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Budget cuts may force to close King County Public Health Center in Auburn may close

The young teenage girl and her boyfriend were at the door of the Public Health Center a half-hour before it opened at 8 a.m. on a Monday, Nurse Practitioner Carol Tanaka recounted to the Auburn City Council this week.

Tests confirmed the young couple's fears — the girl was pregnant. Given the beatings she had endured from her parents — the evidence was all over her body — Tanaka decided it would not be safe for her to go home.

At that critical moment, Child Protective Services and Auburn Police were tied up.

Tanaka got the girl involved with Maternal Support Services, with Women and Infant Child Services and convinced her to wait until more help could arrive.

After two more calls, Tanaka said, Auburn Police came, gathered information and agreed it wouldn't be safe for the girl to return home. It was 3 p.m. before a CPS social worker drove from Everett, saw the girl and deemed it would not be safe for her to return.

Authorities placed her in protective custody.

This sort of thing happens perhaps more often than people realize, Tanaka told the council on Monday.

"I saw 22 of your citizens today, 22, some have insurance, some don't, but we don't turn anybody away," Tanaka said. "These could be your daughters, they could be your sons, your granddaughters, your grandsons, your neighbors, your co-workers ... "

Now, however, there's a possibility that the Public Health Center in Auburn may no longer be there.

Ten years of dwindling financial support have taken their toll on King County's public health services – and now, county officials say, a $15 million annual shortfall is forcing them to make difficult choices. Unfortunately, one of those "difficult choices" may be to close the Public Health Center in Auburn, along with centers in Federal Way, Northshore in Bothell, and Greenbridge in White Center.

No final decisions have been made to date, and Tanaka urged the City to tell the King County Council not to close the center.

"There are many homeless youth, homeless folks, homeless women, at-risk youth in our population, women infant and children, and my specific job is to provide family planning services," Tanaka said. "I see a lot of social issues as well. I am not sure you are aware how many actually live in this community. I live in this community, and I'm passionate about the patients I see."

King County's proposal calls for shifting some services onto the shoulders of community organizations and making reductions to services that have suffered cuts to federal and state funds.

According to a county press release, ever since voters repealed the major source of funding for Public Health 14 years ago, and a voter-approved cap on property taxes restricted the remaining source of local, flexible funding, finances for Public Health—Seattle & King County have been precarious,

County officials say had been able to patch the gap in recent years by "creating efficiencies, spending one-time reserves, securing outside grants and special funding, and reducing staff – including a major round of layoffs in 2009." Now, however, they say, reductions to federal payments for administering Medicaid and other cuts, have pushed the agency past the tipping point.

"We've run out of rabbits we can pull from our hat," said Dr. David Fleming, director and Health Officer for Public Health—Seattle & King County. "To operate with a balanced budget, we may be compelled to reduce staffing and services."

If the King County Council adopts the reductions in November, those six centers could feel the blow. While the Northshore Center would close, one of its satellite clinics would remain open.

County officials say they made the site-closure proposals with the goal of maximizing services to as many clients as possible. While support services for pregnant women and children and for family planning will be lost at these locations, they will continue to be offered at six other locations in King County, including Kent, Renton and Eastgate, Fleming said.

More broadly, reductions would impact a range of core public services – such as reducing the capacity for disease investigations, and curtailing Public Health work on tobacco and obesity prevention.

"This is painful and, like you, I'm concerned about our clients," Dr. Fleming wrote in a message to staff. "We'll work with our communities to try to find ways to mitigate some of these cuts, but at the end of the day, this is likely to result in a loss of services for some of our clients."

Altogether, the proposed reductions could lead to more than 200 layoffs. EMS and restaurant inspections would be not be affected.

Fleming said the department's top priority is preserving the core, irreplaceable functions that only Public Health is able to provide.

Most Public Health funds come from grants, levies or fees that are dedicated for specific purposes, and cannot be shifted to other services. For example, emergency medical services (EMS) are funded by levy dollars that can only be used for EMS. Restaurant inspections are paid for by fees.

The proposed cuts would not impact all areas of Public Health. Most will occur in three areas that rely on more general funding: Public Health Centers, Prevention Services, and services provided through the Director's Office/Administration.

Two of those centers – in Columbia City and North Seattle – would transfer primary care services to other healthcare organizations, as health reform has made it more feasible for providers to take on more patients. The department is in discussions with NeighborCare and Harborview/UW Medicine to make those transitions in 2015.

Budget proposals will be forwarded to the King County Executive, who will balance competing County needs and limited revenues, and work to preserve the most essential services

The King County Council will adopt a final budget in November

All current services will be maintained at Public Health Centers while decisions about the budget are in process.

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