Umatilla County Commissioners officially passed their 2009-2010 budget during a public meeting Wednesday but it wasn't easy. Four Milton-Freewater-area residents once again voiced their objections to closing the Milton-Freewater Public Health Clinic, something they saw as detrimental to the community.

The commissioners and the citizens spent an hour and a half discussing the clinic's closure and public health's role in Milton-Freewater and the rest of the county.

"It hurts me," said Nancy Wolfe, of Milton-Freewater. "I know that we're in trouble financially - everybody in the United States is. However, we are providing a service that, you can't put a price on it. I'm just so distressed about this."

Commissioners Larry Givens and Dennis Doherty explained the county's strategy in building the budget his year: looking at revenues and basing spending off what the county is fiscally able to provide, rather than what the need might be.

The commissioners also countered comments they made earlier this year, when they said a service like public health should be evaluated on needs basis, not a fiscal one. They said those comments, made back in February, were before the budget crisis the county is now facing. Now commissioners know they can't keep the current level of services.

"A certain part of public health services are fee generating, but we don't generate enough fees to support the program,"?Doherty said. "That became very obvious when we began putting things together."

He called those discussions back in February "philosophical."

"In a better world, certainly in a perfect world, you could run programs that aren't self sustaining at the level that we want them to," he said. "As it is we have to adjust in accordance to the revenue streams that support what we can generate to self-sustain. In this case it just didn't work."

The commissioners said services are still being offered in Milton-Freewater, even if there isn't a clinic.

"They're still being offered," Givens said. "Those aren't going away. What is going away is the open door-"

"The accessability," Wolfe countered.

"The accessability," Givens agreed.

She even pointed out taking the free CTUIR?bus from Milton-Freewater to Pendleton would take virtually the whole day.

Another option discussed by commissioners at other meetings was letting people go to Walla Walla for services, since that seems to be where many go anyway.

"Merely saying these folks can go to Walla Walla and having Walla Walla serve them is as a default list is not good government and it's not good public health,"?said Bruce Campbell a Milton-Freewater resident who has spoken out against the closure of the clinic for more than a year.

Campbell said he and others are not just concerned about the cuts in Milton-Freewater, but the ones in Pendleton and Hermiston, too. Starting July 1, the clinic in Pendleton will be open from 8 a.m. to 5 p.m. on Mondays and Tuesdays and the clinic in Hermiston will be open from 8 a.m. to 5 p.m. on Thursdays and Fridays. Wednesdays will alternate between the two. This compared to the Hermiston clinic's old hours, which ran four days a week for 10 hours a day and the Pendleton clinic's which ran five days a week for 10 hours a day.

"We can expect a decrease in immunization rates, an increase in teen pregnancy and a decrease in HIV surveillance,"?Campbell said. "I just want you to know we're equally concerned about the cuts being made to the whole county."

Campbell said he also worried, with Pendleton only open two days a week, would the clinic be able to handle patients coming in from other areas like Milton-Freewater.

Immunizations were another touchy topic. The Milton-Freewater residents pointed to the Milton Stateline Seventh Day Adventist School that closed for a week this year due to an outbreak in flu cases as an example of things gone wrong.

"It was a virus that could have been prevented with proper immunizations," Campbell said. "If we have the same kind of an immunizations record for other things, even just polio, than we're missing out and we're really losing a lot this country has gained in public health if we can't assure every individual is going to be protected from the Umatilla County Public Health department."

Givens pointed out immunization clinics were held and were available within the community at during the flu season of this outbreak, and, even then, half the students at that school didn't take advantage of it.

Campbell said when the immunizations were offered for free, far more people take advantage of them.

"Even had we offered them, would it have changed it? I don't think so,"?Givens said.

"You don't think it would have changed it if the school nurse had gone out to that school in the fall and given them immunizations?" Campbell asked.

"I don't think it would have,"?Givens said, "because they were available and they still chose not to take them. They were available in the community."

Public health is based in outreach, Campbell said. It needs to go out and find people because they're not always going to walk in the door asking for help. Campbell said he didn't think many people knew about flu shot clinics last fall.

When Campbell asked where immunizations would take place in the Milton-Freewater area, Connie Caplinger, director of health and human services for the county, didn't have an answer.

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