Chop from the top

You might expect that when the mayor proposes an "across the board" budget cut from city departments, almost any position in city government would be on the table.
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OPINION San Francisco officials released two very different documents last week. The first was a list of the 596 city employees making $150,000 a year or more in base salary. The second was a letter to the 334 patients of the Chronic Care Public Health Nursing program informing them that as of April 15 they will no longer have a public-health nurse helping them manage their illnesses.

You might expect that when the mayor proposes an "across the board" budget cut from city departments because of a looming budget deficit, almost any position in city government would be on the table. You might expect that maintaining services to the most vulnerable city residents would be a priority. But according to these two documents, you're safe if your salary is $150,000 or more, and you are abandoned if you are poor, frail, and chronically ill.

Last week, Board of Supervisors President Aaron Peskin suggested that instead of just cutting from the bottom, the city also consider cuts at the top. "So let me understand," the Chronicle quotes District Attorney Kamala Harris (No. 55 on the top-earners list), "Aaron Peskin is basically saying we should eliminate all the doctors and lawyers who work for the city."

But Harris didn't understand. Peskin isn't proposing to cut all of those 596 positions. He is proposing that in a fiscal crisis, the agenda should include some cutting from the top, not just the bottom.

As a public health nurse in the program slated for closure, I've been working to treat and make plans for my patients during the day, while working at night to keep the program open. I'm not worried about my job: nurses are in high demand and there's comparable pay in many private hospitals. But private health care rarely serves the people I've come to know doing this job for the past year: frail, uninsured elderly folks with no families; patients who face language and literacy barriers who can't navigate the system and use emergency rooms when they feel sick; long-time residents of Laguna Honda Hospital coming back to the community not knowing how to use a cell phone, let alone monitor their diabetes.

As the number of chronically ill people skyrockets, along with the costs of caring for them, it would seem a no-brainer to fund a group of nurses who are experts in keeping those folks out of the hospital. But our health care system still operates on an acute-care model. While Medi-Cal will pay the city much of the expense of sending a nurse to do brief wound care for a diabetic, it pays much less for a nurse to keep that same person healthy enough to avoid the next wound. Calcuutf8g future savings from chronic care health services is hard. So on paper at least, it's a money-saver, if not the moral choice, to close the program.

When I was in nursing school, my public health professors told me, "in Public Health, you have to be an advocate, because your patients can't be." But I bet those 596 top earners can defend themselves — and Peskin is right, some of them should be given the opportunity.

Stefan Lynch

Stefan Lynch, RN, is a public health nurse at the San Francisco Department of Public Health and a member of Service Employees International Union 1021.