The Maine Legislature on August 2, 2017 successfully rebuked Gov. Paul LePage’s last-ditch effort to block a new law to restore the strength of Maine’s public health nursing program, which protects the state’s people from disease outbreaks and works with communities to provide preventative health services.
The Senate overrode the governor’s veto with a 29-5 vote, well above the two-thirds threshold needed for the bill to become law over LePage’s objection. The override vote also won two-thirds in the House of Representatives, 101-34.
The bill’s sponsor, Sen. Brownie Carson, said the veto override would reverse Gov. LePage’s year long effort to dismantle Maine’ public health infrastructure.
“There is no greater obligation for elected officials than ensuring the health and wellbeing of the residents in this great state, and public health nurses are the vanguard of our public health system,” said Sen. Carson, a Harpswell Democrat. “These dedicated health professionals protect us from disease outbreaks, they work with our families to ensure the health of our children, and they address a dire need for preventative health services at the community level. They work with anyone, regardless of their income or their insurance status. For six years, this administration has attacked our public health infrastructure. This bill is a critical step to reversing the damage.”
Unlike other health care providers who treat individuals, public health nurses promote and protect the health of entire populations, with a goal of preventing disease and disability. In Maine, PHNs conduct home visits with young families and pregnant women, providing education and assessment to help new moms and dads raise healthy children. They also assist families with substance-affected babies, and help frail or isolated Mainers in rural parts of the state stay in their homes by providing in-home care.
But their work goes beyond the household, and PHNs provide crisis response services, such as in 2009 when they established 238 clinics in Maine to provide H1N1 vaccines. In 2011, 59 public health nurses worked throughout the state from offices ranging from Sanford to Calais to Fort Kent. But since 2011, positions in the public health nursing program have been left vacant or eliminated. Today, the program is a shadow of its former self, with just one-third the staff on hand to respond to emergencies and promote wellbeing in Maine. Cuts and understaffing in the state’s corps of public health nurses has jeopardized Maine’s ability to respond to health crises such as disease outbreaks and the drug epidemic.
This year, the biennial budget includes 48 positions within the Public Health Nursing program. Sen. Carson’s bill, LD 1108, requires the Department of Health and Human Services to promptly fill those positions, removing Gov. LePage’s ability to gut public health services by refusing to hire. The bill will ensure professional public health nurses will stand at the ready to safeguard Maine’s wellbeing against health emergencies, chronic disease and epidemic.
Today’s shortage leaves the state unprepared to meet the public health needs of Mainers in the best of times, let alone in an emergency. In the meantime, Maine has bucked national trends to become the only state where infant mortality rates are rising, and a drug epidemic is ravaging communities throughout the state.
Last year, 1,000 drug-affected babies were born in Maine. At the same time, referrals for homes visits by public health nurses are going unfulfilled because of a lack of staffing in the program.
The bill earned bipartisan support, and the backing of the Maine Public Health Association, Maine Medical Association, AARP Maine and the Primary Care Association. Health care professionals including doctors, nurses and public health experts from Eastern Maine Health, Central Maine Health and several rural, critical-access hospitals also testified in favor of the bill.
TESTIMONY FROM EXPERTS IN SUPPORT OF LD 1108:
“We have a public health system for the same reason we have police, and firemen, and the military. These groups all serve to protect us from threats,” said Dr. Dervilla McCann, chief of population health at Central Maine Medical Center. McCann described the 1918 flu pandemic that rocked Maine and killed more people globally in 24 years than AIDS killed in 24 years. “At a time when the state is struggling with an opioid epidemic impacting newborns, it seems extraordinarily ill timed to dismantle the single best tool we have to safeguard at risk children. Similarly, it is foolhardy to leave the citizens of our state in the same state of unreadiness that lead to such tragic loss of life 100 years ago.”
Peter Michaud, J.D., R.N. from the Maine Medical Association, pushed back against the idea that other health care providers can perform the tasks of public health nurses: “Primary care physicians, nurse practitioners, and the nurses who work with them have their hands full with what they do now, and with the opioid crisis they are being asked to do even more. It makes no sense to add the entire menu of public health nursing to their plates. They don’t have the capacity to handle the additional duties, and they certainly don’t have the capacity to respond to a new outbreak of infectious disease.”