Board of Supervisors Budget Hearing — 2026-06-16

All right, good morning everybody. I will call to order the June 16th 2026 meeting of the Santa Barbara County Board of Supervisors and the budget hearings for the fiscal year 2026 through 2027. Madam Clerk please call the roll.

Chair Nelson and members of the board, I do have a few announcements this morning regarding public participation. For members of the public wishing to address the board they will have opportunity to provide comments at the conclusion of each functional group presentation. If you are registering to speak via Zoom please indicate the specific functional group you wish to comment on during your registration. For more information on the Board of Supervisors methods of public participation and instructions on how to provide public comment on items listed on today's agenda or during general public comment, please refer to page 2 of the agenda. Individuals who wish to provide verbal public comment may do so via Zoom by registering in advance using the link provided on page two.

Please note that Zoom is available solely for the purpose of providing verbal public comment and is not intended for viewing the meeting. Alternative viewing options are listed on page 2 of the agenda. If you have any questions, please contact the clerk at the board's office at area code 805-568-2240 again that number is 805 568 2240 and that concludes my announcements for today.

All right thank You Madam Clerk now this time for the members of the public to speak on items that are not on today's

Chair Nelson and members of the board we do have three requests to speak from the public in general public comment today.

All right let's go ahead and get that started and then let's close general public comment.

We will begin here in Santa Barbara with Gregory Lawrence Riker to be followed by Cesar Peralta. Gregory?

Welcome, Mr. Rucker.

Good morning, Bob, Chair and the members. I'm here about this notice and other notices for to vacate a property after during the safe parking program people are allowed to park in certain parking lots for the night And there's some vehicles that pull in that are oversized, they'd end up staying more time. And for two years it's been pretty quiet at a parking lot over here in Goleta by the airport and after one person comes in and makes trash of it then it makes it a notice to vacate for everybody so And that's a reactive system. What I'm thinking about is the proactive system, and Rocky Nook Park has a steward or a park host.

And there's unhoused professionals out there where they were displaced from their homes and in their vehicle. And a lot of times are oversized. And there's a liability issue when they're on the street more than If they're in a park and stable. So with the Rocky Nook type of attitude, you could take the adopt-a-park program which I know about and then stewardship commandeering partnership on an urgency situation to get these people instead of liability driving down the road It allows them to stay in a place but have it more structured where you have a few people that are professional on the property that are unhoused and put them on a board together, three people or five people to decide who can pull in and stay.

And in a temporary basis, like a proving ground kind of situation to see if it works. But when you put these systems together, it's not changing regulation. It's pretty much putting them together like my past is equipment I brought into Santa Barbara the sonar electronic locator LiDAR systems, video pipeline inspections system and the trenchless technologies.

And that's one of my talents is connecting things. I didn't invent them but I brought the systems into the infrastructure. So it's one of my things I can do pretty good is seeing the overall picture and putting it together. And that's what I see for the safe parking program and getting people more more stable because this just notice just displaces a bunch of people back on

the street. Thank you, Mr. Riker that is your time but we do have your contact information I also believe our community services department some of the members are here today they may be able to reach out to you right away or if you have a number where with they can contact you take a potential follow-up

phone and I'm working on this Sunday with a lot of people there on that lot

all right thank you Mr.

Riker.

We will now go to Cesar Peralta then we will go to Zoom with LaWanda Lyons Pruitt. Cesar?

Hello, my name is Cesar Peralta and I'm here to request that the budget plan in all years that follow include the names and job titles to the employees of Santa Barbara California because I noticed that there has been three consecutive names that appear in the budget of 2021-2026 but they have no titles next to their name. Reese Elstad, Wesley Welch, and Stephen Yee Reese Elsted is a person who recently blocked my public records request regarding the conversations done by email between me and Madeline Orr from the Santa Barbara Risk Management Team. I was given the attachment letters regarding my complaint for my false arrest, but I was denied the conversation that I had with the risk management team. The city forced me to accept the settlement because the city management team claimed it was all the city can do that was within their budget for my wrongful arrest that caused permanent damages.

For the past four years, the Supervisors of Santa Barbara have ignored my request for an amended complaint to include damages and fines caused by the city employees. I was arrested in 2026 for failure to pay child support but I had a separated AC joint, a winged scapula, and a long thoracic nerve damage. I was denied the right to introduce my x-rays and photos as evidence, and the right to attend my civil lawsuit conferences. My arrest caused a $9000 civil lawsuit fee caused by the city employees because my civil case was dismissed based on my absence due to my arrest.

