EDITORIAL: In the LePage era, protecting public health required a veto override

Aug. 05--On Wednesday, Maine lawmakers had a chance to counteract Gov. Paul LePage's absurd arguments against public health nursing and the Maine Department of Health and Human Services' decimation of the program responsible for protecting the public's wellbeing.

Surprisingly, they did.

The Maine House voted, 101 to 34, to override LePage's veto of LD 1108, sponsored by Sen. Brownie Carson, D-Harpswell, to restore public health nursing staffing to its needed levels. The vote in the Maine Senate was 29 to 5.

When LePage took office in 2011, the state employed about 50 public health nurses across the state who held a long list of responsibilities: respond to disease outbreaks and other public health emergencies; visit expectant and new mothers in their homes, especially mothers with drug-affected babies; monitor treatment for those infected with tuberculosis or latent TB; train local health-care providers on TB detection and vaccine storage; carry out immunization clinics; and provide school nurse services in rural schools that couldn't hire nurses of their own.

Maine's public health nurses have been a cornerstone of state public health policy for nearly 100 years. They have been around since the 1920s, and were some of the first employees of the state's Division of Public Health, which later became today's Center for Disease Control and Prevention. Unlike most classes of state employees, their responsibilities are defined in state law.

Public health nursing has lasted this long because it works. Take home visits. Just last week, James J. Heckman, a Nobel laureate economist at the University of Chicago, released a new study on the Nurse-Family Partnership, a voluntary program for low-income, first-time mothers. Registered professional nurses start visiting expectant mothers during pregnancy and continue until two years after birth, providing medical, parenting and family education help along the way.

Heckman put the program through its most rigorous analysis to date and confirmed that children who receive home visits are healthier, do better in school and have improved cognitive and emotional skills. Mothers, meanwhile, see improved parenting skills, in addition to better prenatal and mental health. The effects were particularly strong and lasting for disadvantaged boys.

Instead of building up Maine's public health nursing program, especially in the face of the opiate epidemic, the LePage administration has not filled its vacancies -- to the point where ranks of nurses have dwindled to 20. DHHS has eliminated their office space, and failed to ensure they have enough clerical support staff to purchase supplies, process travel reimbursements and help with patient referrals.

At a public hearing in April on LD 1108, medical providers said they could no longer refer new moms and babies with medical needs to public health nurses because no nurses were available. If they did, they had no way of knowing whether they ultimately got care.

LePage failed to recognize reality in his letter vetoing LD 1108, describing the public health nursing program as one with "deficiencies" that is "undergoing reform." But it's his own administration that has caused the so-called deficiencies, such as depriving the program of staff to the point where Aroostook County nurses must regularly travel to Portland and Lewiston.

DHHS has had plenty of time, and the budget, to restore public health nursing. It's chosen instead to block lawmakers from public information about the program and to delete its public health nursing web page.

Under a different type of administration, there would be no need for the Legislature to force DHHS' hand to "promptly fill all public health nurse positions" for which there is funding, as the bill will now do. There would be no reason to explicitly prohibit DHHS from using public health nursing funds for other purposes or to require the program's director to report back to the Legislature on hiring progress.

But that's what it's come down to.

The Maine Legislature succeeded in its oversight role Wednesday. Republicans and Democrats alike chose to ignore the administration's charades and to rebuild Maine's public health nursing ranks, for the betterment of Maine people's health and wellbeing.

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