The city’s bleak financial outlook could spell big changes for the Louisville Metro Department of Public Health and Wellness that could affect everything from Louisville’s ability to prevent and treat sexually transmitted diseases to being able to provide various vaccinations.
The health department is in line for several potential cuts as Mayor Greg Fischer ponders how to make up for an expected $35 million budget shortfall without the help of a tax increase rejected by the Metro Council last month.
This week, the health department is celebrating news of a $4.6 million federal grant for its Healthy Start program. The grant “will help us not to have to use additional” general fund dollars to continue the program, said Dr. Lori Caloia, the department’s medical director.
Nevertheless, it does not wipe out the list of potential cuts Fischer outlined earlier this year. But “I wish that was the case,” Caloia said, immediately following the announcement of the grant from the U.S. Department of Health and Human Services.
During this budget crisis, “grants like this are incredibly important for us,” Fischer said, indicating that he’s working now on his budget proposal for the fiscal year that starts July 1. “It’s going to be tight,” but “I can tell you that my team and I are trying to lessen the impact on our city’s most vulnerable with this proposed budget coming up.”
The department’s Specialty Clinic, which handles at least 3,000 patients a year who need STD services, is one of the things that could be eliminated, Caloia said.
That’s concerning for a number of reasons, including that nationally, “STD rates continue to increase and certainly, we have seen locally kind of an increase in a few populations,” Caloia said.
Syphilis rates have risen from 29.07 cases per 100,000 population in 2013 to 58.47 cases per 100,000 population in 2017, according to the health department.
Also, gonorrhea and chlamydia rates have increased as well, both locally and throughout the country, Caloia said.
Many of the people who visit the clinic are on Medicaid or uninsured and some don’t have their own primary care provider, she said. “We do see a large number of people who don’t really have anywhere else to go.”
But there also are those who choose the clinic because of the privacy it affords. People will say, “I don’t really want to tell my doctor about this stuff, so I’d rather go somewhere where I know that it’s totally anonymous and no one’s going to be judging me for whatever reason I want to get STD testing,” Caloia said.
In some cases, people can’t afford to get treated at their regular doctors’ offices. “That is primarily for things like syphilis or gonorrhea that require IV or intramuscular medications that can be really expensive at the doctor’s office, or sometimes the doctors’ offices don’t even carry the medication,” Caloia said.
The department’s Syringe Exchange Program, which provides clean needles and syringes to people who use IV drugs, also could be affected by the budget shortfall if the city is no longer able to contract with the Volunteers of America (VOA) for mobile-site staffing.
Right now, Louisville Metro employees staff the main location, but VOA staffs mobile sites out in the community.
“We would either have to close a mobile site or we would have to reduce the hours at our main site in order for our syringe exchange staff at the health department to be able to go out to the mobile site,” Caloia said.
Along with providing its main service, the Syringe Exchange Program offers testing for HIV and hepatitis C.
The people who come in “definitely are very open in that setting to getting tested,” Caloia said. “It establishes a relationship between the syringe exchange staff as well as the individuals and so over time, they’re able to build trust with the individuals who are coming in and help them to kind of gradually change behaviors as well.”
So the syringe exchange serves as an entry point to the health care system for these individuals and provides a way to interact with a difficult-to-reach population.
“It’s been a lot harder for some of the rural communities — places that don’t have syringe exchanges — to reach the population that has been at risk for hepatitis A,” such as people using drugs, Caloia said. “I think without having that — the syringe exchange — we would have seen a dramatically different outcome in our city for our hepatitis A outbreak and response.”
In fact, “we would have had it go on a lot longer and seen a lot more cases if we didn’t already have that trust built up in our population that’s visiting our syringe exchange,” she said.
Other potential cuts include reducing HIV personnel; losing staffers at the Louisville Center for Health Equity, which would jeopardize the department’s accreditation; and eliminating the immunization program.
Although immunizations are provided by other health providers in the community, there are significant limitations to that, Caloia said. For example, some pediatricians do not provide childhood vaccinations for financial or other reasons.
When it comes to uninsured or underinsured kids, “many of those children come to us or to the family qualified health centers,” such as Shawnee Christian Healthcare Center, Caloia said. “And there’s just too many kids for those organizations to be able to accommodate everyone in the city.”
Also, the health department is one of the few places that provide a particular category of vaccine (“Section 317”) to underinsured and uninsured adults that need protection from things like hepatitis A.
“We never turn away anyone who can’t afford to pay for a vaccine,” Caloia said. “We make sure that they’re able to get … whatever vaccines they’re due for.”
Helping to ensure that every person in Louisville has a fair shot at achieving their full potential is another role of the health department. Through the Center for Health Equity, the department helps to guide the city in addressing the foundational causes of poor health, such as poverty and racial discrimination, Caloia said.
“Their work is essential to doing that,” she said. “… All of the work that our root cause teams are doing to try to push policy initiatives and changes to those underlying issues are things that if we don’t do that in our city, we are going to continue to see a decline in health.”