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Carroll Health Department faces funding shortfall

The Carroll County Health Department has cut several staffed positions from various programs and eliminated its audiology program as a result of a $420,000 funding shortfall due to a state-mandated employee salary increase. But Health Department staff believes these cuts will not affect Carroll residents in a significant way.

"We believe residents will get equivalent or better service from the [Carroll] Hospital, nonprofits and the private sector," said Deputy Health Officer Henry Taylor during an interview Friday. "Conceptually, the point is the Health Department is reconfiguring what and how we do it. It's a time of change for public health."

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The Health Department is considered an off budget agency, which means when a pay increase is approved by Maryland government, the corresponding funds to account for this increase are not automatically included in the department's share of state funding. The mandated pay raise has resulted in a 5 percent increase in salaries. The largest mandated annual increase in the previous five years was just 2 percent.

Ed Singer, health officer for the department, briefed the Carroll County Board of Commissioners Thursday on the funding deficit, as well as the decision to cut five staffed positions and its audiology program. These positions have already been eliminated, Singer said. The department employs about 160 people.

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"We spent the better part of a month debating what we were going to do," Singer said. "We were trying to make a decision that would have the least impact on Carroll and staff."

The overall department budget is roughly $15 million in fiscal year 2016 and this money is split between 81 different programs. In FY16, the state contributed $2.9 million and the county allocated $1.5 million. The only true discretionary funds comes from Carroll County, as state money is dedicated to eight specific programs.

The remaining $10.6 million comes from federal and state grants. By accepting these grants, the Health Department must use the funds for specific programs, with no latitude for discretionary purposes.

Carroll's Health Department is not the only one in Maryland to face such a challenge, he said. Earlier in the fiscal year, which began July 1, a few jurisdictional health departments had to undergo similar cutbacks, and more departments are expected to do the same later in the fiscal year, Singer said.

Perhaps the most controversial cutback by Carroll's Health Department was the elimination of its audiology program, which serves more than 300 clients a year, Singer said. The program was a redundancy of sorts, he said, as there are two private businesses in Westminster that provide the same service and another 21 within a 30-mile radius of the city.

"The Health Department is there to fill gaps that other organizations can't," Singer said. "If there are other providers out there that are providing the same services, it's really not a service we should be providing at the Health Department; at least that's my position."

The department's audiology program will be discontinued Nov. 1, but he and staff will do everything they can to guide their clients through the process of changing providers to reduce the impact, he said.

Singer is also confident that the department's remaining staff will be able to absorb the duties and responsibilities of the eliminated positions, he said.

Among the more significant positions lost is a nursing position in the communicable disease program.

"I was hesitant to do this," Singer said of cutting the communicable disease nursing position. "It's one of the most important things we do, which is track emerging disease trends to see how it could impact the community as a whole."

Another important position that has been defunded is a community health educator who coordinated Lamaze classes, a teen pregnancy support group, outreach education at Carroll Community College and supports a program that provides volunteer services to the elderly and disabled.

The Health Department's Environmental Health Bureau also took a big hit, losing a full-time environmental health specialist and a $30,000 grant. The grant, Singer said, was meant to bolster the program but it was needed elsewhere.

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The Environmental Health Bureau conducts inspections, reviews and issues permits on matters relating to water quality, septic and sewage systems, and the food service industry.

"I've talked to staff; they feel like they can absorb this, but it may lead to longer processing times," Singer said.

He was also forced to consolidate the department's billing operations, thus eliminating two part-time staff members or the equivalent of one full-time employee.

"We will have to reinvent how we do business in billing, and by making these changes, we believe we can come up with enough efficiencies to make this work," Singer said. "I'm not saying we might not have to tweak things but this is our plan."

Singer said he will soon meet with the department's budget analyst to begin looking at the FY17 budget. Each fiscal year runs from July 1 to June 30. It is difficult to formulate a budget because the state waits to disperse funds until roughly October, he said.

He and his staff are also working on an application to become an accredited health department, Singer said, but have not finalized a decision to actually submit it. An initiative of the U.S. Centers for Disease Control and Prevention, the accreditation program is a "method for achieving a systemic approach for public health improvement" that "promotes high performance and continuous quality improvement," according to the CDC's website.

"We are still not committed to doing that, but if we decide to do that we need to have a strategic plan to identify priorities and anything we could outsource to the private sector," Singer said. "The Health Department needs to get out of providing services for the most part. If there are gaps, we can do that, but our purpose is one of oversight and surveillance and protecting the community rather than individuals."

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