Hospitals & Clinics
September 11, 2012
JoAnn Hanson-Nortey got the awful phone call a year ago this week: Her 10-year-old son, Jordan, running full-tilt on the playground, had collided with another child and suffered a severe head injury.
“It was a freak thing,” recalls the Sherman Oaks mother. “They had banged heads running around a wall. You wouldn’t think it would be that serious, but it caused a skull fracture—the neurosurgeon said it was like a crack in an eggshell.” Had he not received immediate treatment, he could have suffered permanent brain damage or worse.
Instead, emergency medical technicians swiftly transported both Jordan and the other child, who also was seriously injured, to Northridge Hospital’s Richie Pediatric Trauma Center, which celebrates its second anniversary on October 4.
Championed by Los Angeles City Councilman Richard Alarcon with crucial assists from Supervisor Zev Yaroslavsky, state Sen. Alex Padilla (D-Pacoima) and others, the center is one of only seven such units in Los Angeles County. It is also the first and only one to serve the San Fernando Valley’s littlest trauma patients, who until the center’s 2010 opening had to be airlifted to UCLA’s pediatric trauma center or to Children’s Hospital in Hollywood.
“We have saved some real lives,” says Northridge Hospital’s interim president, Saliba Salo, noting that the so-called “golden hour”—the 60-minute window right after an injury in which quick treatment can make a life-or-death difference—is doubly important for children. Indeed, pediatric patients are so much more fragile that doctors refer to their window as the “platinum half-hour.”
“In the fiscal year before we opened the unit, we saw only eleven kids under age 14 for trauma,” says Salo. “But in fiscal year 2011, we saw 151, and we anticipate 155 this year.”
The center has been a longtime goal for the Valley, where doctors, first responders and community leaders advocated for years for its opening. Alarcon, in fact, made it a personal crusade after his 3-year-old son, Richie, was gravely injured in a 1987 car crash on Victory Boulevard; a suicidal driver rammed into the car in which the baby was riding, and because there was no pediatric trauma unit nearby, the little boy’s treatment was delayed while he was airlifted to Children’s Hospital Los Angeles, where he died the next day.
In 2005, Alarcon—who by then was in the state senate—introduced a bill to authorize California counties to levy a surcharge on traffic tickets, a portion of which would fund pediatric trauma centers. The bill was vetoed, but Alarcon introduced it again in 2006.
This time it passed, and when it was scheduled to expire three years later, Padilla authored an extension. Los Angeles County Supervisors, meanwhile, agreed to levy the fine here, and to tap the so-called “Richie’s Fund” revenue to help launch the unit. Although private donations to the hospital remain crucial, the county’s funding distribution to its trauma and emergency care network has since included $1.6 million in startup operating funds for the center in 2011 and $1.74 million this year.
County health officials report that the Northridge unit not only hastens care for the Valley’s trauma victims, but also shortens wait times at the county’s other trauma care units by lightening the patient load elsewhere. Before Northridge Hospital was certified as a pediatric trauma center, every young trauma patient in the Valley or even points north of the county line had to be transported long distances to receive care, usually to Children’s Hospital in Hollywood or to UCLA. This year, nearly 42% of them have remained in the Valley for treatment.
The unit this year treated children from 47 cities and from as far away as Sacramento County, though the bulk of its patients come from the Valley. That proximity is key because having family members at hand plays a big part in a child’s recovery, says Melanie Crowley, who manages the hospital’s trauma program.
“If you or I had a child transported to UCLA or Children’s, we might wonder which car we were going to take to the hospital to see them,” says Crowley. “But a lot of our families don’t even have cars. They have to decide which bus to take.”
Crowley says the center’s cases run the gamut. “But the ones that stick in my mind are the ones that happen just because of the normal things that kids do. Kids who were just jumping on the couch when they fell and got a bleed on the brain. Kids who chased a ball out onto the street and got hit by a car. Kids injured because a car seat was installed improperly.”
And kids like Jordan, who, because the Richie Center existed, was getting a CT scan in preparation for neurosurgery within 45 minutes of his accident.
“The doctor literally called me from his car on the way to the hospital to explain the operation,” recalls Hanson-Nortey, a single mother who remained at her son’s bedside, 24-7, for the next five days. After some physical therapy, he was home, and 3 months later, Jordan was back to school full-time.
“I probably could have gone back in like a month,” the now-11-year-old boy says, “but my mom wanted to be safe.”
