At 7:15 p.m. on Tuesday, June 19th, I arrived halfway through the San Francisco Board of Supervisors Bielenson hearings, state-mandated at any time cuts are proposed for programs serving indigent people.

It was hard to distinguish nervous energy from boredom as Supervisors heard four hours of urgent pleas from an endless queue of distressed public commentators. Tom Ammiano and Aaron Peskin paced. Sophie Maxwell sat rigid. One Supervisor's laptop reviewed "A Mighty Heart." Others walked, or wheeled, in and out of chambers.

Chris Daly had vehemently opposed cuts to affordable housing and health services for the poor and homeless. He soundly thrashed the Mayor for his own substance abuse (both admitted and alleged) and then, according to Human Services Network officials, slashing $8 million from health services including indigent drug rehab and overdose prevention programs.

Daly appeared to use his "bad boy" image to draw press attention to Newsom's 1,000 tiny knives which, in a year with a $248 million budget surplus, will exsanguinate the entire non-profit health and human services system.

"I wish that this type of media would cover four hours of compelling testimony from the people of San Francisco who are concerned about budget cuts," he said. Daly was applauded, and then left.

Newsom's political presence --- and physical absence --- were palpable in the room despite a voter-approved mandate that the Mayor appear at the Board to hear their testimony.

The cacophony of political in-fighting and media hype drowned the voices of this endless line of distressed service providers, workers, and clients respectfully requesting funds be restored to nonprofits and facilities accomplishing humane and worthy work for:

1. Drug rehab and overdose prevention
2. Low-income elders
3. Aid to the disabled
4. San Francisco Hospital Psychiatric Emergency Services serving patients dangerous to themselves or others or gravely disabled, (specifically gutting an award-winning program for the Asian community and creating diversion problems across City emergency rooms.)
5. Essential SRO Collaborative support for low income tenants of Single Room Occupancy Hotels.

Dr. Mel Blaustein, Director, St. Francis Psychiatry noted: "It's very touching and heartbreaking to see all these people out here having to come in and tell their story. It's humbling to see people so generous, making $7.00 an hour and giving so much to other people."


Photo by Terrrie Frye

Here is a sampling of just ten of those voices in paraphrase:

DRUG REHAB AND OVERDOSE PREVENTION

Manisha Jones:

I am honored to represent Jelani House as a client. I am 6-1/2 months pregnant with my first child.
Before coming to Jelani, I was a crack cocaine, crystal meth, and alcohol abuser. I found myself in many life-threatening situations and had little self respect. I was insecure, scared, depressed, and completely powerless over my addiction.

The second I found out I was carrying a life inside me, I began to care about my own well-being and sought recovery. I made the decision to let the drugs go. I realized I needed help to stay clean and learn how to raise a child as well as a safe environment to gain the necessary parenting skills.

By God's grace, I was blessed to be introduced to the supervisor and one of the counselors at Jelani House. They offered to take me in and help me bear a healthy baby girl.

Since I've been at Jelani, I regained confidence in myself and my faith in my Higher Power, which is God, has been restored.

When I thought I had no friends, my recovery sisters filled that void, and being around all of their beautiful children has taught me what it takes to be a good parent.

Jelani has prepared me for motherhood and a life without drugs. I participate in anger management, domestic violence, parenting, medical group, psychology of addiction, SAGE, and smoking cessation groups, as well as NA meetings, and I've also learned self-discipline and how to live in a structured environment. I don't know too many drug rehabilitation programs for pregnant women, women with children, nor families with children. If programs like this are cut, where will women like myself have to turn?

I believe Jelani House clients would agree that the men and women are not here just for ourselves but our children first.. If our children are not enough to keep the funding going, then I don't know what is.

I hope some part of this story touched each of you to receive representation to keep Jelani House and other treatment facilities accessible to every day people suffering from the disease of addiction who desire to get well.

Julie Leadbetter -- Director, Mission Resource Center at 165 Capp between 16th and 17th.

We are the newest drop-in center, opened in 2002 serving 50% mono-lingual Spanish speakers, and 50% African-American, white, and everything in between.

We provide services from street survival --- showers, bathrooms, lockers, laundry, a drop-in space, movies, a snack and coffee, --- to access to higher services: case management, a medical clinic, mental health team, and community programs.

We partner with the DOPE project which does drug overdose prevention staff training, and Naloxone / Narcan distribution.

Giving this drug to somebody overdosing on an opiate will save their life. There is no reason to restrict it. It's not like methadone. It is non-addicting.

