Hundreds of people gathered for a funeral among makeshift gravestones buried in the lawn of City Hall on Dec. 11. The tombstones marked some of the essential public health and community services laid to rest by mid-year budget cuts: health care for jail inmates, day services for the homeless, the SRO Collaborative, and the Laguna Honda adult day care center.
Collectively they amount to a $36 million thinning of an already stretched social safety net that is designed to catch the most vulnerable populations in San Francisco. Of the city's $118 million projected deficit, about 30 percent will be recovered from the Department of Public Health, with cuts to care and counseling for the mentally ill, services for the elderly, and closing some medical respite housing. All these services and more have been suggested by the DPH in response to Mayor Gavin Newsom's request for deep budget cuts.
But advocates and front-line workers say these cuts will only create a greater cost to the city over time, as people with acute illnesses and mental health and substance abuse problems lose their primary care and end up in the emergency room, potentially in worse condition, receiving more costly care.
"The cuts in services are going to cost," Marykate Connor, director of Caduceus Outreach Services, said at the rally. Cuts to nonprofit organizations that handle much of the city's drop-in health services mean more ill people will end up at SF General.
But the city's premier and only public hospital is already crunched. "It's sort of crazy right now. Six to eight months from now if these cuts go through, it will get a lot crazier," said Ed Kinchley, an emergency room social worker.
In a memo to the Health Commission, DPH director Mitch Katz pointed to a higher-than-budgeted census at SF General, which provided a short-term boost in revenue but also stretched resources at the busy hospital and exacerbated its budget situation.
Kinchley, who's been at General for 24 years (12 of them as a social worker), said part of his job is getting substance abusers and people with mental health out of the ER and into care programs. "It's already hard for me to get someone in detox in a day," he said.
On a typical Friday afternoon, he's successful with one in five people. Unfortunately, when someone comes in asking for detox is the time when it can do the most good, if it's available. "It's really crucial in that situation to seize the time," Kinchley said. Though they try to keep in touch with clients and get them in as beds become available, there's high attrition on the waiting list. "They don't have a hell of a lot of choices except to start drinking again that day."
Martha Hawthorne has spent 23 years as a public health nurse for DPH, working out of the Castro Mission clinic. She does targeted case management for high-risk mothers and their newborn babies essentially making sure they're connected with other health care workers who specialize in chronic problems such as diabetes, hypertension, and substance abuse. "I'm one of the people that sees the system from the patient's point of view," she said.
She's also able to illuminate how certain cuts can have spillover effects on a newborn baby. "There are five to six specialized, highly skilled RNs being eliminated. One is an expert in diabetes care for pregnant women," Hawthorne explained. If that nurse is cut, "the clinic will still exist, the patient will have five to 10 minutes with the doctor and receive instructions, but there will be very few people to teach her how to use insulin, to follow the instructions, to change her diet.... A woman without this care can have very sick babies.