By Matt Leingang
Enquirer staff writer

AVONDALE - Twice a day, Clarence Norman gets a visit from a home health nurse who cleans the bedsores on his paralyzed legs.

The nurse is provided by the Cincinnati Health Department through a program that helps 4,400 residents manage a long-term illness or recover from a hospital stay.

Health Department Registered Nurse Nancy Davis attends to the wounds of Clarence Norman, who suffers from paralysis. (Enquirer photo/MICHAEL E. KEATING)

But under the health department's draft budget for 2005-06, the home nursing program would be eliminated.

Half of these patients do not have health insurance and cannot pay an out-of-pocket charge of about $100 a visit, so their care is largely underwritten with taxpayer money.

"I feel lucky that I have someone who visits me," said Norman, a 62-year-old retired maintenance worker who lives in Maple Tower, a subsidized apartment complex in Avondale. Scoliosis left him a paraplegic nine years ago.

The department is under orders from City Hall to reduce spending by at least 7.6 percent over two years.

The cuts would save the city $1.4 million, but wipe out 33 nursing jobs and shut down care for thousands of patients.

The health department's school nursing program also would face cuts. Under one scenario, 10 nurses would be pulled from 16 of the city's 57 elementary schools in 2006, saving $570,400 but resulting in the loss of 11,200 vision and hearing screenings and 1,700 medical referrals for children.

"School nurses are absolutely critical. Students who are sick can't learn," said Shelley Stein, principal of Quebec Heights Elementary School in Price Hill.

This is the first time the health department - the city's third-largest department with a budget of $41.6 million - would cut medical services because of budgetary strains.

The cuts could have ripple effects across a local health-care system already struggling to keep pace with increasing uninsured patients.

Home nursing, for example, is often seen as a way of keeping people from becoming acutely ill and returning to hospitals, where emergency care is costly and can't be denied to those who can't pay.

The fate of home and school nursing will be determined by December, when City Council is expected to approve a two-year budget.

Clinics untouchable

Cincinnati's direct involvement in clinical care - it also runs six health clinics in low-income neighborhoods - sets it apart from other health departments in Ohio.

The city health clinics are considered untouchable in upcoming budget debates. City Council passed a resolution calling for no cuts.

Also safe is traditional public-health nursing, where nurses investigate disease outbreaks, give flu shots, visit new mothers and care for children under the Bureau of Children with Medical Handicaps.

"That leaves home nursing," Health Commissioner Malcolm Adcock said. "It's not something that we want to do, but we feel we have no other option."

Private nursing agencies could step in. But for patients who lack insurance, it would be difficult, if not impossible, to find an agency willing to accept a high volume of uninsured patients, Anderson said.

"I've always said that this is one of the best uses of tax dollars because people really do benefit from it," said Nancy Davis of Oakley, a home-health nurse for the health department for 13 years.

Private agencies say they have little room to absorb uninsured spillover from the city.

The Visiting Nurse Association is a non-profit agency that provides skilled nursing service - for a fee - to about 4,000 people throughout Greater Cincinnati. It made home visits to 500 uninsured patients last year, paid for with a $468,000 grant from the United Way and private donations.

"We'll try (to pick up more uninsured patients)," said Angi Johnson, the agency's executive vice president for clinical services. "But I don't know how much. We'd have to make a big plea to our donors."

Cutting and cutting

Over the past 10 years, the Cincinnati Health Department has found ways to reduce expenses without sacrificing medical services, including:

Eliminating 17 administrative positions, saving $1.3 million.

Having University Hospital take over obstetrics and gynecology services at the city's health clinics, saving $300,000 a year.

Partnerships with pharmaceutical companies that annually provide $1 million worth of free medications for uninsured patients.

But Health Commissioner Malcolm Adcock said the department has exhausted many of those strategies. For the first time in history, the city has proposed cutting medical services, beginning in 2005 with home nursing and school nursing programs.

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E-mail mleingang@enquirer.com