Utah could become the only state in the country without a state health department.
Republican lawmakers are considering handing the duties of the health department -- from tracking and responding to communicable diseases and trying to reduce obesity and cancer rates to inspecting child care facilities -- to other agencies.
The proposed dismantling would save $1.7 million in administrative costs by cutting director and division director budgets. It came as a shock to David Sundwall, the department's director, who learned of the proposal Wednesday morning.
"It would be a breathtakingly bad idea," he said, noting Utah's public health system is one of the reasons the state is often ranked as one of the nation's healthiest.
But Rep. John Dougall, R-Highland, said, "We need to fundamentally question everything," adding that the health department used to be part of the human services department.
Lawmakers are trying to cut $50 million, or 7.5 percent, from this year's Human Services and Health budgets, and $102 million, or 15 percent, from next year's numbers. Republican lawmakers said their philosophy was to pare back administrative costs before they eliminate programs that help people. Such proposals include eliminating out-of-state travel and reducing the mileage reimbursement rate from 50 cents to 36 cents.
"We want to avoid an amputation as much as possible," said Sen. Daniel Liljenquist, R-Bountiful.
Still, lawmakers are also looking at cutting whole programs, and the health department is taking a disproportionate share, Sundwall said, noting 68 percent of the cuts to the two departments come from health.
One of the most troubling proposed cuts, according to health department officials, is reducing inspections of licensed child care facilities. Some 700 facilities, considered "highly compliant" because they have had less than three citations a year, would be inspected once a year instead of an average of three.
Marc Babitz, who oversees the division that includes licensing, said he'd have to cut the usual unannounced visit.
The change might allow serious violations to slip through, he said, noting an infant died this fall at a center that would have been considered highly compliant. But after the baby died, from strangling in a car seat while sleeping unsupervised, the health department found an unlicensed woman was left in charge of too many infants without enough cribs.
"We wouldn't catch her [under the new budget]. It just frightens me," Babitz said.
Other cuts would also impact children's health. A pregnancy risk line, which counsels 20,000 women a year about exposures that can cause birth defects, would be shut down -- and birth defects would no longer be tracked. An autism registry, which tracks prevalence and risk factors for the developmental disorder, would end.
The cuts also mean a slower response time to disease outbreaks and reductions in tobacco cessation, obesity and health promotion programs.
Sundwall said he knows attempts to preserve public health will be difficult; there is no constituency fighting for disease surveillance or the medical examiner's office, like there are for aging and disability services.
"Traditional public health is not just about the vulnerable," he said. "It's about you and me."
Medical care for foster children ages 18 to 21.
CPR training for 10th-graders.
In-state rabies testing of animals. (This cut could lead to more bitten people needing $2,000 shots.)
Early intervention services for 200 moderately delayed children.
Toxicology tests to determine the amount of drugs present in a criminal suspect or in a case of suspicious death. This cut could affect criminal cases and would prevent the medical examiner from determining a cause of death for about 400 deaths a year, hampering collection on life-insurance policies.
Lawmakers on the Executive Appropriations Committee will discuss and finalize the proposed budget cuts Friday. But the budget can still be amended during the 45-day legislative session, which starts Monday.