Some of the city's most important and successful disease prevention programs and health services will be crippled or effectively eliminated early next month because of cutbacks in personnel stemming from the District's financial problems.
For example, the cutbacks will make Washington the only major city in the United States without a program to investigate epidemics and food-poisoning outbreaks, to monitor flu and other reportable diseases and to handle health emergencies.
Even programs for which specific federal funds are supposedly available are suffering. Of the 18 positions on the staff that monitors the city's highly successful immunization programs, 10 are vacant and two more have been eliminated by a new round of firings.
The damage is not limited to personnel. Because of the city's cash-flow problems and long-range budget crisis, supplies such as medications, laboratory equipment and in some cases food have dipped dangerously low. Purchase orders were not approved or suppliers' bills were not paid.
"We don't have any money to buy drugs, we don't have money to buy X-rays -- why don't we close the clinic up and all go fishing?" said Dr. Hazel Swann, who runs the city's tuberculosis program. Swamm will lose three of the four workers who track down TB cases in the city.
Workers in the clinics and disease prevention programs are now getting word that the positions of more than 1,200 health and social service workers will be eliminated soon after Oct. 1. Some of those positions are already vacant.
The loss of the workers will be felt acutely because even health programs that are funded by federal grants -- those that combat venereal disease, or try to lower infant mortality or prevent lead poisoning -- are riddled with vacancies.
Although the money for these programs is supposedly unaffected by the District's financial problems, their managers say that for months District officials have not released the grant money needed to hire staff.
In almost daily meetings, city administrators are making final plans for the layoffs with officials from the Department of Human Services. The officials are already mapping out additional cutbacks to be made a year from now.
James Buford, the department's director, said all the initial program cuts he has ordered were proposed to him by the managers of the programs.
"I gave them a mark," he said. "I said, 'This is what we have to live with.'"
Nevertheless, managers of some programs say they will lose much more than the cuts they suggested.
Because of civil service laws, city employes with many years of seniority who have been fired will be allowed to take jobs in areas where they have no experience, "bumping" other employes who may have years of specialized experience or training, but less seniority. The effect will be to reduce efficiency in many health services.
Not all health programs run by the city are equally affected. Besides the vacancies already included in the approximately 1,200 positions being abolished, there are other cuts suggested by program managers: employes who are willing to retire, who are not needed, or who are considered incompetent.
But a number of employes, in programs throughout the department, are being fired not because they are not needed but because their salaries have been paid for years out of money known as the Medicaid trust fund. The $13 million fund -- a federal grant given to the city to cover the cost of administering the medical assistance program -- is supposed to be used only for employes who directly serve Medicaide recipients, according to Buford.
He said the city is laying off employes throughout the department whose duties do not qualify them to be paid through the funds. But the decision to fire was made before anyone had evaluated whether their services were critical to the city's health programs.
Now, he said, the evaluation is being done -- perhaps too late. The first 100 firing letters have already gone out. "We'll work as fast as we can," he said. "It really should have been done at the time the positions were identified."
For instance, employes who have received notices of firing include Swann's TB investigators, and the entire three-person staff of the human communicable disease control program. That staff is responsible for investigating epidemics and food-poisoning outbreaks, monitoring flu and other reportable disease, dispensing rabies vaccine, and handling health emergencies in the city.
Program by program, here is a sample of how the District's fiscal problems, and the administration's response to them, have affected some health services in the city. Tuberculosis
Washington's TB rate is the third highest of any city in the United States. The firings will eliminate three of the four positions for TB investigators, two coding clerks and a secretary. Without the investigators, Swann said, she will be unable to find, test and treat people who have been exposed to this dangerous, but curable, disease.
Yet, she said, the layoffs left in place the positions of two part-time radiologists who are each paid more than $40,000 a year to do work which takes each only one and one-half hours a week. Swann said the program has cut back so much on X-rays that the doctors can finish reading all the films in that amont of time.
"I could very well have said, 'We do not need three radiologists,'" Swann said. "They didn't ask us. They just called us on the phone and told us who to cut."
Swann said that because purchase requisitions are not being approved by the city controller, the program is running out of medications to treat TB, syringes to test for it, and other supplies.