They are trying to get this opiate antagonist into the hands of drug users. In many places Narcan is only used by paramedics or professionals who oftentimes aren't on scene when the overdose is happening.

The DOPE project is done (at this center) and across the City, in jails, and SRO hotels. We are one place in a network that would lose access to this life-saving drug if the project were cut as proposed, by $75,000. It's pennies.

We are also part of a network of Harm Reduction service providers which last year asked for money from the City for The DOPE Project, The Homeless Youth Alliance serving youth in the Haight with a needle exchange, The STOP (Stimulant Treatment Outpatient) Program, and The Women's Community Clinic which runs a Mission street outreach program.

We focused on those programs to start the momentum to fund grassroots harm reduction programs.

Last year the Supervisors funded these programs. Newsom's proposals cut substance use treatment tremendously. There is a $6.9 million dollar cut to programs serving indigent people

This year the Mayor made a 4% cut to the Department of Public Health budget. So the entire network from the Resource Center to every person who serves homeless folks or is homeless, will be dramatically influenced by these cuts. Many Public Health programs serve homeless folks, poor folks who are without other resources.

I think it's vital the community knows that our overall City budget is not shrinking this year. It's actually growing.

In a time of growth, substance abuse services and services for poor folks are shrinking. Newsom's priorities are more around the Police, greening projects, things that aren't Health and Human Services oriented.

(Newsom supporters) will say, 'No, that's not true. We're funding the Homeless Outreach Team for $ 2 million dollars. We've got this huge health access expansion program and these great new housing things going on."

But when you look at the numbers, you see that substance use in particular is taking a really hard, direct hit.

For us, it has been not just ironic, but sad --- really sad --- that in the year he announces he has a substance use problem and shares the situation with other people in San Francisco and the community, the Mayor accesses Delancey Street, one of our few community resources.

Then, less than a month later he turns around and cuts services for poor folks. That's just not reflective of our priorities in San Francisco which are to stay committed to serving vulnerable populations.

He wants to see a Community Justice Center where people are held accountable for sleeping on the street or being drunk in public. But when it comes time to seek treatment and help, he's cutting those opportunities.

Where is the Care Now? And, where is the Cash?

Right. That's the message that I don't think people are understanding enough. If the Board doesn't reinstate the programs, people will get it.

We are part of a small grassroots network. Human Services Network are 'the big guys.'


Photo by Terrrie Frye

Debbi Lerman -- Administrator, San Francisco Human Services Network:

The HSN is a 10-year-old association of about a hundred San Francisco Health and Human Service non-profits (including Connard House, Walden House, and Baker Places.) Our members provide the bulk of Health and Human Services in the City and County.

We work closely with the Mayor's office, the Board of Supervisors and the People's Budget with which many of our non-profit members are involved, to ensure a voice in policy decisions that impact our sector and the vulnerable San Franciscans we serve.

Mayor Newsom's budget cuts eliminate services imperative to maintaining the health and well-being of thousands of vulnerable San Franciscans.

Almost $3 million dollars in about 20 services that the Board added back to the budget in the last two years after they had been cut, including HIV/AIDS, Juvenile and Youth, Primary Care Medical Services programs, are proposed for cuts again.

The Mayor proposes $ 1.8 million in cuts to substance abuse residential and outpatient treatment services.

The entire budget went up over $300 million with a $248 million increase in the General Fund.

The overall budget of the City and County of San Francisco last year was $5.7 billion. This year, the overall budget is $6.1 billion.

There are $248 million dollars more to spend. Yet they cut almost $8 million dollars in health services.

People need to be a priority. It's the difficult job of the Mayor and the Board of Supervisors to figure it out, but they need to restore these critical health services.


Photo by Terrrie Frye

LOW-INCOME ELDERS AND AID TO THE DISABLED:

James Chionsini -- community organizer for HAT, the Healthcare Action Team of Planning for Elders In the Central City.

We advocate on policy for people discharged from hospitals. We work on health care reform, affordable housing for seniors and people with disabilities doing advocacy around the City budget process.

We worked with the Aging and Disability portion of the People's Budget whose groups put together proposals to fill the community's unmet needs. We presented it to the Mayor and Supervisors. They didn't really listen.

This year there was a surplus. Here are three ways Newsom's budget cuts will affect our services.

1. They didn't expand the In-Home Supportive Services (IHHS) Share of Cost Pilot Project.

Often people make just a little too much from their social security ---instead of $800, maybe $,1000, or $900, or $801 --- to qualify for full coverage for IHSS to have somebody help them at home. The Share of Cost Pilot Project would cover that.