Since then, his scars have healed, his hair has grown back and he plays tennis and begs his mother to let him play football—in vain. She says she has seen a side of her son that is braver than she had ever imagined; he says he’d like to be a policeman someday.
“I wasn’t that scared because I knew the doctors were going to make me better,” he says now. His mother’s perspective is slightly different.
“The people at the hospital turned something really awful into something that was just pretty bad that we could get over,” she says.
August 11, 2011
Most of us are familiar with “urgent care” as the place to go when a medical situation’s not dire enough for the emergency room—but too serious to ignore.
Now apply that concept to mental health issues and you’ll have a picture of what the county’s now offering in a newly-opened facility.
The Olive View Community Mental Health Urgent Care Center, located at 14659 Olive View Drive in Sylmar, is expected to serve 5,000 people a year and to relieve crowding in the psychiatric emergency room of the nearby Olive View-UCLA Medical Center by assessing and treating patients in psychological distress, as well as helping them to swiftly secure follow-up care.
The facility is not just state of the art, it’s full of art—funded under the county’s Civic Art policy and created by Amy Trachtenberg and Jeffrey Miller. Artful elements in the new center explore bright yet soothing motifs, imbued with natural elements. The message—architecturally, artistically and clinically—is one of healing and hope.
The $10.8 million, 10,800-square-foot project—which has earned LEED silver certification—will serve clients from the San Fernando, Santa Clarita and Antelope Valleys. The new facility will allow the county to serve an additional 2,000 people a year. Its opening comes as economic pressures and joblessness are adding stress to the lives of many.
“Opening this new mental health facility today could not have come at a better time. It’s not a moment too soon,” Supervisor Zev Yaroslavsky said. “Demand for our services is going up.”
Here’s a look at the new facility, inside and out:
November 4, 2010
In the public imagination, San Francisco and Los Angeles have long been California’s odd couple. They’ve got cable cars, we’ve got freeways. They’ve got cioppino, we’ve got burgers. They’ve got the pennant-winning Giants, we’ve got…oh, never mind.
But soon San Francisco and L.A. will have someone very important in common:
Dr. Mitchell Katz.
Katz, San Francisco’s top health official since 1997, is set to leave the City by the Bay to become L.A. County’s director of health services in January.
His charge: to lead the vast county health care system into the future—fast. In the course of the next three years, Katz and his department will seek to reshape how care is delivered here. That means implementing national health care reforms that emphasize preventive care and increase access to outpatient services rather than continuing to pour resources into the large public hospitals that have long been the cornerstones of the L.A. system.
“Something I’d like to work on in Los Angeles is creation of a comprehensive ambulatory care system that includes both the private providers and the public providers,” Katz said, describing the county as the “glue” that would unite the systems. “Every clinic has to be clearly connected to a hospital that takes their referrals.”
He also wants to create a “system of record” in which each patient will have a “primary care home” and medical records in a centralized registry. That will make it easier for providers to know, for example, which patients have diabetes and to make sure they keep up with the eye exams their condition requires.
Katz, 50, said he is a “change agent, not a figurehead.” Even as San Francisco’s top health official, he still makes a point of working as a hands-on doctor for about one day a week—something that the Harvard Medical School grad intends to keep doing when he gets to L.A.
“You find out what’s working and what isn’t,” he said. Moreover, the frontline work creates credibility and a sense of shared understanding with the staff—which are important when it comes time to propose new ways of doing things.
“The natural response to an administrator is ‘You don’t know what it’s like to take care of our patients.’ Well, no one ever says that to me.
“When I’m in my room, I have my stethoscope, my prescription pad. I’m like anyone else.”
Katz, who will earn $355,000 a year in L.A., was recruited to come here two years ago but declined, citing unfinished work in San Francisco. That included seeing through the implementation of the award-winning Healthy San Francisco, a voluntary universal healthcare program that provides coverage to more than 54,000 people.
Making the move now, he said, just “feels right.” Many in the Los Angeles County Health Department, which is battling a large deficit and has not had a permanent leader for more than two years, have reached out to him by phone or email since his appointment, offering to do “everything they can to help me,” Katz said.
While Katz believes L.A. and San Francisco are far from polar opposites from a health care perspective—“I think they are more alike than different”—he knows that his management approach will have to change somewhat when he makes the move.
“I’m a very hands-on person,” Katz said. “I know every single health center in San Francisco that’s part of my department. Most of them I’ve actually worked in as a doctor. I can bicycle to any of them.”
