Cutting to the bone
Proposed Health Department cuts, potentially devastating for some of the city's most needy, hint at what's to come for other departments

By Tali Woodward

Everyone knew it was going to be a gruesome budget season. But if the proposed cuts approved by the city's Health Commission May 11 are any indication, it promises to be even worse than expected.

At the meeting, patients and providers pleaded with the commission not to shut four free-standing mental health clinics, including two esteemed programs in the Mission District, as well as close the Renal Center at San Francisco General Hospital and the Laguna Honda laundry department – both perennially threatened programs that the city supervisors have bent over backwards to rescue in past years.

No one doubts the cuts would challenge some of the most disadvantaged city residents, particularly those who live in the southern part of town. One doctor compared the mental health cuts to "taking the guts, the heart, and the brain out of mental health services in the Mission."

Patient Charles Evans said Mission Mental Health, which provides therapy and medication on a 24-hour basis to more than 1,300 people a year, is the best program he's seen in his 30 years in and out of care. Jan Sparks said that with the help of Mission Assertive Community Team, a program that aims to keep 100 severely mentally ill people out of the hospital, "I have every reason to believe that sometime soon I'm going to achieve both my goals: to hold a full-time job and to marry a woman."

But perhaps the most moving testimony came from a patient who spoke with much difficulty, barely eking out the words: "Have mercy on the clients ... are nothing but human beings ... I'm losing my cool."

Under the proposal, some staffers from three clinics – Mission Mental Health, Sunset Mental Health Clinic, and the Older Adult Mental Health – would be shifted to nearby primary care clinics, where they could continue seeing some of their patients. Hundreds of others would be funneled into less-expensive nonprofit programs.

The Mission cuts have generated the most concern because the primary care clinics involved are on the periphery of the neighborhood and are already strained. Plus, the Mission ACT program, which deals with the most severe cases, would simply be shut down.

"It's purely budget; it's one of our stellar programs," acknowledged Dr. Bob Cabaj, DPH's director of behavioral health. Cabaj has spent the past week trying to save the Mission programs by finding a more affordable building for them. At press time he told the Bay Guardian it looked like part of both Mission programs could be moved to a DPH building on South Van Ness Avenue. If that plan works out, he said, "a majority of the services will be saved."

But of course the specifics have yet to be determined, and health care workers warn that any cuts will threaten this fragile population, particularly those who don't speak English, have multiple diagnoses, or are homeless. Mission ACT case manager Amanda Scott told us, "Already [clients] are talking about going back to the hospital, becoming suicidal, hearing voices – because they're scared."

Patients and staff at the Renal Center, who have just barely avoided the budget axe several times this decade, also worry about the future. "What am I going to do? Where am I going to go?" asked Daniel Vasquez, who's been getting his blood cleaned through the dialysis unit for four years, as he picketed in support of the clinic May 13.

Supposedly the patients will be placed in privately run units throughout the city, but some say those clinics don't have the staffing to accommodate 100 more patients, some of whom have complex health problems. Staffers also worry about the care that's provided at stand-alone dialysis centers, many of which are for-profit (see "Kidney Punch," 5/14/02).

Other controversial cuts include the Laguna Honda laundry service and several HIV support programs. DPH also plans to begin requiring people in the Healthy Workers program to pay a co-pay for medication, and it intends to eliminate 37 more administrative positions, when it already cut 98 earlier this year.

"We know, and you'll hear in testimony, that real individuals will be affected by this," department head Dr. Mitchell Katz told the Health Commission May 11. "All I can say is that in a horrendous budget year, we did the best we could."

Even some who object to specific proposals agree the DPH plan is better than expected. But DPH got off relatively easy: while most departments have been asked to trim 15 percent off their budgets, Mayor Gavin Newsom required DPH to cut just over 8 percent.

The fact that a budget including so many challenges to important services is greeted largely with relief portends badly for other departments. Which of course adds urgency to the various calls for the city to identify more sources of revenue. The Service Employees International Union, which represents most city workers, marched through downtown last week calling on businesses there to pay their fair share. And some groups, including Coleman Advocates for Children and Youth, are also asking that the San Francisco Fire Department's budget be reduced.

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