Lack of vaccines, health education after nurses leave St. Charles County health department

The St. Charles County Department of Public Health canceled vaccine clinics, education programs and CPR training this fall after more than half of its nurses and a health educator resigned.

“Kids aren’t getting immunizations. They’re not being educated on everything from tobacco to STDs to hand-washing practices,” said Brittany McNamara, a former health educator with the department who resigned in August over concerns about management. “This administration’s failure to rectify personnel issues has crippled their capacity to provide needed public health services.”

Four out of seven public health nurses resigned from the department in the first half of 2017, leading to the cancellation of four back-to-school vaccine clinics and about 2,400 fewer immunizations last summer.

The department administered 4,133 vaccines to children in July and August 2016 through a federally funded program that provides free vaccines for low-income families. This year, it gave 1,754 vaccines in July and August.

The nursing shortage also delayed the department’s CPR training classes for day care employees until 2018, health officials said.

Two positions have remained open since the summer. Hope Woodson, the department’s director, said that between a “huge outpouring” of job applications and a remodeling of the offices on Boone’s Lick Road, she hasn’t had much time to do interviews.

“We’ve had a staffing issue but we are filling those roles as quickly as possible,” she said. “Public health nurses turn over quickly.”

After a spate of staff departures over the summer, the county’s human resources department conducted a satisfaction survey of health department employees. The majority of employees said they were satisfied in their jobs, according to the human resources report on the survey, while “some employees expressed a lack of trust in leadership and/or a feeling of lack of honesty from management.”

The staffing shortage coincided with the department’s plans to revamp its services in an effort to increase revenue. The department’s health services division has projected revenue of $1.4 million and expenses of $2.1 million in 2018, according to the county budget.

The health department shut down its sexually transmitted disease clinic this month and terminated the position of nurse practitioner. Residents will no longer be able to get STD exams or treatment through the department. There were more than 2,000 STD clinic visits in 2017 and all testing and treatment supplies were provided by the Missouri Department of Health and Senior Services.

Woodson said the demand for STD treatment was outweighed by requests from residents for new services including travel vaccines and cholesterol, blood pressure and glucose screenings.

“We’ve been tracking concerns for years,” she said. “Now was a good time to provide those services.”

Between 2016 and Oct. 31 of this year, the health department’s immunization clinic received 158 requests for typhoid vaccines, 53 requests for yellow fever vaccines and 41 requests for malaria vaccines (which are unavailable in the U.S.).

A spokesman for the department said there are no records on community requests for blood pressure and cholesterol screenings.

In an exit interview from July obtained by the Post-Dispatch, a former nurse said the health department “has future plans that do not take into account the community needs and wants … the immunization and education program has significantly decreased their services, when the needs have tremendously increased.”

While St. Charles County has some of the lowest poverty rates in the region, more than 8 percent of children, or about 7,700 kids in the county, live at or below the poverty level, according to 2016 U.S. Census Bureau estimates. That’s up from 6 percent in 2009.

Last year, the department hosted 531 health education presentations on topics that included eating disorders, drug and alcohol use, hygiene and STDs to schools, day cares, prisons and community groups. There were 268 such presentations in 2017 with the health educator position vacant from July to November.

“The cutbacks at the county health department have affected our students and families,” said Mary LaPak, spokeswoman for the Wentzville School District. “We used to be able to refer our students to the county for required immunizations, but they have not been the resource they were in the past due to lack of supply and personnel.”