By BILL LUNDQUIST
GOLD BEACH The state probably wont be able to provide public health services at the same level the county does now, according to a state official.
Curry County Commissioner Marlyn Schafer said if the county does not turn public health over to the state, it also wont be able to provide services at current levels.
Tom Engle, director of the Office of Community Services in the Oregon Department of Human Services-Health Division, was one of the state officials who met with the county commissioners Tuesday morning.
He said the state can only provide public health funding supplied by the federal government. It, like the county, cannot afford to fill in with other funds.
Engle said the state would do its best, but he didnt believe it could provide services as effectively as the county government, given the same amount of money.
He said the Curry County Public Health Department is able to tap into more volunteer resources.
Curry County Public Health Director Barbara Floyd said her department is also able to generate about $750,000 a year in fees.
After listening to the state officials, and taking some public comment, the commissioners said they would submit a balanced budget to the full budget committee on April 15. That budget does not include the Public Health Department.
The budget committee is made up of the three commissioners and three lay members. Schafer said if a majority of the full committee wanted to keep the health department, they would have to find other ways to balance the budget.
Before adjourning, the commissioners scheduled another workshop on public health for 1:30 p.m. Monday in the commissioners hearing room to further explore the issue.
Of the 36 Oregon counties, said Engle, only Gilliam has no health department. The state is the public health authority there. He said Sherman County works with Wasco County on public health.
Engle said three other counties, Columbia, Union and Wheeler, had signed contracts with health districts to provide public health services.
Engle said the statute designating counties as the public health authorities does provide for them to relinquish that authority to the state.
He said if Curry County relinquishes its authority, the state will become its public health authority, based in the state Human Services office in Portland.
He said it would examine each program, and spend the amount of money it would normally provide to the county on vendors to provide services.
Engle said the state is mandated to provide five public health services. It must provide epidemiology, and prevent and control communicable diseases.
It must provide parent and children health services and family planning. It must collect and report health statistics.
The state must also provide environmental health services and serve as a reference for health information.
Commissioner Lucie La Bont said the county had planned to keep providing environmental health services like food and water inspection through its Public Services Department.
Engle said the county must already have an agreement with the state to provide those services.
As the public health authority, said Engle, the state would look at that agreement.
The big concerns to the public, said La Bont, is the county relinquishing its public health authority, and the possible loss of services in the North County.
There are a lot of low-income, needy people there, she said.
La Bont said the county currently has public health offices in each of its three cities. She asked if the state would continue to provide services at that level.
If the state provides services, said Engle, you will probably lose some services.
He used the countys Women, Infants and Children (WIC) nutrition program as an example.
He said it currently has 500 to 600 clients. He said the state may try to serve them all out of one office, or it may have to cut the number of clients.
Wed have to study that, he said.
La Bont asked if the state could look into the programs within two weeks and tell the commissioners what it planned to do with them.
You wont know until you make your decision, said Engle.
He said if the county relinquishes its authority soon, the state will have to work full time into July to implement the change.
Commissioner Rachelle Schaaf asked what oversight authority the county would have if it contracted public health services out.
Engle said the counties that have done that have contracted out their authority and the requirement for a public health administrator.
Your power is in the contract you write, he said. Were on partly new terrain here. No one has tried a model where the county retains its authority and contracts out all services.
Schafer said contracting out services currently provided by union employees could also be a union issue.
She asked how the state would look at those it would serve in Curry County.
Will you care about those babies and mothers? she asked.
Of course we care what happens to those people, said Engle. We will contract the best services we can for the money available.
Well have $62,000 for the WIC program.We will do the best we can to make it the most efficient.
Your heart is still in trying to provide those services? said Schafer.
Absolutely, said Engle.
La Bont said if the state can only spend so much on public health in Curry County, the county could keep the department and use the same spending cap.
She asked what the difference would be if the state took it over.
The problem of providing efficient services doesnt change, said Engle, but the public health authority would sit in Portland.
Public health works best if local people manage it, said Engle, regardless of the amount of money. Its problematic if the local authority is 370 miles away.
Unless its a different local provider, said Schafer.
I suspect we would have several different providers, said Engle.
Schafer said the schools could take over some programs, like Students Today Arent Ready for Sex (STARS).
Those will all go away if we keep public health, she said. Even with no general fund money, you guys could provide the five mandated services better.
Engle said the state may approach neighboring counties about providing those services for Curry County.
Schafer said neighboring counties are thinking about following Curry Countys lead in turning public health back to the state.
It may just be that some services will have to go away, said Engle.
Schaaf asked why the state couldnt contract with the Curry Health District.
Engle said it could for services, but the state would remain the public health authority.
La Bont said, The state could say it will provide services but make people travel to Coquille to get them.
Engle said that was possible.
Schafer said if the county retains its Public Health Department, but has to cut services, people will be harping at us continually for services.
I hate to provide a service we cant do well, she said. Especially if we cant provide it as well as you.
We cannot provide a better service than you can, said Engle.
La Bont said because of the union issue, the county may not be able to contract services out, but the state could.
Floyd said she understood that if her department remained within the county, drastic reductions would be necessary.
She said with appropriate technical assistance with her budget, she could develop a different structure, but it would take some planning time.
It is possible to put a plan together with little or no general fund contribution, she said. Give me a target to shoot for, even if we try it for just one year.
Engle also said the state statute makes some reference to the state billing the county for services.
Schafer said, The statute says if the county doesnt provide services, you can take the money from the county treasury.
Engle said the state is not necessarily looking at that, and would have to go back and figure out the legislative intent of the statute.