If they pay the share of cost for their home care worker, they can't pay their rent and risk homelessness.

They may try to struggle by on their own. They won't have somebody to walk down the street or the stairs with them. Falls are the biggest way the elderly end up injured or dead. If they are hospitalized for a hip replacement, that ends up costing The City more.

We are asking for $150,000 to help 41 people.

2. We are asking for housing modification funds of $150,000. That helps make rental units wheelchair accessible for people with disabilities.

Without a lift to go upstairs, a ramp, or an electric door, 85-year-old wheelchair-bound Charlie struggles. He either can't open the door or is forced to wait for people to help.

3. Newsom is ignoring the Shallow Rental Subsidy Program proposal of $375,000 to cover rent bump-ups in non-rent controlled units.

Newsom ignored the voice of the people giving the money to his pet projects, and, of course, the police whose union contract was up for renegotiation this year.

PSYCHIATRIC EMERGENCY SERVICES:

Mark Leary, M.D. -- San Francisco General Hospital Deputy Chief of Psychiatry:

I am deeply concerned about the proposed cut of an entire 22-bed (Inpatient) Psychiatric Unit at San Francisco General, a safety net for 2,500 mentally ill patients admitted each year.

The Acute and Emergency Psychiatric Services in San Francisco are already facing a crisis. Patients currently wait in the Psychiatric Emergency Service at the General (PES) for up to two days for a hospital bed.

Police and paramedics are turned away from PES one third of the time because there is no space in PES and no hospital bed upstairs.

These involuntary 51-50 patients are then transferred into private hospital emergency rooms in the City where they may wait days only to be transported back to San Francisco General for hospitalization.

Something must be done. Closing hospital beds at this time will only make the crisis worse.

(Supervisors were given) letters from the National Alliance For the Mentally Ill, The Northern California Psychiatric Society, The Mental Health Board, and our own Paramedics Association urging them to please restore the psychiatric beds in San Francisco.

AARON PESKIN: I don't mean to be argumentative. But, this is being done on a backdrop that you have all gotten large raises.

DR. LEARY: Currently we have four vacant psychiatrist positions on our four inpatient psychiatric units. We have not been able to recruit psychiatrists at the far below market rates that are being paid. Even our Public Health director, Dr. Katz, admitted that we vastly underpay our psychiatrists at San Francisco General. Something simply had to be done or we would have to close units for lack of doctors.


Photo by Terrrie Frye

Richard Patel, M.D. Medical Director SFGH Psychiatric Emergency Services:

SFGH Psychiatric Emergency Services, the only emergency psych facility in San Francisco, servicing about 700 people a month, had to go on "Condition Red" (or) diversion from (SFGH) in March, April, and May 2007. People on 51-50s --- danger to themselves or to others, or gravely disabled, unable to care for themselves for psychiatric reasons ---must be taken by police to medical emergency rooms without psychiatric staff. As Dr. Leary said, they languish there for several days only to be returned to SFGH for continued care.

A closure of 22 beds would devastate our ability to maintain care within the Psychiatric Emergency Department. ADU's, (Acute Diversion Units), suggested as a replacement, provide subacute care. They cannot handle acute patients.

Ed Kinchley -- San Francisco General Hospital ER Social Worker; SEIU Local 1021 Health Care Industry Chair, representing San Francisco Psych and General Hospital City and County workers:

Our workers believe the Mayor has no reason to cut 14 inpatient locked acute care psych beds and fund 14 new additional (ADU) Acute Diversion Unit beds, a considerably lower level of care. Patients are not generally discharged from locked psych facilities to ADUs.

His proposal saves just $130,000. It creates a Community Urgent Unit open only 16 hours a day. Psych Emergency patients are 5150ed and put on a legal Hold as threats to themselves or others. To make believe that they can be in a Unit open only 16 hours a day doesn't make sense.

If the Mayor were concerned about the populations our hospital and non-profits serve, he wouldn't eliminate a psych unit containing important award-winning focus groups programs for HIV/ AIDS, LGBT, African Americans, and Latinos (begun in 1980 by Dr. Francis G. Lu, SFGH Attending Psychiatrist, Cultural Competence and Diversity Program Director.)

He claims to want to clean the streets of homeless people. If these inpatient psych beds are cut, more crazy people will live homelessly on more dangerous streets. The Cops and the Public Defender will be busy taking care of them.

