The Prince George's County administration is searching for a new head for the health department in the wake of the forced resignation of Dr. Donald Wallace. The leadership change has prompted officials to reexamine a host of health problems facing the county.
Dr. Helen McAllister, 54, a psychiatrist who has been with the health department for 10 years and director of the mental health division for a year, has been named acting health officer. County officials have advertised in public health and medical journals and major newspapers across the nation, seeking applications from administrators with public health experience.
Wallace, who headed the department for seven years, was asked to resign early last month by County Executive Lawrence J. Hogan and the County Council. Wallace's administrative style kept him at odds with Hogan as well as with former executive Winfield Kelly. His strict adherence to regulations frustrated council members, according to an interview last year with former council chairman William B. Amonett. The doctor often pitted one interest group against another, and in the past, Wallace and county officials argued over the location and operation of clinics and the inspection of swimming pools and restaurants, said one county official.
Wallace's "area of difficulty," according to Dr. Ruth Singer, the state official who oversees local health administration, was that he wanted to exercise considerable autonomy in performing his job, and resisted consulting with other county leaders before making decisions.
As is the case with many government employes in Maryland, the payment of Wallace's salary was shared by the state and county, and state officials would not go along with the county's previous attempts to remove him from office. However, passage of a state law which became effective July 1 made it easier to hire and fire local health officers.
The new law also will allow the county to hire a non-physician with public health experience as health officer. The salary of only $51,000 has not brought doctors rushing to apply for the job, as most physicians can make considerably more money in private practice.
Although McAllister has been acting health officer for less than three weeks, she said she has become familiar with several difficult health problems in the county.
Of greatest concern, she said, is the need to curb venereal diseases and tuberculosis. Excluding Baltimore City, Prince George's accounts for half of all gonorrhea cases reported in the state, said Arthur Thacher, county director of epidemiology. The rate of gonorrhea increased 40 percent, and the number of syphilis cases doubled in Prince George's between 1979 and 1980. The reason, according to Thacher, is that the county does not have enough field workers to follow up on individuals who have been exposed, and make sure they receive treatment.
Thacher said the tuberculosis rate remains fairly constant at about 60 new cases each year. However, he said, many Indochinese immigrants have been exposed to TB and require medication as a preventive measure. This presents "tremendous language problems" for public health workers, he said.
McAllister said she found during a recent visit to the county detention center that conditions are "pretty bad." She said she found that the jail is overcrowded "beyond belief," sanitation is poor, no recreation facilities exist and mental health services are inadequate.
The acting health officer also wants to make significant improvements at Cheltenham, a state institution for emotionally disturbed children located near Clinton. The facility has been operating primarily as an outpatient treatment center and rarely makes full use of its capacity for 20 live-in residents.
Children now are referred to Cheltenham through the school system, an often cumbersome process that means children must wait for treatment, McAllister said. She wants the facility to begin accepting children committed by the courts, because many of the youngsters have been abandoned by their parents and have nowhere else to go.
Both McAllister and Hogan's health liaison officer, Irv Smith, agree that the issue that overshadows all else is the fact that 750 health department employes will have to provide services to the county's 670,000 residents with less state and federal money in the coming year. Prince George's health expenditures were about $11.5 million dollars in fiscal year 1981, which ended June 30. Though the county has budgeted for an additional $400,000 in 1982, officials expect cuts in some state and federal programs before the year is over.
No specific plans to cut services or fire employes have been made yet, said Smith. Health planners are waiting to see what effect the new federal block grants will have on health programs. Smith, however, hopes the budget squeeze will force planners to study existing programs for duplications of services that can be reduced.
McAllister believes the nation's tight economic situation will manifest itself in several ways.
"I see many more people under stress who lash out . . . take out their problems on others," she said. She expects this to lead to a rise in the number of people seeking psychiatric help, as well as an increase in child abuse. From her vantage point as a mental health specialist, McAllister adds that the paucity of funds makes this a bad time to continue a nationwide initiative to move patients from mental hospitals back into the community.
Money concerns are nothing new for health department workers. Because Prince George's County employes are still paid according to a state scale, their salaries are not competitive with those in other parts of the Washington area.
From her own experience as a program manager, McAllister says the low salaries make for unhappy workers. She said a social worker who is director of one of the community mental health centers in Prince George's earns only $20,000. A comparable position in the District pays nearly $30,000.
The department also has "a terrible time attracting physicians," she said. Many foreign-trained doctors are willing to work for the county, but often face a language problem.
Although patients' Medicare and Medicaid payments go to the department, doctors who are contracted to provide services are paid about $21 an hour. If they billed directly to Medicaid, they would make about $30 an hour, and even more if they were seeing private patients, noted McAllister.
McAllister has signed a contract to serve as acting health officer for six months, but probably will stay longer if the position is not filled within that time. Asked if she would consider applying for the post herself, the psychiatrist said that she loved her job in mental health, but is also enjoying the administrative experience. "I may consider it," she conceded, "but nothing definite."