Ginny and Danny Sacrenty of Bandon believe the Parent as Teachers program offered by the Coos County Health Department is invaluable to them as new parents of Amie, 2. The program has helped the Sacrentys once a month for the last two years with everything from potty training to picking books to read to Amie. World Photo by Madeline Steege

Increased child abuse incidents.

Fewer children immunized.

More children being sent to foster homes.

Escalating cases of sexually transmitted diseases and unwanted pregnancies.

Those are but a few of the nightmarish possibilities Coos County Health Department officials are portending if the Coos County Board of Commissioners follows through with an unprecedented plan to relinquish control of its public health department to the state of Oregon.

While staring down the barrel of a $7 million budget shortfall due to the expiration of a federal timber payment subsidy, the board is considering the dramatic action, which no other county in Oregon has ever taken.

The action would cut about 30 county public health employees, many of whom are registered nurses who conduct personalized care to needy individuals enrolled in a raft of health and wellness programs.

Also in jeopardy is the level of service provided locally for enforcing drinking water standards, ensuring food safety at local restaurants and preventing the spread of infectious diseases, such as tuberculosis.

“One of the principal differences between our lives now and 1,500 years ago is public health,” said Oregon Public Health Director Dr. Susan Allan. “You can drink clean water, eat food safely. I think if you lost that, you go back to the 1780s, or back to being a developing country.”

If the county does choose to have the state take over, Coos County's Public Health Director Frances Smith said the thousands of people her department serves need to brace for significant changes.

Allan agreed.

“We are not staffed to do these things,” she said. “The question of what we would actually do, and how long it would take to get geared up is an active discussion at the state level. It won't be as good - I can assure you of that.”

Allan said several counties are considering the measure, but none is as far along as Coos County.

The other option the county is considering is having a health department budget with zero dollars from the county's general fund.

Last year, with the aid of the timber money, the county was able to chip in around $600,000 for public health's $3.8 million annual budget. As of Monday, Smith and the department's business operation's manager, Sherrill Lorenzo, had crafted a 2007-08 budget, scaled back to $2.8 million, with only $127,000 county dollars. The general funds are used as local matching dollars for a cavalcade of mainly federal grant programs. Without the match, the programs won't survive.

“The county general fund has kind of been our safety net. But there is not much of a net left in this proposal,” Lorenzo said.

Perhaps, the most serious consequence of giving control back to the state is delays in response time for suspected communicable diseases, such as TB. Allan said the community should worry about that, because time is of the essence to keep disease from spreading. It's the strong ties the county has with local doctors and lab technicians that would far surpass what the state would be able to do at first.

“If it goes through the state there will be more delays and more people will be exposed in the process,” Allan said.

In addition, Smith's nurses spend several hours a month with clients at their homes providing care and dispensing information. But if the county is out of the picture - those clients could be dialing an 800 number instead.

One thing is for certain, there will be fewer people served.

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One of those clients is a 52-year-old Bandon mother, Ginny Sacrenty. She and her husband, Danny, are in the process of adopting a daughter, Amie, now 2 years old, who was born into a home of a San Diego family where methamphetamine use was prevalent. The Sacrentys participate in a county program, Parents as Teachers, in which a nurse visits their home once a month to help teach child-rearing techniques.

“The idea of them cutting back on that is very sad. It's very sad. It's very disturbing. We need to be going forward, not backward,” Ginny Sacrenty said.

While the Sarcentys, who never had children of their own, read up on how to be good parents, Ginny has overheard what she considers ghoulish tales from other parents who think proper discipline techniques including dipping children in ice water and coating mouths with Tabasco sauce.

“It's hard to imagine the misinformation, or the inability of some to parent,” Smith said. “It's partly because they didn't have good role models.”

Daphne English, 28, is a stay-at-home mother who lives in North Bend. She joined the Parents as Teachers program when her 8-year-old, now diagnosed with attention deficit hyperactivity disorder, was a year old. She also has two other children.

The county's parent educator visits her home monthly and gives advice about any problems she has with her children.

“I have a little one right now who is going through separation anxiety and my parent educator gave me some tips to help me with that,” English said. “They help a lot. They keep you sane when you don't have any other way to deal with it.”

She said she's horrified at the thought of the program being cut, saying she feels comfortable calling the county nurse for advice on weekends and late at night.

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How long it would take the state to take over the county's public health program is unknown. A breast and cervical cancer program shut down last April due to a reduction statewide in federal dollars has yet to be reinstated by Oregon Public Health, Smith said.

Allan recommended the county not give up control.

“They're making a leap of faith that the state is going to step in and make it all OK,” she said. “I don't think that is necessarily the case.”

State officials are pondering what services it would be mandated to provide, Allan said, and how the understaffed department would provide the services.

“We do not have any extra money,” Allan said. “We are one of the most poorly funded state health departments in the country.”

Smith said she expects an enormous disruption in service if the county chooses to abandon local public health, noting that her staff is “very stressed” over the possibility of getting laid off.

Still, there is a bright spot, she said, noting Gov. Ted Kulongoski has a proposal in his budget to drastically increase state support for public health.

“We want to keep local public health,” Smith said. “It won't take much to have this collapse, but we are willing to give this a try. We think the community deserves that.”

Background: On Jan. 3, the commissioners announced that due to Congress' failure to reauthorize a federal timber payments subsidy program, the county likely would lay off more than 100 of its 410 employees, from all departments, by March 1.

The subsidy program shuttled about $6 million to the Coos County general fund this fiscal year, and $1 million to the road department, and accounted for about 45 percent of Coos County's general fund. The 6-year-old timber payments law expired in September. In the Pacific Northwest, the subsidy came about to make up for severe restrictions placed on logging after legislation passed in the 1990s to protect endangered species.

Last week, the Coos County Sheriff's Office outlined a plan to lay off 32 jailers, deputies and others to save money for the county.