Alyana Perez, 22, struggled with homelessness after escaping an abusive home. At San Francisco’s Michael Baxter Larkin Street Youth Clinic, she said, a therapist helped her restore her confidence and begin putting her life back together.
“This clinic really has changed my life,” Perez said. “Lisa has saved my life by giving me another chance to build my self-esteem up.”
Perez delivered emotional testimonials about her experiences — in April and May — during budget deliberations at City Hall where she pleaded with elected officials to save the clinic.
“If you take these clinics away, it really will kill a lot of people,” she said.
Perez was among dozens of residents who attended city Health Commission budget hearings and urged elected leaders to stop the proposed closures of the Michael Baxter Larkin Street and Cole Street youth clinics, and the South East Mission Geriatrics clinic.
Department of Public Health leadership presented the proposals as part of a package of about $40 million in reductions the mayor’s office directed the department to identify. Closing the clinics would save an estimated $2 million a year, department officials said.
Sophia Padilla, a behavioral health clinician at the Larkin Street clinic, said she recalled thinking the $2 million savings represented “such a small point” in the department’s budget that she believed the clinics could stay in operation if elected officials chose to prioritize them.
But as organizations across San Francisco celebrated restored funding through the Board of Supervisors’ budget add-back process last week, clinic advocates learned their sites were absent from the list. Staff for the office of Budget and Appropriations Committee Chair Connie Chan said there was no budget line for supervisors to restore because the consolidations were considered an operational decision.
“I was like, ‘Oh, then why am I here?’” Padilla said. “What is there to advocate for with the Board of Supervisors if they have very little power to add us back to anything?”
Officials said the youth clinics serve a relatively small numbers of patients — about 255 individuals per year for the Cole Street clinic and about 355 for the Michael Baxter Larkin Street clinic.
to preserve the specialized youth clinic, saying it “changed my life.” Credit: Images courtesy of SFGovTV
Combining the facilities, officials said, would enable staff reassignments to higher-volume sites while maintaining access to care through other clinics and a telehealth pilot. No transition plan has been publicly disclosed for the geriatric clinic.
Health Director Daniel Tsai presented the proposal to the Health Commission — at a budget hearing and again at what is known as a Beilenson Hearing, which California law requires before a local government significantly reduces or eliminates certain health care services.
“There’s no decisional vote today,” Tsai told the commission, adding that the department was, “required to hear from folks” and that public comments would be passed along to the mayor’s office “as part of the budget process.”
Patients, clinicians, union representatives and community organizations attended the hours-long meetings in an effort to persuade Mayor Daniel Lurie and the Board of Supervisors to preserve funding for the clinics.
“It’s been overwhelming, this whole process,” said Susanne Zago, a behavioral health clinician at the Cole Street Youth Clinic. “There’s so many different currents going on, and different debates, so it’s hard to keep track of everything.”
Padilla said she felt that the proposed closures were not presented straightforwardly.
“Because of the lack of transparency from DPH, it’s all mixed together with this budget, it’s very confusing, and it impacts the most vulnerable people in the city,” she said.
The Department of Public Health did not respond to questions about whether it considered the clinic consolidations budget decisions, operational decisions or operational decisions undertaken to achieve budget savings, or whether the department could reverse the consolidations without further action by the mayor or Board of Supervisors.
Department and clinic staff clash
In statements to news media and the Health Commission, Department of Public Health leadership said the proposed reductions emerged amid an unprecedented fiscal squeeze on San Francisco’s health system. City officials said federal and state changes to Medi-Cal and Medicaid funding had opened a $643 million, two-year city budget deficit, including roughly $306 million tied to reduced health care revenues.
Although Lurie has proposed increasing the department’s general fund support by more than $300 million to cushion those losses, his office has directed the department to identify an additional $40 million in ongoing reductions — split evenly between personnel costs and contracted services — to help balance the city budget.
Department leaders justified by the decision by saying the clinics serve a relatively low volume of patients. Clinic staff disputed that assessment.
Zago said the department artificially depressed patient volume through years of staff vacancies and repeated employment shortages, which forced shorter operating hours and limited outreach, making it inevitable that fewer patients would receive services.
“Throughout the years, they kept cutting and cutting and cutting positions, which then led to understaffing, and which then led to clinic closures,” she said. “We used to be open five days a week, and just before they made this announcement, we were open two days a week.”
Melisa Ram, program director at South East Mission Geriatrics, said the clinic was intentionally structured to serve a smaller number of patients with more intensive needs while providing care across multiple health programs.
“We serve older adults who often are overlooked, individuals who are isolated, medically complex, and navigating some of the most vulnerable stages of their lives,” Ram said.
Staff and advocates said replacing these programs with general adult primary care overlooks the expertise and relationships that make both models effective, and many patients are unlikely to transfer successfully if familiar providers and trusted locations disappear.
“It took 30 years to build these models through trials and errors,” Zago said. “It’s a very specialized, very niche type of services, and that will disappear.”
The Michael Baxter Larkin Street and Cole Street youth clinics provide integrated primary care, reproductive health care, behavioral health services, case management and referrals for adolescents and young adults, many of whom are experiencing homelessness, poverty, trauma, discrimination or unstable housing. The clinics are embedded within youth-serving organizations, allowing patients to receive medical care, mental health treatment and supportive services in settings designed for young people.
Similarly, the South East Mission Geriatrics clinic cares for older adults, a population more likely to have multiple chronic illnesses, complex medication regimens, mobility limitations and age-related health conditions that often require coordinated, multidisciplinary care. Unlike general primary care, geriatric practices target the medical, functional and social challenges associated with aging.
“I’m emotional today because I know the suffering this will cause. These cuts are going to kill,” said Francisca Oropeza, a South East Mission Geriatrics behavioral health clinician. “This is the last mental health clinic for older adults. Have compassion. This is fiscally irresponsible and criminal, to be honest with you.”
Negotiations are ongoing
Clinic employees said they have been frustrated by what they describe as a lack of meaningful involvement in decisions about how services will be reorganized.
Jennie Smith-Camejo, who handles communications for Service Employees International Union Local 1021, said the union is using impact bargaining over layoffs and budget cuts to secure a pilot program for the youth clinics and a formal “meet and confer.” She said the process is intended to include the voice of clinic employees.
“Representatives of the folks who are actually working in those clinics should be part of that process,” she said.
Smith-Camejo said the meet-and-confer process will begin July 15 and continue “pretty much like indefinitely,” adding that “our goal with this is to keep those clinics open and to keep them properly resourced.”
