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The Los Angeles County Public Health Department is taking many risks as President Trump vows to curb government spending and curb federal money with new restrictions.
Federal grants account for about two-thirds of the budget, and are making funding efforts to detect avian flu and other infectious diseases, control HIV/AIDS and tuberculosis, and serve children with chronic illnesses. Feller spoke with the Times about how the Trump administration has affected the LA County public health sector so far, and what’s ahead.
This conversation has been edited for length and clarity.
Question: How has the ongoing changes since President Trump took office affected the public health sector at this point?
Answer: The biggest impact is that there is a level of uncertainty about the direction in which the federal government is in. But we recognize that there may be significant risks in our budget, which creates uncertainty.
Q: Did you have any frozen funds?
A: We lost one of our fired friends in public health. These are the CDC people that are being loaned to us. This person had been loaned to us for two years and she sadly received a notice of fire. Her employer is the CDC and not the local public health department.
Here we have 12 employees assigned to us by the CDC. Some of them have received verbal notices that their work has been completed, but no one else has received an official letter of cancellation. …If those people actually lose their jobs, that would be a huge gap. …
We receive notifications about some grants – almost every day. …Our sense is how we interpret these orders and there is a lot of confusion when these orders are actually applied. …
Approximately 54 people here are volunteers at Americaorps and have received notifications about their grant applications. In fact, the Americanorps volunteers assigned to us have already certified that they are fully compliant with all executive orders, but we are going back and forth about it.
Q: Has the department ever done in response to these notifications?
A: Not before. There are existing contracts with Grant deliverables. We adhere to those grant deliverables. …We’re just working. We are going to do high quality work. We hope that by doing high quality work, we will continue to gain bipartisan support that we have relied on in the past.
Q: What are your biggest concerns when you start seeing how health policies are being restructured?
A: There is a really important role for governments in ensuring public health. …I know that the new administration is taking it very seriously that it has an obligation to cut governments to make sure it is efficient. And I think we always share the goal that these are taxpayer dollars and we need to be responsible for them. We need to be transparent about how we use them. Most importantly, we need to be as efficient as possible in achieving our goals of protecting the public.
But my hope is that as the administration settles it takes them time to learn the important work that is going on and why continuing this job really helps them benefit. I think the biggest concern is that there is no due diligence to rush to the promise of a campaign and actually better understand the breadth, depth and importance of public health activities that are actually being carried out through government agencies at the federal, state and local levels.
Q: The CDC has suspended one of its flu vaccination campaigns: “Calm from the Wild” campaign. How does that affect efforts at the county level to promote vaccination?
A: My hope is that these are very short pauses and we will continue to work in the business of making sure people have good information about the importance of vaccines. So, vaccines save thousands of lives, and we can’t really backtrack this.
Q: One of the other big things that the federal government is going on right now is these proposed cuts in Medicaid. What impact will your department have?
A: It will immediately affect us in two big ways. There are services that charge Medicaid. We are also healthcare providers through clinic services. …The other is that when people’s access to health care is reduced, public health services are in a higher demand. You also need to worry about the decline in results. …Let’s look at cancer. If people delayed seeking care and were diagnosed with late stage cancer, the impact on their lives and their family lives is enormous, but it was costly early and lost this opportunity to provide better care.
Q: Are there any expected effects on the area of concern about avian flu that you would expect from the changes in administration?
A: I really don’t know so I want to avoid speculation, but I want to say that we make millions of dollars in the annual fees that allow us to have a public health lab here. So I really rely on the ongoing support of the Institute of Public Health. But we also have people on the ground. Wastewater monitoring is available.
These are all activities that are primarily supported through our federal grants. …If federal grants don’t continue, they won’t be able to do the level of work we do. And it’s not just around the avian flu. Here, I was able to get a local dengue case for the first time. …Dengue fever is a dangerous disease. It can cause serious illnesses and even death, and you really don’t want anything here that we haven’t seen endemic.
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