The committee has asked all agencies to report how they would be affected by additional cuts of 10, 15 or 20 percent in FY ’11. For OSDH, a 10 percent cut would equate to a $6.8 million funding drop.

Such additional reductions, according to a budget document distributed by the  Department, will continue to erode Oklahoma’s public health infrastructure, impacting vital departmental services, and increasing  the state’s vulnerability to disaster and disease:

State appropriated reductions at this level will continue to erode the public health infrastructure across the state, impacting services that are imperatives of the department.  Specifically, infectious disease control and emergency preparedness and response depend on a minimum level of infrastructure to mount a rapid and effective response.  While the department has been able to meet the challenges presented thus far, erosion in the clinical nursing infrastructure over the past few years has left the State vulnerable.  Continued reductions in this infrastructure may result in reduced response times and the inability of the department to protect the citizenry from natural or man-made disease occurrences and disasters.

The department plans to introduce a few cost saving measures that would adversely impact core health services. These measures would mostly reduce agency staff. Departmental duties of vacant positions will be absorbed by remaining staff, slowing department responsiveness across the board, and impacting vital clinical and  social services.

Staff reductions and other measures will impact clients of various social supports across the state. These include staff reductions in clinical nursing services. Each county nurse serves about 2,000 Oklahomans per year. Six nurses have already accepted voluntary buyout offers, and their vacancies in the county Health departments of Creek, Garfield, McIntosh, Pottawatomie and Pushmataha counties will potentially affect about 12,000 clients. Drops in administrative support positions within Family Health Services will affect programs like Supplemental Nutrition Program for Women, Infants and Children (WIC) and Maternal and Child Health Program (MCH).

The department is planning to overhaul the Child Guidance system, which provides behavioral health services for young children. The Department plans to eliminate 23 Child Guidance specialists staff positions, along with the elimination or reduction of various Child Guidance Clinics. In counties where services are to be eliminated or reduced, 2,745 individual clients were served in 2009.

Reductions to the clinical nursing infrastructure may impact the state’s ability to protect citizens from natural or man-made disease occurrences and disasters. Other reductions in staffing to the Acute Disease Service have contributed to the agency’s inability to conduct approximately 675 disease investigations within the expected response time, and an inability to review, update, or create 200 fact sheets, educational materials and bulletins provided to 5,700 health care providers and the general public. Furthermore, additional fees are proposed for influenza vaccinations and for tuberculosis investigations, including skin tests and x-ray consultations.

The regulatory and licensing functions of the Health Department are also being eroded by staffing reductions. For example, the Department expects processing time for licensing applications for barbers, alarm companies and other businesses to increase by approximately 33 percent. The length of time it will take to issue Nurse Aide registration is expected to increase by 20 percent, while the response time for complaints about long-term care facilities will be slowed by 25 percent. Without adequate staffing, the ability of regulated professions to receive timely and efficient service from the state will diminish and Oklahomans will be at greater risk that complaints and threats to public health will go unaddressed for a longer period of time.

Although staff reductions may meet the immediate needs of responding to budget cuts, the long-term effect for Oklahomans is grim in terms of maintaining the public health infrastructure. The elimination of 295 positions since 2008 means a loss of 15 percent of the public health infrastructure for our state.The reduction or loss of health services will greatly impact the health of infants, children, persons with disabilities, and the elderly.

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• This year’s cuts have already forced the Department of Mental Health and Substance Abuse Services to eliminate inpatient treatment for children with behavioral health problems, adults with drug addictions, and others. The Department estimates that additional cuts of 10 percent would leave 8,043 people without mental health services. Commissioner Terri White warns that with fewer services, families will suffer, and the impact will be felt directly by the state’s criminal justice system as more untreated individual with mental health and substance abuse problems commit crimes.

• Staffing at the Department of Corrections has fallen to historically low levels. The Department has only 1,881 correction officers on staff, which is 72.82 percent of its authorized number of 2,585. The department has added about 700 new offenders since last April, but has no remaining available beds to house them. Over 1,500 inmates are in county jails awaiting transport to DOC facilities. The Oklahoman warns that “Oklahoma could be headed for a mess of historic proportions.”

