South Dakota Department of Health seeks staff, federal authority amid rise in maternal and infant deaths and lab backlogs

Melissa Maegstead, South Dakota secretary of health, told the Joint Appropriations Committee on Feb. 6 that the department is asking for new positions and federal spending authority to respond to several public‑health problems including rising maternal and infant mortality and slow follow‑up on newborn screening results.

Maegstead said the department’s quality improvement work reduced some federal‑grant overspending and improved service delivery — for example, adding about 1,700 hours in school health and allowing the WIC program to serve roughly 1,000 additional mothers and more than 6,000 babies and children per month — but that other problems require new staff and federal authority.

Maegstead told the committee the department is seeking a 1.0 full‑time equivalent (FTE) women’s health coordinator to focus on maternal mortality and a separate 1.0 FTE to manage newborn‑screen follow‑up. “The benchmark for follow‑up on newborn screening is 85 percent. South Dakota’s follow‑up rate is 21 percent,” Maegstead said, attributing the low rate to part‑time staffing for a time‑sensitive program.

The department also described turnaround improvements in its public health lab’s forensic chemistry section: blood‑alcohol test turnaround times, once more than 30 days and sometimes 40, are now averaging 14 days after process changes and new workflows. Maegstead asked the panel for one senior chemist and two case managers to keep improving throughput, saying chemists were spending two to two‑and‑a‑half days on case management activities instead of testing.

Licensure and certification staff reported a surge in complaints and surveys for long‑term care and assisted‑living facilities. Maegstead said complaint surveys rose 187 percent in the last year and 370 percent since 2018; she told legislators many complaints are serious — for example, wrong‑site biopsies, assaults on incapacitated patients and failures of patient lifts — and that the majority of investigated complaints are substantiated. She said the licensure unit was seeking additional operating funds rather than new FTEs, since qualified surveyors are difficult to recruit for road‑heavy work.

On maternal and infant outcomes, Maegstead presented data showing a statewide rise in maternal mortality and infant mortality with a pronounced disparity for Native American mothers and infants. She said the maternal deaths the department is reviewing are mostly occurring within a year after delivery and are commonly tied to substance use disorder, motor‑vehicle crashes and suicide. “When we address behavioral‑health and suicide numbers, we are actually making a difference in our maternal mortality rates,” Maegstead said.

The department described BrightStart, a home‑visiting program supported in part by Medicaid, and said analysis of BrightStart’s return on investment is under way. Maegstead also said a proposed $300,000 general‑fund cut to BrightStart would be absorbed through other federal funding and internal efficiencies so service to counties would be maintained.

Maegstead highlighted the public health lab construction and renovation underway at the 4th and Governors site and said the project so far has cost about $10 million. She reiterated that the department is 70 percent federally funded overall, roughly 10 percent general‑fund supported and the rest from fees, and that budget requests include inflationary and programmatic changes tied to federal match requirements.

Committee members pressed on causes of the maternal and infant disparities and on collaboration with Indian Health Service; Maegstad said the department is convening a multi‑stakeholder maternal strategic plan and is traveling statewide to work with tribes and health systems. She described efforts with IHS and tribal partners, including federal deployments to tribal areas to examine ground‑level conditions.

The department also asked for federal authority to make newborn‑screen and women’s‑health positions full time, and said it had completed lean process work that reduced waste and improved lab and program throughput but that some needs now require added personnel. Maegstead emphasized the department will seek to use federal grant authority where possible.

Ending: The committee deferred decision to budget deliberations; Maegstead provided follow‑up commitments on detailed fee revenues and newborn‑screen follow‑up outcomes and indicated the department would supply additional analysis requested by legislators.