Virginia Garcia Buckles at Assuming Washington County Public Health Services

The county has proposed ending its medical public health services, including vaccinations, family planning and STD screening in order to focus on education and epidemiology. But the handoff could strain safety net clinics already overwhelmed by the healthcare expansion.

Washington County has plans to unload its public health medical services, including vaccinations, family planning and venereal disease screening onto the safety net clinics, but a director of one of the private safety-net clinics is balking at shifting the role to his clinic.

“We provide these services as part of the whole array of services for our patients,” said Gil Munoz, the executive director of the Virginia Garcia Clinic, who met with Washington County officials after news of its policy proposal was featured in The Oregonian. “Our main focus is expanding our capacity for primary care. We are less interested in assuming responsibility for the county clinic’s public health services.”

Marni Kuyl, the director of the Washington County Health & Human Services Department, who has spearheaded the policy direction, said that Virginia Garcia, along with the Neighborhood Health Center, would receive county funding to hire new staff according to the county plan.

“We think it’s better to support them,” she told The Lund Report.

But Munoz said the Affordable Care Act, which brought statewide Medicaid enrollment to nearly 1 million people, has strained its resources, and they’ve yet to keep up with the need for new staff and resources to serve everyone. “We’re already trying to absorb nearly 8,000 patients across all our sites.”

The Affordable Care Act has increased the insurance numbers in Oregon to an estimated 95 percent, and visits to the Washington County health clinics have seen a sharp decline. If patients can take care of family planning, vaccinations and venereal disease screening through their insurance with their regular doctor, this will free up money for the public health department to run more educational campaigns and hire an epidemiologist to help contain communicable diseases, Kuyl said.

Rep. Mitch Greenlick, D-Portland, who is working to reform the state public health system, supports the county’s direction. Since insurers are required to cover preventive medicine at no extra cost to their members, public health departments should shift their focus to other responsibilities, he said.

“More and more people are covered by insurance, and we really believe they should have a medical home,” said Kuyl.

Vaccinations are increasingly available at pharmacies. But relying on primary care homes for sexually transmitted disease screening effectively means people will have to wait about two weeks to get an appointment with their physician rather than receive typically same-day service at the health department. Washington County has clinics in Beaverton and Hillsboro; a third clinic, in Tigard, has already closed.

Kuyl oversaw a similar restructuring of the public health system in her previous post in Clark County, Wash., with funding to that county’s safety-net clinic, Sea Mar, to provide the services. That funding was eventually cut, leaving Sea Mar to provide such services without support.

The Oregon Latino Health Coalition director, Alberto Moreno, expressed his opposition to the shift as well, noting that the loss of these services could most significantly impact immigrants -- many of whom are denied access to the Oregon Health Plan.

“It’s an abdication of public health responsibility,” Moreno said. “The problem for the Oregon Latino Health Coalition is that it shifts what we see as important public health policy to our community partners who are already taxed in providing for our marginalized communities.”

Any decision on the future of Washington County’s clinics won’t be decided until the county commission meetings in December or January, Kuyl said, giving the public plenty of time for input. But Kuyl said all of the affected county employees have already been notified, and she hopes that all of them will either be able to move into jobs at the private safety net clinics or into new positions at the county.

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