Earlier this year, the administration of Republican PA Governor Tom Corbett announced a plan to close nearly half of the state’s health centers by the end of the summer. SEIU Healthcare PA and some Democratic members of the General Assembly challenged the plan’s constitutionality in court on the grounds that the executive doesn’t have the power to make that policy decision without the legislature, but a Commonwealth Court ruled in favor of the Corbett Administration, choosing not to stop the plan. The plan’s opponents appealed that ruling and now the highest court in the state, the PA Supreme Court, has ruled in their favor, temporarily halting the health center closings and asking for a speedy hearing on the issue. Many Pennsylvanians who would have lost their only means of accessing health care services are in luck – for now.
The Corbett Administration plan in question would close 26 of Pennsylvania’s 60 health centers, where people who are sick or injured but don’t have health insurance or the money to pay for the care they need out-of-pocket can go for some health care services, and eliminate 73 jobs in the PA Department of Health. Of course, the Corbett Administration says this will save over $3 million, but that isn’t the whole picture. As I pointed out when I wrote about this case when it was in Commonwealth Court earlier this year, community health nurse of Lebanon County Rosemary Birt says:
For months we have been educating our lawmakers that the proposed savings from Governor Corbett’s plan does not justify the potential public health risk for communities across Pennsylvania. It could take as little as twelve cases of multi-drug resistant Tuberculosis to wipe out the three and a half million dollars Corbett claims we would save by closing these centers.
I also quoted an op-ed by former PA Secretary of Aging Linda Rhodes that further fleshed out the role of these health centers in our state’s health care system and the potential human cost of shutting down half of them.
[M]embers of the public never hear about the public health crises [health centers have] averted throughout the state’s counties. These include: preventing the spread of a Hepatitis A outbreak among 30 kindergarteners; containing the nation’s largest Hepatitis A outbreak that claimed three lives and over 650 confirmed cases by immunizing more than 9,500 people; discovering the cause of a rise in infant deaths and educating new parents to prevent it; organizing a dental clinic in response to adults and children showing up in emergency rooms with painful abscesses; identifying and treating an exchange student with tuberculosis, thus, avoiding exposure of an entire high school; providing mass immunizations against the H1N1 influenza; halting the spread of HIV Aids and a syphilis outbreak at two local colleges; and thwarting the spread of whooping cough by immunizing 700 employees at a local plant.
These real-world Pennsylvania examples are the tip of the iceberg.
Community health nurses also stand ready to protect the public’s health following weather disasters, rabies exposures and food-borne illnesses. Nursing homes, day care centers, colleges, schools, clinics, senior centers, hospitals and local doctor’s offices rely on the “eyes and ears” of community health nurse’s to alert and advise them on emerging public health issues.
They are the backbone of outreach and public education to prevent injuries and address the never-ending incidence of heart disease, cancer, obesity and diabetes that plague our communities.
Today, the community health system that keeps you and your family safe and well is, itself, under threat. The Corbett administration euphemistically refers to the closing of state health centers as “consolidation” with neighboring counties.
It also plans to eliminate the jobs of nearly one out of every six public health nurses around the state – even though Pennsylvania already ranks dead last among states for public health employees per capita, with staffing levels one quarter of the national average.
No assessment or study has been released showing that Pennsylvania can absorb these cuts without endangering the public health.
Our readiness as a state to deal with things like Hepatitis, infant deaths, painful abscesses, tuberculosis, H1N1 influenza, HIV AIDS, syphilis, and whooping cough isn’t something to pinch pennies about. And as the lawsuit from SEIU Healthcare PA and some PA Democrats point out, this plan is egregious on two levels – first, in so recklessly endangering the health and lives of Pennsylvanians, and second, in trying to do so unilaterally with no input from the General Assembly. It violates common sensibilities about how our form of government is intended to function, and it also violates the law. As a press release about the lawsuit from SEIU Healthcare PA points out, a 1995 law mandates the ongoing operation of all 60 health centers, last year’s budget continues funding for all of them through this fiscal year, and the PA Constitution prevents the governor and the executive branch from overruling laws enacted by the legislature.
Even though the Commonwealth Court hearing this case when I first wrote about it apparently didn’t take these objections too seriously, the PA Supreme Court did. Last week they issued a two-sentence ruling temporarily stopping the plan from going forward and calling for the issue to receive a speedy hearing. From the Philadelphia Inquirer:
The state has already closed health centers in Carbon, Beaver, and Mifflin Counties, and 18 community health nurse positions have been eliminated, with nine community health nurses laid off and the remaining nurse positions moved into existing vacancies, according to SEIU…. The ruling would require the state to reopen health centers that provide testing for communicable diseases and other services and reinstate the nurse positions pending appeal, the union said in a statement.
Joe Donahue, who was laid off from this position as a Department of Health school nurse consultant in May, said the decision “marks an important step toward protecting public health and ensuring community access.”
And from TribLive:
SEIU Healthcare Pennsylvania said the court’s move means closed centers must reopen and bring back employees the union represents…. “We’ve been concerned since our clinic in Waynesburg shut down earlier this month because some of our people don’t know where to go now for treatment,” said Greene County Commissioner Archie A. Trader, a Republican from Waynesburg.
Registered nurse Joe Donahue’s job as a school health consultant in Greensburg for the Department of Health was eliminated.
“I was offered a position in Butler County, but it was a two-hour drive. Financially, it wasn’t feasible. You don’t hear anything about public health, and that means we’re doing our job. Another outbreak will occur, and the state won’t have the staff to respond,” said Donahue, 60, of Uniontown.
Workers at the now-closed health center in Vanport, Beaver County, distributed potassium iodide tablets for residents living near the Beaver Valley Nuclear Power Station. People also went there for vaccinations as the 2003 hepatitis A outbreak traced to a nearby Chi-Chi’s restaurant killed four people and sickened more than 660.
“We’ve had so many closures and so many reductions in services that we can’t afford it — no matter if it’s Armstrong County or any other county — to keep losing health centers,” said Armstrong County Commissioner Robert Bower, also the county coroner.
Monessen Mayor Mary Jo Smith recalled hundreds of people lined up outside the health center there in 2009 for swine flu inoculations. The center was set to close by the end of this month, according to City Administrator John Harhai.
“The governor needs to understand (that) there are people in this world who need these services,” Smith said.
As hard as the Corbett Administration tries to push the nigh-absurd idea that we can save millions of dollars by closing nearly half the state’s health centers without risking and in some cases losing the lives of Pennsylvanians in the greatest need, we hear it right from the source just how wrong that idea is. When centers shut down, people who went to them because they had no other options don’t know where to go. If they don’t know where to go, many of them probably now have nowhere to go. I think it’s significant that in addition to this plan being halted it’s also being reversed for now with the reopening of recently closed health centers, but it’s important to not lose sight of the fact that this is just a temporary ruling pending a future decision following a future hearing. Tragically, those whose lives are depending on the ultimate outcome of this case continue to be at what there is of the mercy of the Corbett Administration.