The Maine Center for Disease Control and Prevention has decided to stop contracting with the city of Bangor to employ public health nurses, a service the city has provided for decades, public health staff reported at a City Council workshop Monday.
Bangor’s two public health nurses primarily focus on maternal and child health care and conduct free home visits, a service that is particularly vital for low-income families and those facing challenges related to disabilities, substance use disorder, and housing instability.
Maine CDC has said that it plans to start providing those services using state public health nurses rather than continuing to fund Bangor’s program.
Although the Maine CDC director claimed in a letter to City Manager Carollynn Lear that there will be “no disruption to services for clients or families,” Bangor leaders expressed skepticism about whether the state will be able to provide the same level of care as the city’s locally-based public health nurses.
The change also comes at a time when maternal health care is becoming increasingly difficult to access in the northern part of the state after multiple delivery units have closed and financial struggles at Northern Light Health, one of the state’s largest health care providers, is complicating Mainers’ decisions about where to go for care.
Bangor has provided public health nursing services as early as 1990, public health director Jen Gunderman said Monday. She said it’s hard to believe that the state’s services will be “as robust and comprehensive as what we’ve been able to offer.”
“To expect Maine CDC to be able to step into an infrastructure that we built for decades — I am concerned,” Gunderman said.
In the Aug. 21 letter to Lear, Maine CDC Director Puthiery Va said the agency decided to take over these services after hiring more public health nurses through the state. It previously outsourced public health nursing because of vacancies in those positions, Va said.
Maine’s public health nursing program has been plagued by staffing issues for years. Former Gov. Paul LePage largely dismantled the program while in office, and the administration of Gov. Janet Mills struggled to rebuild it during the COVID-19 pandemic. More recently, the state has been “largely successful” in hiring a full staff, Va said.
The current contract for Bangor Public Health to provide these services expires on Sept. 30. After that, clients will be referred to Maine CDC’s public health nurses.
Bangor’s program currently serves 217 clients who sometimes need multiple visits, according to Jennifer Doyle, Bangor’s public health program manager.
Doyle also told city councilors on Monday that she was skeptical of the state’s ability to bring on public health nurses who are as experienced as Bangor’s and replicate the longstanding relationships those nurses have built with clients and local organizations.
Bangor’s nurses work with “a high concentration of very complex cases” that require them to put in extra time building trust with organizations like recovery homes and domestic violence shelters or tracking down clients who are homeless, Doyle said.
“One of my biggest concerns is that while state public health nurses are professional and competent, I don’t know that they’ll have capacity to go above and beyond like we do to meet these critical needs,” she said.
The nurses who currently provide these services have a combined experience of more than 25 years in OB/GYN services, mostly in Maine, according to Gunderman. They also both have certifications in lactation consulting or counseling and training related to perinatal mood disorder.
City staff found out about the state’s plan to restructure how services are delivered when Maine CDC issued a request for proposals this summer that was limited to providing local public health nurse services in southern Maine, Gunderman said.
Maine CDC told city staff it eventually plans to take over services for the whole state, Gunderman said, although the letter noted that Maine CDC is still supporting local public health nursing in southern Maine because it does not currently have the capacity to serve that region on its own.
Va said she sent the letter explaining the decision at Mills’ request and acknowledged the lapse in communication with Bangor about the changes. “The transition away from contracting these services deserved clearer communication to impacted partners. The City of Bangor and Bangor Public Health should have been made aware of the rationale for the programmatic re-envisioning,” she said.
Va also raised the idea of offering Bangor additional funding through a Public Health Infrastructure Grant that would “redeploy” the city’s nurses to “address other public health priorities for the community.”
But Gunderman noted that these grants only cover two years of funding, while the request for proposals that excludes applicants from northern and eastern Maine would have provided five years of funding.
Gunderman hopes that the state will reconsider its plan, she said Monday.
If Maine CDC goes ahead with the transition, securing the two years’ worth of grant funding would be essential to keep Bangor’s two public health nurses on staff, Gunderman told the Bangor Daily News. In that case, the city would plan to offer and potentially expand maternal and child health services that do not duplicate the work of the state’s public health nurses, such as its lactation and maternal mental health programming, she said.
