Both the city of New Orleans Health Department and Emergency Medical Services are facing cuts to personnel and discretionary operating expenses as the city trims its budget, the agencies’ directors told city council in 2021 city budget hearings Monday morning. At the same time, both agencies described their plans for managing a surge in COVID-19 cases and continuing strain on the healthcare system during the pandemic.

The Health Department’s core budget — not including EMS, which is categorized as a part of the department in the budget — is funded almost entirely by grants from state and federal agencies, which the city does not control. Just 6.5 percent of the budget comes from the city’s general fund, and that is being cut by about 30 percent, or $1 million, mostly in personnel.

A number of city departments are facing cuts of 20 percent or more next year. At the Monday budget hearing, Dr. Jennifer Avegno, the Health Department director, described the cuts as “commensurate with the other budgets before you.”

The proposed EMS budget is down nearly 20 percent, or $3.7 million. $3.4 million of the cuts to EMS come from personnel.

The budget cuts come as the city anticipates a steep decline in revenue from sales tax due to business closures and the loss of tourism during the COVID-19 pandemic. This year, city officials say that recurring revenues — from taxes and fees — are down $150 million overall.  But the city been able to fill most of that gap with $110 million in “one-time” funding from federal relief, property sales, and a large legal judgment.

Officials said that they anticipate a comparable deficit in 2021. The proposed budget cuts overall spending by $16 million, but spending from the city’s general fund — which accounts for the bulk of departmental budgets — is cut by $92 million.

The proposed cuts to Avegno’s office and EMS come as numbers of COVID-19 cases are surging in the state, which over the weekend reported a 21 percent increase in hospitalizations above the previous week. New Orleans’ case numbers have been lower than in other parts of the state, but on Friday the city reported the highest number of new cases since July. Avegno and other public health officials have warned that gatherings during Thanksgiving and Christmas could accelerate that spread.

Health Department core

Personnel cuts to the Health Department’s core budget come from a combination of furlough days, pay cuts, and leaving what Avegno described as “critical” positions” unfilled

Avegno told City Council members on Monday that she “anticipates an intense focus on COVID vaccination” in the coming year.

“This is a herculean effort,” she said. “No one around the country or the world has done this before. We plan to anticipate every logistical hurdle. We plan to get vaccinations to everyone, everywhere. That is the only way that we are going to get back to normal.”

Pharmaceutical companies Pfizer and Moderna have announced preliminary results that suggest their COVID vaccines are highly effective and nearly ready to be distributed, although neither has released full data on trials, leaving some open questions. According to a vaccine distribution plan drafted by the Louisiana Department of Health, the first doses will be distributed to frontline healthcare workers and those living in congregate settings like nursing homes and prisons.

Avegno said that the department is also considering adapting its drive through and community COVID testing sites to distribute the vaccine once it becomes available to the general public.

However, she said, the city may soon be taking a hit to its testing ability as it deals with a surge in cases and hospitalizations.

“There is some question about how long the National Guard drive-through testing will continue,” she said. Right now, the city is anticipating that it will lose National Guard testing on Dec. 17, although she said that the state is working to prevent that from happening.

If that happens, she said, the city’s other testing partners — primarily LCMC, Ochsner, CORE, and the Louisiana Department of Health — will be asked to take up the slack.

“The state,” which provides most of the funding for COVID-19 testing, “has not indicated that they are going to cut funding,” said Avegno.

Under those circumstances, she said, the city will maintain “adequate testing.”

The Health Department is also losing about $2 million in grant funding to cover personnel, including two Department of Justice-funded case managers for the city’s LEAD program, which diverts people arrested in NOPD’s 8th district for petty crimes related to drugs, mental illness, or “social challenges” into social services.

According to a budget brief released by Mayor LaToya Cantrell’s office two weeks ago, a number of other Health Department programs are also facing staffing cuts, although the impact is harder to assess.

All positions in the Healthy Start Grant Initiative, the Healthcare for the Homeless program, and Ryan White grant program administration are eliminated in the proposed budget. All are federally funded programs that provide health services to underserved communities. In their place, the budget proposes a catch-all “grant operations” department.

The Health Start Grant helps parents access benefits like SNAP and Medicaid, and provides counseling and job training services. Healthcare for the Homeless is a federally qualified clinic that provides medical and dental services. Ryan White is a program that provides medical care and support services for uninsured people living with HIV.

The grant operations department that appears to replace all the stand-alone departments would cut almost 6 full-time staff out of 51 total. Those cuts include lab technicians and a dental hygienist and assistant.

The Health Department also runs programs funded by grants from the Louisiana Department of Health and Human Services. Those would lose 4.7 of 14 full-time employees, including roughly four positions from the Women, Infant, and Children supplemental nutrition program, which provides breastfeeding education and vouchers for food and formula for children under the age of five.

EMS

Like the Health Department, the proposed personnel budget cuts for EMS come primarily from continued furlough days, pay reductions, and unfilled non-critical vacant positions.

However, so far, EMS Director Dr. Emily Nichols said, administrative staff are taking furlough days, while field staff are not. She told City council that the service created additional cost reductions by “reductions in deployment of staffing,” which means that the service has one or two ambulances fewer each day, out of just over 20 total.

The 2021 budget brief appeared to show a total reduction of 13.5 full-time positions within the EMS, out of roughly 150 employees.

The total EMS budget, $16.7 million, is less than the EMS total revenue, which includes federal reimbursements for emergency services, Nichols said.

She said that the EMS has monitored its response time as it has implemented furloughs, and seen slight decreases in response time compliance. In August, 74 percent of ambulance calls were responded to within the goal of 12 minutes, while over the last four weeks, the number was 70 and 72 percent.

Nichols attributed those decreases to the loss of state-funded surge ambulances, which had come to the city for hurricane responses and left on November 1st. “We’re constantly working with the state on these,” she said, and suggested that the surge ambulances could come back as flu season puts additional strain on the medical system.

At the same time, she said, calls for EMT service have rebounded to normal after decreasing over the summer. Overall call volume is about 75 percent of 2019 so far this year.
But the expected increase in cases is likely to bring more calls.

“At COVID’s peak in March,” Nichols said, “we had a 25 percent increase in calls.” At the same time, she said, COVID infections reduced the staff by a quarter.