In L.A., “I have to think of a completely different way to be. You can’t do a lot of walking around when it takes two hours to drive somewhere.”
The county’s vast sprawl can be even more daunting if you’re a self-described bad driver.
“I’m terrible!” Katz said. “It’s certainly going to be a challenge to me.”
Katz, a committed bicycle commuter in San Francisco, said he can often be seen pedaling around town in tie and jacket, his backpack stuffed with papers. “It’s not unusual,” he said, “for someone to yell out, ‘Hi, Dr. Katz!’ “
After he moves to L.A. in January (his partner, Igael Gurin-Malous, a teacher, and their kids Maxwell, 8, and Roxie, 6, will join him when the school year is over) Katz intends to continue his cycling ways.
He’s looking for a house in a neighborhood, perhaps Silver Lake or Los Feliz, that’s within biking distance of his new office and County-USC Medical Center. He knows he will need to get behind the wheel to get to more far-flung hospitals such as Olive View-UCLA Medical Center in Sylmar. “I’ll just have to do it,” he said.
But he doesn’t sound like he’s planning to become a Southern California car culture convert any time soon.
“I do not love cars,” he said. “I think that the world would be a better place if more people bicycled.”
November 3, 2010
After more than a year of tortuous negotiations between state and federal health officials, it was announced this week that California will receive $10 billion in health aid during the next five years through the renewal of its ongoing Medicaid waiver.
The infusion of new federal funding will expand health coverage for uninsured low-income residents, improve access and quality of care for seniors and the disabled, and help implement federal health care reform when its new rules take effect in 2014.
The negotiations took place between the Centers for Medicaid and Medicare Services and California’s Department of Health and Human Services.
The County of Los Angeles—constituting roughly 30% of the state’s population but 34% of the state’s medically indigent and 36% of those living below the federal poverty level—will be a major beneficiary of the aid. Those funds have helped to underwrite the County’s continuing reform and restructuring efforts since 1995, when the Clinton Administration granted the initial five-year federal waiver under Section 1115(a) of the Social Security Act.
That waiver allowed Los Angeles County to reconfigure its health-care services, creating public-private partnerships with non-profit community-based clinics and expanding ambulatory and outpatient services with federal money. This was accomplished by “waiving” federal requirements that had restricted the funding to reimbursement for in-patient hospital services, the costliest type of medical care.
To learn more about the recently approved agreement, formally known as California’s “Bridge to Reform: A Section 1115 Waiver Proposal,” visit the California Department of Health Care Services site here.
September 29, 2010
Supervisors on Tuesday approved $1.1 million to staff a new ward for patients with tuberculosis and other infectious diseases at Olive View-UCLA Medical Center, clearing the way for the facility to begin operating next year.
The supervisors’ decision to fund the unit came as a result of a motion by Supervisors Michael D. Antonovich and Zev Yaroslavsky. The money will be enough to staff the unit, set to open in March or April, for just half a year. Going forward, it will cost $2.2 million annually to staff the facility—less than was originally envisioned because of lower operating costs and more potential revenue from moving patients into the facility from other parts of the system. Even the reduced costs, down from $4.6 million originally estimated, will add to the department’s deficit but also will provide needed health care beds for infectious disease patients elsewhere in the overcrowded system.
“It does not make sense for this brand new building to sit empty [when] for a relatively small cost, it could be part of the solution to overcrowding in the hospitals and provide more appropriate care to these long-term patients,” the supervisors’ motion said.
Tuberculosis has been declining for years in Los Angeles County, but public health officials say it is important to remain vigilant. The new ward is seen as an important resource for treating some patients who require long-term hospitalization, including the homeless and those who live with small children and people with compromised immunized systems. The county lost its only dedicated tuberculosis ward when High Desert Hospital in Lancaster closed to inpatients in 2003.
The new Olive View facility also could be used to treat victims of a bioterrorism attack, and, on a more routine basis, for patients with infectious diseases other than tuberculosis. Such patients now often are confined to isolation rooms within intensive care units but could be relocated once the Olive View facility is up and running.
Carol Meyer, chief of operations for the Department of Health Services, said the decision to fund staffing for the new facility was a mixed bag: an added ongoing expense for an already financially-troubled system but, “from a patient perspective, it’s a positive.”
