to consider the budget eliminating and/or reducing medical services provided by the department of public health. >> thank you, madam clerk. colleagues, and ladies and gentlemen, as you know, every year if there are any potential elimination or reduction of medical services, we need to hold a beilenson hearing [speaker not understood]. we are still required to hold a hearing for the 2013-2014, 2014-2015 years. what i would like to do is acknowledge department of public health director who is here, and give an opportunity to make some opening comments and we will open it up to public comment. >> good afternoon, supervisors. [speaker not understood] issues in our bielenson hearing today, [speaker not understood] the mayor stated the prior hiv and

aids reduction, there are new cuts that continue from the federal government that includes both hiv and aids. and tb as well. the second is in preparation for health care reform to reduce costs and increase revenues. this coming year we would need to reduce services that are not revenue generating. and this is reflective of our reduction of our $2 66 million base of community service contracts and these will be proposed by 8.8 million reduction in fiscal year 13-15 annualize today 7.6 million in 17 16. the process we will be doing these reductions will be a new rfp going out of general fund contracts. as well we will be closing one of two new skilled nursing facilities on the san francisco general hospital campus and organizing those services to

support discharges from san francisco general hospital and we believe increase revenue by organizing the services. i'll just leave it there for the public and we're more than willing to and here to answer any questions [speaker not understood]. >> thank you, director garcia. colleagues, any initial questions to staff from the department of public health? supervisor breed. >> i'd like to know a little bit more specifics about the cuts in terms of the impact onward 86 at sf general. >> and those in our hrd area and there are service cuts by the federal government in both service programs that you were concerned about. and those are due to the federal cuts from the federal government. >> so, with the -- there was anticipated 8 million total. >> those cuts are not part of the rfp that i discussed. the cuts for the hiv services are part of the federal government cuts, that's about a 3 million total amount that is

listed in the list that we have for you. >> so, initially it wasn't 8 million initially before the -- in terms of the federal cuts -- [multiple voices] >> in terms of federal cuts it was 4 million. the restored -- >> of the total 8 million? >> yes. >> so, at this point there is an additional 3 million? >> 3.1. >> okay. and then based on -- i just wanted some clarity. so, in terms of that 3 million now, how would ward 86 be impacted? >> i can give you that amount. i'd just have to look at the list. >> okay, thank you. >> supervisor cohen. >> thank you very much. director garcia, could you talk to me a little about the mental health care cuts? >> the mental health care cuts are -- this is part of the behavioral health center design. and, so, presently as part of our looking at health care reform, we have several programs of duplicative. and one of those is at the

behavioral health center over the last 10 years, we have been reorganizing those services to ensure that people are able to move from san francisco general to the community. and into the behavioral health center. so, what we'll be doing is closing the skilled nursing facility. many of those individuals will be going into community placement. those that need lao abound a honda's admission will go into laguna honda. and we will be ~ reorganizing the floor to become a residential care facility. so, in some ways we'll be increasing the level of care that we believe we need for those discharging at san francisco general hospital. the mayor restored most of the mental health cuts from the previous cuts that we had [inaudible]. >> i'm curious. is there room at laguna honda hospital? you're going to be moving people around. i'm wondering if there is room at laguna honda. >> we have consistent turn over

the patients at laguna. not all will be going into the skilled nursing facility. there are many that meet the criteria. many will be going into placements in the community those who need locked facilities. >> and do you know how many people are currently in the skilled nursing facilities now? >> i believe there are 39 beds at the skilled nursing facility we have today. >> all across the city? >> 34 beds, in the skilled nursing facility on the campus of san francisco general hospital. >> no, i'm talking about laguna. >> yes. >> that's about 7 80. >> so, you're going to be taking folks out of other skilled nursing facilities and moving them into laguna honda. i'm concerned about the number of folks who need the facilities will outnumber the number of beds that are available at la laguna honda hospital.

>> no, we have a census -- we only have the many beds we have. we ask individuals leave the facility, that's how we'll be transferring people over. in fact, we're starting that assessment as of this last month. so, we'll have a year of transition for them. >> and i want to go back to what you said about mental health cuts. for the most part the mayor restored the mental health care cuts? >> all of them. >> all right, thank you very much. >> thank you. supervisor wiener. >> thank you, mr. president. i want to follow-up on supervisor breed's question about hiv/aids cuts primarily and it's primarily in the form of ryan white, cuts from the federal government and cuts in funding from the centers for cdc. hiv/aids prevention funding. and just to walk through what the cuts have been in the last few years and it's really been

potentially devastating to san francisco's ability to maintain our commitment to those living with hiv/aids and those at risk for the disease and the federal government in its, what has become unfortunately standard irresponsible budgeting has just been just bombarding us with cuts for hiv/aids treatment and prevention programs. and i hope that it stops. but between what was already happening and sequester, it's been potentially devastating. two fiscal years ago in 2011-2012, we were hit with a mid year $1.5 million cut and we backfilled that as a board and with the mayor out of our reserve. last fiscal year, the cuts i believe were approximately $8 million. mayor lee, much to his credit, proposed backfilling all $8 million and this board approved that.

