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This month’s Health Commission meeting  late Wednesday afternoon was both absorbed in the usual minutiae of governance (“I see five new food service workers in this budget. Why is that?” said commission president James Illig, while looking over some new documents on Laguna Honda Hospital) and the larger crisis (Mayor Newsom showed up to tell the commission that the department’s budget was likely to be $102 million short.)

“You have the largest budget, and the largest general fund of any city department,” Newsom said, addressing the commission. “You have never had budget cuts at the same level as other city departments. Arguably, you have the toughest job in the city. And yet, layoffs must be on the table again.”

The problem, Newsom said, was that the state of California had built its budget on the assumption that it would get $6.6 to $8.3 million from the federal government. Instead, that amount now looks to be more along the lines of $1.5 million.

Which means that, after already deep cuts, the Department of Public Health will need to either make further cuts, or raise money to makeup the shortfall on its own.

“I don’t know what they can possibly do to get out of this mess,” Newsom said to the commission, clearly agitated. “We have Pelosi, Feinstein, and Boxer. No city in America has more political influence than we do.

“But the $49 million that was in San Francisco’s rainy day reserve fund is now down to $25 million. Last year we had federal stimulus money, which was a one-time solution. Every day we delay means we will have a greater risk of not balancing our budget.”

“I suggest you look into revenue strategies,” Newsom said. “I just met with the director of Park and Recreation about this and I thought some of his revenue ideas were brilliant, and others were the worst I’d ever heard. I’m not going to tell you which were the worst.”

“Good luck! We’re all in this together!” And with that the mayor turned around and walked out in an exaggerated vaudevillian tiptoe.

After the mayor left, attention returned to the details. Could nurses be brought down to part-time? Unlikely, it was decided. Most of them were under 40 hours a week already, and state laws about nurse to patient ratios meant that if their hours were cut further, other nurses would likely go into overtime (a situation that has proved true in other city departments).

Custodians could be shifted to part time, but what if that meant that rooms didn’t get cleaned in time? That would necessitate hiring more custodians.

Mitchell Katz, Department of Public Health Director, mentioned that the elevators at San Francisco General Hospital need to be replaced, since they had been put in during the 1970s and were out of service contract. “Is that really true?” said Illig, “They’re from the 70’s?”

“That’s what we do,” said Katz. “Provide the best healthcare without adequately maintained equipment. No modern hospital would keep elevators without a service contract. It’s just not done.”

“Well,” said Illig. “We’ve raised $8.4 million so far this year.That’s ten percent of the $102 million. Perhaps the rest can be done with revenue services.”

This is the third budget meeting for the Health Commission already this year (last year there were seven). The meeting ended with a resolution to immediately follow the public budget discussion with a closed budget discussion (all were in favor.) The next meeting will be held on March 2nd.

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Heather Smith covers a beat that spans health, food, and the environment, as well as shootings, stabbings, various small fires, and shouting matches at public meetings. She is a 2007 Middlebury Fellow in Environmental Journalism and a contributor to the book Infinite City.

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