The San Francisco Department of Public Health has revealed its plan to slash an additional $40 million from its budget over the next two years, as requested by the mayor in late February.
Half of the proposed savings will come from axing 121 full-time staff positions, a tiny percentage of the department’s thousands of employees, according to a memo sent to the city’s Health Commission last week. The other half will come from cuts to contracts with service providers whose offerings include harm reduction, peer counseling, and workforce development.
San Francisco faces a $634 million budget deficit over the next two fiscal years, with almost half of the shortfall stemming from federal and state healthcare cuts that would “crater” the city’s services, its officials wrote. City departments have been asked to make cuts toward reducing $400 million in general fund expenditures.
“These decisions were made carefully and, importantly, were made with the aim of protecting the health care safety net and the public health system that our residents depend on,” the memo read.
Still, last week’s internal announcements of the upcoming cuts upset many Department of Public Health employees. They’re sharing their grievances at the public Health Commission meeting Monday afternoon, before Mayor Daniel Lurie incorporates the health department’s plan into his June 1 budget proposal.
Position cuts
Sixty percent of the positions slated to be eliminated were already vacant.
Thinning out “redundant administrative layers” by cutting analysts and managers will contribute to a significant portion of the remaining cuts, according to the April 17 memo.
To minimize layoffs, the health department wrote that it has tried to move staff into alternative roles, especially if they are capable of providing clinical services. Fewer than 10 administrators will be without another job.
The department’s maternal, child and adolescent health unit will lose four managers, including its director Aline Armstrong, staff told Mission Local.
Public health nurses in that unit, who visit vulnerable families in their homes to link them to care, said the loss of their top leadership will impact the services they’re able to provide.
The work is “intense and time-consuming,” they said, and productivity is not easily quantified. Managers are needed first to support the 30-some nurses with “boots on the ground” and, second, to write grants to obtain outside state and federal funding.
“It’s been really shocking,” said public health nurse Candace Hill. The cuts, which she said were announced last week during a 30-minute phone call, are a “blatant signifier that they want our department to descend into chaos and dysfunction.”
Daniela Vargas, another nurse, added that the maternal health unit has been left out of important decisions in the past, such as the Strong Starts program Lurie announced in February to “improve maternal and infant health incomes.”
“The city does not prioritize women and children and the next generation,” said another healthcare worker, who asked to remain anonymous out of fear of retaliation. “This is how we prevent them from sleeping on the streets.”
Clinic and contract cuts
Lurie instructed the Department of Public Health to prioritize retaining contracts that directly prevent overdose deaths, start and keep people in addiction treatment, reduce strain on first responders, and “meaningfully narrow health disparities.” Programs must demonstrate “sustained success” to be preserved, the memo said.
While a solid chunk of the contract cuts will be administrative, some service providers will still see changes. For example, the health department will remove peer counselors from eight substance-use treatment providers in favor of more “effective” ways of engaging clients.
In early April, staff at three health clinics funded by the health department, two of which serve youth, told Mission Local they were being reassigned. In the April 17 memo, the health department wrote that it was closing and consolidating these clinics because of their “consistently low utilization.” Each saw between 200 and 300 patients a year, and fewer than 10 a day.
Lurie also asked the health department to reevaluate “harm reduction services that have negative collateral impacts on our communities.” Over a million dollars will be cut from the city’s harm reduction programs, including $400,000 from the San Francisco AIDS Foundation’s syringe cleanup services due to lower demand, the memo said.
“Any funding cuts” would cause “disproportionate harm to communities that are already disenfranchised by existing health care systems,” the foundation’s CEO, Tyler TerMeer, wrote in a February statement.