As the Maine Legislature gets closer to deciding on what to do with a diminished health program that helps Maine’s infants and people with infectious diseases, the state agency charged with protecting Maine’s health has repeatedly failed to give lawmakers, and others, public information that could inform their course of action.
Last month, a legislative aide for state Sen. Brownie Carson emailed a Maine Center for Disease Control and Prevention staff member with a straightforward request: He sought copies of two public reports prepared by a national health organization that accredited Maine’s public health nursing program in 2009 and again in 2012.
The CDC staff member, who works for Maine’s public health nursing program, responded the same afternoon, April 19: “I forwarded your document request to my administrative superiors (Deb Wigand, Maryanne Harakall, Stacy Thibodeau) this morning. I have not been authorized to respond to your request.”
Carson, a Democrat from Harpswell, still hasn’t received a copy of either report.
The experience of requesting public information and not receiving it has become the norm in recent months for Carson and others who have sought details and basic documents about public health nursing from the Maine CDC, an office within the Maine Department of Health and Human Services.
Carson is sponsoring legislation this year that would restore Maine’s corps of state-employed nurses whose responsibilities include preventing the spread of infectious diseases such as tuberculosis, responding to disease outbreaks and public health emergencies, and improving the health of moms and their newborns by visiting them in their homes.
The legislation, LD 1108, follows several years in which the LePage administration has left nurse positions vacant even as the Legislature has appropriated funds to fill them. When Gov. Paul LePage took office in 2011, Maine employed about 50 public health nurses spread across the state. Earlier this year, according to the Legislature’s nonpartisan Office of Fiscal and Program Review, only 23 of the program’s 48 funded positions — fewer than half — were filled.
A Bangor Daily News Maine Focus article last summer, citing several former public health nursing employees, described DHHS managers’ efforts to largely hobble program operations — including by instituting a policy of not allowing the program’s former manager to email employees without approval from staff in Commissioner Mary Mayhew’s office, and eliminating office space and desks for public health nurses.
DHHS officials rarely spoke publicly about their plans for the public health nursing program as they let the program shrink by more than half and as health care providers throughout the state started noticing limited availability of nurses to follow up with patients infected with latent tuberculosis (which becomes active TB in 5 to 10 percent of those infected) and to provide home visits to drug-affected newborns.
DHHS, whose budget represents more than a third of state spending, didn’t respond to the BDN’s requests for public health nursing information last summer.
Later in 2016, DHHS terminated the staff member who coordinated the release of public information within the CDC, alleging she breached agency protocol for allowing a public document requested by the BDN to be sent to the newspaper.
And in preparing his nursing legislation this year, Carson has found it nearly impossible to get specific details about public health nursing operations from the CDC, the state office in which the nursing program is housed.
“I am in a position now of being responsible not only to the voters of my district, but the people of the state of Maine, for knowing whether the Maine Center for Disease Control is wisely managing disease prevention for the people of Maine,” said Carson, who is serving his first term in the Maine Senate, “and I can’t tell because they won’t give me stuff that is public.”
In February, Carson sent a list of 45 questions seeking specific details about public health nursing, including the number of nurses currently employed, the process used by the CDC to decide whether to assign a nurse after receiving a patient referral from a hospital or doctor’s office, data on the number of referrals accepted and rejected for public health nursing services, and information the CDC has used to inform its decision to cut public health nurse staffing.
Sheryl Peavey, the Maine CDC’s chief operating officer, responded to Carson nearly a month later with a letter that contained none of the details Carson sought but described in broad terms “a comprehensive overhaul” of public health nursing.
“Your letter referenced several topics including: accreditation, the vision for public health nursing, staffing, productivity and other data metrics, and emergency preparedness,” read Peavey’s response. “These are the areas of focus the Department has worked to address and I assure you were are moving in the right direction.”
“[N]early two years ago this administration made the decision to prioritize public health nursing services to focus on our most vulnerable infants, substance affected newborns, infectious diseases and refugee health,” Peavey wrote.
A DHHS spokeswoman didn’t respond to questions from the BDN this week seeking much of the same information sought by Carson.
In March, the Maine CDC deleted its public health nursing web page, which housed a handful of old annual reports for the program, a program brochure and contact information for public health nurses.
The reluctance to provide public information about a public program marks a departure from how the public health nursing program operated before the LePage administration, said Jan Morissette, who served as public health nursing director from 2005 to 2011.
“My recollection was, when there was a request for information, it was, ‘Drop what you were doing and provide it,’ and especially when it came from the Legislature,” she said. “You were expected to provide the information, whatever they were asking for. Usually, it was data, and we had data. We had the information.”
“We’re providing a public service,” Morrissette said. “We’re a public entity. We’re not a private entity, so when information is asked for, you respond.”
Since Carson introduced his legislation earlier this year, Peavey and Dr. Christopher Pezzullo, the state health officer at DHHS, have spoken on a few occasions before the Legislature’s Health and Human Services Committee about public health nursing. In March, Pezzullo described public health nursing as “really broken” and said, “We have been taking [it] apart to put it back together.”
On April 26, during a committee work session on Carson’s bill, Peavey spoke of boosting the number of patient visits per day to a national standard that she said Maine’s public health nurses weren’t meeting and wanting to use program data to inform hiring decisions. She and Pezzullo have discussed shifting more public health and emergency preparedness responsibilities to private organizations, instead of relying on state-employed nurses.
Meanwhile, a number of health care providers who testified in support of the legislation earlier in April described a state program that could no longer meet its mission. A number of medical providers said they could no longer refer patients — including, in one instance mentioned by a Portland doctor, a substance-using mother of a newborn — to public health nurses because no nurses were available. If they referred patients, they had no idea whether they ultimately received a nurse’s services.
Decades of research have shown that sending a nurse into a new parent’s home, both prenatally and postpartum, is associated with a range of positive outcomes, from reduced likelihood of preterm births, infant deaths and child abuse, to improved language development and school readiness for the child and improved health for the mother.
Peavey provided no data on patient referrals in response to Carson’s request for the information. Carson sought the accreditation reports from 2009 and 2012 in hopes of reading the assessment of Maine’s public health nursing program by an independent third party with public health credentials.
“Sheryl Peavey and the current management of CDC, with all their criticism, have never produced one shred of data, not one piece of evidence to back up their claim that public health nurses are inefficient, that they’re not somehow doing their jobs,” Carson said.
Maine Focus is a journalism and community engagement initiative at the Bangor Daily News.