County Health proposes clinic staffing cuts and pharmacy consolidation amid federal funding shifts

County Health told the Board on April 13 that federal and state reimbursement changes and long‑running structural deficits have forced a painful set of recommendations that focus the bulk of reductions on clinic operations.

Director Hamami said the department is proposing $24.3 million in cuts and a reduction of roughly 129 full‑time positions countywide within Health, with the heaviest impacts in the county’s five health centers. In clinic operations specifically, the department recommended cutting 97.5 FTE (72 of them currently filled), producing about $13.2 million in savings. Hamami said the cuts are intended to “right‑size” staff to industry standards and align staffing with lower utilization in some centers.

To reduce pharmacy operating costs the department proposes consolidating three county pharmacies into a single location, which staff estimate could save about $8.4–8.5 million by eliminating duplicate staffing and drug‑inventory costs. Hamami acknowledged the consolidation will change how some patients access prescriptions and said the department has contracts with retail pharmacies to help patients obtain drugs, and will provide navigation for patients who lose on‑site pharmacy access.

Hamami requested a partial restoration of 16 medical assistant (MA) positions (about $2M) to create a float pool intended to support provider productivity and cover leaves and vacations. “We are asking for a partial restoration of 16 MAs,” Hamami said, adding the restorations were designed to preserve physician productivity and avoid clinic closures. The CEO’s office recommended the department’s restoration request in its $7.4M package.

On specialty care, the department proposed sunsetting several low‑volume specialty clinics and retaining those with higher volume and payer mix at the Santa Barbara site; staff estimated some specialty lines saw as few as 50 patients per year. Hamami said she worked with SenCal (the county organized health entity) and community partners to identify alternative specialty providers where possible. She emphasized that none of the five health centers were slated to close under the proposal, but specialty services at some sites would be curtailed.

Public and board questions probed plan review timelines, how closures might shift demand to hospital emergency departments and the justice system, and the department’s efforts to boost clinic productivity (centralized scheduling, reductions in no‑show rates, and telemedicine). Hamami said the clinics have an approximately 20% no‑show rate and have been testing centralized scheduling and productivity targets to increase visit volumes per provider.

The board and staff said the ultimate scale of any restorations will depend on state action (the May revise) and the board’s final direction in June.