There has been no director of Primary Care for over a year, and the system-wide Medical Director for the Clinic system was eliminated this Spring. This leaves the Director of Nursing as the only system-wide director for the Clinics.

In addition, the administrative staffs of the Clinics themselves are being severly cut, virtually insuring chaos. . Combined with the cuts to the to system-wide administration, this effectively dismantles the Community Health Network. The proposed cuts to the administrative teams of the Clinics are:

The elimination of principal clerks at the centers

A 50% reduction of Nurse Managers

3.5 fulltime Clinic Directors would be eliminated from 9 Public health centers and the remaining 5.5 Directors would work half-time at the medium sized health centers.

The Principal Clerks and Nurse Managers are supervisors that together are the hands-on operations managers for the health centers. They play a critical role and are responsible for tasks essential to the running of the centers, such as:

* Processing new hires
* Payroll
* Training of eligibility/registration staff
* Maintaining supplies
* Medical records
* Eligibility
* Overseeing the sheriff on duty and the porter
* Backup for registration and appointment making.
* Reception
* Facility maintenance

The one half-time Director at the Castro-Mission Health Center is on record as saying that "reducing the number of health center administrators will definitely shift their attention and focus away from the community and DPH involvements and towards on-site administration … leaving a vacuum in organizational and decision making leadership"

Who will take on these essential tasks? The remaining clerks are already swamped. The Nurse Managers are slated to be cut by 50%, which leaves the Medical Directors, who spend 50% of their time providing direct services. One scenario is that no one will take on these tasks, creating chaos and stress. Alternatively, the remaining management team will take on these tasks, and will have to substantially reduce or eliminate their time for providing direct services.

There are two possibilities. The first is that no one will take on these tasks, creating chaos and disorder. Alternatively, the remaining management team will take on these tasks, and will have to substantially reduce or eliminate their time for providing direct services. The consequence is longer waits for appointments, currently there are up to 3 month waits and only a few of the clinics have any same day appointments which are limited and snapped up immediately.

The current cuts have to be viewed in the context of primary care administration at the top levels of the DPH. The Medical Director for Primary Care has been eliminated in the current budget and there has been no Director of Primary Care for over a year. The only one left at the top levels of primary care administration is the Director of Nursing. This combined with the cuts to the to the administrative teams of the clinics would dismantle the Community Health Network.

The capacity of the Community health Clinics would be so diminished that they would only be able to deal with acute illness.