07/17/08 — Four-day work week applies to Health Department

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Four-day work week applies to Health Department

By Phyllis Moore
Published in News on July 17, 2008 1:19 PM

Citing concerns over delivery of some health services when the county converts to a four-day work week, the Board of Health Wednesday voted to seek a 30-day extension on the policy, only to have the county manager hours later turn down the request.

Board members and department managers debated the effectiveness of "essential services," particularly prenatal patients.

Dr. Robert Thiele of Goldsboro Ob/Gyn Associates raised several concerns over the move to a shorter work week -- lab results and accessibility to care among them.

"(The policy) may save the county some money but increases the cost if services are moved to the hospital," he told the board.

Board member Dr. Kim Larson said she had a similar concern when the policy was first announced, feeling that "public health was being jeopardized. For some people this is their source of health care."

Steve Smith, board chairman, said that while the Health Department is part of county government, it is also a service provider for Wayne County residents and should be considered such.

"In terms of essential services, my fear is there could be savings on one hand," he said. "On the other hand, you're jeopardizing the health of citizens that we serve. It's a fine line that we walk."

Understandably, Smith said, this is a time of a "tremendous budget crunch." By the same token, he noted, the Health Department is in business to serve the public.

"I'm not trying to say that any other (county) departments are any less important. The services are different," he said.

The bottom line, Smith suggested, is to consider the impact the move will have and how it can be resolved.

Evelyn Coley, director of nursing, discussed the department's Friday clinics, which cater to routine patient visits and walk-ins. Looking at the months of May and June, she said, there had been seven "add-ons" in May, 16 in June.

Included in the 23 patients, she said, were seven routine visits, three labor calls referred to the hospital, and five follow-up calls that required doctor visits.

Wanda Westbrook, public health nursing supervisor,also addressed the board.

"We're not providing primary care. We're providing prenatal care," she said. "The majority of those problems, we could have seen them any other day of the week.

"We're not treating sickness. I consider pregnancy a natural part of life and it can be scheduled any day of the week."

Copies of maternity patients' records are typically sent to the hospital, she added.

Even so, Dr. Thiele noted, the purpose of routine prenatal care is to be in place to respond to whatever problems arise.

"When you can't follow up on them, we're going to miss something," he said. "We're kind of dropping the ball here."

Sue Guy, human resources director for the county, maintained the rationale behind the proposed shorter work week, which goes into effect August 4. Shutting down entire buildings, she explained, is expected to be an effective cost savings across the county.

"It's anticipated that it will save 15 percent," she said. "We're going to track it for 12 months. We think at a minimum it will be $300,000 in savings."

Responding to the concerns, Ms. Guy said that county officials remain willing to weigh other solutions to ensure a smooth transition. Already, she noted, efforts have been made in the areas of day care and flexible hours in some cases.

Board member Dr. Michael Gooden said he can see both sides of the issue.

"The Health Department patients, you have to understand, are the source of a whole lot of frustrations for the obstetricians," he said. "They don't work within the system. They cause more frustration. And they're the patients for whom you receive the least amount of income."

The debate over cutting back services has increased concerns among physicians, Dr. Thiele said.

"We're just trying to put the care of the patient to the forefront," he said. "I'm afraid of missing something. This really is where the majority of my liability comes from."

The hour-long meeting was adjourned with the hope that an extension would be granted and the board would have more time to address the issues raised. County attorney Borden Parker told the board that County Manager Lee Smith had ultimate authority on the matter.

By day's end, Roosen said he received word that the request had been denied.

Ms. Guy said Lee Smith, currently out of state on vacation, was contacted about the request. She told the News-Argus today that she and the county manager want to reassure physicians that their concerns have been heard and the county intends to maintain its strong
relationship with them.

However, Ms. Guy said, the county has not seen any data "to be overly concerned" about closing the office on Fridays.

Besides, the issue is something that has been under consideration for several months, she said, and notification has already been posted and publicized.

Ongoing assessments can always be made, she said, with some fine-tuning to be done as needed.

"That is the beauty of it," she said.

In an earlier interview, Lee Smith said that the county would need to follow through on the new schedule for at least a year in order to go through all four seasons.

Also contacted this morning, Health Director James Roosen said, "I think the best thing that we can do right now at the Health Department is to measure how well we're able to provide access to our services once we go to this four-day work week. We have already got good numbers historically to do what we have done."

--News-Argus staff writer Steve Herring also contributed to this story.