From the Emergency Coalition to Save Public Health:
Important Notice: Docs in Some DPH Primary Care Clinics Told Not to Make
Appointments After June 30th
Because of the "contingency plan" to shut down 50% of primary care
clinic hours, doctors in some of the Department of Public Health primary
care clinics are being told that they may not give patients appointments
after June 30.
This plan has NOT even been approved by the Health Commission yet.
Patients with chronic illnesses need to see their doc at least every
two to three months. Clinic doctors fear that this "contingency plan" is
already resulting in patients who badly need regular care being cut off
So we are now looking at the reality that people with diabetes, HIV and
other significant diseases that need close monitoring will just be "cut
loose" from their regular doctors with no alternative.
Lawyer Mike Keys, of Bay Legal and People's Budget (MKeys@baylegal.org),
Can you get low-income patients who get caught in this referred to
me? The most obvious group would be medically indigent (no Medi-cal / no
way to pay for treatment somewhere else) who need care and will be at
serious medical risk if they don't get it.
THE HEALTH COMMISSION IS BEING ASKED TO VOTE ON THIS PLAN APRIL 8TH.
The next regularly scheduled
meeting of the Health Commission will be Tuesday, April 8, 2003 at
3:00 p.m., 101 Grove Street, Room #300, San Francisco.
The following letter was written by Doctor Kevin Grumbach and has been
signed by all the Chiefs of Service at San Francisco General Hospital. It
is to be presented to the Health Commission at their April 8th meeting
where they vote on the second rounds of DPH Cuts, which include shutting
down Health Centers half-time, eliminating Mental Health day treatment,
eliminating most substance abuse treatment, and closing the OMI Family
Letter to the Health Commission
April 3, 2003
|Honorable Mayor Willie Brown
|Commissioner Edward A. Chow, M.D.
|Commissioner Roma Guy, M.S.W.
|Commissioner Lee Ann Monfredini
|Commissioner Harrison Parker, Sr., D.D.S.
|Commissioner Michael L. Penn, Jr., Ph.D.
|Commissioner David J. Sanchez, Jr., Ph.D.
|Commissioner John I. Umekubo, M.D.
|Supervisor Matt Gonzalez
|Supervisor Jake McGoldrick
|Supervisor Aaron Peskin
|Supervisor Fiona Ma
|Supervisor Chris Daly
|Supervisor Gerardo Sandoval
|Supervisor Sophie Maxwell
|Supervisor Tom Ammiano
|Supervisor Tony Hall
|Supervisor Gavin Newsom
|Supervisor Bevan Dufty
|Chiefs of Service and Members of the Medical Executive
Committee, San Francisco General Hospital
|Proposed Contingency Budget Cuts Affecting Primary Care Clinics
We are writing to express our profound concern about the proposed
contingency budget cuts that would reduce by 50% the general fund support
of the Community Primary Care Clinics administered by the San Francisco
Health Department. We recognize that the City faces a dire budget
predicament, and that difficult choices must be made about funding of City
services. However, the proposed reductions in Primary Care Clinic services
would decimate a vital element of the Health Department's infrastructure,
with catastrophic consequences for both the patients served by these
clinics and the viability of the entire range of clinical services at San
Francisco General Hospital.
The Department of Health's Community Health Network is built on a solid
foundation of primary care clinics. This exemplary integrated system of
care with a primary care foundation means that low income and uninsured
patients in San Francisco receive:
** Preventive care, to avert new cases of HIV infection, diagnose
cancer at an early, curable stage, avert pregnancy complications, and
immunize children and adults against life-threatening infections;
** Comprehensive treatment of diabetes, high blood pressure, and
other chronic illnesses, to maintain quality of life and avoid
hospitalization for medical complications of these chronic conditions;
** Integrated mental health, substance use, and medical care,
addressing the needs of homeless patients and other vulnerable
populations and mitigating the social consequences of untreated mental
illness and substance use.
The proposed contingency budget cuts for the Primary Care Clinics would
cripple operations at these sites, reducing them to urgent care centers
performing crisis management rather than providing comprehensive,
prevention-oriented primary care. Patients would suffer from drastically
reduced access to essential primary care services. The result would be
greater medical disability among San Franciscans, further damaging the
City's economic health and productivity.
Moreover, these services reductions at the Primary Care Clinics would
also produce an ominous ripple effect at San Francisco General Hospital,
compromising all hospital services including trauma care, the emergency
department, and inpatient units.
Why would the proposed cuts cause a "tsunami-sized" ripple effect at
San Francisco General Hospital?
** Patients unable to obtain timely appointments at the Primary Care
Clinics would turn to the SFGH Emergency Department for their care. The
Emergency Department would potentially face 50-100 more visits each day
from patients formerly treated in the Primary Care Clinics, forcing an
already overloaded Emergency Department to go on diversion at an even
** More patients would be hospitalized at SFGH due to deterioration
of their chronic illnesses and failure to receive timely, early care in
the clinic setting. Research has documented that poor access to primary
care is associated with higher rates of "preventable" hospitalizations
for conditions such as diabetes, asthma and heart failure. These
hospitalizations would be costly to the City and stress a hospital
already often operating at peak capacity, adding to the frequency of
diversion of patients.
** Patients would not be able to be discharged from SFGH in a timely
fashion when there is no capacity for arranging adequate primary care
follow up after discharge. Short lengths of hospital stay are contingent
on having coordinated primary care follow up in place. Without this
capacity, lengths of stay would increase, adding to hospital costs,
increasing the number of unpaid decertified days, and compounding the
inpatient logjam that places the hospital on diversion.
** The shifting of care from community-based primary care clinics to
the emergency department and inpatient wards of SFGH that would
inevitably occur in response to the proposed cuts in the Primary Care
Clinics would have a disastrous effect on the operations of SFGH. An
overcrowded hospital and emergency department would compromise all
hospital services. Trauma patients would lack available hospital beds
for emergency admissions. Surgery would have to be cancelled due to a
shortage of hospital beds to receive patients following surgery.
** The primary care cuts would also lead to reduced revenues for SFGH,
precipitating further financial deterioration for the Health Department
budget. Diminished access to the Primary Care Clinics would drive away
clinic patients with Medi-Cal coverage -- particularly pregnant women --
who might be able to find care elsewhere. The exodus of these patients
from the Community Health Network would lead to the collapse of
obstetrical services at SFGH which currently depend on the patient
volume and Medi-Cal revenues associated with Community Primary Care
patients coming to SFGH for birthing services.
We believe that the proposed contingency budget cuts for the Community
Primary Care Clinics would produce an intolerable wound in the integrity
of the entire Community Health Network. At a time when concern about
public safety is paramount, the cascade of events that would be set in
effect by the contingency budget plan would jeopardize the ability of SFGH
to effectively operate its trauma and hospital services. We respectfully
urge you to reconsider the proposed contingency cuts affecting the
Community Primary Care Clinics and develop an alternative approach for
addressing the City's budget needs.
|Mitch Katz, Director of Health