going into the next fiscal year we're looking at, at a minimum, $11 million in federal hiv/aids cuts worse than the current fiscal year. the mayor backfilled 8 million of those 11. he had already put 4 million in last year's two-year budget, this year will be year two for that budget. and he proposed his now making increasing that 4 million to 8 million. and supervisor campos and i have worked with folks in the community and the mayor's office and i'm grateful to the mayor for doing that. but that leaves a $3 million gap and so right now after the mayor's proposal there is still $3 million in hiv cuts [speaker not understood] that will have a devastating impact if we don't backfill them. i know we are working very, very hard we as a board backfill every penny of those $3 million. i will also say we are anticipating yet another federal hiv/aids cut that could

be as much as $1.5 million that will come down sometime in the middle of our fiscal year. we can't backfill it now because it hasn't happened. that wouldn't be the right way to do budgeting, but that's something we need to keep our eye on. i will say it is absolutely carry that we could experience this level of cuts from the federal government in a city that has been so impacted and continues to be so impacted by this epidemic. and we all need to really keep a close eye on it and work really hard to make up the difference. >> supervisor campos. >> thank you, mr. president. i want to thank director garcia and her staff for all the work that they have done in trying to minimize these cuts, and also to mayor lee and his staff for many of the restorations that have already taken place. i know that there are a number of organizations in my district that still are being impacted

by some cuts and look forward to having those discussions with the agency, with the department. but i do want to emphasize the importance of restoring the 3 million for hiv funding, and i want to highlight a couple of programs in my district that would be essentially eliminated if these cuts remain. and that's [speaker not understood] hiv prevention work as well as [speaker not understood] and [speaker not understood]. so, what we're talking about is a very vulnerable population, a population of gay, bisexual, latino men mostly, where we do need to make sure that there is hiv prevention that is funded. if we fail to, to fund programs

[speaker not understood] which has been in existence for quite sometime and has proven to be a very effective program, what we're talking about is not only an increase in the number of infections, but you're talking about in the end having to spend a lot more money to provide services to these individuals, from a monetary standpoint it is a lot better, a lot wiser to spend money on prevention than treatment. and, so, i hope that we do everything we can to make sure that the $3 million is restored. i know that for my community the loss of a program like [speaker not understood] would be devastating and i don't think that we as a city can afford to see something like that happen. thank you. >> thank you, supervisor campos. and i want to associate myself with the comments of supervisors com campos and wiener, vis-a-vis these

projected cuts. with that, supervisor breed. ~ >> thank you. i just wanted to take a step back. my goal in asking the questions today is asking just to clearly understand what this means in terms of that 3 million, its impact specifically onward 86. i know that there are other issues ~ and i don't feel like based on the money that's been restored for hiv funding, but i clearly understand what specific programs these might impact. so, for example, some of us, i'm sure, are familiar with the fact that the ward 86, because of the ryan white cuts, anticipate a $500,000 cut. with the specific dollars that have been restored, i'm not certain how much money would be going into this particular ward

because this is, as some of us know, a really important clinic that is a one-stop-shop for women living with hiv and they have an extremely successful rate of giving birth to children in the 90 percentile that they don't transfer hiv to their children because of the support, the medication, the attention this this particular place. of course, you're completely familiar with the success of this place and how amazing it is and how those cuts could really take us a step back considerably if we're not able to do what's necessary to maintain the same level of service at this particular location. so, i really would like a clear understanding, and i'm not certain if you're prepared for that today, but just a clear understanding of what those

cuts mean. and also i have some other concerns as well specific -- more specific to district 5, and that is the challenges that we have senterra round mental health issues, drug abuse issues, and as we -- some of us know health right 360 which is combined haight/ashbury free clinic, and walden house are two of what i consider the most respected places that help with treatment for those dealing with substance abuse issues. and they are looking at overall for the locations that they have. we're looking at close to $2 million in cuts to a number of their locations in the haight. and i just overall have a real concern with the proposed cuts

and what this would mean to the ability to provide services, especially because of the challenges that we're dealing with specific to our blake and the haight/ashbury, and having place like larkin street youth and walden house and other places that are usually at capacity, having the ability to take on the challenges that we face as a city means this could be setting us back. and, so, just wondering do we have any plans to try and address some of these proposed cuts? >> on the issue of walden and health right 360, those cuts were backfilled by the mayor's office through the original mayor's budget. so -- >> all of them? >> all of them, all of them. >> okay. [multiple voices] >> what's left now is the hiv cuts. thank you for acknowledging ward 86. it's one of our historical facilities and one of our first