"They (Swann's staff) said, 'Listen, we don't have but 200 syringes left.'" Swann said. 'I said, 'What the hell difference does it make? We don't have anybody to give the shots anyway.'" Disease Control
The three-member staff of the program that investigates outbreaks of food poisoning and of diseases like hepatitis, typhoid, German measles, or influenza have all received firing notices. Its director, Dr. Martin Levy, said that even if the position of his assistant is reinstated, the firings would leave no one to take telephone reports of these illnesses.
Dr. Phillip Nieburg, the physician assigned to the District by the federal Center for Disease Control, said in a letter to Mayor Marion Barry that the cuts would "allow the District's entire capacity to respond to disease outbreaks and epidemics to evaporate. . . ."
Asked about the firings, acting commissioner of health Dr. Roselyn Epps said they occurred because the employes could no longer be paid through the Medicaid trust fund. "We'll have to stretch ourselves to cover areas that are critical," she said. Immunizations
Immunizing children against disease is one District health program that has a dazzling record: 95 to 97 percent of children entering school have had all their shots. Yet, even as a new law extends immunization requirements to college-age children takes effect, the federally-funded program that monitors immunization records and provides vaccine has become seriously understaffed, jeopardizing the gains that have been made.
Of the 18 positions on the program staff, director Al Harry said only six will be left after the current firings. Harry has been trying for a year to get approval for city administrator Elijah Rogers to fill the vacancies, using federal grant money that has been appropriated specifically for his program. But he said his applications to hire have been rejected by Rogers and no one has told him why.
"When you have only half your people, you can only do half the job," he said. D.C. Village
About a month ago, D.C. Village -- the District's public nursing home -- ran out of staple foods including eggs, bread and milk, according to Long Term Care administrator Paul Lavigne. He said the shortage occurred because his predecessor had borrowed from the food budget last winter to add to the heating budget when the facility's heating oil ran out.
For several weeks, while emergency requisitions were processed by city administrators, D.C. Village dietitians borrowed food from other facilities. aLavigne said residents subsisted mostly on eggs one week, mostly on turkey the next, depending on what was available.
"The patients got fed. Nobody starved," he said. "The main thing that suffered was the variety of food."
Other program managers said such shortages are occurring because the city controller is not approving requisitions except in emergencies. "If you say you have ten (of an item) left," said one, "they tell you to call back when you have one left." D.C. General Hospital
The closing of three city-run clinics and their pharmacies last May has sent a flood of patients on medical assistance to D.C. General's pharmacy. Even as the demand for medications increased, some drug companies refused to do business with the hospital because their bills have not been paid by the city, according to medical director Dr. Stanford Roman.
This raises the specter that once again, as happened in the mid-1970s, during the hospital's darkest days, D.C. General may run out of critical drugs. "They're very close. Dangerously close," Roman said.
Roman said he did not know whether the situation would improve after Oct. 1, when the city's shortage of cash should ease once the 1981 budget goes into effect.
Other vendors are also refusing to serve the public hospital. "When the air conditioning broke down during the heat wave, we had to find an air-conditioning company that we had never done business with before," Roman said.
He said the hospital is also being forced, despite its lack of psychiatric facilities, to keep mentally ill patients who are dangerous to others because the city's mental health facilities say they have no space for them.
"We've got people that we've kept in the intensive care unit because we couldn't put them on the open ward and we couldn't transfer them out," he said. c"It's a real zoo."
Managers of other health programs -- such as clinics, mental health cneters, and the city's laboratory -- said they do not yet know how their services will be affected because they have not received notice of how many employes they will lose.
Even after letters arrive, the situation will change as fired employes move to other programs, "bumping" those with less senority.
Buford said the "bumping" of trained staff by employes from other programs is a feature of the civil service system that he cannot control.
"I think that the integrity of the process ought to be protected and I just assume that it works fairly," he said.
Neither Buford nor Epps, the acting health commissioner, would comment on problems that managers were having with supplies, or filling vacant, federally funded jobs. Efforts to reach officials in the city administrator's office, the city budget officer or the controller's office for comment were unsuccessful.
Both Buford and Epps said they were trying to determine which of the positions being abolished were critical to health services, so they could reinstate employes or reassign others. Once a firing letter goes out, an employe remains on the job for another 30 days.
"I know that there's an inequitable disposition of manpower in the department," said Buford. "I am beginning to determine how many people it takes to do things."