Sunday, March 31, 2013

Health Department Cut: Children's Story on Immunizations

The San Angelo Standard Times ran a column by City of San Angelo Health Director Sandra Villareal.  It stated:

The Health Department has experienced some significant changes this fiscal year, which began Oct. 1

In January, the Texas Department of State Health Services suddenly changed policies for the Texas Vaccines for Children childhood vaccine program. This was in response to reductions in state and federal immunization funds, increased federal accountability for publicly funded vaccines, as well as increases in prices for some vaccines.

These changes have affected a portion of San Angelo’s citizenry and how the Health Department conducts business.

The January referenced above did not occur after Oct. 1.  The "sudden change" came January 2012, according to a December 28, 2011 memo from Texas Vaccines for Children:

The following changes to TVFC patient eligibility are effective beginning January 1, 2012.

1. Children who have private insurance that covers vaccines will no longer be eligible for TVFC vaccines in public health department clinics, but instead will be referred to their medical home for immunization services. In some cases, local health departments may be the medical home that provides comprehensive healthcare services. In these cases, private insurance is accepted in those public health settings. Private stock vaccine must be purchased and/or acquired in order to continue vaccinating fully, privately insured children.

Any vaccines given to "privately insured children" from January 1 to October 1, 2012 had to come from private stock.  This change should be reflected in 2012 immunization numbers and/or department costs.:

A rough estimate suggests half of all children and adults who were served by the Health Department’s Immunization Division were insured.

Here's the immunization history from City Budget documents:

Actual Doses of Vaccine (the only immunization measure listed)
FY '03-04 - 18,000
FY '04-05 - 18,000
FY '05-06 - 19,000
FY '06-07 - 15,000
FY '07-08 - 16,000

Number of Children's Immunizations:
FY '08-09 - 7,629
FY '09-10 - 6,340
FY '10-11 - 4,600
FY '11-12 - 6,657 Budgeted
FY '12-13 - 2,300 Budgeted

Oddly, a September 2012 State Immunization Report on Increasing Vaccine Coverage had this to say about local health departments:

Local Health Department (LHD) Contracts

Immunization contracts with LHDs require activities that support the medical home.  LHDs should vaccinate children who come to public clinics for immunization services and assist them in applying for Medicaid or the Children’s Health Insurance Program (CHIP) as appropriate. They should explain benefits of a medical home and refer families to possible medical home providers for future care.  LHDs report on the number of children referred to Medicaid, CHIP, and medical homes three times per year.
This calls to question our local health department's capabilities in helping children quality for Medicaid or CHIP, as it jettisoned social services several years back.  The City dropped the its Pediatric Clinic long ago, closed its pharmacy (which ran a Pharmaceutical Assistance Program for the public), and shed Social Services.

Mayor Alvin New and Interim City Manager Michael Dane entertained feedback from a State Health Department physician on health department budget cuts.  The doctor lamented the draconian cuts to immunizations and the STD clinic.  New lectured the physician on how neighboring communities get more state funding than San Angelo.  My take is the cut is part of San Angelo's state/federal shakedown

City Council approved cuts of $138,000, apparently not worried about the upcoming flu season or children's health.  This same council approved another holiday, cost of at least $135,000, and an unfunded $225,000 for Downtown Master Development.  It's not that this council won't spend, it won't spend on effective public health programs, like childhood immunizations and STD clinic services.

The City had 10 public health nurses in '03-04.  It's now down to one nurse, a 90% drop. It once spent $30,000 a year on vaccines. that's now zero.

If the Health Department implodes much further, there will be no need for a Health Services Director.   I imagine Sandra Villareal is in a terrible spot.  That's the same place many residents find themselves in getting basic public health services.

Update 4-11-15:  I ran across the city's fiction on this issue in news story.  "The STD clinic was eliminated in 2012 when a state policy change resulted in a funding loss."  The City cut funding so they could ask the state and feds to backfill.  That's clearly their motivation.  

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