Four-year-old Nonye Baker, a bright, talkative girl who still can't walk, was scheduled to get daily physical therapy at the city-run Sharpe Health School in Northwest Washington to help counteract a paralyzing birth defect and improve her chances of walking.
But because of budget cuts and staffing problems at the school, she had to wait six months until her therapy started last March, and now receives only three treatments a week instead of the five that doctors say children in her condition should receive.
"I'm not sure when she is going to walk," said her mother, Iris Woodridge, "I just couldn't believe that because of a cutback, my daughter would be one of the ones who would not get a service."
Before enrolling at Sharpe last fall, Nonye had had daily physical therapy at another facility and was making progress, her mother said. But after Nonye graduated to Sharpe, and there was a delay in treatment, there was "very little progress."
Now the Crippled Children's Services, already strapped by budget cuts and unfilled staff positions, is scheduled to lose $119,000 more starting Oct. 1, as part of the city's projected loss of $4.4 million in federal health and social service block grant money under the Reagan administration's New Federalism.
The crippled children's program is one of about nine run by the city Department of Human Services (DHS), which are being consolidated into a single maternal and child health block grant under the Reagan plan. Together, the programs are being forced to absorb a cut of nearly $1.6 million or almost 25 percent. The Barry administration, in turn, has set the size of the cutback for the crippled children's program.
In this one relatively small corner of the city's massive health and human services field, the impact of a new cut, according to city health officials, will probably not be immediately visible. Rather, they say, it will likely result in more small and largely invisible consequences like those affecting Nonye Baker.
The proposed cut also illustrates, they say, the many potentially painful decisions faced in dozens of city health and social services programs affected by the Reagan cuts.
"Right now, I am sort of in a state of shock," said Dr. Ishild J. Swoboda, acting administrator of ambulatory health care, who, along with other DHS officials, have to decide whether to accept the proposed $119,000 cut in the program or restore part or all of it at the expense of other vitally needed programs. "Right now, I don't know how we are going to deal with it, in terms of balancing the needs of one program versus another," Swoboda said.
The Crippled Children's Services, founded in 1938 and funded partly through the 1935 Social Security Act, has a $1.1 million annual budget to provide free diagnosis for any handicapped child in the metropolitan area and run free outpatient clinics for D.C. residents on the grounds of D.C. General Hospital. There and at two other sites, including Sharpe school, at 13th and Allison streets NW, roughly 4,000 children a year are treated for handicaps ranging from severe birth defects to burns and allergies. About 90 percent of the children are from low-income families.
Early treatment of crippling ailments is crucial to possibly preventing more severe problems later in life and, in addition, possibly eliminating the need for more costly extended treatment, according to Dr. Micheline S. Levy, the pediatrician who runs the main crippled children's hospital unit.
On June 25, even before the news of the impending $119,000 cut, Levy wrote to her superiors that the program was in "grave danger" because of budget and staff problems. "The staff is extremely dedicated, but the morale is at an all-time low ebb," wrote Levy, who has worked for the program for 15 years.
"We have already been tightening our belts for years," said Levy, the only full-time physician on a staff of about 70 doctors, therapists, nurses, social workers and secretaries. The program has lost $130,000 in federal funding since 1980, according to DHS, in addition to losing more than a dozen city-funded job slots that have gone unfilled in the last several years. While no single cut has severely damaged the program, Levy said in an interview, an accumulation of budget cuts has eroded some children's chances of overcoming handicaps.
In recent years, crippled children's staff of up to 20 physical and occupational therapists has dwindled to 10; the chief medical officer's job has gone unfilled; some medical staff positions have been vacant for up to 18 months, and social workers have been without a secretary since 1979, according to Levy and her staff.
As a result, children who previously would have been seen by doctors within a matter of days are now waiting eight weeks or longer for their initial visits, and up to 12 weeks for some special services, Levy said.
"It is a terrible problem," she said. "You learn that your child is handicapped. I am a pediatrician, but I can't see you for eight weeks or longer." Because of unfilled vacancies, Levy herself works three jobs, filling in as both the chief medical officer and chief of Crippled Children's Services, administrative duties that take away from her time for treating patients.
"We love these kids," Levy said. "The people who are specialists who work here don't come for the money. They could make so much more in private practice. We love these kids. We would also love to do more for them."
At Sharpe school, 20 children whose doctors prescribed therapy for them are not receiving it because the therapy staff has been reduced from seven to three in recent years, according to school records.
Patricia Cope, who directs the therapy programs, said that ideally her therapists should be treating about 12 children daily, but their caseloads are about 30, meaning that they can't see each child often enough.
Although Dr. Levy has functioned for two years as chief officer of her unit, she said she has never known its precise budget and has never been included in discussions on the subject, which she said DHS treats as "top secret."
"It's a big SNAFU. I am not getting any support. I have no representation downtown" where budget decisions are made, Levy said. "No representation for crippled children. I have nobody to speak for my kids."
James A. Buford, the DHS director, said yesterday that crippled children's is among his department's "priority" programs, and said he thought it was "likely" the department could come up with money to offset the new cut. But he said he could make no assurances of this, or any other program, until DHS completes its budget plans for the coming year.
Dr. Arthur H. Hoyte, the city health commissioner, said, "Unfortunately, I think we are in the position where some of the loudest squeaky wheels, those that are most aggressive and have access to the points of decision-making, may be better off."
Levy said she is deeply concerned that the competition among programs set up by the new block grant structure will be particularly damaging to her program: "How many voices and how many votes do the handicapped have?"