When Gov. Paul LePage indicates his goal is to cut the size of the state government workforce in order to pay for state income tax cuts, in part by leaving vacant positions unfilled, he’s referring to jobs like those of public health nurses.
When Maine faced an outbreak of a novel strain of influenza in 2009, H1N1, it had 50 public health nurses at the ready to set up and staff more than 200 vaccination clinics, to go into schools and immunize students, and to train others on vaccination protocols, including safe storage and distribution of limited vaccine supplies.
With public health nurses’ help, Maine was able to vaccinate children and seniors against the H1N1 influenza strain at some of the highest rates in the nation.
Today, Maine’s corps of public health nurses — one of the first positions in the state’s Division of Public Health, which today is the Maine Center for Disease Control and Prevention — is half as large. The diminished ranks throw into question Maine’s ability to respond effectively to a disease outbreak similar to H1N1, which infected thousands and caused outbreaks at 40 summer camps and 200 schools.
Aside from being prepared to respond to a public health crisis, Maine’s 25 remaining public health nurses who are regularly out in the field maintain a long list of responsibilities aimed at improving the public’s health in communities across the state — including visiting new moms and babies in their homes, particularly drug-affected babies and those with other special medical needs — and controlling the spread of communicable diseases, especially tuberculosis.
The state’s public health nursing program didn’t shrink as the result of a mass layoff or a single budget cut. It became smaller gradually as nurses left their positions and the Maine CDC never attempted to replace the departing nurses despite the pleas of the program’s directors and lawmakers who purposefully kept funding in the state budget to fill the positions.
“Basically, I was just told, ‘no,’ and I would request every week or every other week for those positions to be filled,” said Ted Hensley, the former public health nursing director.
In addition to leaving positions unfilled, Maine Department of Health and Human Services leadership implemented policies that simply made it more difficult for the public health nursing program to function. DHHS closed many of the program’s regional offices and cut clerical support for nurses, leaving nurses filling out paperwork in their cars. Hensley, as the program’s director, was barred from emailing the staff members under his supervision without approval from staffers in DHHS Commissioner Mary Mayhew’s office. DHHS leadership ordered public health nursing to remove its program brochures from circulation, limiting the program’s ability to get the word out to health care providers.
It all contributed to a demoralizing and secretive work environment, in which nurses didn’t know what was happening to the program they worked for as it shrank around them. Between April and July, five nurses departed.
“Everything was secrecy, not transparency,” said Ronnie Paradis, who worked for 10 years as a public health nurse in Lewiston before retiring in June 2015. “We didn’t know if we were going to be fired or let go or what. Everything was a secret. Nobody would tell us what they were doing.”
With so few nurses left on the job, the remaining nurses are spread thin. The Bangor area is down to one full-time nurse and one part-time nurse out in the field, covering a territory that spans rural Penobscot and Piscataquis counties and, nowadays, because of unfilled positions, parts of Kennebec County. When a nurse’s services are required in Lewiston, often to monitor a patient undergoing treatment for latent tuberculosis, a nurse may be called in from the Augusta area since Lewiston staffing is so limited.
In undermining the ability of public health nurses to effectively do their jobs, the LePage administration has undermined a core part of Maine’s public health infrastructure and the state’s ability to respond effectively to the next public health threat.
It’s one example that shows that when the LePage administration wishes away a fifth of the state workforce in order to pay for income tax cuts, there are bound to be consequences.