her department would have “a lot to lose” if the proposal is approved. Last March, Stratford’s health department was one of three in the state to receive national accreditation. If the departments are merged into Pino’s proposed districts, her department would no longer have the accreditation.
“The proposal needed to come after having a more robust conversation about what the structure of public health should look like in Connecticut,” Boissevain said.
Brault said that if Pino’s proposal came to fruition, towns like Monroe would no longer have a health director, and that if Brault was still in Monroe, she would most likely have a different title. She also said that under Pino’s plan, residents would still receive the same basic health services, but the town would have to pay for those services through a tax.
So far, the proposal does not include information about whether the state would provide any funding to the potential health districts. David Knauf, the director of health in Darien, said that Pino’s plan calls for towns to pay considerably more for health services than they currently do.
“I can tell you it’s 10 times more in Darien than what they currently pay for a health director here.”
He also said the only state funding that has been mentioned is the pre-existing grants the state gives to health departments that would continue to be available to the potential health districts.
“With the budget cuts we’re all facing, that money might not be there in the future,” Knauf said.
As the districts are intended to be self-sufficient, it places the heightened public health costs on the residents of Connecticut.
“It’s an outrageous burden on the towns, especially as more and more state funding for different town services is being cut or held back,” Trumbull Health Director Shonda Capuano said.
She also said that Pino’s proposal would likely cost Trumbull residents an estimated $2 million for the consolidated health district.
Boissevain said the Stratford Health Department currently uses .28% of of the town’s budget.
Health directors have also voiced their concerns about the absence of details in Pino’s proposal.
Boissevain said “there’s a lot of logistic stuff that needs to be worked out.”
Knauf said the proposal is more of a “concept” then a plan, and that it fails to address how the consolidation would work and does not explain what would happen to infrastructure like vehicles currently used by the local departments.
“There’s a lot of detail work that [the commissioner] said we’ll have to work out,” Knauf said. “For the life of me I can’t figure out how you can not have details worked out before you ask for appropriations.”
He also said he found himself with more questions than answers from the proposal.
“It boggles my mind how we can have a bill go in front of the legislature without details of how it’s going to work and supporting documents on why we need it,” Knauf said.
Capuano said the proposal “doesn’t make sense,” as the state doesn’t have county-wide infrastructure. She also said Pino’s plan doesn’t outline how the health districts would improve public health.
“[The] proposal has never really clearly explained how it’s going to improve public health service delivery,” she said.
She said she’s curious as to why the local health directors weren’t invited to be more involved with the planning on Pino’s proposal.
The newly consolidated districts would each be maintained by a regional health director appointed by Pino.
As for employees of local health departments, many part-time employees might find themselves without a job if the consolidation plan were approved. Knauf said Pino claims there wouldn’t be any layoffs and that state law requires all full-time staff to be permitted to stay on when government agencies merge. However, it doesn’t offer the same protection to part-time staff, Knauf said.
Capuano said nothing has been mentioned about what would happen to the part-time staff.
“It makes me believe that they won’t be included in the transition,” she said.
Capuano said she thinks the plan is “drastic,” especially since Connecticut has been rated high on the national health scale the past few years.
In December 2016, Pino announced that the United Health Foundation’s 2016 America’s Health Rankings placed Connecticut as the third healthiest state in the nation. In 2015 the United Health Foundation ranked Connecticut as the sixth healthiest state in America.
Taking that ranking into consideration, Capuano said, “we’re all scratching our heads trying to figure out why such a drastic measure has been taken.”
If Connecticut was lower on the list, Knauf said, he could understand why the commissioner would want to revamp the system, but it doesn’t make sense to recreate the health system when the state is ranked that high.
Capuano said she understands some of the state’s reasoning but “it seems that this one-size-fits-all approach is like throwing the baby out with the bath water.”
The Courier was unable to get a comment from Connecticut’s department of health or the health commissioner’s office.
