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Note: The following guest opinion piece appeared in the November 25, 2004 Bay Area Reporter newspaper, entited Wheres the AIDS czar?
Refreshingly, we now learn AIDS czar Jeff Sheehy
belatedly questions San Franciscos budgeting process as
being too politicized (AIDS czar questions
budgeting process, November 18). Given Sheehy was nowhere
heard influencing HIV/AIDS budgeting processes as they unfolded,
where has he been the past six
months since becoming Czar on June 10? Mr. Sheehy
is, rightly, alarmed by the current proposed cuts, but his absence
since becoming czar may have set the stage for more cuts that
While Sheehy claims the HIV/AIDS service cuts Health Director Dr. Mitch Katz recently proposed aren't focused" or strategic, and Katzs processes weren't transparent and need reform, why didnt Katz consult Sheehy prior to elevating Sheehys ire? Why wasnt Sheehy present at the November 9 Health Commission meeting, publicly opposing the HIV/AIDS cuts Katzs introduced there?
Where was our Czar during four separate monthly meetings of the CARE Council held between July and October? During those four meetings, the council developed its CARE-funded budget for healthcare services for the new fiscal year set to begin next March. Sheehys failure to attend any CARE Council meetings during his five-month tenure shows he neglected to become involved in the very processes he is now criticizing.
Where was Sheehy when the Council battled with Katz last May, while Sheehy was being vetted for AIDS czar? Katz unilaterally, and without consulting the council beforehand, pitched a proposal to Supervisor Chris Daly to use general fund backfill money the supervisors had allocated to restore lost CARE funds for methadone maintenance instead. While the council stopped Katzs folly, it did so without Sheehys involvement. The council, also without Sheehys help, fended off Health Commissioner Jim Illigs criticism, who sided with Katz. Apparently, neither man understands the council is mandated to direct DPH and the mayor on service priorities, not the other way around.
Where was Sheehy on July 26 when the council voted to restrict eligibility provided at new Centers for Excellence facilities formerly called Integrated Service Model (ISM) programs to only those having a severe need, or those who are special population members? This eligibility restriction portends that only those with dual or triple diagnoses (HIV/AIDS, plus a substance abuse, or plus a mental health, diagnosis) will be eligible for ISM services. Czar Sheehy missed the councils additional vote to increase ISM funding by $4.2 million to a total of $6.4 million, or 25.4 percent of San Francisco's direct services CARE Act award, whichever amount is higher, potentially cutting services to those having a single diagnosis of HIV/AIDS. Despite council members concerns they did not have sufficient, empirical data documenting the number of people legitimately diagnosed with severe needs; had no idea about how many clients would be served by ISM providers; and had no idea how many single-diagnosis clients might lose CARE-funded services, the council voted to do so without our czar present advocating against this.
Where was Sheehy August 30 when I noted to the council that single-diagnosis clients might be left in the cold if San Francisco again takes a deep cut next March, having mandated that 25.4 percent of FY 05-06 funds be dedicated to ISMs? During that meeting, the Council further set service category priority rankings, over which council members expressed concern that categories were being moved about without substantiation, and ranking support to the council dead last, at rank 30, absent Czar Sheehys presence.
Where was Sheehy on September 27, when the council increased during its allocation process following its prioritization process the council support budget for FY 05-06 by a staggering $179,734, to a total of $521,334? This represents a whopping 108.5 percent increase over the FY 02-03 $250,000 budgeted amount, and the expenditure likely will further curtail actual HIV/AIDS services.
Where was Sheehy on October 25 when the Council considered various funding scenarios to employ, should San Francisco receive another major cut to its CARE award next March, which scenario(s) will determine whether entire categories are again defunded, disrupting client services and agencies funded even further than Katz's current budget ax? Knowing San Francisco is set to lose, at minimum, $700,000 next March given pre-existing formulas, how is Sheehy shaping policy helping the City find $300,000 the U.S. Office of Inspector General has demanded Katz repay due to improper, illegal billing by CARE-funded Baker Places for detox clients who werent even served in that CARE program? Between these two problems, at minimum $1 million in additional service cuts loom next year, even while Sheehy remains concerned about the very processes he neglected to participate in.
As I advocated this spring, Sheehy is the wrong person for the Czar job. He should be replaced, or resign, at once, giving someone who will find the time to attend council meetings a chance to influence budgeting processes.
Last Friday The Examiner reported the City suddenly found $1.8 million that had reportedly been lost. Some of that money could avert the mid-year AIDS service cuts drawing Sheehy's frustration. It could also be used to fund a salaried Czar position. Perhaps a czar paid a salary might become involved in processes before the fact, rather than complaining about processes after the fact.
Patrick Monette-Shaw is a San Francisco accountability activist who operates two websites: www.thelastwatch.com and www.stopLHHdownsize.com
Copyright (c) 2004 by Patrick Monette-Shaw. All rights reserved. This work may not be reposted anywhere on the Web, or reprinted in any print media, without express written permission of the author. E-mail him at email@example.com.