Public health alarm sounded City urged not to privatize jobs
By Nick Kotsopoulos TELEGRAM & GAZETTE STAFF
WORCESTER — Public health advocates and other concerned citizens last night appealed to City Manager Michael V. O’Brien to ensure there will be broad and diverse representation on the task force that will develop a public health mission for the city, in the wake of deep budget cuts that have virtually wiped out the city’s Public Health Division.
They said the task force needs to include consumers and public health stakeholders who are most familiar with the needs of the community. They added that it is essential for the city to maintain its authority over public health, and not have those responsibilities turned over to local institutions.
“The public health and safety of citizens is the pre-eminent responsibility of government,” said James Gardiner, the city’s former acting commissioner of Public Health and Human Services, who lost his job last month because of budget cuts. “We rely on a strong public health infrastructure in our daily lives. That’s why it is critical to focus on the (public health) needs of the community rather than talking about establishing a core mission. Public health needs to be reflective of the community.”
More than 40 people attended a hearing held by the City Council Public Health and Human Services Committee on public health services to be provided by the city. Fourteen people testified, with just about all expressing dismay over the public health budget cuts.
Because of budget constraints facing the city, Mr. O’Brien’s $491.1 million fiscal 2010 budget proposal has virtually dismantled the Public Health Division, with its overall staffing being reduced from 20 to five. Among those laid off were five public health nurses, leaving two to cover the city.
The manager recently announced that the city is partnering with UMass Memorial Health Care Inc. and the University of Massachusetts Medical School to redefine its public health mission. He said he will assemble a task force by May 31, in cooperation with the Board of Health, to research and develop a public health core mission for the city that is based on national best practices and reflects a sustainable financial model.
He said he also expects the task force’s recommendations, which will be due by Sept. 30, will ensure the city’s public health mission complements work already being conducted by local hospitals, physicians, community health providers, colleges, universities and social service agencies.
“There is a 100-year tradition of great work being undertaken by the Division of Public Health., and there are many good employees doing good work on behalf of our citizens,” Mr. O’Brien said. “I stand here with great respect and admiration for that work, but we have to deal with unprecedented fiscal realities. We are faced with three alternatives moving forward: limit our public health functions to core obligations, raise taxes and new revenues to support the existing model, or seek a model that is sustainable and focused.”
Ann Cappabianca, one of the two remaining public health nurses, said the city “is not safe” now when it comes to public health because of inadequate coverage. She said the provision of public health is a public safety issue, and one that should be provided by the city and not local institutions.
“Just as we don’t want to privatize police and fire, we also can’t privatize the services my colleagues and I provide,” Ms. Cappabianca said. “The reason is simple; our goal is to be accountable to you, the City Council, and through you to the people of Worcester.”
She also contended there is a conflict in having UMass direct the task force because that institution could end up taking over many of the city’s public health functions.
“Am I the only one in this room that doesn’t see what a clear conflict of interest this presents?” Ms. Cappabianca asked. “This task force needs to be independent, with no connection to UMass or any other private entity.”
Mr. O’Brien said the task force will be broad-based and will include community health providers, education institutions, public health experts, social service programs and neighborhood representatives.
Testimony Before Worcester City Council Public Health & Human Services Subcommittee
Ann Cappabianca, RN, Worcester Public Health Nurse
Good afternoon and thank you to Chairman Rosen, Councilor Rushton, Councilor Haller and Mayor Lukes for this opportunity to testify on behalf of the Worcester Public Health Nurses, the Massachusetts Nurses Association and as a proud member of the Coalition to Protect Public Health in the City of Worcester. My name is Ann Cappabianca and I have been a public health nurse for this city for more than 12 years. As I told you all during my testimony on May 5th, I, along with my former colleagues, have been on the frontlines, serving as the city’s health care safety net, working every day to protect this entire community. As I informed you then, we are proud of the job we do, and we believe we have already been engaging in the best practices in the delivery of public health to the city of Worcester. While this hearing is devoted to speaking about the city manager’s plan for a task force to pursue privatization, I want to make sure you realize the dire state we are in right now.
I am one of only two nurses left to provide public health services to this, the second largest city in Massachusetts. As of the last five working days, I have been the only Public Health nurse working, as the other nurse is on vacation. There is no plan for coverage of vacation and sick days. You need to know as we debate this “plan” this city is not safe. Let me say that again, and say it loud so you all can hear me clearly – THIS CITY IS NOT SAFE. Statements made on May 5th assuring you that no harm was done to our safety net with the recent cuts were untrue. Every day we debate a plan and leave this city understaffed by five nurses, the risk of spreading communicable diseases increases. Poor children go without needed vaccinations. There has been an immediate repercussion of the City’s decision to close the Immunization and Travel clinic. In the last two weeks, three of the agencys we have referred people to for immunizations have asked us not to refer to them because they cannot accommodate the increase of patients. We have not even entered into the busy time of August school immunizations. The question you need to ask is why the city manager decided to call for a plan to provide public health services after decimating the service and not before.
As to the plan itself, it is a sham. Let’s be clear here. The city manager has stated publicly that it is his goal to partner with private interests in this city to deliver the services we currently provide. He is not doing this to implement best practices, he is doing this to pass off services that have always been the responsibility of government to provide onto the private sector. The problem is, the provision of public health is a public safety issue. Just as we don’t want to privatize police and fire or civil defense, we also can’t privatize the services my colleagues and I provide. The reason is simple, our goal is to be accountable to you, the City Council and through you to the people of Worcester. You and the people are our bosses and the only people to whom we should be held accountable. In fact, in the case of disease surveillance and treatment, we have authority to inspect and sanction the same private institution that the City manager wants to take over these services. He wants the regulated to regulate themselves. It’s not only a bad policy, it is a dangerous one.
We would also point out that it is an absurd proposal to have the private institution that you have expressed an interest in taking over many of these services to be the entity you have chosen to direct the task force to study the feasibility of that privatization. Am I the only one in this room that doesn’t see what a clear conflict of interest this presents
As someone who is personally accountable to the state of Massachusetts and to this city to keep this community safe, I am telling you we need to restore these services now, or you are placing your constituents in danger.
If you do form this task force, make it a real and independent task force, with no connection to UMass or any other private entity. Someone from this Council should chair it, and it should include those of us who actually provide the services. It should include representatives of the Coalition to Save Public Health, particularly representatives from groups who advocate on behalf of the vulnerable populations who we care for, And, if you are interested in studying best practices, then give a leading role to the only organization that understands best practices. I am speaking of the professional organization that is comprised of the best minds in the field of public health – the Massachusetts Public Health Association.
Whatever you do, remember what is at stake in this process – it is the safety of our entire community. This is not a responsibility that any one of us should want to turn over to private interests. This IS the role of Government. Yes these are tough times, but this is also the time when we need our government and our public officials to stand up and protect those who are most vulnerable in these difficult times. I implore you: keep the public in public health. Thank you for your time.