Chemist Cheryl Soucy runs water tests at the Maine Center for Disease Control and Prevention in 2014. The agency had about 450 employees in 2011, but by 2019 had lost 111 workers, about 25 percent of its workforce. JOE PHELAN/Portland Press Herald

When Jeanne Lambrew stepped into Maine’s top public health agency as the new health and human services commissioner in January, she noticed what wasn’t there – enough workers.

The Maine Center for Disease Control and Prevention had lost 25 percent of its employees since 2011, when Republican Gov. Paul LePage assumed office. Lambrew, a former Obama administration health official, was nominated by Gov. Janet Mills, a Democrat who succeeded LePage, and confirmed as Department of Health and Human Services commissioner by the state Senate in February.

“(The Maine CDC) was significantly smaller than it was,” Lambrew said. “It was not performing as well as it could be, although the staff that is there are incredibly dedicated and work really hard.”

Lambrew said the LePage administration mostly reduced the CDC staff by not filling vacant positions. The agency had about 450 employees in 2011, but by 2019 had lost 111 workers, about 25 percent of its workforce.

“What we discovered is that there’s a budget for these jobs, but the old process meant first the commissioner and then the governor had to approve posting for these jobs, and they weren’t being posted,” Lambrew said in an interview with the Press Herald. “I streamlined the process. I don’t need to approve a public health nursing job posting. Now it just gets posted the second there’s a vacancy so we don’t have a lag in nurses leaving with nurses being hired.”

The Maine CDC is now going on a hiring spree, looking to immediately boost the CDC by 35 positions. The goal includes hiring public health nurses and filling other jobs, including epidemiologists, laboratory positions, and jobs to track chronic diseases, and for issues such as lead exposure and tobacco prevention.

DHHS also is conducting a nationwide search for a permanent CDC director, Lambrew said. The CDC – with a budget of about $120 million – is being run by acting director Nancy Beardsley.

Lambrew said that after the first 35 positions, the department will conduct a review to determine how many positions they should fill and whether there need to be technological upgrades to help employees.

“It is 2019, not 2011. What does a 2020 CDC look like? It may not look the same as it did in 2011. We don’t know if 111 (employees) is the right number, the magic number,” Lambrew said.

Comparisons among states for public health funding are difficult, in part because of differences in structure and responsibilities. For example, Maine has no county health departments while many states do. Also, public health spending can be spread out among different agencies. However, Maine ranked 21st for public health funding in the 2018 Trust for America’s Health report, conducted by the U.S. Department of Health and Human Services.

Maine lawmakers and LePage had a protracted battle over public health nurses, and the Legislature passed a law over a LePage veto that went into effect last year mandating that the LePage administration hire the nurses. LePage officials at first indicated that public health nurses would be hired by early 2018, but hiring efforts stalled, and the public health nursing workforce remained in the low 20s even though the law mandated the workforce be no fewer than 48 nurses.

Public health nurses in Maine have typically earned between $40,000 and $50,000 a year, and do front-line work in communities, such as responding to infectious disease outbreaks, helping at-risk mothers and their newborn babies, and performing a number of illness prevention duties.

Lois Skillings, president and CEO of Mid Coast Hospital in Brunswick, said she’s encouraged by the news that the Mills administration is working to boost the Maine CDC.“What we have seen over the past several years is our public health infrastructure diminished,” Skillings said. “Public health is foundational for all health care. If we can prevent a disease from happening in the first place, that’s much better than treating the disease.”

Skillings said the public health nurses were difficult to find in the past few years, and the nurses would work with low-income mothers at the hospital and shortly after delivery at home.

“Public health nurses are such a trusted group of people, helping new moms and infants to get them off to a good start right out of the gate,” Skillings said.

She also said Maine had become vulnerable to not being able to respond effectively to an infectious disease outbreak during the past few years.