The recession is adding to the workload at the Moore County Health Department.

At the request of the health director, the Board of Commissioners on Monday agreed to a request to hire a maternity care coordinator and to an amendment to the obstetrician's contract.

"Due to a recent increase in eligibility for service, there is an urgent need for maternity care coordination and newborn postpartum services for our citizens," Health Director Robert Wittmann said in a presentation to the commissioners.

Wittmann said his department currently has 117 maternity patients, and new patients are continually being enrolled in the maternity program. The department is predicting 162 deliveries during the 2011 fiscal year.

In a brief interview prior to the meeting, Wittmann said the increased number of maternity patients largely reflects increases in Medicaid enrollments. Medicaid, which is administered through the Department of Social Services, is the medical insurance program for the indigent uninsured. It is financed by the federal and state governments.

Wittmann asked the commissioners to exempt the position of social worker II from the hiring freeze imposed several months ago in response to an expected revenue shortfall. The social worker's duties would cover maternity care coordination and newborn postpartum services for patients.

The position will carry a caseload of about 60 maternity patients and is expected to generate at least $67,996 in fees annually, more than enough to cover the social worker's salary, benefits and attendant expenses. The salary range is $34,830 to $39,357.

The fees would be paid through Medicaid and other insurance sources.

In addition to the $67,996 for maternity care fees, the department estimates that a minimum of $14,374 would be collected in fees for newborn postpartum services, bringing the total to $82,370 in fees to support the position.

Although the social work position is new, it was still subject to the hiring freeze review process. It is likely that the position will be reclassified to that of public health nurse II.

Later in the meeting, Wittmann cited the same reason - an increased maternity workload - in requesting an amendment to the contract with Dr. Michael J. Maness, the obstetrician providing obstetric and family planning services to the department.

The board approved the request to amend the contract by adding $573.33 for services provided to the department in June. Funds to cover the addition are to come from surplus revenue generated by the department in the current fiscal year.

This action was followed by approval of the doctor's contract for an additional period from Sept. 1 through June 30, 2011. The contract, not to exceed $76,083.62, is renewable for one-year periods not to exceed five years.

Wittmann said the department needs an obstetrician to provide medical services for the family planning, maternal health and dysplasia clinics and to provide primary physician supervision of the obstetric-gynecological nurse practitioner/physician extender, as required by the N.C. Medical Board and the N.C. Board of Nursing.

Bids for the contract were requested from three medical practices in Moore County, and this was the only response received, the health director reported.

The Health Department position was one of four hiring freeze exemptions approved during the Monday meeting.

Two positions exempted are in the Public Works Department and include a water pollution control plant operator and a utilities maintenance technician. Both positions became vacant when other employees were promoted to supervisory positions.

The commissioners were advised that if these positions are not filled, the county will incur additional expenses in the form of overtime pay and delay in some projects.

The fourth position is a social work investigator with the Department of Social Services. The investigator is responsible for checking on child abuse reports, assessing the situation and recommending treatment.

Not filling this position would result in an unacceptably high caseload for existing employees, a situation that could place the department in noncompliance with state guidelines. While state guidelines call for a workload of 10 cases per investigator, the Moore County department currently averages 16 cases per investigator.

At this meeting, the commissioners voted to drop their policy of voting individually on each request for reinstatement of positions vacated by resignation or retirement and to return that responsibility to the county manager. However, the manager was instructed to reduce the county workforce by 2 percent.

Contact Florence Gilkeson at florence@thepilot.com.