• The Oklahoma Indigent Defense System, which provides legal counsel for indigent defenders outside Tulsa and Oklahoma City, has cut 15 employees, including three lawyers, this year, even as its projected caseload is increasing over 10 percent. OIDS Executive Director, Joe Robertson, stated that deeper cuts could lead to a federal challenge to how the state provides legal counsel to indigent defenders. “We do our best to maintain a constitutional level,” Robertson said. “That is why I am so stressful right now. I see that slipping away.”

• A combination of state cuts and federal funding delays have led the Oklahoma Department of Transportation to postpone several major road construction projects.  ODOT saw its state funding cut by $15 million this year. According to ODOT Director Gary Ridley,  cuts could eventually lead to a delay of the widening of Interstate 44 in Tulsa, among other important projects, and prevent the Department from selling $150 million in bonds.

• The Oklahoma Health Department is making plans to close child guidance centers in 17 counties as an effort to save money. Only 16 centers will remain open to support children with speech, hearing, behavioral and developmental problems. Closings mean mothers like Darla Cooper, whose children rely on SoonerCare for hearing loss help, will be forced to commute an hour to reach remaining centers. As part of the closing process, 18 jobs will be eliminated. Selected employees will be provided with a buyout option.

• As a consequence of a potential $9.7 million dollar budget cut, Tulsa Public Schools has authorized the elimination of 225 teaching positions, almost 7 percent of certified staff. $5,000 incentives were offered to teachers who would give early notification of retirement, but only 72 teachers took that offer. As a result, class sizes will be increased if the proposal is approved. Chief Financial Officer Trish Williams noted that the decision to increase class sizes was not taken lightly, since the state “has always maintained a low class size.”

• In an effort to save $38,000, Sapulpa police are expected to take four furlough days. This is a result of the city’s tax revenue dropping $371,000, which is expected to climb to about $600,000 by the end of June. City Manager Tim DeArman noted that while the furlough days are expected to help the revenue problem, other services will need to be affected as well. Meanwhile, the City of Norman is eliminating 38 jobs, instituting furloughs, and cutting funding to social service programs to balance a budget that will be 21 percent less than the one approved last year.

• Gov. Brad Henry’s $250,000 insurance program for Oklahoma National Guard members has been suspended due to state budget cuts. The program insured about 10,000 Guard members in the state. With the Guard’s budget decreased by 14 percent, Guard members will still be insured but will have to pay their own premiums. A spokesman for the governor mentioned that the plan would be reinstated once state revenues improve.

• Under a furlough plan for Oklahoma Senate employees announced by Senate President Pro Tem Glenn Coffee, Senate employees will take 12 furlough days between July and December. With the Senate’s budget drop of 14 percent, employees are also being offered a buyout option. Depending on how many accept the buyout offer, employees could be laid off. The Senate faces another potential $1.26 million cut in July.

• Budget shortfalls have already led the Department of Human Services to announce 18 furlough days for its employees in the upcoming year. This action could possibly reduce the number of federal food stamp recipients in Oklahoma by 105,000. The agency cautions that with additional budget cuts of 10 percent, as many as 5,600 seniors who receive home-based Medicaid services will be forced into the more expensive nursing homes. DHS Director Howard Hendrick warns that “we’re seeing thousands of people who will have to go to nursing homes unless we get some money, because we can’t continue to support and finance the community-based alternative, which is actually a better value and less expensive.”

We will be looking more closely at how enacted and impending cuts are affecting several agencies in the days ahead.

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Professor Cutler is the Otto Eckstein Professor of Applied Economics, Department of Economics and Kennedy School of Government, Harvard University. He served on the Council of Economic Advisers and the National Economic Council during the Clinton Administration and was an adviser to Barack Obama’s Presidential campaign.

Dr. Cutler will examine insurance coverage and population health, medical care delivery and costs, and public sector financing.   No registration is required.  Click here for more information on this event.

Update: Video of Dr. Cutler’s presentation is available here (wmv)

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Budget cuts in recent months appear to have affected Oklahomans from all walks of life. Many agencies have been forced to cut jobs, offer bailouts, or implement furlough days, but cuts have required agencies to go further and eliminate services altogether.

