About Us

Contact Us


April 30, 2003


Michael Lyon: Major Cuts to Primary Care Health Centers Still a Danger

$8.6 million in reductions to the 8 City-operated neighborhood Health Centers were proposed March 14 as contingency cuts. They involved 50% cuts in clinic hours and General Fund supported staff, loss of 95,000 visits to 18,000 patients, and remaining staff and management teams covering pairs of clinics. Among the 129 Full Time Equivalent positions lost were 11 staff physicians, 4 clinic medical directors, and 4 nurse practitioners.

On April 3rd, we were told that this plan is off the table as a contingency cut, but as the attached e-mail from Primary Care Medical Director David Ofman indicates, the same cuts in a different form are still being considered as an option if deemed necessary. The alternative $8.6 million cut calls for keeping all 8 health centers open full time but with staff reductions equal to the earlier plan, including more than 50% reduction in public health nurses, nurse practitioners (not RNs) performing billable clinical duties such as triage visits, and clinic medical directors working 60% time as clinicians.

As Director Katz's April 3rd memo to the Health Commission states: "One of the most critical services at risk if we are required to take further contingency cuts are our primary health centers. . The primary care administration team under the direction of Deputy Director Barbara Garcia are working on a new model that would achieve the same total savings but would have a less devastating effect on access to care and on our revenue. . I must emphasize that even with this model, there will be a significant decrease in our ability to provide primary care. It is our hope that we do not need to make such drastic cuts to our primary care centers in order to meet a contingency budget requirement." So, as we said before, cutting half of the General Fund payment to Health Centers may not be on the table, but it is being kept in easy reach, if needed.

Balancing the City budget using just cuts is not a viable option. The City needs more revenue, which must come from those most able to pay: downtown business and the very wealthy.

In other updates, David Ofman's memo says:

Pharmacy Services will change July 1st, so that clinic patients must use one retail pharmacy assigned to that clinic, or the SFGH Outpatient Pharmacy, or mail order. (Some clinics’ assigned pharmacy is further than SFGH, particularly SouthEast.) No pharmacy is all-night, and only one stays open until midnight. The transition from the current arrangement will be difficult.

Problems in transfers from Health Centers to Emergency Departments: Diversion at SFGH ED, currently about 30%, continues to result from not enough beds for admitted patients, rather than overcrowding in the ED itself. Although SFGH ED sees walk-in patients even if it is on diversion, Health Center providers are supposed to get authorization from the SFGH ED before transferring patients there, to discourage this from happening. If SFGH ED is on diversion, Health Center providers requesting a transfer are supposed to be refused, and be advised of other Emergency Departments in the City that are not on divert. The problems are that DPH patients are reluctant to go to non-SFGH EDs for fear of being billed, non-SFGH EDs hassle referring Health Center providers, other EDs are often also on divert, and Health Center docs are too busy to find an ED that will accept their patients. All of these factors will get worse for providers and patients alike, as more Health cuts are made.


Timeline of cuts


Base budget: $20 million COLAs, $18 million General Fund reductions (6% of $300 GF funding):

MHRF downgrade: $8 million
Cut some mental health day treatment
Cut some substance abuse
Eliminate SFGH patient referral, cut SFGH interpreters
Eliminate Adult Dentistry


Contingency budget: $40 target, listing first $16 million, the remaining $28 million as yet undetermined. Health Commission refuses to endorse this. Listed cuts:

Cut rest of mental health day treatment
Cut rest of substance abuse outpatient treatment except methadone
Cut 8 Health Centers staff 50% (129 FTEs), and hours 50% (95,000 lost visits to 18,000 patients): $8 million

Intervening time: DPH works out alternative plan to cut staff 50%, save $8 million. Keep all Health Centers open full time, on half staff. NP’s to do triage visits and other billable duties regardless of budget outcomes, displaced RNs to be reassigned to fill vacancies at SFGH or LHH.


Katz announces 50% cuts to Health Centers temporarily off table, but modified plan, if enacted, will still significantly reduce primary care delivery.

New City budget presupposes $80 million City workers’ retirement contribution, $45 million more from State than previously expected, and $75 million City-wide cuts (beyond the $150 million cuts the City proposes in base budget, totaling the $350 million original shortfall estimate.)

New DPH target for additional base budget cuts: $12 million

$6.7 million expected revenue increase
$5.3 million General Fund cuts, formerly contingency cuts, now base budget cuts
Cut more mental health day treatment
Eliminate Primary Care Substance Abuse Services (PCSUS) counselors
Health at Home
HIV contracts
Employee Assistance


DPH announces $5 million additional base budget cuts as requested by mayor.
Substance Abuse outpatient services (from 3-14-03 contingency budget)
Mental Health outpatient and day treatment services, (from 3-14-03 contingency budget)
Case management services
HIV prevention

Other cuts to Primary Care:

Ryan White HIV/AIDS care: Federal funding cut over 2-3 years, SF General Fund no longer to make up difference. (Tom Waddell, Castro-Mission, Maxine Hall most effected)
Limit P103 (per diem) RN time, as-needed MD and NP time, and overtime.