facilities that really responded to the hiv and aids cuts. and within that it's about $71,000 that's focused on women's services that you addressed and that's from the center of excellence that is at ward 86. and clearly as all of the supervisors have spoken, i think hiv services, we've done an incredible job in the city in response to hiv services. the federal government, in looking at the rest of the country, is trying to fill other needs and we will continue to be reduced by the federal government and hiv and aids care. as well with health care reform, the ryan white area, particularly to provide medical services, there is a push for the federal government through the state to us to ensure that everyone who qualifies for health care reform will be moved to those programs, and that is another reason why we will see federal reduction. there is the need to do that

planning, but that planning is having to be done right now and this is why we're here today because we could not backfill all of those cuts. >> and what does this mean for larkin street? >> larkin street, unless it has -- it's on the list. >> it is. >> it is. would be the same issues for larkin street for all the other programs. larkin street i believe had a separate amount of dollars coming from -- directly from the federal government and we were able to backfill that last year. so, it is now on the list. >> for this, the coming fiscal year they are on the plan? >> i don't see them actually on this list. so, i believe we -- i do not see them. i don see them on this list. >> it's on page 4 of 7. >> according to -- 4 of 7 and 2 of 7, they're on both. >> that is included as part of the process. they were part of a separate funding source from the federal government directly and we did

incorporate those in the cuts. >> and the last question i wanted to ask was specifically about laguna honda about -- it's my understanding that some of the beds at laguna honda are being used for people who aren't necessarily elderly or they don't necessarily fit the criteria, the purpose intended for laguna honda and i'm just wondering why that's the case. >> i understand the sensitivity of the laguna honda admissions policy and we are following the admissions policy through this change of behavior health center. although we don't want to discriminate people with psychiatric issues, the people that we believe need to have psychiatric support services are going to community placements and those who meet the age criteria of laguna honda and admissions criteria will only go to laguna honda. so, there's been some comments

about the fact that we're moving psychiatric patients to laguna honda. we are following the admissions policy. not changing laguna honda admissions policy and we've been very sensitive to the age issue. so, any patient that does not meet the age level we felt is appropriate for laguna honda would be put in community placements and the elderly would be put in laguna as the admission criteria allows. >> and you think the impacts of the changes of the number of beds and the expense of running a hospital like laguna honda has been a challenge? >> well, particularly because of the fact that the federal government has continued to look at medi-cal rates [speaker not understood]. that will continue to be challenging to us for having such a large hospital and skilled nursing facility. and in fact, there is ab 97 which at the state level trying to reinstate those cuts for us. so, yes, it's going to be a challenge for any hospital system, particularly with health care reform as they change the way that we are being funded by our services.

the future of health care reform will be in primary care and we will have to really manage our hospitals, including laguna and san francisco general hospital [speaker not understood]. >> supervisor wiener. >> thank you. to supervisor breed, specifically about larkin street, larkin street has been receiving a $500,000 [speaker not understood] part d grant directly from the federal government, not through the city. and last year that was cut, [speaker not understood] was cut. at the board, we added back 500,000 for the current fiscal year for larkin street to make up for that. and then we put 250,000 in for year two, the upcoming fiscal year. so what we're trying to do is put in the other 250,000 to make that grant whole. and i also just want to reiterate and be a little more specific to what director garcia just said in terms of why we originally started losing ryan white funding. we were more or less being fund

for our success. we're doing a good job because of the models of care and prevention we have used for many years in terms of addressing our infection rates. other parts of the country started i think surpassing us in terms of their infection rates and some of the newer areas that we're seeing a lot of infections. so, the federal government started focusing more resources there and reducing what san francisco was receiving, which while i understand why they did it, i think it's a terrible decision in terms of punishing us for our own success and potentially starting to increase infection rates and reduce quality of care. again, i don't think there is any possible justification that i can ever even think of for cutting cdc prevention funding. it's just completely irrational and i'll leave it at that. thank you. >> thank you, colleagues. any additional comments or questions? okay. at this time why don't we go to

public comment for this bielenson hearing. if i could ask folks if you want to line up on the right-hand side of the aisle and we will be here as long as it takes to hear public comment. each member of the public will have up to two minutes to speak, and why don't we hear first from our first speaker. good afternoon. i'm patrick [speaker not understood] speaking as a private citizen. i have some documents that i'm going to want to show on the overhead. if this committee and mayor lee accepts the bielenson cut to reconfigure the murf into housing, you will be no better than ronald reagan who shut down california's mental health hospitals in the 1970s. on the one hand, dennis herrera is outraged about nevada's psychiatric patient dumping into san francisco. but herrera hasn't said a word about san francisco's process