Some examples:

• The Bill Willis Community Mental Health Center faces more cuts, despite having eliminated its 20-bed men’s substance abuse program. That was to save $1.2 million. Now, the center has been asked to trim $300,000 more. According to Executive Director Margaret Bradford, “without this type of treatment you’re going to see more and more people end up in the criminal justice system,” costing the state more money than the treatment.

• Cuts to the Medicaid program will be hitting kidney dialysis providers hard. According to the Tulsa World, payments to dialysis centers are set to be cut 40 percent for diabetic supplies and 75 percent for patients with Medicaid as their secondary insurance as of April 1st. The result may lead some dialysis centers to close and patients will have to travel much farther to get life-sustaining treatment. According to a spokesman for Fresenius Medical Care, a major dialysis provider, the need to travel further for treatment will end costing the Medicaid program more in transportation and hospitalization costs.

• Ongoing budget shortfalls at the Department of Corrections have left staff levels  at 1,411 fewer than the authorized level of 5,895. Board of Corrections member David Henneke warned that the Department can’t continue to lose employees and keep the public safe. “Someone at the Capitol has got to understand we can’t continue the way it is, or someone is going to die,” he said.

• Closure of the Norman  Alcohol and Drug Treatment Center has been among the consequences of 7.2 percent cuts to the budget of the Department of Mental Health and Substance Abuse Services. Adult substance abuse treatment beds, transitional housing, children’s mental health beds and the jobs of about 100 employees have been lost this year. “These are horrible choices we’re having to make”, said Commissioner Terri White. “Every decision we make is a loss of services to someone.”

• Budget shortfalls affected teachers when about 2,600 nationally certified school teachers received $350 less in bonuses than promised. The Oklahoma State Department of Education was short $4.6 million to pay for certified teacher stipends, and left it up to districts to cover the shortfall. “We are not supposed to assume any portion of the state’s obligation to fund this. We are quite upset that the state shorted the teachers, but it was the state who shorted the teachers, not the school district,” said Debra Jacoby of Union Public Schools.

• The state Health Department has offered 15 percent of its workforce a buyout option, hoping that half  will accept the buyouts in order to save $8 million in payroll costs. The department expects to lose $5.5 million in funding. Health services are in great demand, according to Health Commissioner Terry Cline. “Right now we are having to cut services and programs to Oklahoma citizens,” said Board of Health President Barry Smith.

• The Boynton-Moton School District in Eastern Oklahoma may not survive a $100,000 cut to its budget. School board member Albert Joe Cherry worried that the school may not even finish the year. Superintendent Shelbie Williams said, “we cut salaries, services without going to the bone and marrow. Last month, we did all we can do to make payments.”

• Domestic violence and sexual assault victims’ programs have faced an additional 10 percent cut.  These programs were already facing monthly 5 percent cuts since July. While demand for services is up according to the Victim Services Unit, programs like the Women’s Resource Center in Norman is having to halt counseling and prevention programs. As the Executive Director of the state Coalition Against Domestic Violence observes, “they’re cutting staff, cutting benefits, doing away with outreach services. In most cases, they are doing everything they can to keep the most essential services open, which are the shelters.”

• The Office of Juvenile Affairs cut funds to gang-prevention services like the Tulsa Youth Intervention Project, which have boasted a 61 percent decrease in drive-by shootings. According to Alice Blue of the Community Service Council of Greater Tulsa, “My fear is that once the program is dismantled, it will have to be re-created over a period of time. You lose all the accumulated knowledge of working on the Tulsa streets.”

• Broken Arrow schools have been advised to cut their budget by about $3.6 million dollars. If this is not achieved, the schools will lose 91 teaching jobs. Superintendent Gary Gerber has been reviewing several solutions, including 1,100 suggestions made by district employees. Teacher furloughs are being considered, even though many teachers are adamantly opposed to  this solution.

• In response to dwindling tax revenue, Sapulpa police are expected to take four furlough days. According to City Manager Tom DeArmann, the city is down in tax revenue by $371,000, which is expected to climb to $600,000. The furloughs are expected to save the city $38,000 through June.

Unfortunately, this may all just be the tip of the iceberg. Next year’s shortfall is in the range of $800 million to $1.55 billion, depending on one’s calculations.  As Speaker Chris Benge grimly noted last week, “agencies are currently facing significant additional cuts if revenue projections prove true.”

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