Dr. David Westfall, director of District 2 Public Health, which administers health departments in Hall and 12 other Northeast Georgia counties, said he was lucky he didn’t have to give more people the bad news.

"Obviously, these are very difficult decisions," he said. "We tried to give them enough notice so they could start looking for jobs elsewhere."

Of the six who will be terminated when the state fiscal year ends on June 30, some had clerical jobs and some worked in nursing, Westfall said.

He’s actually eliminating 11 positions from the budget, but only six employees were affected.

"One position we were able to transfer to a different budget, because they had some responsibilities outside of Hall County," he said. "Two were environmental health positions that we had not filled for a while. And two others were clinical jobs that we were actively recruiting for."

Those cuts only apply to Hall County, Westfall said. "The other 12 counties in the district are having similar issues," he said, though he did not yet know how many others in the region might lose their jobs.

He said several factors have converged in recent years to put the squeeze on District 2.

"As we’ve had increased responsibilities for emergency preparedness that have been added on to what public health already does, we have not had a corresponding increase in funding to support those additional requirements," he said.

Westfall said he’s had to pull workers away from their clinical duties in order to conduct seminars on topics such as preparing for bird flu.

He added that District 2’s general expenses, such as for travel and for employee health insurance, have increased without any adjustment in funding from the state. "Our costs have gone up just like everyone else’s," he said.

But the biggest blow came several years ago, when Georgia decided to transition its Medicaid program into a managed care model.

"Medicaid income was one of the ways that public health was funded," Westfall said.

But the Medicaid managed care companies operate like HMOs, severely limiting how much they reimburse for services.

For example, in fiscal year 2005, the health department’s dental program received almost $830,000 in Medicaid payments. This year, that amount dropped to about $356,000.

"For fiscal year 2008, we’re projecting a shortfall of $866,208," Westfall said. "We’ve used up the reserves that we had, and we can’t go to that well again."

Earlier this year, Westfall approached the Hall County Commission and asked for about $574,000. The county has its own budget issues and wasn’t able to give that much, but Westfall said even partial funding would be helpful.

"We don’t have the final number from them yet, but we think we’re going to get between $200,000 and $300,000," he said.

But the loss of six jobs will have an impact at the health department, which already struggles to meet the demand for services.

People who want to come in for family planning, immunizations or STD testing "may experience delays in getting an appointment," Westfall said.

However, the department’s primary care clinic will not be affected by the job cuts. "Primary care is on an entirely separate budget," he said. "They get some funding from Northeast Georgia Medical Center."

Westfall said some people may think they’re not affected by the situation at District 2 because they never go to the health department. But public health performs a variety of important functions, such as overseeing the school vaccination program and tracking the spread of infectious diseases such as tuberculosis.

"People would complain if you cut the police or fire budgets. But public health is not visible," Westfall said. "It’s like the virus protection program on your computer that runs in the background. You never notice it unless it stops working."