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Committee advances retroactive $4.5M Kaiser grant to DPH for electronic health records amid retroactivity questions
Summary
The committee advanced a retroactive $4.5 million Kaiser Permanente grant acceptance for San Francisco Department of Public Health to support Waves 2–3 of an enterprise electronic health record project; supervisors pressed DPH on retroactivity, reimbursement of prior expenditures and a pattern of retroactive acceptances.
San Francisco’s Department of Public Health (DPH) asked the Budget & Finance Committee on March 3 to retroactively accept a $4.5 million grant from Kaiser Permanente, through the San Francisco General Hospital Foundation, to fund further phases of the city’s enterprise electronic health record (EHR) implementation.
DPH staff said Wave 1 of the EHR went live in August 2019 and that DPH was invited to apply for additional funding soon after. The department said COVID-19 response and shifting priorities delayed finalizing the grant agreement until November 2020; as a result, DPH requested retroactive authority to accept funds covering the period beginning Nov. 1, 2019 through Oct. 31, 2021.
Vice Chair Supervisor Asha Safaei questioned whether DPH had already spent money that the grant would reimburse; DPH said it has incurred some expenditures from a continuing fund and that accepting the grant would allow the department to apply those prior expenditures to the grant and preserve future appropriation authority. Safaei and other supervisors said DPH has frequently sought retroactive acceptances and asked for follow-up about internal practices to reduce the occurrence.
DPH and staff agreed the retroactivity was not ideal but characterized the long delay as tied to pandemic-response priorities. The committee approved non-substantive amendments to the resolution and voted 3–0 to recommend the item to the full Board, with Chair Haney advising DPH staff to be prepared to answer retroactivity questions at the Board hearing.
Public commenters reiterated concerns about retroactive acceptances and urged more rigorous vetting of foundation gifts.
