State to close nearly half of health centers

(Pittsburgh Post Gazette) When the H1N1 virus broke out into an epidemic here in 2009, nurse Joe Donahue participated in an immunization effort in rural state health centers that provided shots to 26,000 people in southwestern Pennsylvania. Maggie Beall Orosz, a school nurse in Butler County, used the centers to immunize schoolchildren. Kathy Brodala, a nurse in Beaver County, has seen at least one tuberculosis patient every year receive daily treatment at one of these centers.

Unless a lawsuit filed by the union that represents these nurses is successful, nearly half of the 60 centers in the state will be closed and 27 district office nursing positions will be eliminated, in a consolidation effort by the state Health Department of Health to save $3.4 million and bring health services more directly to the community. Of the 27 nurses affected by the change, eight will be furloughed and the 19 others will work other jobs within the department.

These state centers were set up by the Legislature to provide low-cost or free immunizations, sexually transmitted disease testing, TB treatment and other public health services. Among the changes, clinics in Beaver and Armstrong counties are closing and services will be consolidated at the center in Butler; Greene County’s center would be consolidated with the Washington County health center; and the Monessen State Health Center in Westmoreland County would close to be consolidated with the Westmoreland County health center in Greensburg.

State officials said that these facilities are not well used, and that administering the same services in different locations throughout the community will be a more effective way to help rural populations.

At the rural health center in Kittanning on a recent Thursday, the state’s diagnosis of the facilities being underused seems apt. The small brick building sat empty next to a dress shop and a beauty parlor. Of 25 people interviewed in the surrounding area, only two had ever used the facility, and both for flu shots.

“I just thought it was part of the dress store,” said Pam Toy, a worker at the salon, Polished by Hands & Tans, next door.

Some of these centers see as few as one walk-in client per month, said Holli Senior, the deputy press secretary at the Department of Public Health. Armstrong’s sees one walk-in a week, and the one in Beaver sees three or four.

Statewide, about 233,000 patients are served in these rural centers, mostly in immunization and other clinics.

Though the health department contends the centers are not well-used, nurses who work at these facilities say this characterization vastly underrepresents the impact that these health centers have on the community. The nursing positions that will be eliminated, for example, share and coordinate public health information with other nurses in the community, like school nurses.

These facilities helped Mrs. Beall Orosz understand how to best contain epidemics, such as the H1N1, or occasional outbreaks of bacterial meningitis at local schools. They also ensure that students receive immunizations before kindergarten and to quarantine dogs that have bitten children, she added.

“Not having them will be kind of like cutting off a lifeline,” Mrs. Beall Orosz said.

The facilities also provide daily care to those in need, such as regular TB treatment — which not only helps the patient but aims to ensure the health of the community of this highly contagious disease, said Ms. Brodala, a nurse at the Beaver County facility. .

State officials insist that none of the primary services will be eliminated. In the case of tuberculosis, Aimee Tysarczyk, press secretary and director of communications for the Department of Health, said nurses will visit patients’ homes when necessary.

Ms. Brodala, however, said this uncertainty is unsettling. “It’s a scary situation,” she said. “The most important thing right now is that there’s no plan.”

Patients also visit the facilities for STD testing and immunization. The state health centers are usually booked during an STD testing clinic or a flu clinic, said Joe Donahue, a community health nurse in Butler.

Additionally, Mr. Donahue is concerned about what will happen in the state if there is an epidemic.

After an outbreak of hepatitis A at a Chi-Chi’s restaurant in Beaver County in 2003 that killed four people and sickened 660 others, the state inoculated 10,000 people in two weeks, Mr. Donahue said.

Down the street from Kittanning’s health center, Pam Salsgiver, who works at a Sunoco, said that she has never used the health center and does not see the facility get a lot of use. “Are they for low income?” she asked. “Because then they ought to be booming. We’ve got a lot of people like that around here.”

Some of these communities also have large Amish or immigrant populations that need health care, said Tammi Stuck, who was a community health nurse for 35 years. Closing these facilities is, “really going to have a negative impact on Pennsylvania for a long time to come,” she said.

The nurses worry that these patients will not be able to drive the extra distance to a facility in another county. Mr. Donahue said that an STD or TB patient is not going to be able to drive 45 minutes to another rural facility.

State officials responded by saying that the new system will actually improve accessibility.

“The department believes we can be more effective by mobilizing staff into the communities rather than having them come to us or find transportation to get to us,” Ms. Senior said.

This decision was based on the fact that the walk-in clinics do not see very many patients, all clinics are already scheduled and many clients have difficulty transporting themselves to the facilities.

Ms. Senior said that the department will post information about clinics online. For those who do not have access to the Internet, the information will be posted in local newspapers, state libraries, churches, legislative district offices and possibly even local diners.

“We will maintain a physical presence in each county,” Ms. Senior vowed.

In addition to disagreements between the state department and nurses over the decision to close the facilities, a legal battle is brewing.

The current system of health centers was set up in the 1970s and 1980s. In 1996, Gov. Tom Ridge sought to close all the state health centers in Pennsylvania. The Legislature blocked this move by passing Act 87, which states that the department must “provide at a minimum those public health services in effect as of July 1, 1995 … .”

The Service Employee International Union Healthcare Pennsylvania said that based on this act, the closures are not legal without approval of the state Legislature. The department said that even though there may not be a brick and mortar health center in every county, the same services will still be administered to each population. Additionally, the department contends that Act 87 was enacted to prevent the privatization of health care services that will not occur under the proposed plan.

So far, a Commonwealth Court judge has denied a request for an injunction requested by the SEIU.