Byline: LINDA McNATT, STAFF WRITER
SUFFOLK -- Frustration with public health and with what she says is inadequate funding was behind Dr. Sujata Buck's decision to quit as director of the Western Tidewater Health District.
Buck, after six years in the sprawling, 1,400-square-mile district, resigned two weeks ago. Her last day is today.
``I find - really - no hope for public health in this state,'' she said last week.
Buck cited three major concerns: not enough state money, the lack of a full-time state health commissioner for over a year and managed care in the public health sector, which, she said, isn't working any better in public health than it is in the private sector.
For example, in home health care, local health departments are required to complete a long questionnaire when they make an initial home visit and whenever the smallest thing changes for a patient.
In addition, patients requiring those services - mostly the elderly and disabled - are allowed only so much money each year.
``What happens to that person when the money runs out?'' Buck said. ``That's what concerns me. It's a whole set of new regulations.''
Prenatal care has suffered as well, Buck said, and that's especially important in a district that covers the cities of Suffolk and Franklin and the counties of Isle of Wight and Southampton. The rural area has a population of about 110,000 and some of the highest rates in the state for low birth weights and infant deaths.
Buck, 50, joined the health district in August 1983. A native of Shillong, India, she has a medical degree from All India Institute of Medical Sciences in New Delhi. She served her residency in pediatrics at the Medical College of Virginia and got her master's in public health from the University of North Carolina at Chapel Hill.
She has worked at the Norfolk Health Department, at the U.S. Embassy in Lima, Peru, and the Chesapeake Health Department. More recently, while still in the Western Tidewater district, she was acting director on the Eastern Shore for five months last year and acting director in Virginia Beach for four months in 1997.
Buck has been a ``tremendous asset,'' Suffolk City Manager Myles E. Standish said.
``We have a very large, very diverse district here - urban, suburban, some very rural,'' Standish said. ``Under Dr. Buck's supervision, the health department has done an extraordinary job. She is extra humane and a good administrator. I hope we can find someone else like her.''
She has expressed to him her concern about inadequate state funding, Standish said.
``My overall concern is that there are a number of things falling on the local budgets,'' he said. ``This is just another example of services becoming the local government's responsibility rather than the state or federal governments'.''
Dr. E. Anne Peterson, acting state health commissioner, was on vacation last week and could not be reached for comment. But Jeff Lake, assistant commissioner for Community Health Services, said that Peterson, as acting commissioner, has ``full authority.''
In addition, Lake said, both state and local funding to the Western Tidewater Health District has increased over the last five years.
Until managed care came on the national scene, residents with poverty-level incomes were served by local health departments. Now, many of those patients go to private doctors, who are reimbursed by Medicaid.
Managed care has caused revenues in Buck's district to drop from $4.5 million in 1997 to $3.8 million in 1998. The shortfall is mostly in home health, Lake said.
The state legislature has tried to help, said Del. Phillip A. Hamilton, R-Newport News, chairman of the House Health, Welfare and Institutions Committee.
The General Assembly last session, for example, took some burden off rural health districts in regard to septic tank inspections, Hamilton said. Now, if health inspectors can't get to the job in a reasonable time, inspections from private contractors are accepted.
That has been one of the biggest burdens for the Western Tidewater District, where a vast majority of building permits are registered on land with no central sewerage, according to Buck.
As far as funding, Hamilton said, ``I know that the department feels some stress.''
Legislators in the last General Assembly allocated more than $70 million in new funds to mental health, after the state was sued for the death of a woman in a state institution.
``Funding for health care is an area I think we've lagged a little bit behind on,'' Hamilton said.
``We are really stretched to the max,'' Buck said. ``There is no slack in the system. If somebody is on vacation or sick, we have to cut back on clinics. We would need several more positions to do what we do and do it well.''
Employees in the Western Tidewater District who have left in the last 18 months have not been replaced, Buck said. Others are ``hanging on until retirement,'' she said.
Del. William K. Barlow, D-Smithfield, said that Buck has come to him in the past to plead for more money for local public health departments, and he thinks her concern is legitimate.
``It seems to me - particularly in good economic times like we're having - we should be looking at how we can improve public health,'' he said. ``The key is prevention, whether in private medicine or public health. I've been impressed with Dr. Buck's efforts.''
Buck will be replaced temporarily by Dr. Ken A. St. Andre, Portsmouth Health Department director. Until a replacement can be found in Western Tidewater, St. Andre, 45, will handle both districts.
St. Andre, a native of Long Beach, N.C., has a degree from Tulane School of Medicine in New Orleans and a master's degree in public health from the University of North Carolina in Chapel Hill. Retired Navy, he has worked in Portsmouth since last October and before that worked for Blue Cross/Blue Shield of Virginia.
St. Andre said Friday that he has not found funding to be a problem since he has been in Portsmouth.
``I can't speak for her experience, but I can for mine,'' St. Andre said. ``I might say something different if you talk to me again in six months.''
There are many differences in the two districts.
Portsmouth, for example, doesn't provide home health care. In Western Tidewater, it's one of the department's biggest responsibilities.
Portsmouth is mostly urban, whereas Western Tidewater is sprawled over rural back roads. Buck, one other doctor and a nurse practitioner served the district, which has with some of the highest rates of sexually transmitted diseases and tuberculosis in the state.
For now, said Buck, who lives in Virginia Beach, she plans to ``take a break and then look at what I'll do next.''
``This has been a very hard decision,'' she said. ``There are such good people, very dedicated people, across this whole state. To walk away is very hard.''
CAPTION(S):
Color photo on page B1.
Dr. Buck
Graphic
HEALTH CARE FUNDING
As state and local funding has increased, revenue the Western Tidewater Health District receives from patient care has decreased because many poor patients now see private physicians. The result, said Dr. Sujata Buck, is a funding crunch that partly led to her resignation as director of the Western Tidewater district.
State Local Match Revenue
funding
1995 1,653,811 1,082,866 4,123,889
1996 1,698,916 1,112,612 4,221,655
1997 1,610,418* 1,048,963 4,532,911
1998 1,729,151 1,121,959 4,407,219
1999 1,796,970 1,183,719 3,778,983
*State funding dropped in 1997 because of a state early retirement program that reduced the number of employees.
WESTERN TIDEWATER HEALTH STATISTICS
1995 figures, the most recent available
Per 100,000 population, except where noted.
Western Tiedwater State
average average
Teen Pregnancy 36.8* 37.4*
Infant Mortality 9.7 7.7
Syphilis 120.917.5
Gonorrhea 212.9 157.9
Tuberculosis 9.2 5.3
*Per 1,000 population
SOURCE: Virginia Department of Health
Graphic
PERSONNEL
Dr. Sujata Buck will be replaced temporarily by Dr. Ken A. St. Andre, Portsmouth Health Department director. Until a replacement can be found in Western Tidewater, St. Andre, 45, will handle both districts.
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