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Cutbacks at health centers a bitter pill to swallow

Monday, June 14, 2004

San Francisco Mayor Gavin Newsom's budget for the new fiscal year includes more than $3 million in cuts to the city's neighborhood public health centers, an amount he and his health director contend will have limited impact on patient care.

But ask the doctors and nurses who provide the care, and some of the patients who rely on the safety-net system for their medical needs, and they offer a different view.

"In my darkest moments, I fear that we're abandoning our mission of public health, abandoning care for those who need it most,'' said Dr. Paul Quick, a public health physician working out of the Tom Waddell Health Center. The center is about a block from City Hall and serves homeless patients. It has become one of the focal points in this year's budget battles in San Francisco.

The Tom Waddell center is not being eyed for closure, but it could lose its urgent care clinic -- one of only two in the city; the other is at San Francisco General Hospital -- or have to cut its clinics for people with HIV, women and the transgender community.

Dr. Mitch Katz, San Francisco's health director, said the city has no intention of turning its back on the poor, and that the proposed budget shifts resources to make the system as efficient as possible. And while services may be reduced at Tom Waddell, other centers will be expected to pick up the slack, he said.

"People may have to go to other sites for their care,'' he said. "But I believe we'll be able to serve the same number of people in our system.''

Newsom, faced with a projected $307 million deficit, has said repeatedly that his $5 billion budget was balanced with the goal of preserving as many services as possible for the city's vulnerable population.

Already, he has backed off plans to shut mental health clinics in the Sunset and the Mission, and reversed course on cutting in half the budget for satellite health clinics in homeless shelters, residential hotels and public schools.

He said he's willing to change his mind again, including on the trims aimed at the health centers -- if a compelling case can be made.

"The arguments are hardly going to fall on deaf ears,'' Newsom said. But, he added, the city's bleak fiscal outlook mandates the need to do things differently.

"You're going to start hearing from a lot of people that change isn't possible, that the world will fall apart if we try something different,'' he said. "But I think we can do things differently, and more efficiently and effectively.''

The budget is now up for debate at the Board of Supervisors.

Under Katz's plan, staffing at the health centers would be shifted so that, in general, there would be one doctor for every two exam rooms at a health center -- which he described as industry standard -- and the nursing and support staff would be realigned accordingly. Under that scenario, two health centers, Maxine Hall in the Western Addition and Southeast in the Bayview, would gain staff, while Tom Waddell and Castro-Mission would lose.

Critics of the cuts say they will be felt throughout the neighborhood health care system. The Silver Avenue Family Health Center, for example, is bracing for the loss of more than half its nurses and a couple of clerk- receptionists, as well as management staff, workers there say. They are wondering who will answer the phones and tend to the sick when they walk through the door.

The system, critics of the cuts say, is already overtaxed. One afternoon last week at Tom Waddell, the waiting room at the urgent care clinic was full. Patients, too sick to wait for an appointment through the regular primary care system but not sick enough to land in the emergency room, were there for everything from an upper respiratory infection to a bum leg.

Christopher Hunter, a 50-year-old crack addict and musician, came from a South of Market detox center hoping to get his four prescriptions refilled for bipolar disorder and high blood pressure. He said he had lost his medication four days earlier and wanted to make sure his conditions didn't deteriorate.

The idea of having to make the trek to the urgent care clinic at S.F. General Hospital in the Mission District if Tom Waddell's service wasn't available didn't sit well with him.

"We need this here,'' he said. "This is where people are used to coming.''

Quick said many of the 6,000 unduplicated patients cared for yearly at Tom Waddell's urgent care clinic are homeless, and many have drug and alcohol addictions and mental health problems, such as paranoia. That makes caring for them more difficult, he said. The idea of making an appointment for a regular clinic, and then keeping it, can be daunting for some patients. Many, he said, simply show up at urgent care when they're in pain.

If urgent care isn't readily available, he predicted, some patients will go without medical aid until their problems worsen, forcing them into the emergency room later on. Katz disagrees with the doomsday prediction.

If the proposed cuts go through, the answer over who was right will come later.

The overall plan for the city's web of health centers and satellite clinics calls for eliminating 27 front-line workers, among them doctors, nurses, secretaries and custodians, and the top layers of on-site administrators at the health centers.

In all, the proposed cuts total nearly $3.3 million. The current budget for the centers and satellite clinics is $43 million, and the centers are staffed by the equivalent of 443 full-time employees, Katz said.

In years past, the Board of Supervisors restored funding for popular public health services by finding savings elsewhere in the mayor's spending plan. Several supervisors already are on record saying they hope this year won't be any different.

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