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A special series by Sarah Reith about the financial realities of Mendocino County governance.

Public Health stretched thin

A building with a sign that says "County of Mendocino Health & Human Services Agency/Public Health 1120 South Dora Street," next to some xeric landscaping.
Mendocino County Public Health building in Ukiah.

An infusion of state money could help increase training, recruitment, and retention of public health workers. Mendocino County's public health department is lean on nurses and key leadership positions.

June 2, 2022 — With a state budget surplus of $97 billion, a coalition of state public health departments and community advocates is weighing in on how to invest a promised $300 million to rebuild the state’s public health infrastructure, especially the workforce. The PublicHERO initiative spells out how much money the coalition wants to be allocated to which priorities in training, recruiting, and retaining people for specialized positions. In addition to organizational backing, the proposal has support from the Governor and Senator Richard Pan, who is also a pediatrician.

The gaps in Mendocino County’s public health department are not entirely unique. Between the Great Resignation, burnout, an aging workforce, and decades-long disinvestment, public health departments across the state fared badly during the pandemic, according to Dr. Karen Relucio, the Public Health Officer for Napa County. “Sixty-two senior local public health officials in California cities and counties have left their positions since the start of the pandemic,” she said at a press conference for the PublicHERO initiative. “That includes 21 health officers, 20 agency directors, and 21 local health department directors.”

Competition with the private sector is stiff. The last two nurses who quit Mendocino County’s public health department left because they could get 50% more money elsewhere. Mendocino County Public Health Director Anne Molgaard says in addition to a shortage of nurses, there are other significant gaps in the local department. “We also don’t have a Director of Nursing right now,” she said; “who would supervise those LVNs and all of the different nursing programs that we have. And we are also going to start advertising shortly for a new position called Director of Health Education. What we realized is that so much of our public health work is around communications and education. As the science changes, we need to figure out how to explain the science to non-scientists.” The DIrector of Nursing position remains vacant, despite regular advertising.

Kim Saruwatari, the president of the County Health Executives Association of California (CHEAC) and the Public Health Director for Riverside County, says the height of a pandemic is the wrong time to recruit and train a workforce. “During covid, we had to double our workforce,” she said. “We went to almost 1400 employees in a matter of weeks…so there was less stringent hiring requirements, evaluation of skills, and then, once we were able to identify people and bring them onboard, we had to do extensive training…so really, the net effect of this is that we had a workforce that was not ready and trained as the public expects and deserves. We also lost time in the response because we had to divert resources to doing this training. So some of our response activities suffered as well.”

The local public health department has eight nurses, and is looking to hire six to twelve more. Molgaard said with inflation, a lot of the state money might go toward salary increases, which could be key to retaining employees. Public health is stretched thin, with Public Health Officer Dr. Andy Coren doing a lot of educational work, which takes time away from delving into epidemiological data and other “things that he, as a medical professional, is specialized at,” Molgaard noted. A Director of Nursing would oversee maternal, child, and adolescent health, the WIC and home visiting programs. “So right now, we’re just doing those as we can,” Molgaard said. “But they deserve more leadership. And they deserve more focused leadership.”

Directors of public health labs are among the specialized positions the PublicHERO initiative would like to see funded. But Mendocino County has not had a lab for about a decade. Molgaard acknowledged that it would be easier to send specimens across town than all the way to the lab in Solano, “but would we be able to attract the people needed in order to properly staff a lab?” she asked. “Doubtful.” She estimated that she only has to send an employee to Solano about once a month.

When it comes to the biggest concern for the department, outside of being understaffed, “The pandemic is still our number one issue,” Molgaard said. “And no, monkeypox is not our number two issue. Probably venereal disease is our number two issue. I hate to say it. But it’s not pretty in Mendocino County right now.”

The final numbers from the state budget should be available this month. “If they’re together in Sacramento, early June,” Molgaard predicted. “If not, it can spill into late June or July. But I’d love to report back then.”