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Health director warns contractor and staff cuts will reduce services; advocates urge protection of clinics and nurses
Summary
Dr. Mitch Katz told supervisors the Department of Public Health would implement across‑the‑board contractor reductions and pursue co‑location of mental and physical health services to save money, while nurses and community health advocates warned proposed downgrades and layoffs would harm patient care and public‑safety programs.
Dr. Mitch Katz, director of the Department of Public Health, laid out the department’s midyear proposals and explained which line items carried near‑term dollar savings and which were conceptual. Katz emphasized transparency and handed supervisors a line‑item sheet noting shaded items included in the mayor’s proposal and others that required board action or further work. He told the committee he wanted to avoid the impression programs had been cut without transparency and that some items currently listed had no dollar savings this year but were included for discussion.
Katz described an approach to achieve savings that would include co‑locating physical and mental health services where feasible, collapsing certain administrative functions and pursuing a mix of across‑the‑board percentage reductions and targeted contract adjustments. On HIV prevention, Katz said the planning council recommended an across‑the‑board cut that would remove $500,000 from a roughly $6,000,000 portfolio, and that the department had tried to preserve needle exchange and core services where possible. On Laguna Honda, Katz said a proposal to change the adult day health center had many conditional assumptions and therefore he had not advanced it as a primary revenue strategy in the short term.
Supervisors asked specific questions about service impacts. Supervisor Daly highlighted that the largest single line on Katz’s list was a proposed $3,900,000 reduction in community behavioral health contracts and pressed for estimates of how many service slots that would eliminate; Katz said behavioral health cuts were generally being implemented as roughly 5% across the board and offered rough proportions of substance‑abuse versus mental‑health shares but did not provide a precise slot count. Multiple speakers from San Francisco General Hospital and community clinics argued that deskilling clinics (replacing RNs and unit clerks with lower‑paid classifications) and eliminating certified nursing assistants would jeopardize patient safety and could violate state or federal scope‑of‑practice rules.
Public comment included multiple nurses and clinic staff providing first‑hand examples of how RN and CNA roles prevent admissions, complications and readmissions; speakers urged the board not to cut direct patient care positions. Katz and supervisors acknowledged the painful tradeoffs and said further refinement and community engagement would continue between the committee and department staff prior to Tuesday’s follow‑up meeting.
