Windfall grant may soothe states’ pain, provide relief
Don’t expect TB funds to be restored completely
Smarting from cuts enacted late last year to federal cooperative agreement grants and riled at the way the cuts were handled, TB controllers are hoping for relief from a last-minute congressional grant of $8.6 million. In fact, some relief is probably on the way — but probably not as much as programs would like, insiders say.
"A lot about that $8.6 million is still unknown," says Carol Pozsik, RN, MPH, director of South Carolina’s division of TB control and president of the National Tuberculosis Controllers Association (NTCA). "It’s not likely all of it will get passed back [to the programs]." That’s because part of the windfall will likely be siphoned off by an administrative "tap" intended to fund various special Centers for Disease Control and Prevention (CDC) projects.
"That means they don’t know if they’ll wind up with $3 million, $6 million, $7 million, or what," notes Walter Paige, executive director of the NTCA. "Ken [Castro, MD, chief of the CDC’s Division of TB Elimination, or DTBE,] thinks he’ll get most of it. But he doesn’t know yet for sure."
DTBE turns on diplomacy spigot
While CDC administrators and program heads awaited word on when more dollars would start to flow, the DTBE turned on the diplomacy spigot, seeking to soothe hurt feelings the cuts had provoked.
"Some blood pressures were definitely up, mine included," says Pozsik. "Some of us wound up feeling we were unjustly jabbed. And some of us were thrilled to find we weren’t touched at all — which made the rest of us feel even worse." (See report on Los Angeles County’s program, p. 11.)
And even though Castro and others at the CDC were predicting that a decision about the windfall grant should be reached by the end of January, that doesn’t mean programs should start counting their chickens, cautions Paige.
The reason? The decision not to keep using "carryover" funding from previous years, though it remains the chief reason for this year’s scaled-back grants, was implemented under a new set of rules, and even if more money becomes available, those rules won’t change. That means programs that re-apply for pieces of the windfall money will be judged by the same criteria as before, Paige explains.
"So any additional money will be awarded according to the same guidelines," he says. "Programs that were cut because they didn’t perform well [according to the new rules] may not do any better the second time."
Damage control over dinner
Damage control began with two back-to-back meetings called by Castro in Atlanta. The DTBE chief huddled with Paige and Pozsik over dinner, and then again the following day, trying to restore good will and answer questions.
Pozsik says she was speaking not just for South Carolina but for other programs as well when she asked Castro whether the budget cuts were intended to be read as punishment for poor performance. "I felt like we’ve been doing a pretty good job here. I wanted to know whether this meant we were being punished," she says.
No way, came Castro’s reply. "They said no, no, no — that’s not at all what the cuts were about," says Pozsik. "It was simply that they ran out of money. I left the meeting feeling that in a sense, they were bound by forces that to some degree were beyond their control."
At the Atlanta meeting, Castro tried to suggest ways programs could recoup some of their losses — perhaps by getting lobbyist organizations, such as local chapters of the American Lung Association, to champion their cause before legislatures and perhaps shake loose extra money at the state level.
Castro, Pozsik, and Paige also set up a conference call for Feb. 16, during which the CDC’s top TB boss was scheduled to field questions from other TB controllers. (Questions could be submitted in writing ahead of time to Paige, or lobbed on the spot during the call.)
As plans fell into place, morale in the field seemed to be lifting a bit. But ruffled feathers were still to be found, and not just because of cuts, Paige says.
One reason program chiefs were upset was because of the way the DTBE jettisoned an agreement struck two years ago between the NTCA and the CDC about how cuts would be handled. The reason, Pozsik says Castro explained, was because, when it came down to the crunch, the agreement was too narrow to fit messy realities.
Another cause of ill will sprang from the way the announcement of the cuts was timed — so that it coincided with a long-scheduled regional conference. The upshot was that many would-be conference goers, now under deadline pressure to respond to the CDC’s announcement, had to jettison their conference plans.
To add insult to injury, Paige says some TB controllers had gotten word from division spokespersons that they had nothing to fear — only to discover that wasn’t the case at all. Others, when they called asking for an explanation of why their programs were trimmed, were told sniffily that the division "wasn’t obliged to provide any explanations."
"I think we all knew these cuts were coming," sighs Pozsik. But it would have been helpful, she adds, if the CDC had been a little more upfront about how much it was going to hurt.
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