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Supervisors hear hours-long testimony as health officials defend plan to shift some psychiatric care to community sites
Summary
Supervisors held a prolonged hearing on a DPH proposal to reduce some inpatient psychiatric beds at San Francisco General and expand community urgent care and adult diversion units; health officials said services would not be eliminated until community alternatives were operating, while clinicians and advocates warned closing beds first risks patient and public safety.
San Francisco In an hours-long Finance Committee hearing, supervisors and dozens of witnesses pressed health officials over a Department of Public Health plan that would reduce a portion of locked inpatient psychiatric beds at San Francisco General Hospital and expand community-based alternatives run by nonprofits.
"It was very troubling to me that this issue was advanced without, I think, the kind of deliberation and vetting that I think it required," Supervisor Ross Mercarimi said, opening the hearing and asking DPH director Mitch Katz to explain the department's timeline and safeguards.
Dr. Mitch Katz told the committee the departmentand its clinical partnersaim to provide a 1:1 substitution of services, not a net reduction. "We will not decrease any psychiatric emergency services or any inpatient services until the urgent care and the ADU are up and running," Katz said, adding that the plan assumes existing inpatient locked beds would total about 70 while acute-diversion unit (ADU) capacity would grow. He said current ADU capacity is 40 beds and the proposal increases community options by adding 14 ADU beds.
Steve Fields, executive director of Progress Foundation, which would run the community urgent care and additional ADU beds, said his agency has been operating diversion programs for decades and that the new units are designed to take pressures off PES by serving people earlier in a crisis. "If we can just divert 25 to 30 percent of the people who currently have to go into PES," Fields said, "we will take the heat off PES's pressure."
Clinicians and hospital leaders urged caution. Dr. Mark Leary, deputy chief of psychiatry at San Francisco General, said the proposed community beds are "apples and oranges" compared with locked hospital beds and called closing inpatient capacity "a high-risk proposition." He said the hospital had been on "condition red" (full) about one-third of the time in recent months and that reducing inpatient capacity before community alternatives proved themselves would endanger patients.
Family members, clinicians and union representatives gave extended public comment warning of harm if beds close prematurely. Multiple speakers described patients waiting in psych emergency for days to reach an inpatient bed and urged the board to keep the 14 beds at General open until the Progress Foundation units are demonstrably handling the caseload.
Supervisors pressed DPH on contingencies, timelines and metrics to measure whether community programs actually reduce inpatient demand. Katz and Progress Foundation pledged to keep inpatient services until the community units were operational and to monitor outcomes; the department later said its current timeline targets an April opening for the Progress Foundation site. Supervisors asked for additional financial and operational detail and directed further hearings and analyses before any final reductions would occur.
The committee did not adopt a formal action to change the budget at this hearing; supervisors agreed to continue the item to the call of the chair to allow further review of budget, patient-flow data and community-readiness benchmarks.
Next steps: supervisors asked DPH to supply a detailed implementation plan, explain contingency funding, and return with data linking ADU diversions to reductions in PES census and condition-red hours.
