Budget panel backs four public‑health nurse positions for maternal and child health after debate over vacancies and productivity

The San Francisco Board of Supervisors’ Budget and Finance Committee on Tuesday voted to forward a supplemental request that would fund four public‑health nurse positions and to amend those positions to be scored to the Department of Public Health’s maternal and child health (MCH) division.

Chair Chris Daly, who sponsored the legislation, said the additional positions are meant to reduce long wait lists for prenatal services and support programs serving largely immigrant and non‑English‑speaking clients. "We have a huge weight of actually over 140 mothers… waiting to receive care this year," Daly said in presenting the request, adding that authorizing positions can help recruit nurses by showing long‑term commitment to the program.

The committee’s deliberations centered on two disputes: whether DPH is holding vacant positions and how to measure nurse productivity. Budget analyst Mr. Rose reported the department had 27 vacant public‑health nurse FTEs out of 84 authorized positions — a 32% vacancy rate — and that the daily target of three home visits per nurse contrasts with actual averages of roughly 1.37–1.42 visits per 8‑hour day. Based on the vacancy rate, DPH’s share of costs from general funds and the lower-than‑target productivity, Rose said he could not recommend unconditional approval of the four requested positions.

DPH staff responded that many of the vacancies are posted and actively being recruited for. "There are a large number of vacancies… and they're being recruited for," said a DPH representative, and DPH leaders said maternal and child health in particular had only one vacancy at the time and expected hires soon.

Frontline nurses and the union urged the board to approve the positions. Lanny Adleman Heaney, nurse manager for the field public‑health nursing unit, said her unit had 202 prenatal clients on a wait list and urged the committee that "prenatal clients without services is unconscionable." SEIU representatives and several public‑health nurses described complex, high‑acuity home visits that they said are not fully captured by a simple 'home visits‑per‑day' metric.

The committee took a compromise step. Supervisor Aaron Peskin proposed amending the allocation so that the four positions would be scored to MCH; DPH said re‑scoring could increase Medi‑Cal reimbursement because a higher share of MCH clients are Medi‑Cal eligible. Budget staff agreed to re‑examine revenue calculations. The motion to amend — to move all four positions into MCH — was seconded and adopted without objection, and the items were forwarded to the full board with the committee’s recommendations.

What happens next: the full Board of Supervisors will consider the ordinance and associated appropriations and any final adjustments to funding sources. DPH and the budget office agreed to review and provide updated Medi‑Cal revenue estimates and to report back on hiring timelines; DPH told supervisors it would continue active recruitment for posted vacancies.

Sources and figures cited at the hearing: the ordinance materials requested $394,476 in general‑fund reserves to support four positions for nine months; the sponsor referenced an amendment amount of $276,476 in general‑fund changes during the hearing. The budget analyst cited 27 vacant public‑health nurse FTEs (32% of 84) and reported average actual home visits per nurse of about 1.37–1.42 per 8‑hour day, compared with a target of three visits per day. DPH said maternal‑child health reported approximately one vacancy and expected a new hire to start later in September.

Quotes

"We have 202 prenatal clients that are on our wait list, and we have frankly gone long enough without adequate staffing," said Lanny Adleman Heaney, nurse manager for the field public‑health nursing unit.

"Given the city's general fund pays approximately 70% of the cost, the current high 32% vacancy rate, and the very low rate of home visits per day… the budget analyst cannot recommend approval of the four requested new public health nurse positions at this time," Mr. Rose told the committee.

Ending

The committee’s amendment leaves the ultimate hiring and funding decisions to the full Board; members asked DPH and budget staff to return with refined productivity measures, updated revenue estimates (including Medi‑Cal reimbursement calculations), and hiring timelines before final action.