Lafayette’s public health unit struggling to hire

Three women are seen through a glass window.
Staff members of the Lafayette Public Health Unit talk in the intake section of the clinic on Tuesday, October 24, 2023 in Lafayette, La. Photo by Alena Maschke

When Lafayette Parish Council members changed course this month and abandoned a slew of higher property tax rates for the coming year, they did so convinced that parish government’s services were sufficiently funded.

At least one service was counting on increased revenues: the Lafayette Parish Health Unit, which has been understaffed by two nurses and unable to attract applicants for two months.

“We are not competitive,” Regional Medical Director Dr. Tina Stefanski told council members during a discussion about the millage increase at a Parish Council meeting. Located on the city’s north side, the health unit offers an array of services, with a focus on patients who struggle to access medical services.

But after a veto by Lafayette Parish Mayor-President Josh Guillory of a proposed increase in funding for the health unit, and the council’s decision to sustain it, the unit’s plan to increase pay to attract staff is in question.

In a letter explaining his decision to veto the increase, Guillory cited principle as the reason, arguing that changes to millages should not be up to councilmembers but voters to decide.

The measure vetoed by Guillory would have adjusted property taxes to the maximum previously approved by voters based on the recommendation of Parish Assessor Conrad Comeaux.

Comeaux said if the millages are not set at their maximums for a reassessment year, which is 2024, they will permanently be lowered, reducing the amount of money produced to operate the city and parish.

Two council members who initially supported the increase in September, Bryan Tabor and John Guilbeau, changed their mind and voted to uphold the veto. Neither council member could be reached for comment.

Despite the veto shakeup, Stefanski is hopeful that the necessary funds will be found. Council members assured her that adequate funding would be provided to increase the salaries offered for nurses to ensure that vacancies will be filled, the medical director said.

According to Stefanski, who oversees public health in Acadiana for the Louisiana Department of Health, the Lafayette Parish unit is consistently among the busiest in the state.

At the clinic on the corner of the Evangeline Thruway and Willow Street, 47 staff members and a contracted pulmonologist see around 1,500 patients every month.

One of the clinic’s main services is providing reproductive health care for women, regardless of their ability to pay.

Charges for services are sliding-scale and income-based. Some patients, so low on funds they can’t afford even the discounted cost of services, scrape together a few dollars just to make some form of contribution.

“We don’t turn anyone away for inability to pay,” Stefanski said. For many women who visit the clinic, it’s the only place they can get necessary services like pap smears and mammograms.

The public health unit also helps curb the spread of communicable disease by providing vaccines, testing and treatment. Sexually transmitted diseases are especially common, Regional Nursing Director Kelly Lanagan said.

“Our STI rates are, unfortunately, horrible,” Lanagan noted. “We cannot seem to get ahead of the curve with that.” Louisiana has the second-highest rate of sexually transmitted infections per capita in the nation, surpassed only by Mississippi.

Staff at the clinic perform tests, prescribe and dispense medication, and even follow up with patients and their partners to ensure they follow through with treatment and prevent further spread or reinfection.

“It’s a lot of legwork,” Lanagan said.

Some funding for the health unit’s work comes from state and federal sources, but the provision of services like women’s reproductive health and STI testing and treatment receive little federal funding. After the state reduced its funding of public health units under then-Gov. Bobby Jindal, the health unit turned to the parish for help. Since then, Lafayette Parish has spent roughly $1 million each year to fund its operations.

Stefanski said she’s very thankful for the parish’s contributions and points out that the unit tries to limit the strain it puts on the parish’s finances, for example by using state and federal resources to perform drive-through Covid tests during the height of the pandemic.

“We are very protective of the parish funds,” she said.

But the unit has also made efforts to expand its services in recent years. It’s hired two community health workers, who help patients access housing, food and other necessities, in an effort to improve health outcomes through a holistic approach to wellbeing. It’s also increased the frequency of visits by a child and adolescent psychiatrist, after seeing the need for trauma care in the community.

The pandemic worsened an already-existing nursing shortage, making the market more competitive, a challenge for the unit as it looks to fill vacancies.

“We’ve proven that we can’t hire,” she concluded of the unfilled nursing positions. “So we need to start the process to request to increase that line item in the budget.”