In a move that could affect the lives of transgender people, people living with HIV and AIDS, drug addicts, mental health clients, and homeless people, the San Francisco Health Commission voted 4-3 Tuesday, March 4 to approve about $19 million in mid-year cuts and decreases to the fiscal year 2008-09 budget from the city public health department.
The cuts are a result of Mayor Gavin Newsom's request that the department cut its use of the general fund by 8 percent - or about $28.1 million. At this point, final approval of the mid-year cuts is up to Newsom.
The commission's meeting was meant to give the public a chance to comment on the cuts and for the commission to vote on a recommendation to Newsom and to the Board of Supervisors.
Charles Siron, who is living with HIV, was one of dozens of people who crowded into the auditorium at the department's Grove Street offices to speak with commissioners. Siron talked about how San Francisco is supposed to be a city of compassion and sanctuary and expressed dismay at the cuts.
Noting likely cuts to HIV and AIDS funding, Siron told the Bay Area Reporter that city officials have walked away from people like him.
"We need an advocate like Pelosi," Siron said. "So far, we're not seeing that."
Siron was referring to House Speaker Nancy Pelosi (D-San Francisco), who's helped restore HIV and AIDS funding in the past when the federal government makes cuts.
Reflecting the sentiments of many others at the meeting, Mark Bernstein, of Sunset Mental Health Services, said, "I am personally hurt and demoralized" by the cuts, which he said amounted to "throwing patients and staff under the bus for political reasons."
One of the biggest cuts was the elimination of about $2.2 million for the chronic care public health nursing program. Nurses in the program make home visits to patients, several of whom have AIDS.
Commissioners made the recommendation reluctantly. The approved resolution stated the commission "is deeply concerned about the extent of reductions proposed and the potential impact on the department's ability to provide the wide range of services critical to fulfilling the mission of the department."
After the vote, Commissioner Dr. Edward Chow said mid-year budget cuts are unusual, and "all cuts are hard." People are used to health officials being able to magically pull the rabbit out of the hat during hard budget times, but "there aren't too many more rabbits," Chow said.
The city is facing a $233 million deficit for the 2008-09 fiscal year.
Dr. Mitchell Katz, the director of the city's health department, said after the meeting, "We're nowhere near the targeted amounts to meet the city's requirements."
At this point, the mid-year cuts are out of the Board of Supervisors' hands, but there's plenty of work ahead for the supervisors as they hammer out next year's budget.
Supervisor Bevan Dufty, who represents the Castro, told the B.A.R. Tuesday that he was troubled by the cuts, and he's planning to meet with Newsom.
"We all recognize the need to reduce spending, but I think the budget still has to be collaborative," Dufty said.
Board President Aaron Peskin also expressed concern about the cuts, which he described as unilateral. He said Newsom is refusing to spend money already appropriated by the board.
"These are all tragic cuts that are going to have very real impacts on very real people," Peskin told the B.A.R.
Newsom's office did not respond to requests for comment on the budget.
One group likely to be affected by the cuts is the Center for Special Problems, which provides mental health services to clients including HIV-positive people and transgender people, as well as trauma survivors, sex offenders, and perpetrators of domestic violence.
The cuts include a proposal to move six clinical directors to vacant positions within the health department and replace them with clinical managers.
More than 20 people spoke at the commission meeting in favor of keeping Melissa Bloom, who has a doctorate in clinical psychology, as the center's clinical director. Bloom's position is budgeted at about $92,000 a year, plus benefits.
"I think it's a mistake," Bloom told the B.A.R. outside the meeting. She said she respects the health department, but "I think there's lots of other ways where cuts can happen by addressing the wasteful spending that goes on."
She cited a San Francisco Chronicle report about the Board of Supervisors possibly spending $1 million on a wheelchair ramp in the board chambers as an example. The board rejected that plan Tuesday, and Supervisor Michela Alioto-Pier, who is a paraplegic, said that she would sue the city.
Nan O'Connor, the project coordinator of the center's HIV mental health case management program, said in a phone interview before the meeting that imagining Bloom moving is like "imagining a city without a mayor, or a team without a coach ... This could have a profound, damaging effect both on the quality and quantity of care we're able to provide."
O'Connor said the center has been serving the LGBT community for more than 30 years and was the first mental health clinic to provide services to the transgender community. She said the center serves many people who are uninsured, on Medi-Cal, or undocumented.
O'Connor also said Bloom's clinical expertise across all program areas is unique. That's "a huge part of the problem," she said.
Bloom has a caseload of her own and provides direct clinical supervision to each of the coordinators of the center's specialty programs. Dr. Robert Cabaj, director of the health department's community and behavioral health services division, which oversees the center, said there are many people in the department with expertise similar to Bloom's.
Bloom, who will be re-assigned to a job that hasn't been determined yet, said she isn't so much interested in remaining in the role as she is having the position maintained on site. Unlike Bloom, the manager who replaces her won't be on site fulltime, and Bloom said that will make a difference. The job "really does take being there," she said.
Some at the meeting spoke of Bloom's knack for dealing safely with combative clients.
"It's a matter of public safety, because we serve some really dangerous clients and the clinical director provides on-the-spot supervision and intervention with these clients when these clients become out of control," O'Connor said.