The Mississippi State Department of Health (MSDH) has fallen on hard times in recent years with a lack of funding cutting into the department’s ability to hire adequate staff to deliver critical public health services throughout the state.
State Health Officer Dr. Ed Thompson is optimistic that the Legislature will make major progress this year in providing the additional funding needed to rectify the staffing problems. He is also hopeful the Legislature will approve an amendment to allow the MSDH to move ahead in building a new state public health laboratory.
“These two financial issues are the main priorities for the Department of Health in this legislative session,” Thompson said. “These are enormously important priorities. One is for an increased appropriation of state dollars to operate the health department. This request is based on restoring our capacity to deliver services in the field at county health departments.”
The request is directed almost entirely towards hiring more nurses and disease investigators. The numbers of those workers have declined in recent years and have reached the level that the state can’t provide the safety net for public health that is needed.
Front line workers
“We have to build up the number of front line workers,” Thompson said. “We have requested an additional $16.4 million in state general funds. That request is going to be reduced by at least $1 million by a change in our needs for an information system to keep up with patients. We have come up with an alternative to do that more cheaply than originally estimated. That will drop our request to $15 million or less.”
Approximately 87% of the increase is directed at field activities and 12% in support of field activities. Only 1% is focused on central office work. The bulk of the request, $7 million, is to hire new personnel. Another $3 million is to provide better pay for classes of employees such as nurse aids and clerical workers.
“These realignments have been approved by the state personnel board as necessary and justified in some cases two or three years ago,” Thompson said. “But they haven’t been implemented because the funds were not available. Some classes of employees are grossly underpaid compared to the competition, so it makes it hard to retain them.”
The other major request is for a new public health laboratory. The current lab building is 50 years old and has limitations that make it incapable of housing a modern, state-of-the-art public health laboratory.
“Twenty-six states and the District of Columbia have built new public health facilities in the past 10 years,” Thompson said. “Mississippi desperately needs to do the same thing. Most of those actually did it within the past five years. They have either done it or are in the process of planning or building. So, we are way behind with a 50-year-old lab.”
The problem is the health department can’t add more equipment because there is no space. Working conditions are cramped. The electrical system is at maximum capability and would have to be completely replaced to handle additional laboratory equipment and that would be prohibitively expensive.
“We need to expand lab services to what is needed in the 21st Century,” Thompson said. “It is a health protection issue. The state laboratory serves everyone in the state, and not just someone who goes to the health department for something like a pre-marital blood test. We test water supplies across the state, we test milk to allow milk to be sold in interstate commerce, and we do emergency testing for biological agents that could be used in a terrorist attack. We are the only lab in the state that does tests to detect things like nerve gas.”
In 2006, the Mississippi Legislature authorized $25 million in bonds to build a new laboratory but contained a provision that requires the health department to pay all the principal and interest on bonds from revenues generated by bringing into the lab genetic screening tests now being contracted for in a national laboratory.
“We reviewed that part of the plan and determined it was not feasible,” Thompson said. “As a result, we are asking Legislature this session not to authorize any new bonds but to amend the already authorized bond bill to change the funding provisions to general obligation bonds. We’re not asking for any additional bonded indebtedness. We’re asking for an amendment to the existing bill.”
Ready to move
Property is available and the architectural work has already been done on the new laboratory, and the MSDH is ready to move forward with bidding soon if the amendment is made.
This is an important issue for businesses on several levels. One example is the testing done for anthrax back in 2001 when the whole country went through a very difficult period because of the anthrax attacks that occurred.
“We didn’t know at that time how widespread the distribution of anthrax had been,” Thompson said. “All over the country, we received concerns of white powders found in homes and office. The first we had in Mississippi was a business, and that business was shut down while a specimen was sent to our public laboratory. The sample was found not to have it, and the business was able to reopen. That business could have been closed a lot longer. We did this testing hundreds of times across state, sometimes for businesses and sometimes for other entities.”
In 2001, the only way to identify anthrax was a culture that took 24 hours to grow. Modern laboratory technology has a test that can determine whether anthrax is present in six hours.
“We can buy the instruments to detect anthrax and other agents with federal dollars, but we can’t use federal dollars to build a building,” Thompson said. “That isn’t allowed. So, in order to make modern technology available, we must have new laboratory space.”
The state lab also does testing to assure the purity of water that is used in businesses and homes. And the milk industry couldn’t sell products out of state if MSDH wasn’t testing the milk products for potential contamination.
“There are just numerous ways businesses in this state rely, often without realizing it, on a public health laboratory that is functioning,” Thompson said.
Another business-related issue is if a business suspects a worker might be infected with tuberculosis. The sooner it can be determined whether or not the employee has tuberculosis, the sooner measures can be instituted to protect other workers and the public.
The MSDH requests have been given a sympathetic hearing from members of the Legislature who are familiar with the needs. But Thompson acknowledges it will be difficult for the Legislature to find funds to meet all the needs.
“We all realize the state is in a tight budget situation this year, and no one is going to be unrealistic,” Thompson said. “The Legislature can’t make money out of nothing. We know it will be difficult to find funds to meet all our needs, but we have prioritized our needs to the most critical. We are confident the Legislature will fund at least part of increase in order to rebuild our field staff. We are very encouraged by the response from the leadership in House and Senate, but we also know what they are up against.”
Still early in the process
Sen. Alan Nunnelee, who is currently chair of the Senate Appropriations Committee and vice chair of the Senate Public Health and Welfare Committee, said the tight budget situation makes it inappropriate for him to commit to any particular funding request at this point.
“But I’m elated Dr. Thompson is requesting additional funds for field staff as opposed to increasing administration costs,” Nunnelee said. “If we are going to see additional improvement in the state’s health, it will attributed to the field staff of the state Department of Health. One thing we are going to be looking at from all state agencies is if you ask for additional funds, what results can we expect? I’m anxious to hear from MSDH and any other state agency has to answer to that questions. Far too often I find legislators have focused on inputs. I think we should focus on results rather than merely manage the inputs.”
Nunnelee said the needs for a new state laboratory have only grown in the past two years since bonds were authorized for the new lab.
“But the repayment formula presented by the administration and MSDH two years ago was not workable,” he said. “I recognize the fact the needs are great in that area, particularly if our state were to have some type of bioterrorism act or avian flu outbreak. We have to be prepared for that type of catastrophe. And right now the state is not prepared for that type of catastrophe.”
‘Absolute very best’
Rep. Steve Holland, chair of the House Public Health and Human Services Committee, said the board of health has made a very realistic request to the Legislature.
“Much of that includes field staff, and field staff is where services get delivered,” Holland said. “But it is going to be hard to get that kind of money with the budget realities we are facing. Mississippi is facing the same economic downturn as the nation and usually we have a more severe downturn than the rest of the nation.
“The health department has gone through a lot of crises, and has come through that with a lot of renewed energy and good leadership now. As chairman of health subcommittee on and health committee, I’m particularly interested in doing the absolute very best we can to bring the health department back up to the level of respect and responsibility that it deserves.”
Contact MBJ contributing writer Becky Gillette at firstname.lastname@example.org.