of dumping patients out of county. senate president pro tem darrell steinberg has also proposed the program to make a difference regarding mental health services in california. we're doing exactly the opposite. in 1987, voters were asked to approve a 185-bed murf costing 39 million. nine years later it opened, but with only 147 mental health beds. now they want to drop it down to 24. you can't keep doing this. i direct you to my report. who's dumping grandma available on my website www.stop [speaker not understood],.com. you bifurcate this cut and return it to the department of public health. the full health commission did

not discuss the bielenson cut to the murf. they didn't discuss their budget submission b1 or f9. and they also didn't discuss an increase to that is pending before you to increase out of county contracts for mental health services in other counties. you need to supplement from this back to their committee [inaudible]. >> thank you very much. one thing i want to announce as is the typical policy of this board. if there are seniors, if there are folks who are elderly, if there are parents who have young children with them, we'd like to give them priority and i ask if they are able to, if you could please join the front of the line. but why don't we hear from the next speaker. yes, and anyone else who is also disabled. hello, my name is vivian [speaker not understood]. i'm past president of the national alliance on mental illness both in san francisco and at the state level.

i have 35 years experience in the mental health field. decades ago, nami supported a ballot proposition to build a mental health facility so people would not be shipped out of county. voters agreed and the murf now the behavioral health center was built. family and friends can visit. patients are not isolated. experts provide specialized care with an array of pertinent programming. on the surface, you may think that transferring patients to laguna honda where i worked is a viable alternative. it is not. it would remove patients from a special community where they are sub poderthed by staff and one another. it would remove patients from qualified professionals who have both interests and experience in providing appropriate focused care. contrast this with laguna honda staff who bids for assignments

based strictly on seniority, with mental health expertise not a requirement. contrast this with a very different population where people have debilitating physical conditions. moving patients to laguna honda would give them a foreboding message of permanence, not recovery. as they become not patients, but residents, this is a dee moral -- there is a demoralizing [speaker not understood]. patients deserve nothing less than an environment where hope is the road and recovery is the destination. (applause) >> thank you very much. if i could just remind people that in the board chamber, we have rules that prohibit applause or displeasure to comments out of respect to various members of the public that speak in public comments.

next speaker. hi, good afternoon, president chiu and supervisors. my name is michael smith wick. i'm the executive director of my tree compassionate care. we are a 15-bed residential facility providing 24-hour nursing care to san franciscans with advanced aids. in need of hospice, end of life care, and encouraging them now, we're starting to bring in residents who have advanced aids with medical frailty where we can stabilize them over a period of months to send them back into the community for a second chance at life. we are -- have served over 1,000 san franciscans in our 26 years and have always had a waiting list. we've already absorbed at my tree cuts from last year-end of ryan white contract. so, this latest round of cuts would be in addition to that. we absorbed those cuts so far by -- without impacting our resident care by aggressively reducing our administrative overhead. in fact, we've reduced our

total operating budget by more than 20% over the last few years. in essence, we've cut to the bone. additional cuts would almost certainly mean we'd need to leave beds empty since we'd be unable to afford the nursing care that licensing requires for all 15 beds and residents. that means under this scenario, 4 or more persons with advanced aids would likely have to suffer or die alone and some of those presumably would be doing so on the street. so, aside from the human tragedy of that scenario, the overall cost to the city would be much higher under this scenario with the cuts since the people or residents would be in and out of san francisco general and other medical facilities on a frequent basis versus with us under our nurturing care, highly leveraged by our volunteers and our private community donations. we have many residents at my tree now who are not ambulatory and simply couldn't make it today, but i am here to let you know we do have 6 who have

chosen to join us. they really wanted to speak to you directly and we offer them an opportunity now. good afternoon. my name is nicky he have rent. i don't have my teeth in, so, listen closely. i am a resident at my tree. and since being a part of the my tree family, they have helped me vastly. i underwent a stroke. i started dialysis and many other things have gone wrong. i've lost 65% of my eyesight. and i feel that places like this are necessary because i'm quite sure if i had been at home or somewhere had provided

a lesser quality of care, i would certainly not be with you this afternoon. i feel that places like my tree and other places, laguna honda are so necessary for people who one such as myself don't have family, can't afford someone to care for them on a personal level. and these places offer so much compassion and care and concern and those who have no one, which hiv and aids is a very lonely disease because sometimes families turn their backs on people. you can find alternate family and support and these people who provide this alternate support need to be compensated and not pushed aside. i'd