"The cheapest way to give care to the poor is to give stopgap crappy care from poorly qualified providers in unpleasant clinics that the poor don't want to return to, thereby preventing future costs on their behalf."  It's the same strategy as DPH's intention to charge its patients $5 and $10 co-pays for each of their prescriptions each month, not to raise revenue, but to decrease their use of medicines by 13%, the equivalent of going without medicines one day per week.

To paraphrase Mitch, these cuts are about harm reduction and trying to maintain a skeleton of public health to rebuild on when times improve. He pointed out that giving good primary care to the poor, the disabled ill and the disenfranchised costs money.  The more care you give, the better off patients are and the more care you have to give them to keep them in good shape.  The cheapest way to give care to the poor is to give stopgap crappy care from poorly qualified providers in unpleasant clinics that the poor don't want to return to, thereby preventing future costs on their behalf.

Specific cuts to Primary Care Clinics:

Total losses will be 4.7 providers; 19.68 nurses; 5.11 clinical support staff. Revenue loss will be $716,389

All numbers are FTEs (full time equivalents):

Castro Mission HC will lose

* * 2.25 doctors
* * 3.3 RNs,
* * 4.78 clinical support
* * 12.33 clerical support staff
* * The evening clinic on Tuesdays will close
* * Nursing is essentially eliminated,
* * The city's commitment to managed care clients, such as Healthy Workers, Healthy Kids, and San Francisco Health Plan Medi-cal, will not be met due to lack of appointments for them.
* * Diabetes education will be lost with the loss of RNs.
* * Clinic functioning will be in chaos.


Tom Waddell will lose
* * 1.76 doc
* * 2.04 NP
* * 11.9 RNs
* * All the satellite clinics have been targeted for elimination although that is still in negotiation.
* * Health care or the homeless and transgender will be exceedingly curtailed.
* * Any type of nursing-based care or case management for the homeless, multiply-diagnosed patients making up so much of TWC population will be decimated.

Potrero Hill will lose
* * 0.18 doc,
* * 0.1Nurse practitioner
* * 0.15 RNs
* * 0.88 clerical support
* * The Medical Director who is also district health officer

Maxine Hall will lose 0.4 RN.

Silver Avenue will lose
* * 2.4 RN
* * 0.8 clinical support staff
* * 1.22 clerical support.

Chinatown will lose
* * 2 RNs
* * 1.7 clinical support staff

Ocean Park will lose
* * 1.6 RN
* * Family and health education will be minimal if at all.