The health directors agree that all residents should have access to public health, and they support Pino’s effort to ensure that the services are being carried out, but say it could be done without consolidating the departments.
“The way I see it, every health department should be delivering the 10 essential public health services and there needs to be some sort of assessment to ensure that we’re doing that,” Brault said.
The 10 essential public health services are:
- Monitoring health status to identify and solve community health problems.
- Diagnosing and investigating health problems and health hazards in the community.
- Informing, educating and empowering people about health issues.
- Mobilizing community partnerships and action to identify and solve health problems.
- Developing policies and plans that support individual and community health efforts.
- Enforcing laws and regulations that protect health and ensure safety.
- Linking people to needed personal health services and assuring the provision of health care when otherwise unavailable.
- Assuring a competent public and personal health care workforce.
- Evaluating effectiveness, accessibility, and quality of personal and population-based health services.
- Researching for new insights and innovative solutions to health problems.
Boissevain said because the towns would be paying more for public health services, more funds would be available to provide public health services for residents. She also said that Connecticut’s public health “could stand to be updated.”
Boissevain noted that the health districts would be able to bill residents for public health services. Not all health departments are currently able to do.
The only benefit Brault and Capuano could see in Pino’s plan was that it intends to provide equity assurance.
Knauf, however, said he “doesn’t know” if there are any benefits to the plan.
“If there was to be a proposal that would enhance the public health in Connecticut, certainly I would be supportive of it,” Knauf said. “I don’t see anything in this proposal that really tells me or other health directors how this proposal is going to improve the health of Connecticut residents.”
Knauf recognizes that Pino’s plan intends to ensure that health services are provided to all residents, but he said local health directors have asked what gaps currently exist in the system and where they are located, because that way they could be fixed without overhauling the current public health system. He said a targeted approach might provide a better solution than consolidating the districts.
Boissevain said, however, that Pino had informed the state’s health directors that approximately 174,000 residents are not currently receiving public health services.
In addition to concerns surrounding the cost of Pino’s plan, Knauf voiced worries over a loss of autonomy.
“This proposal takes away local decision-making abilities from our local governments, from boards of selectmen and mayors,” Knauf said. “The larger you get, the more you lose track with the local communities.”
Brault said many people are concerned about the loss of local focus that accompanies Pino’s proposal.
“It’s very difficult, because in Connecticut we’re all about home rule. There are costs and benefits — the benefit is that you could have better public health services but there are a lot of unknowns,” Brault said. “They want their own control of their town or their district. They want to be able to focus on the type of programs that are important to them.”
State Rep. Holly Cheeseman of East Lyme and Salem proposed a bill to prevent Pino’s proposal from coming to fruition. She put forth a bill that would prevent health departments from being consolidated into health districts. Her bill is brief and concise, arguing that “the existing health district structure [should] be maintained.”
Capuano and Knauf both said they were pleased with Cheeseman’s efforts to block the consolidation.
Boissevain said there needs to be a conversation about public health at the state level and that Cheeseman’s bill is more of a statement than a bill.
The Courier was unable to get a comment from Cheeseman about her bill.
State Rep. J.P. Sredzinski of Monroe said he opposes Pino’s plan.
“The proposed plan to consolidate all health department services into county-sized districts will not serve Monroe or Newtown well — it will cost our taxpayers more and reduce their level of service,” Sredzinski said. “This proposal is not something I would support in its current form and will do what I can to stop this from becoming law.”
At the local level, Monroe First Selectman Steve Vavrek said he is “100% against any state mandate that forces any additional tax burden to individual towns’ or cities’ taxpayers.”
Vavrek said he hopes other legislators will work to block consolidation.
Brault said the town’s Board of Health is opposed to the commissioner’s plan.
“We need more details before we commit. We need to make well-informed decisions, and it [the plan] is very open-ended right now,” she said.
The health commissioner will be holding an informational session about the proposed health districts at the Office of Emergency Management in Bridgeport on Jan. 24 at 10 a.m.