Citing backlog, state health agency pleads for funds

Budget cited in drop in safety, medical scrutiny

“I thought they sincerely and genuinely understood what was going on,” Dr. Lauren Smith said about lobbying legislators for more funding.
Leslie E. Kossoff for the Boston Globe
“I thought they sincerely and genuinely understood what was going on,” Dr. Lauren Smith said about lobbying legislators for more funding.

The Massachusetts Department of Public Health, reeling from years of budget cuts, has fallen significantly behind in investigating consumer complaints about medical facilities and lacks sufficient staff to conduct safety inspections of every­thing from summer camps to food manufacturers to housing for migrant farm workers.

There’s a wait of more than five months for investigating problems reported in Massachusetts hospitals, nursing homes, dialysis centers, and clinics. Meanwhile, medical and biological waste from roughly 600 biotechnology firms is not being routinely monitored to ensure proper disposal.

Inspectors will be needed to ensure that children have Coast Guard-approved life jackets in camps this summer, as ­required by state law. The depart­ment has fewer than half the minimum number of ­inspectors required to meet federal standards for ensuring that food plants follow safe practices.


These gaps, detailed in a budget memo obtained by the Globe, surfaced as agency leaders pleaded with lawmakers for more money to hire inspectors. The agency, which is still dealing with the aftermath of two scandals last year, says it needs more staff to prevent another crisis.

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The House did not include the money in its recently ­released budget for the next fiscal year, and the department is lobbying the Senate to include roughly $1.6 million in the spending plan it is slated to ­unveil Wednesday.

The money would be used to hire approximately 24 new staff members to help monitor the broad array of industries the department is charged with regulating.

Health officials say in the budget memo that the plan would be cost-neutral because it would recoup the money by assessing new or increased fees on the industries it regulates.

“The department has done a herculean task at doing the best it absolutely can with the resources that have understandably been short over the past half decade,” Dr. Lauren Smith said in an interview last week, her last as interim public health commissioner.


Over the past four years, the bureau responsible for health care safety has seen its budget reduced by about $4.7 million, a 26 percent cut when adjusted for inflation, according to an analysis by the Massachusetts Budget and Policy Center.

Smith said the department needs to make the case for more funding “before there is any adverse outcome for any particular patient.”

Last year, more than 740 people were sickened, and 55 died, in a national fungal meningitis outbreak that was linked to a Framingham specialty pharmacy. The pharmacy had not been regularly inspected by the state pharmacy board, which is overseen by the health department.

Since then, the board has conducted routine, unannounced inspections of 40 similar pharmacies, uncovering numerous problems, and Governor Deval Patrick’s proposed budget includes about $1 million in new funding for additional staff to continue the surprise inspections.

The House included the pharmacy money in its budget, but not money for the additional inspectors the administration sought.


Weeks before the fungal meningitis outbreak, officials discovered that a state chemist working in the health department’s crime lab had allegedly mishandled or falsified drug ­evidence, potentially tainting as many as 190,000 cases processed by the lab during her nine-year tenure.

‘I thought they sincerely and genuinely understood what was going on.’

Internal e-mails from chemists and supervisors at the troubled laboratory that were ­obtained by the Globe last fall ­described a staff drowning in work and pleas for additional staffing. The lab has since closed.

Smith, who was appointed interim commissioner at the height of the meningitis outbreak last October, said she asked her staff when she took office for a “very frank and honest assessment” of the backlogs in inspections and other shortfalls they were shouldering across the agency’s 10 bureaus.

“I wanted to know, first up, if there were areas where we were wondering about, as ­opposed to having it pop up as a problem and have to backpedal,” Smith said.

Among the gaps brought to her attention were that minimum waits for investigations of indoor air quality complaints run six to eight weeks and that only about five of the state’s 76 farm labor camps for migrant workers are typically inspected annually, according to the budget memo.

The department receives about 14,000 consumer complaints a year about health care facilities, ranging from patient falls and allegations of sexual abuse to surgeries performed on the wrong part of a patient’s body.

The memo noted that the five-month backlog in responding to these complaints means that inspectors performing routine reviews often are unaware of the pending issues.

Smith said she spent recent weeks lobbying legislators for more money. “I personally met with a half-dozen House leaders to make this case,” Smith said. “I thought they sincerely and genuinely understood what was going on and why we needed to do this.”

While the House budget left out the $1.6 million for new inspectors, Representative Brian S. Dempsey, a Haverhill Democrat who chairs the Committee on House Ways and Means, noted in a statement that it did include the $1.3 million the ­department requested in additional staffing for its troubled pharmacy board.

David Falcone, spokesman for Senate President Therese Murray, declined to answer questions about whether the Senate might include the requested funds in its upcoming budget, saying instead in a statement that leaders will “have these discussions as the budget process continues.”

Differences between the Senate and House budgets will be ironed out in negotiations among the chambers’ leaders.

The health department has not detailed the new fees it would charge industries for ­licenses or inspections to pay for more inspectors, but said in its memo to legislators that the fees are “fair, comparable to other states, and can be implemented under existing statutory and regulatory authority.”

The memo added that “in many cases, these fees have ­either not been assessed or not increased in many years.”

The Massachusetts Hospital Association said in a statement that its members are already shouldering more fees than they can handle.

“The state should not be shifting more and more of its costs onto hospitals, while at the same time requiring hospitals to lower their expense trend,” said Tim Gens, the association’s executive vice president.

The state’s nursing home ­industry said it was similarly displeased by the idea.

“It’s another unfunded mandate, on top of . . . six consecutive years of rate freezes,” said Scott Plumb, senior vice president of Massachusetts Senior Care, a trade association. “This may seem like a little straw,” he said, “but the camel’s back is pretty frayed.”

Kay Lazar can be reached at Follow her on Twitter @GlobeKayLazar.