There's statute of limitations now, and every person involved that represented my child has been funded except for my child, the mother, and myself. The SB courts got paid, the county jail got credits. The public defender and the DCSS workers all got credits for pretending to care about my child but when there was no care. David Collins, Jennifer Diaz, Alicia received over a million dollars in credits for representing my child on behalf of the Child Services.

There's too many people who have benefited off my daughter's case and I feel like there's too many unethical and corrupt practices done by the representatives of Santa Barbara, California. It's not just the public defenders and the court representatives but the city leaders and the supervisors are also taking advantage of the people. And I'm hoping that the extra $50,000 you paid yourself makes you 50,000 times more efficient this year to actually do something for the people instead of doing things for yourself. Thank you.

We will now go to Zoom with LaWanda Lyons-Pruitt and we just had a late request to speak from George Alvarez here in Santa Barbara so we'll go to George after LaWanda. LaWanda?

Good morning Chair Nelson and members of the board, LaWanda Lyons Pruitt representing Santa Maria Lompoc NAACP Coming to you regarding the Santa Barbara County Youth Fund, the creation of one. We totally support it because it can help youth leadership programs, mental health and wellness services, prevention program and youth-led projects. And this is, the creation is from the cannabis tax revenue.

It's more than funding The proposal would create a youth commission so that young people can have a formal voice in county decisions that directly affect them. It can help improve school attendance, academic engagement, college enrollment and long-term opportunities for young people. We thank you for prioritizing this and thank you for your time. Have a good day.

Thank you, Miss Lyons-Pruitt.

And we will now go to Santa Maria for our final speaker George Alvarez. George?

Good morning everybody I'm here on a very serious note I didn't during your process of giving things in the agenda I didn't see it in the agenda so my concern is a It's a serious one. I can stand here before you actually represent a large population base here in Santa Maria and Guadalupe in this issue. I received the letter that you will be closing our pharmacy here in Santa Maria, and I'm trying to figure out why?

If we're going to transfer it to Lompoc, it's an inconvenience for us to go to Lompoc to pick up our pharmacy things but Why? We have over, I'd say roughly estimate 1500 people to get served here in Santa Maria. It's convenient. A large population base are minorities, Mexicans and whatnot. And I go for the three of you board members that are Democrats that since you always preach that you're there for the people it's a no brainer. You're going to vote to keep it here in Santa Maria Politics is a dirty game. I don't know if it's being played here or not, you're saving money. I don't know why we were in the deficit owing retirement funds for the people that don't deserve it. Why should I be paying retirement? Or the farm workers paying retirement for your employees when we don't get anything for ourselves and general.

So please do not shut down our pharmacy. It helps a lot of us old people get our medicine. Thank you.

And that concludes general public comment for today.

All right, with the conclusion of general public comment we will now go on to departmental item number one. Madam Clerk will you please read departmental item number one into the record?

Chair Nelson and members of the board, departmental item number one is from the county health department. It is a hearing to consider recommendations regarding a public hearing for impacts to medical services provided by the County of Santa Barbara.

All right thank you. Director Hamami

Good morning Mr. Chair, Supervisors. We're here to provide updates on some of the services that are going to be changing at our County Health Centers and with me is Lindsay Walter who is our Deputy Director for Clinical Services and to my left is Gus Mejia who is our Chief Financial Officer So the reason we are providing this as a requirement of the Beilenson Act, which requires a public hearing whenever the closing elimination or reduction of medical services.

This hearing would present an opportunity for the public to provide input to the board before you adopt the budget as recommended. The California Health and Safety Code requires as well the board to conduct a public hearing to discuss the closure, elimination or reduction of medical services that are provided by the county. It additionally requires the board to designate County Health to provide a 24-hour information service line To give eligible people immediate information on the available services and access to them, and to receive and respond to individuals and our patients who are eligible for services. We have established a 24-hour information line at 805. Oops sorry Thank you Lindsay We have established a 24-hour information line at 805-681-5100 to support our community during these changes.

In order to help us address our ongoing budget challenges while preserving access to patient care, we are proposing changes to some of our clinical services. While some of these changes will be discontinued, changes will offer more choices, better hours and more reliable access to many patients through expanded community partnerships. It is important to remember that our primary care access Our sliding fee discount scale and our financial assistance remain in place and will not be affected by those changes.

We are proposing the discontinuation of in-house phlebotomy services at the Lompoc Health Center and the Santa Maria Health Center. Currently, these are the two centers that offer on-site phlebotomy services. These are blood draw and acquirement of samples from patients. Santa Barbara Health Center discontinued on-site blood draw a while ago due to staffing limitations.