August 10, 2010
A seven-member board of directors for the new facility, being created as a partnership between the county and the University of California, was approved Tuesday by the Los Angeles County Board of Supervisors.
The board’s members, who came jointly recommended by the county’s Chief Executive Office and the UC, are Southern California leaders in the fields of medicine, health care management, business and law. (See bios below.)
One of the appointees, Paul King, the president and chief executive officer of Children’s Hospital of Los Angeles Medical Group, said the array of talent and experience on display among his new colleagues would be enough to intimidate many hospital administrators.
However, he said, this will be a board “that understands the difference between governance and management.”
The directors, who are expected to come together soon for their first meeting, will work with the project’s management team as it moves toward opening the facility in 2013. Under the agreement, the county is funding and rebuilding the facility to modern seismic standards while the UC is taking charge of all physician services there. The private, non-profit hospital will have 120 beds.
It will replace the former Martin Luther King Jr./Drew Medical Center, which closed to inpatients in 2007 after years of mismanagement and patient care lapses. The idea of joining forces with the UC to create the new hospital was first proposed by Supervisor Zev Yaroslavsky.
Helping to restore a crucial health care provider to people in South Los Angeles is a strong motivator for the directors, who will serve without pay.
“I think it’s an exciting time,” said one of the new board members, Manuel A. Abascal, a partner at Latham & Watkins. “I think every community deserves great health care.”
Other new directors echoed that sentiment. “I really believe that the South Los Angeles community deserves better access to quality health care,” said Dr. Elaine Batchlor, chief medical officer of L.A. Care Health Plan.
But no one was underestimating the size of the challenge ahead.
“It’s going to be quite the task,” King said. “Most of us who’ve been approached look upon this as a community service, seeking to really return health care to that community…We’ve got a lot to do. 2013 will come faster than anybody thinks.”
Manuel A. Abascal…
is a Los Angeles attorney who often works on health care cases.
Dr. Elaine Batchlor…
is Chief Medical Officer of L.A. Care Health Plan.
is president and CEO of Griego Enterprises, Inc.
is president and CEO of Children’s Medical Group.
is the former CEO of Providence Healthcare of Southern California.
Dr. Robert Margolis…
is Managing Partner and Chief Executive Office of HealthCare Partners.
is the former president and CEO of Citrus Valley Health Partners.
July 27, 2010
That was the message Thursday as officials sounded their most dire warning yet about the state of the deficit-plagued Department of Health Services. The county will have to drop hundreds of thousands of patients and significantly downsize its health care system unless some pending state and federal funding decisions break in its favor—a prospect that is looking less and less likely as Sacramento and Washington hunker down in contentious budget struggles of their own.
“This is a situation that’s increasingly looking like it’s in freefall without a parachute,” said Supervisor Zev Yaroslavsky, as the Department of Health Services looks to bridge a deficit of up to $429 million this fiscal year.
Of the 730,000 patients now treated each year, some 420,000—more than half—could be turned away, according to a motion by Supervisors Gloria Molina and Yaroslavsky. The cuts would seriously harm some of the sickest people in the county, and also would hamstring the county’s ability to transform itself to meet the demands of federal health care reform, the motion said.
Supervisors approved the motion, directing officials to provide a detailed worst-case analysis in 15 days, after budget updates from the health department and Chief Executive Office provided only a general overview of what will happen if federal and state funding relief does not come through.
The reports did not mention closing hospitals or other health facilities. But the discussion during the meeting made it clear that those actions and others may be on the horizon soon.
“What facilities are going to close? What kinds of facilities are going to close?” Yaroslavsky asked CEO William T Fujioka and Health Services interim director John F. Schunhoff.
The county is looking at three possible ways out of its predicament. There will still be a big deficit to confront, however, even if all three come through.
One hope is to obtain from Congress an extension of the “enhanced FMAP Medicaid matching rate” that would provide some $33.8 million. (FMAP stands for Federal Medical Assistance Percentages.) The measure was not included in the recent vote to extend jobless benefits, however, and it is unclear whether it will be reintroduced in another form.
Another option involves obtaining a favorable decision on the hospital provider fee the county would receive from the Centers for Medicare and Medicaid Services (CMS.)That could mean $115 million in fiscal 2010-11.
Finally, county officials have been hoping for an additional $150 million from the so-called “1115 Waiver,” which would provide support to public hospitals that treat needy patients. (1115 refers to a section of the Social Security Act that deals with how Medicaid services are provided in states.)
