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April 4, 2003

  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 from it.

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),  writes:

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 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 Health Center.

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 greater frequency.

** 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
Barbara Garcia
Gene O'Connell