We currently offer limited hours for plobotomy services at Santa Maria Health Center. Four hours per day, Monday through Friday from 8 30 till 12 30 with the last straw at 12 p.m. The hours at Lompoc health center are from 7 30 to 5 p. m but these hour change depending on the availability of staff All collected samples are sent to Quest Diagnostics or Pacific Diagnostic Laboratories, PDL for analysis. Results are then sent back to us and our providers follow up on patients.

As an alternative, we were able to negotiate with Quest and PDL to perform the blood draws and sample collections from our patients upon referrals at their labs. This will offer a reliable consistent scheduling and better hours as Quest and PDL are open early in the morning and later in the evenings. The availability of multiple nearby labs also provide accessibility that these are within one to two miles of our health centers and impacted locations, and will improve access.

And through our contract with Quest and PDL, our patients will not encounter any extra cost for these services. Pharmacy services in Santa Barbara and in Santa Maria will shift to community options and to the Lompoc Health Center pharmacy, resulting in extended hours additional location options and more flexibility for patients at the same rate that the county offers for discount pricing.

We currently operate three pharmacies in Santa Barbara, Santa Maria and Lompoc Health Centers. Our pharmacies currently have limited hours Monday through Friday at 8 a.m to 12 p.m and 1 p. m to 5 p. M with no evening or weekend availability we are proposing the closure of both pharmacies at Santa Barbara and Santa Maria and keeping one pharmacy at the Lompoc health center We have contracted with Walgreens in Goleta, Lompoc and two in Santa Maria to dispense prescriptions to our patients.

This will provide patients that have health coverage better access due to evening and weekend hours. Santa Maria has a 24-hour pharmacy and locations that are within couple of miles of our health centers. Patients will keep the same medication pricing they receive today. And for uninsured patients, the patient assistant program participants, they will continue to receive their medications with no interruptions through Lumpoc and delivery to other clinics.

Franklin and Carpinteria Health Center pharmacy services remain unchanged as our Lumpoc health center pharmacy will be able to fill their prescriptions similar to how we were doing in the past. Some select specialty services at the Santa Barbara Health Center will be discontinued, with patients supported in transitioning to community specialists. These specialties include Nephrology, Urology, Neurology and Gastroenterology.

The Santa Barbara Health Center will continue to offer Surgery, Endocrinology, Orthopedics and Infectious Disease Specialty Services. These specialties are only offered at the Santa Barbara Health Center and are not offered at any other county clinic today. Our primary care providers in Lompoc and Santa Maria coordinate the needs for specialty care through referrals to other specialists.

A total of 792 patients per year are normally served through all these four specialties, of which 635 patients or 81% have some type of health coverage whether it is SENCAL which is the majority or MEDICAL or Medicare. Our patients in Santa Barbara have already been notified and are being individually supported by a clinical transition team that are coordinating their needs for specialty care.

It is important to remember that these patients are still receiving their primary care services at our centers, and their primary care is fully available and unchanged across all our county centers. To support this transition in Santa Barbara we have planned referrals to trusted available specialists within CINCAL Health Network. Our care teams are assisting with appointment coordination, medical record transfer, and transition of care support.

Some of these providers we currently contract with and have agreed to continue to care for transition patients at their clinics, and some even agreed to provide the discounted sliding fee rates for those that are self-pay. Since our primary care services remain fully available and unchanged across all our centers, our providers and case managers will also be able to coordinate care and address any challenges patients might encounter through this transition.

Patients will continue to receive communication, resources and support through health center staff and the 24 hour line which again is 805-681-5100. Lastly we do understand the effect of these proposed reductions on our team members. We have tried our best to support those who are affected And we are collaborating with County HR. Affected employees have been supported through job fairs, counseling and transition sources. We remain committed to ensuring that all residents continue to receive access to safe, reliable and affordable care.

We ask the board to approve these recommended actions A-C. And we are here to answer any questions.

All right, thank you Director Hamami. Before I go to public comment any initial questions from the board?

Supervisor Lavagnino. Thank you Mr. Chair. So Director Hamami can you just kind of explain the delivery system? I'm just kind of curious how that's all going to work so let's say i'm a person in Santa Maria and I'm a current patient and I have an existing prescription So I can either go to Walgreens or how's the delivery? What

so that very good question. Thank you, Supervisor. Let me start with the delivery system because this is something that we currently do for Franklin and Carpinteria. Franklin Carpinteria do not have their own pharmacy when a physician prescribes a provider prescribes a prescription it is sent to the Santa Barbara Clinic It is filled and our own carriers will take it back to one of those clinics, and patients can come and pick it up when it's available.