But those funds could end up being siphoned off by the state of California, which previously had been seen as an ally in negotiating with CMS for the waiver.
“The state’s key interest is helping to solve their budget problem for [fiscal year] 10-11,” Schunhoff told the board.
Molina, the board chair, said it is unrealistic to count on the three options coming through.
“I think we’re being overly optimistic because we haven’t solved last year’s deficit,” she said.
Yaroslavsky noted that the situation is growing worse as the health department continues to spend—with no deficit solution in sight—in the new fiscal year.
“We’re in a very serious situation,” Yaroslavsky said. “We now have 11/12ths of the fiscal year remaining, and we are still spending as if assumptions [of new revenue] are going to come to pass.”
“The longer we wait, the deeper the cuts are going to be,” said Supervisor Michael D. Antonovich.
Supervisor Don Knabe asked the CEO and Health Services chief not to simply propose shutting specific facilities, but to spread the pain throughout the county health system.
And Supervisor Mark Ridley-Thomas asked that the report include information on county departments, such as the sheriff and probation, that receive unreimbursed health department services.
Underscoring the discussion was the reality that officials here will have to work through the looming crisis, with or without outside help.
“Should the federal and state governments fail to help Los Angeles County obtain essential revenue streams…then this board must be prepared to implement these cuts,” the Molina-Yaroslavsky motion said.
June 15, 2010
Los Angeles County is spending more than $16 million to build a dedicated tuberculosis ward that also could serve as a treatment center to isolate victims of a bioterrorism attack.
But something’s missing: people to staff it.
With construction on the ward almost done and an opening to the public possible by January, 2011, there’s been no appropriation of the $2.4 million it would take to operate the facility in its first six months. The project is part of the effort to build a new emergency room at Olive View-UCLA Medical Center, at an overall cost of $53.2 million.
A lot has changed since the project to build the ward was launched in 2004. Tuberculosis cases have continued a steady decline while money’s gotten a lot tighter, with the county Department of Health Services now facing a $400 million deficit in the coming fiscal year.
The health department did not include a request to staff the unit as part of its 2010-2011 budget proposal “because of the fiscal issues at the moment,” said the department’s interim director, John F. Schunhoff.
Still, two supervisors—Zev Yaroslavsky and Michael D. Antonovich—have indicated they want to make sure there is funding to get the unit up and running when final changes to the county budget are made in September. Both Supervisors have advocated for full funding by including the TB ward’s staffing in their “unmet needs” lists submitted as part of the budget process. (For all the supervisors’ full lists, click here and scroll down.)
Unless funding is found, the 15 new Olive View isolation rooms will likely sit idle. That, in turn, could place pressure on hospitals elsewhere in the system, which must provide bed space to some infectious TB patients until they are medically cleared to leave.
Consolidating TB care in one facility would be an efficient way to make day-in, day-out use of a facility that would have an important mission during a disaster like an anthrax attack, said Carolyn Rhee, chief executive officer of the county’s ValleyCare Healthcare Network, which includes Olive View. The ward also would free up isolation beds at other county facilities for patients who need them.
The county hospital system currently has 295 isolation rooms—in which negative air pressure keeps infectious airborne particles from spreading beyond their walls.
Schunhoff noted that a dedicated facility could offer better care to TB patients because of its specialized nature. However, facilities to treat the disease—once widely feared and commonly known as consumption—have become increasingly rare, as noted in this recent New York Times article about a Florida facility that is the last of the country’s original TB sanitariums.
Los Angeles County lost its only dedicated tuberculosis ward when High Desert Hospital in Lancaster closed to inpatients in 2003. Olive View itself started off as the county’s tuberculosis sanitarium when it first opened in 1920.
But times have changed. In a June 7 letter to supervisors, County Chief Executive Officer William T Fujioka said the years-long decline in TB cases means that the number of patients eligible to be transferred to the new Olive View facility, which would have a capacity for 30, “is calculated to be as low as 6 and rarely more than 12.” The letter estimated that the county would receive some reimbursement from Medi-Cal or Medicare for treating a majority of the patients but said that would not be enough to offset the costs of operating the facility.
Tuberculosis, which preys on people with weakened immune systems, was on the rise during the worst years of the HIV epidemic, hitting a peak of 2,198 cases in Los Angeles County in 1992. As the HIV crisis was brought under control, TB steadily declined, with 706 cases reported countywide last year.
