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Note: The following guest opinion piece appeared in the November 25, 2004 Bay Area Reporter newspaper, entited “Where’s the AIDS czar?”
Refreshingly, we now learn AIDS czar Jeff Sheehy
belatedly questions San Francisco’s 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
are looming.
While Sheehy claims the HIV/AIDS service cuts Health Director
Dr. Mitch Katz recently proposed aren't “focused" or
“strategic,” and Katz’s processes weren't “transparent”
and need reform, why didn’t Katz consult Sheehy prior to
elevating Sheehy’s ire? Why wasn’t Sheehy present at
the November 9 Health Commission meeting, publicly opposing the
HIV/AIDS cuts Katz’s 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. Sheehy’s
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 Katz’s folly,
it did so without Sheehy’s involvement. The council, also
without Sheehy’s help, fended off Health Commissioner Jim
Illig’s 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 council’s 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 ISM’s? 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 Sheehy’s 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 weren’t 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 pmonette-shaw@earthlink.net.