For This transition period, we are focusing on those that do not have other options. That means those that do not have insurance. Those that have insurance can go to any of the Walgreen pharmacies get their prescription filled immediately the same day with the same discount pricing because of our 340B contracts. Those that do not have insurance, the self-pay will have the option for the patient assistant program to have their prescriptions filled by Lompoc and delivered to either Santa Barbara or Santa Maria where they can pick it to the clinic yes okay

okay very good thank you.

All right there might be a couple more questions but let's go to public comment this time.

Chair Nelson and members of the board we have two requests to speak from the public on this item, we are going to remain here in Santa Barbara with Leo DeCasas and we will go to Santa Maria with George Alvarez. Leo?

And while Mr. DeCasa is coming up let's go ahead and close public comment on this hearing. This item

Good morning Chairman Nielsen and members of the board. My name is Leo Decasaus, and I'm here today representing SEIU members who work in our County Health Department specifically in our pharmacies, laboratories, and specialty medical services. Both our union members and the community we serve are deeply concerned and disappointed about the decision to eliminate and reduce critical medical services These are not optional programs, these are essential services that thousands of residents rely on for their health and well-being.

These programs being eliminated currently serve thousands across the county. who rely on consistent accessible care for their medical needs. The impact of these reductions is real and immediate, the county's proposing to rely on outside providers including Walgreens a non-union for profit corporation while assurances are being made about maintaining sliding fee discounts there is no guarantee that these cost protections will be sustainable for the long term The board letter indicates medications will still be available for pickup in Santa Barbara, Santa Maria.

However at the same time pharmacy technicians, the ones responsible to administer these drugs to the residents are being laid off. This raises a fundamental question I think Supervisor Lavinino referred to in his question who would be responsible for safely managing and dispensing these medications locally? Even as of this proposal, over 2,000 patients have yet to select the pharmacy.

That is thousands of individuals who are at risk of disruption and access to critical medications. In addition to pharmacy services, this proposal also eliminates specialty care. Services that are not offered elsewhere very commonly. Patients with complex medical conditions will now be forced to navigate on their own an already strained external medical healthcare system.

While we understand and sympathize with the county facing budget constraints, shifting care outward in reducing these services does not eliminate the need. It shifts the burden onto our most vulnerable residents, our most vulnerable patients and creates uncertainty. This proposal reflects a significant disruption to healthcare safety and continuity of care.

Before you adopt this budget, we strongly urge the board to reconsider these extreme service reductions and prioritize solutions that protect healthcare. Thank you.

Chair Nelson and members of the board, we will now go to Santa Maria with George Alvarez and then we will return to Santa Barbara with Mike Stoker who signed up before public comment was closed. George?

Yeah, again my concern basically is I have Medi-Cal and whatnot so I'll be taking care of from that perspective in Walgreens but the other population base isn't. And will still have to go to Santa Maria to pick up the pharmaceutical drugs that they need. The question I have is what drove this point of us being closed in Santa Maria? Isn't It would be logical to step back and say, wait a minute. We have this proposal. What are the effects if we do it now? Can we wait to figure out exactly how we can generate information and give it to the population base that's going to be non-served? Meanwhile let it be 1,500 or 2,000 people that need to be educated as to where to go those who can't pay will have to be educated The pickup is and what's going to be required of them.

And it's chaos among that population base. It bothers me because we're a rich county for every action we do, we have reactions in this case letting go some of our technicians which do a fantastic job in Santa Maria. I insurance pays for that. I pay partial sometimes. I see others that don't pay anything And I think this is more of a knee jerk quick reaction to save money. We're all trying to save money, but sometimes saving money hurts the population base. It hurts the people you serve And it solves a problem that financially looks good on paper, but in the long run people are going to be hurt by this. Before you take that step consider what's happening affecting the people that is going to affect us in the long run so please I would hold off for awhile and really study this before you pull the trigger.

Thank you.

We will now return to Santa Barbara with Mike Stoker. Mike?

Mr. Chair, I just want to make sure I'm not confused. I came in late are we were focusing on anything on item one right or are we just focusing on the pharmacies because I'm focused on health care clinics it's the whole package okay I thought it was I guess what I wanted didn't didn't want to make sure I had gone off script there Chairman Nelson, Honorable Board Members. The proposal before you would close specialty county health care clinics that provide services in four specialty areas. As a result, a total of 792 patients will no longer have access to county-provided healthcare as required by applicable laws. The staff report simply states quote patients affected by these changes have been notified and provided information about identified referral specialists.

