San Francisco

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A little less than an hour before the Tenderloin Health Resource Community Center is scheduled to open for the afternoon, a line forms outside and stretches down Leavenworth Street. If they arrive early enough at this drop-in center for the chronically homeless, people can get health services or be put on a list for a bed in a homeless shelter. For many, the drop-in center is simply a place to use the bathroom, have a snack, or take refuge from the street.

Once the doors have been unlocked, every seat inside the center is filled. Most clients are African American men. A few are in wheelchairs. One has a hacking cough. The atmosphere feels like a rundown waiting room at a doctor’s office, filled with dispirited patients. Standing quietly near the entrance is a security guard, dressed all in black with a pink mask covering her nose and mouth.

Tenderloin Health is contracted to provide services for 6,000 individual clients per year, according to Colm Hegarty, the organization’s director of resource development. In reality, it serves twice as many.

But it appears that the center’s days are numbered. Its initial city funding of $1 million a year was halved in 2008, Hegarty explained. In the latest round of deep budget cuts — dealt to address next year’s gaping budget deficit — the rest of its funded was eliminated.

While the decision hasn’t been finalized, Hegarty says, the center will likely have to close its doors for good June 30. It’s just one of many San Francisco health and human services programs that will be affected by looming budget cuts, which were mandated by Mayor Gavin Newsom to balance an unprecedented shortfall, projected at more than $500 million for the coming fiscal year, that was triggered by the economic downturn. Newsom, meanwhile, has twice vetoed legislation passed by the Board of Supervisors calling for a special election to ask voters to raise taxes to save programs such as this one.

For the clients of Tenderloin Health, just a stone’s throw from City Hall, the deep cuts have real-life consequences. "The question is going to become where will these people go?" Hegarty wonders.

Brendan Bailey, an occasional client at the drop-in center who says he’s currently staying in a shelter, echoed Hegarty’s concern. "I’d think that they would rather have them here than wandering the street," he said, gesturing toward the center’s crowded waiting room.

Jennifer Friedenbach, executive director of the Coalition on Homelessness, sounded a similar note at a recent Human Services Agency budget hearing, where it was announced that homeless shelters might also be shut during the day in an effort to save money.

"We were basically putting forth this idea that if they’re both going to close the Tenderloin Health and close the shelters during the day, it really ends up being a recipe for disaster in terms of people’s ability to get off the streets," Friedenbach said. "It just would be incredibly problematic … They need to be somewhere."

Another blow to homeless services are cuts to the Mission Neighborhood Resource Center, which operates a program that caters to homeless women. All told, Newsom wants 25 percent slashed from the Department of Human Services budget for the 2009-10 fiscal year. According to a list of proposed reductions presented to the San Francisco Human Services Commission Feb. 12, at least 62 staff positions will be eliminated. That figure doesn’t include layoffs that are taking effect in the next couple months as a response to the current year’s midyear budget adjustments.

Another eliminated component of human services is the agency’s Civil Rights Office, which consisted of two full-time staffers who were responsible for investigating complaints from clients who felt they had experienced some form of discrimination. When the Guardian contacted one of those staff members, she declined to comment but did acknowledge that her position had been written out of the budget.

Steve Bingham, an attorney with Bay Area Legal Aid, notes that state law actually requires the city to have a civil-rights mechanism in place. "The law doesn’t require that there be specific full-time people to do it. The law requires that somebody be designated and that certain work be done," he explained, adding that he’d been told the civil-rights responsibilities would now be shared among several staffers.

"I’m very disturbed that they’re basically going to divvy up responsibilities," he said. "We are constantly bringing to the attention of management in the department deficiencies that are essentially civil rights deficiencies. For example, somebody who just can’t process written information misses a meeting with a worker that he was informed about with a notice. Accommodation means that you figure out that that person needs a telephone call. If you miss a meeting with a worker, you get a notice that you’ve been terminated from benefits."

Human Services Agency executive director Trent Rohrer did not return repeated calls requesting comment about budget cuts.

Meanwhile, in the Department of Public Health, the consequences of deep budget cuts are already taking a heavy toll. Over Valentine’s Day weekend, 93 certified nursing assistants employed at Laguna Honda and SF General hospitals received pink slips, a blow that represents just one of several rounds of layoffs being administered in the wake of midyear budget cuts. (An earlier round, which included 19 CNAs, took effect Feb. 20.) The fallout from budget reductions for the 2009-10 fiscal year won’t take effect until May 1, according to Deputy Controller Monique Zmuda. Everyone the Guardian spoke with expects that round to be worse because there’s a much larger projected deficit.

Ed Kinchley, healthcare industry chair and executive board member of SEIU Local 1021, is employed as a social worker in SF General’s emergency room. He says the cuts have diminished the quality of service the hospital can provide. "Part of my job is trying to hook up the patients who are coming into the emergency room with services, and almost every week when I come into work, there’s some service we have had in the past that isn’t there anymore," he says.

"The biggest thing they’re doing is what we call ‘de-skilling,’" Kinchley continues. "For example, in the first round, they took 45 unit clerks — the clerical people who sit at the centralized desk and make sure the right labs get done and sent to the right place — and replaced them with clerks who don’t have any medical knowledge. That’s at the clinic where all the people go who are supposed to be getting quality care under Healthy San Francisco."

Reassignments are another issue, he says. When an African American nurse was reassigned, she was made to leave her post at a program that offered therapy for youth and adolescents that had suffered sexual abuse. Since many of those clients are African American, Kinchley points out, her removal diminishes the culturally competent service that was previously in place for these youth. Sometimes the new assignments shake up people’s lives: staffers in the process of completing nursing programs who were recently reassigned to completely different work hours, for instance, have had to abandon their studies because of the scheduling conflict.

The end result, in his opinion, is a decline in both the quantity and quality of service at SF General, even in the wake of voters approving a bond measure in the November election to borrow some $887 million to rebuild the facility.

"I have worked there since 1984," Kinchley says. "Right now, morale is lower than I’ve ever seen it."

As the cuts create ripple effects in the lives of health and human services staffers and the clients they serve, a City Hall fight over raising city revenue continues between the Board of Supervisors and the mayor. In the face of opposition from Newsom and the business community, the special election proposed for June 2 has been pushed back to late summer at the earliest.

"I firmly believe that moving forward precipitously with a special election not only puts the success of needed revenue measures at risk, but bypasses our responsibility for finding long-term and enduring budget solutions," Newsom wrote in a Feb. 13 veto letter to the Board of Supervisors.

Labor, meanwhile, continues to advocate for raising city revenues, saying it’s the only way to stave off cuts to the most critical services. A group called the Coalition to Save Public Health, comprised in part of SEIU members, will host a forum called State of the City: Budget Crisis Town Hall to discuss across-the-board cuts (See Alerts for details).

"If the voters of San Francisco are willing to vote for a tax increase — or even if they’re not — if they’re given the opportunity to vote for it, then they’re not going to hold that against [Newsom]," Kinchley says. "The initiative is coming from the Board of Supervisors anyway. All he needs to do is get out of the way."