Lawrence, Methuen deal nears collapse
End of public health partnership may cost cities almost $2m
Pooling public health resources was supposed to be a win for both Lawrence and Methuen, allowing them to manage tasks such as disease tracing, home and restaurant inspections, and code enforcement more effectively than either could on its own.
Instead, the two-year partnership may be on the cusp of collapsing, a setback that could cost both cities almost $2 million in public health grant money and leave them out of step with a growing effort in Massachusetts to build regional collaborations that promise to make public health services more effective and equitable.
“I’m going to be extremely disappointed if we end up losing out here,” said Neil Perry, Methuen’s mayor. “These are tough times, inflationary times, and budgets are stretched thin.”
Methuen officials, including Perry and Kelly Townsend, director of health, human services, and inspections, say the breaking point for their shared services agreement came at the end of February, when Lawrence refused to continue working with Ethan Mascoop, a state grant-funded consultant serving as shared services coordinator for Lawrence and Methuen. And Lawrence has continually failed to meet standards that would allow it to effectively partner with Methuen, said Townsend.
“That’s not fair for our community,” she said. “We need people who are well versed, or at least getting to that point.”
The fraying of the shared services agreement between the two cities could cost them both.
They received $582,000 last year in state grant money available only to municipalities in such agreements. The time for that grant’s renewal is now, and without a functional public health partnership, the cities would lose out on about $1.7 million over the next three years, officials from both cities said.
Lawrence officials acknowledge they struggle to maintain effective public health services because of the city’s poverty and a long history of underfunding public health. City health officials outlined the inadequacies of Lawrence’s public health services at a City Council
meeting Tuesday, prompting councilor Wendy Luzon to describe the situation as “a failure of the administration.”
Lawrence is scrambling to mend fences, according to the mayor’s office, but in the meantime, Methuen is prepared to move on. City officials were working with the state Department of Public Health to establish a new partnership, possibly with Haverhill, by Monday, which should allow them to still be eligible for the DPH shared services grant, Perry said. That would leave Lawrence without a partner and ineligible for the grant money.
The growing rift between the two cities highlights the challenges facing Massachusetts health officials as they attempt to build a more robust, equitable public health system for the state. Unlike in other states with strong county governments, public health in Massachusetts is managed by the state’s 351 municipal health departments, many of which are underfunded and understaffed. Poorer communities are far more likely to have worse public health services.
“We have an almost uniquely fractured, inefficient, and inequitable local public health system,” said Carlene Pavlos, executive director of the Massachusetts Public Health Association.
Shared services is one solution, and two years ago the state committed $200 million to training, data management, and shared service agreements. As a result, about 320 municipalities participate in shared service agreements, according to DPH, and the Legislature is considering a bill designed to encourage local public health departments to meet state performance standards.
In Lawrence and Methuen, vastly different economic conditions and financial commitments to public health have become stumbling blocks to collaboration. Methuen budgets $21.62 per resident on public health, officials said, compared to less than $2 a person in Lawrence.
Lawrence, a city of nearly 90,000, is overwhelmingly Latino, and just under 20 percent of the population lives in poverty, according to the US Census. Methuen is the smaller city, with about 53,000 residents, the majority of whom are white and wealthier than their neighbors in Lawrence. Its average household income is nearly double Lawrence’s.
“We do not have the resources, this department does not have the resources, to hire the people that we need to help us improve the public health of this city,” said Joel Gorn, chair of Lawrence’s board of health, at the city council meeting Tuesday.
Lawrence, a former mill town and one of the state’s poorest cities, is challenged by decrepit housing that dates back to the late 19th century, serious issues with tuberculosis, homelessness, and addiction, and an influx of migrants with health problems and no insurance, Gorn said.
“It’s the citizens of Lawrence that are faced with unsafe food establishments, lots of apartments that aren’t to code, that are a fire hazard, and public health challenges that are huge,” Gorn added.
Mascoop presented a report on the problems he’s observed in Lawrence’s public health services at the city council meeting. In the report, he highlighted that the city had 400 licensed restaurants, but no clear documentation of which were due for health inspections.
The report documented one incident in which the health department learned trash containers were being cleaned in a school’s kitchen sink. Inspectors checked out the dumpsters, but never stepped foot in the kitchen, according to his report.
Housing inspections need more transparency, too, Mascoop wrote. When Lawrence cites landlords for code violations, tenants and even the board of health aren’t notified if they appeal, Mascoop wrote.
Mascoop’s report also described what he called mismanagement of state funding given to the city to improve public health in the wake of the COVID19 pandemic. Lawrence had received a state grant to hire an epidemiologist for contact tracing, but instead used the money for inspectors.
Santiago Matias, chief of staff to Lawrence’s mayor, said in an interview Friday that the city still intends to hire an epidemiologist.
Peter Blanchette, Lawrence’s interim director of Inspectional Services, which also oversees public health, said enforcement efforts must take into account that many food service businesses are run by immigrants who may not be familiar with American health and safety standards.
“There’s a lot of things that need to be done, but they’re not things you can just do overnight,” he said.
A state dashboard showed the two cities’ collaboration ranked low on the DPH evaluation of the state’s 51 shared service arrangements. The cities met 62 percent of the state’s performance standards for services such as environmental protection, sanitation, and disease control and prevention.
Mascoop was among the officials in both cities trying to bridge the differences between Lawrence and Methuen, but became a lightning rod himself.
Matias said Lawrence put Mascoop on leave pending an investigation into what he described as communications misunderstandings involving the city’s overwhelmingly Latino population, though he did not provide details of what he believed went wrong.
Townsend said she considered the accusation baseless, saying Mascoop, who was formerly Framingham’s public health director, is a well-respected public health expert.
In an interview Friday, Mascoop said he didn’t know what communications problems Matias was referring to.
“I’m clueless as to what they’re talking about,” he said.
Methuen interpreted Mascoop’s forced leave as the end of the shared services agreement, according to Perry, the city’s mayor.
“I clearly don’t understand them walking away from the grant,” said Perry. “It’s a missed opportunity.”
Now, Lawrence is ready to make big changes fast, Matias said. The city would work with Mascoop again, will decouple the health department from Inspectional Services, and is trying to hire a public health director.
Townsend, though, said she has met repeatedly with Lawrence officials and, along with Gorn and Mascoop, sounded the alarm for close to a year that the shared services agreement was at risk.
“I care about the people of Lawrence, but I just don’t know at this point what we can work out,” she said.