It's a irony Newsom ran for Mayor exploiting an issue that is not his highest priority.

Mel Blaustein, M.D. -- Psychiatry Medical Director at St. Francis where SFGH Psych patients are dumped:

We are pretty overwhelmed. Practicing here over 30 years, I have seen the closing of Psych Units at Mt. Zion, St. Luke's, St. Mary's. I hear rumors about CPMC closing.

This is a crisis time for care for the mentally ill in a city known for compassion. Many mental patients come here because it is a place you can find services and care.

St. Francis Hospital on the hill has 24 inpatient psychiatric beds. Earlier this year, we expanded our Emergency Room to 18 beds, providing medical services to San Franciscans with stroke, heart attacks, diabetes, out of control injuries, and accidents.

Now comes this "Red Alert" Diversion program at the General.

Patients brought to our Emergency Room are overwhelming our ER. Of the 18 beds, half of them are often taken up by Psych patients. There is a wait of about ten hours. You can wait 72 hours in our Emergency Room to be seen and to be brought upstairs to Psych.

Police and Mobile Crisis bring patients in. We have many Tenderloin walk-ins. Bottom line, with 18 beds, we're pretty swamped. I was on call this weekend. All 24 beds were full.

An Urgent Care Center won't cut it. These are seriously mentally ill patients with medical problems who wind up in Urgent Care and right back into the hospital.

It's hard to provide both medical and psychiatric services. I worry about the demise of our St. Francis psychiatric Unit which will mean a severe impairment in the number of beds available in this City. Right now, we are getting slammed. It's a real crisis.

(Dr. Blaustein canceled his patients to be at this hearing.)

(In an interview outside Chambers)

I don't understand the rationale. St. Mary's, St. Luke's, Mt Zion --- all psych units closed. We've got only a few left. We have a City with a large number of mentally ill patients and homeless, and we are closing services.

The most severe part is the closing of beds at General, creating a devastating back-up effect. If you can't treat the patients, the issue of homelessness will increase.


Photo by Terrrie Frye

SRO COLLABORATIVE SERVICES TO LOW INCOME TENANTS IN SINGLE ROOM OCCUPANY HOTELS:

Elaine Sharp -- Volunteer, Mission SRO Collaborative, Albert Hotel Resident:

We do primarily homelessness, overdose, fire and earthquake disaster prevention--- arming people with their rights.

Their volunteers work preventing homelessness and victimization by SRO owners (of) residents unaware of their rights.

Collaboratives offer tenant advocacy to tenants who have no advocacy. We are the agency of last resort for people in hotels.

Without that information and outreach, people are too overwhelmed and hopeless to look for this information, and they live without it.

When I moved into the Albert Hotel, 3-1/2 years ago, they had posted illegal signs. The manager would knock on your door if your visitor stayed more than four hours. He'd tell you,"Your visitor has to leave, or I'm calling the police." People from the Mission SRO Collaborative came to my door doing outreach. I found out he couldn't do that, and we actually have rights in SROs.

Without the funding, there is no reason to believe that the landlords won't go back to the old illegal tenancy practices with an immediate increase in homelessness.

The City cannot afford to cut the Collaborative budgets. They operate on a shoe-string.

The total 2007 cut to all Collaboratives is $233,000. The effect of these cuts will be increased costs to the City for providing catastrophic services.

When you're balancing a budget, and you have the most needy disenfranchised people, if you let them fall through the cracks, they're going to cost huge amounts of money in catastrophic services.

I ask that the entire budget be restored.

We want parity for Families In SRO Collaboratives City-wide, as well as the Central City SRO Collaborative. They serve some of the most profoundly disadvantaged children in our City.

Susan Marsh, Albert Hotel resident:

Over the years, I have seen unhealthy conditions, an atmosphere of intimidation and abuse like visitor fees and illegal evictions in the SROs.

It gets worse than just abusive rules. At one time, It wasn't even possible to acquire tenant's rights. People were kicked back out on the street in a game of musical rooms simply to prevent them from acquiring those rights.

Landlords are finding ingenious new ways to push people out or simply not rent. There is a Land Rush in the Mission, a "happening place." Without an advocacy group, low income SROs may be replaced by gentrified SROs.

Collaboratives are the organizations addressing these problems, leading to decreased costs to the City and human cost from increased homelessness, health problems, and fires.

Collaboratives have broken through our isolation, given us a voice, empowered us, and encouraged us to stand up against the abuses that generate so many problems and costs for the City.