Public health officials say that’s good news—but no reason to be less vigilant about a disease that infects one-third of the world’s population and kills nearly two million people a year.
“When I trained at County Hospital in the ‘80s [when the AIDS epidemic was raging] people died left and right, like flies,” said Dr. Rashmi Jan Singh, assistant director of the county’s Tuberculosis Control Program.
“It’s still around, and just waiting for opportune conditions to create problems.”
So vigorous efforts are needed to keep TB in check, including making sure that patients continue treatment long enough to get well and avoid infecting others.
That can be a challenge, particularly when dealing with homeless people with substance abuse problems, who are among those likely to contract TB in Los Angeles.
“It’s really complex,” Singh said. “Patients take off to use drugs, to use alcohol. We have to bring them back.”
The disease is curable, but patients with active pulmonary tuberculosis must remain isolated until they are no longer infectious—which can present a problem both for the public health workers trying to make sure they take their medicine and get well, and for the hospitals that need that bed space for acutely ill patients.
Most hospitalized TB patients can leave the hospital once the acute phase of their treatment is concluded, and finish taking their medicine at home. But that’s not an option for some, including the homeless and those who live with small children and people with compromised immunized systems, like those with HIV and diabetes, who are most vulnerable to the disease. For them, an extended hospital stay is often unavoidable.
And even now, with effective treatments available, the disease can take a devastating toll.
“Its social impact is sometimes incredible,” Singh said, recalling a case in which a 28-year-old woman who hadn’t acted on her symptoms early enough died after spending weeks in intensive care at Olive View. The woman’s 10-month-old baby was infected as well, but survived and is still being treated.
“It devastated this family,” Singh said.
So from Singh’s vantage point, a dedicated TB ward at Olive View would be an invaluable weapon in an ongoing war.
“For us, as TB control,” she said, “it would be a great thing.”
April 20, 2010
Out there on the front lines of the war on contagious disease in Los Angeles, the 14 centers run by the county’s Department of Public Health have seen it all—from hepatitis A to tuberculosis.
Now the centers—which log about 280,000 visits a year—need some medicine of their own.
The new proposed county budget calls for a sweeping “regionalization plan” that would improve the bottom line for the deficit-plagued public health department, but would also lead to the consolidation or even elimination of services in many centers.
Seeking to buy some time—and perhaps ease the pain of budget-driven service cuts—the Board of Supervisors on Tuesday approved two motions seeking funding relief for the department as the county’s budget process moves forward.
Supervisors Zev Yaroslavsky and Don Knabe noted that the proposed budget submitted by Chief Executive Officer William T Fujioka already sets aside $3 million in reserve funds for use by the department, whose deficit is expected to hit $21.2 million in the coming fiscal year. But in their motion the supervisors said that $1.7 million more may be needed to preserve jobs and allow DPH a year to come up with an efficiency plan that does not jeopardize its mission to protect the public health. The motion directs the CEO and department to closely monitor this year’s DPH budget and to allow the $1.7 million carryover from any funds remaining when the new budget is finalized.
In a related motion, Supervisor Mark Ridley-Thomas asked the department and the CEO to provide before-and-after maps showing the “volume and accessibility” of public health services now and what they would be after the proposed cutbacks. He also asked the CEO to explore whether other outside funding sources could be found to help maintain service levels.
As things stand now, the department is looking at as many as 75 layoffs—out of an estimated 131 countywide. It also is facing cutbacks under the budget-driven plan to consolidate services at some centers while eliminating a number of key clinical functions altogether at its Hollywood/Wilshire and Torrance health centers.
The centers’ mission is to provide treatment and testing for TB and sexually-transmitted diseases as well as care in the broad category of “communicable disease triage.” They also offer immunizations. In addition, the centers are the launching point for the county’s public health field staff, which takes the fight against contagious disease out onto the streets and into restaurants and other workplaces—anywhere an infected person may have come into contact with others.
After the board meeting, Jonathan E. Freedman, chief deputy director of the Department of Public Health, said he was cautiously optimistic about the coming year but noted there was little financial wiggle room, given the challenging budget picture.
“We have a delicately balanced budget here with very little revenue-generating possibility,” Freedman said.
The supervisors’ public health motions were among 10 offered Tuesday, asking the CEO to report back to the board on a variety of topics as budget deliberations get underway. Public hearings on the $22.7 billion budget are set to begin May 12, with budget deliberations set to start June 7.