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Health departments facing coronavirus crisis after budget cuts trim staff

Nassau County Department of Health Commissioner Dr. Lawrence

Nassau County Department of Health Commissioner Dr. Lawrence Eisenstein and Nassau County Executive Laura Curran hold a briefing outside the Nassau County Theodore Roosevelt Executive and Legislative Building in Mineola on March 21. Credit: Newsday/J. Conrad Williams Jr.

Long Island’s county health departments, the front lines of local government’s coronavirus response, are facing the unprecedented crisis with disproportionately less staff than a decade ago, a Newsday analysis found.

Since 2010, budget cuts in each department have reduced, by as much as 30%, the number of workers who play the most essential municipal roles in trying to limit spread of the virus, such as epidemiology trained public health nurses.

In comparison, the overall Nassau and Suffolk workforces shrunk by about 10% during that time period.

“We’re working long, hard days and just trying to get the job done,” said Mary Pat Boyle, a Suffolk County public health nurse who typically directs the health department’s HIV and sexually transmitted disease control program.

The county health departments, in normal times, have responsibilities ranging from public health education and infectious disease control to restaurant inspections and environmental testing.

Today, with public health nurses at the forefront, they're consumed with tracking positive coronavirus test results, informing patients of their quarantine responsibilities and attempting — as much as still possible with nearly 25,000 cases on Long Island — to trace their recent contacts.

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“It’s a big challenge,” said Boyle, a 23-year health department veteran.

She declined to dwell on past layoffs that hit her department more than any other but said that Suffolk public health nurses have been splitting staff between office and remote work – and between “A” and “B” days – to limit the impact of a possible in-house coronavirus outbreak.

"We're on call 24/7," Boyle said.

In 2010, the Nassau and Suffolk health departments had a combined workforce of 1,754, a number that included the staff at several Suffolk health clinics that have since been privatized, as well employees of the large John J. Foley Skilled Nursing Facility in Yaphank, which was closed in 2013.

Excluding reductions associated with the privatizations and closure, Suffolk’s health department dropped from a roster of about 1,100 workers to just 817, or 24%.

Nassau’s smaller full-time health staff dropped from 220 in 2010 to 167 this year, again 24%. Though its cuts were largely focused on administrative and clerical positions, it eliminated a group of public health educators in 2013.

The Suffolk health cuts, driven by layoffs in 2012 and subsequent attrition, have reduced budgeted public health nursing positions, including supervisors, from 51 to 35, or 31%, records show.

“They’re bare bones,” said Mary Finnin, a retired Suffolk public health nurse who frequently protested health department cuts before the county legislature. “They have not had the support they needed.”

Suffolk’s number of public health nurses would be even lower had legislators and health advocates like Finnin not beat back further downsizing attempts last decade by former County Executive Steve Levy and County Executive Steve Bellone, including as recently as four years ago, when Bellone proposed cutting the bureau of public health nurses focused on at-home visits to the county’s most vulnerable population.

Under that proposal, most public health nurses would have been transferred to general nursing functions at the county jail and other areas.

“We almost completely eliminated our public health nurses. Thank God we didn’t,” said Suffolk Legis. William Spencer (D-Centerport), a physician who has chaired the legislative health committee since 2012. “We really now see the importance of having them.”

In an interview Saturday, Bellone said that no government can properly staff for a global pandemic, but that he believes the work of the health department staff that are "closest to the ground in these health crises" can now be more appreciated.

"People have gotten a fresh look at how important county governments are in our overall system. Because the core of what we do is public health and public safety," Bellone said. "And at the end of the day, we do have to make sure that these governments are able to function and have the capacity to carry out these critical services."

In Nassau, Health Commissioner Lawrence Eisenstein said, “we’ve managed with whatever cuts and budgets we’ve been given. In a situation like this, you do it by prioritizing."

"We understood that this is a life-saving measure that the public health department is doing," he continued. "We are every bit as vital in saving lives as every other component of health care and law enforcement right now.”

Nationwide, city and county health departments have seen a nearly 25% reduction in staff since 2008, according to the National Association of County and City Health Officials.

“They're in the survival mode all the time,” said Lori Tremmel Freeman, the association's chief executive officer, about local health departments. “But when you have a public health crisis of this nature, that's this widespread and this devastating, then the workforce cuts are really going to have an effect on your response.”

 She said a municipal health department's coronavirus disaster plan may ultimately get realized, but with less staff, routine immunization or maternal health programs, for example, go by the wayside.

“You rely on robbing Peter to pay Paul to do the work,” Tremmel Freeman said. “Something has to give, right?” 

An all-hands approach by Long Island's county health departments has required contributions from the public health sanitarians normally focused on the restaurant and water quality inspections – and even from employees in other departments, such as the school crossing guards manning coronavirus informational hotlines.

“Everybody has really stepped up,” said Boyle, the Suffolk public health nurse, noting that she and her colleagues are trying to reach as many of the county’s positive tests as possible, educating them on quarantine guidelines and offering supplies and guidelines to those in the most need.

While tracing the contacts of every local case is no longer possible, the staff in Suffolk is focusing on those with ties to nursing homes, first responders and any similar high-risk demographics.

“At times like this, it creates extra stress on support staff," said Dan Levler, who leads the 6,000-member Suffolk County Association of Municipal Employees, which represents most county health department workers. "Because there’s not a lot of things that can wait.”

 Bellone called the work being done by public health nurses and other department staff "absolutely incredible," noting that all county employees are being asked to respond in one way or another.

"We've had to utilize people from across different depoartments, put people into work doing things that they don't normally do," he said. "And that's just part of what you have to do in a crisis situation."

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