This is one little, little example of a staff cutback that has a direct effect on care."
Furthermore, the way the cuts are being exacted carves deeper into the social safety net than ever before. For example, Progress Foundation contracts with the city to do acute diversion and transitional housing and services for mentally ill people coming out of General's emergency room. Its annual budget is roughly $14.8 million, mostly funded by Medi-Cal with matching state monies. A smaller amount of city money fills the gaps.
DPH has asked Progress, as well as many other nonprofit providers, for a 5 percent cut but the cut is based on the entire foundation's funding, not just what the city gives them. Executive director Steve Fields said that means closing two out of three acute diversion programs or four out of six transitional residential treatment programs.
"It ends up closing about $3 million in programs to save $700,000 [of city money] over the next 12 months," Fields said. "I'm sympathetic to the problem, but it just doesn't make sense to give up that much [state and federal] money." He pointed out this represents 40 to 50 transitional beds or 20 acute diversion beds in facilities that have been licensed, permitted, received neighborhood approval, and have been functioning at 90 to 95 percent capacity. "Once you lose these beds, you don't get them back."
And, he said, the real effects are felt on their clients. "However you look at it, the need will be there. They don't leave town. We end up seeing them somewhere. They're going to be in a hospital bed or they're going to be in jail or they're going to be in a longer-term skilled nursing facility" all more expensive solutions to a chronic problem. "We may be making decisions that we may regret down the road because we've had to react so immediately to the crisis," Fields said.
"This is happening at a time when there's all this increased need," said Jennifer Friedenbach, executive director of the Coalition on Homelessness.
The numbers for families, provided by Compass Community Services, are grim: between 2007 and 2008, the number of families seeking shelter jumped from 75 to 148. At the same time, the city has reduced family shelter beds by 20 percent, and the waiting list is now more than four months long meaning families are waiting for shelter longer than they can actually stay in it.
"It's a really brutal time to cut health and human services," said Friedenbach, whose group is advocating for an alternative list of cuts that incorporate some of the suggestions posed by SEIU and the Coalition to Save Public Health. They call for capping city salaries at $150,000 and letting go of all management staff brought in since a 2007 hiring freeze.
Hawthorne pointed out that while these cuts hit the neediest hardest, public health for everyone will suffer, pointing out that the city will be less prepared for a large-scale emergency or epidemic.
"SF General is a trauma center, and anybody who needs top-level trauma care is going to end up there. If it's crowded with people who don't need that level of trauma care, their response will be slower," said Hawthorne, adding that all emergency rooms in public and private hospitals are ultimately affected by cuts to clinics and nonprofit services.
"On a hopeful note, there's huge potential as people realize the depth of these cuts," Hawthorne said. "The public needs to demand the human right to health care."