If Maine tomorrow faced an infectious disease outbreak on the scale of the 2009 H1N1 influenza that broke out at 40 summer camps and 200 schools in Maine, there’s serious doubt in the state’s ability to mount an effective response.
The reason? The state today lacks a key tool in its disease containment toolbox — a public health nursing program operating at full capacity.
In 2009, the state employed a corps of about 50 public health nurses who were able to respond to an unpredictable outbreak quickly. They helped set up and staff 238 vaccination clinics. They helped school nurses vaccinate students and ensured vaccines were effectively distributed and safely stored. They educated others charged with vaccinating at-risk populations. With public health nurses’ help, Maine managed to vaccinate children and seniors — the populations at greatest risk — at some of the highest rates in the nation. Maine was among only a handful of states that didn’t see any children die from H1N1.
Today, Maine’s corps of public health nurses is down to fewer than 20 who are available to fulfill responsibilities that require that they be located throughout the state. Those responsibilities include responding to disease outbreaks and other public health emergencies; visiting postpartum mothers and their babies at home, particularly drug-affected babies who require medical follow-up after their release from the hospital; and providing school nurse services in rural schools that don’t have the funds to hire nurses of their own.
“Public health nurses were our response to H1N1. If they’re gone, who will respond to H7N9, which has recently surged in China? Or tuberculosis, the rate of which is increasing in Maine?” Peter Michaud, a nurse and associate general counsel for the Maine Medical Association, told lawmakers this spring.
Maine’s public health nursing program isn’t the casualty of cuts in a tight budget environment. Legislators have made a point of funding public health nurse positions. The LePage administration, however, has simply refused to fill most vacancies as they’ve come up. As they’ve watched the program shrink, officials in the Department of Health and Human Services have also attempted to prevent the program from properly functioning. This year, as lawmakers have considered legislation to restore the program to full staffing, Maine DHHS officials have tried to create the impression that public health nursing is outdated and inefficient.
The inefficiency, however, is largely of Maine DHHS’ own making. With greatly diminished staffing, the state agency has had to dispatch Augusta- and Bangor-based nurses to Washington County and put them up in hotel rooms during their temporary assignments.
This year, nurses from Aroostook County have consistently had to travel to Portland and Lewiston to staff clinics at which they monitor the treatment of patients with latent tuberculosis, which has a 5 to 10 percent chance of developing into full-fledged, highly contagious TB.
A shrinking number of nurses puts the state’s ability to contain the spread of a highly infectious respiratory disease in doubt.
That’s one of the reasons the House and Senate last month passed legislation sponsored by Sen. Brownie Carson, D-Harpswell, to restore public health nursing to its pre-LePage administration staffing levels. The bill, LD 1108, easily passed the Senate and passed the House by a closer margin. In Maine’s new two-year budget that passed at the start of the month, lawmakers reversed a LePage administration proposal to cut more public health nursing positions.
On Thursday, lawmakers have another chance to show their support for a critical part of the state’s public health infrastructure. In order to eliminate its price tag, the bill has been scaled back to one that would simply require Maine DHHS to hire nurses for all of the program’s remaining staff positions that are funded in the state’s new two-year budget.
Passing it is a needed, common-sense step on the way to rebuilding Maine’s capacity to provide for the public’s health.