$1.74 Million was restored to reinstate the direct caregivers (docs, nurses, nurse practitioners, and health workers), and keep the Tom Waddell Urgent Care Clinic. These were all cut in the contingency budget.

$192,000 was restored for DEAP (Disability Evaluation and Assistance) at Tom Waddell, reinstating a physician's service, a psychologist, and a medical records clerk who do a small subset of DEAP's work. This is not sufficient to restore the essential nature of the program, and DEAP workers have already had to turn away clients. DEAP's specialty is enrolling homeless who are not in treatment into SSI/SSDI, a painstaking, specialized task other City agencies cannot do because it is extremely difficult to demonstrate disability for clients whose past medical records are either non-existant or badly scattered. DEAP also connects these homeless with other health services through case management. These two functions are ceasing. Each year, DEAP enables over 100 patients to get Social Security. This allows the City to collect $750,000 - $5 million or more in revenues from Medi-cal and Medicare. The program needs to be fully funded, which would cost $309,000 and restore 5 more FTEs. Eliminating this program means not only that revenue will be lost but also SFGH will have to provide medical care without reimbursement.

Some $300,000 was restored to re-instate the clinic-level nurse managers, but this was supposed to be supplemented by DPH funds in order to retain all Primary Care Clinic Nurse Managers. This has not happened yet. This is important from a health delivery standpoint, since the Nurse Managers also provide direct services. If the primary care providers have to assume the roles of the Health Center Directors and Nurse Managers, it will decrease the primary care providers' care for patients and compound fiscal problems by decreasing providers' billable hours.

However, the system-wide and clinic-level administrative structure of the Primary Care Clinics remain shattered, which endangers the system's long-term survival since there will be nobody within the Department to advocate for the neighborhood clinics as continuing providers of primary and preventive care, or even for their continued operation. We all remember that last year DPH proposed closing half the clinics and selling off the buildings.

 

Endangering two mental health programs for vulnerable populations

$196,000 was restored to allow Southeast Mental Health Clinic (general and geriatric care), Team II Clinic (general and LGBT care) to remain in their current locations.

In addition, DPH threatened to merge two major mental health facilities, Sunset Mental Health and Mission Mental Health, into already-overcrowded and under-staffed Primary Care Centers that are loosing key administrative staff under the new budget. DPH backed down on these early in the budget process.

Charging patients so much for medicines that many will have to do without

$232,500 was restored to prevent mandatory $5 and $10 co-payments for each prescription each month for DPH patients making as little as $777 per month. DPH planned to reduce its pharmacy costs 13% knowing patients could not afford all the the co-pays.

 

Closing the Kidney Dialysis Center at San Francisco General Hospital

$340,000 was restored to keep open the SF General Hospital Renal Center for the City's poor, homeless, or mentally-ill population with End-Stage Renal Disease. This is the only location where this vulnerable population can get dialysis. (Assumes JCHAO will allow continued operation at SF General until Dialysis Center is ready at Laguna Honda Hospital, estimated at three years.)

Cut even more interpreters at SF General Hospital

$372,000 restored, saving 5 of 14 FTEs, in a program with over 150 encounters per day.

Privatize Jail Health, with tremendous risks to prisoners and the community

The immediate threat of privatization is removed. However, there has been heavy pressure from Mayor's office and at least some supervisors to balance the budget through major cuts from Jail Health, by forcing DPH Jail Health to lower its costs to be competitive with private prison health contractors. The City's initial goal was $4.5 million in cuts, which has been reduced to $3 million in cuts, in effect making Jail Health absorb last year's inflationary cost increases. A Blue Ribbon committee, probably comprising of City, Labor, and other interests, will decide how the cuts are to be made, and is due to report March 1, 2005. Some 25 City workers are expected to be offered other City jobs. Many questions are left unanswered.

Reports from the jails indicate that understaffing has already resulted in being unable to triage prisoners. This means prisoners will either go without care or be diverted to the SF General Emergency Room, which is already over-stressed. If San Francisco uses the Health Department to duplicate the cost savings of the notorious prison health contractors, they will run the same risks of prisoner injury or death.

Cut experienced Medical Social Workers who connect patients to services and could generate large amounts of revenue.

$444,000 restored, plus grant-funding, are sufficient to reinstate the 11 Medical Social Workers