What the staff report does not mention is how many of the 792 patients have already transitioned, how many of the referral specialists identified will accept these patients and what will happen to any of the 792 patients who do not have SenCal i.e., the uninsured? The Santa Barbara County Taxpayer Advocacy Center has been informed that many of these identified referral specialists have not even been contacted yet by the county and at this point asking if they will accept SenCal or uninsured patients. The Santa Barbara County Taxpayer Advocacy Center strongly believes that many of these specialists will not accept SenCal patients, and most likely none of them will accept uninsured patients that the county currently serves in the specialty clinics.

The Santa Barbara County Taxpayer Advocacy Center believes it is premature for the Board to approve these closures before the transition of these patients is completed. If the Board wants to proceed in this direction, the SBTCAC would support these closures under two conditions. First, the closures do not happen until all 792 patients I have transitioned to a specialist provider and second that these providers have agreed to provide those serve these services with no expectation of billing the county for the services until these conditions are met. Either patients currently being provided with health care services will be left without services and or the anticipated budget savings being represented to this board will not be realized as the county being invoiced by these private providers for these services that it will be legally obligated to pay, will end up costing the county more for paying out services to referral specialists than rendering the services through the county-operated specialty health care clinics.

On behalf of the over 350 members of the SBTAC, we encourage you not to adopt the recommendations to close a county specialty health care clinics until these two questions can be answered to the board and to the public which the Billingson Act envisions. Thank you for your time consideration on this important matter.

Thank You Mr. Stoker

And Chair Nelson, members of the board there was some miscommunication on one of our members of the public and we did have an additional request to speak that was approved by the chair. We are going to our final speaker Troy Walton. Troy?

Hello honored Board of Supervisors and Board of Trustees regarding Benson's hearing Opposition to the closure of public health pharmacy. Good morning, members of the board my name is Troy Walton I'm a resident of Santa Barbara and use County of Santa Barbara Health Clinic for my health and prescriptions. I am speaking here today to strongly oppose elimination of our local public health pharmacy services.

Losing farmers is not as simple budget adjustment It is a direct threat to the health and safety of our community's most valuable residents. For patients who rely on this faculty facility, This meeting is being recorded for the purposes of public hearing. This meeting includes low income families, seniors and fixed incomes and those managing chronic health conditions like diabetes, hypertension and asthma. Pharmacy is a literal lifeline.

Many individuals here face several barriers forcing them to travel further or navigate I urge the board to reject these cuts.

And that concludes public comment on departmental item number one.

All right, back to the board for some additional questions. Supervisor Kaps.

Dr. Hamami I know you referenced this in your opening presentation but just bears repeating can you just speak to the communication has gone to the patients already? Just elaborate a bit more.

Yes, so as we mentioned 81% of these 700 something patients have health coverage of which probably the majority have SENCAL. We have communicated with SENCAL as well as with our patients about the changes and we have acquired a list of providers that do accept SENCAL as part of their managed plan and care for that There are others, as I mentioned as well where we have our current contracted specialists that said we will even see those in our private practices. Now let's remember that some of these services are only offered through our clinics for four hours a month so we're talking about a limited number of patient per specialty that are requiring transition and several of our providers said we will be more than happy to continue seeing them As well as several that did, and we have some emails that said we will continue to provide the discounted sliding fee scale.

Now one thing to add is that Let's say a patient is struggling in finding a specialist that is still our patient, that is still being seen by primary care provider. The same way a physician, our physician or our provider in Santa Maria or in Lompoc is coordinating through all that And we are not aware of any of them ending at the ER in Marion or in Lompoc Valley Medical Center. The same process is going to be put in place and we will closely monitor and make sure, and this is why we have a transition team that is now currently evaluating each one of these cases and ensuring that those that are critical and need immediate We are coordinating with everybody, including the providers to ensure the continuity of care. Now with such transition would someone probably be more challenged or not as easy to follow up?

Probably yes but this is why we have the transition team. This is why we have case managers. This is why our providers are going to be very much on top of the issue in making sure that they provide or they find a solution for that patient

Thank you and can you speak to those patients that go to the pharmacies, what the communication has been too? I know again you've referenced it but just to elaborate a bit more.

Yeah in a similar way as well we have signs at our clinics, we also have sent letters to our patients Informing them of the upcoming changes come July 1st. We have provided the discounted pharmacies that the four pharmacies that I mentioned with their addresses or where they can get those and all that, and also ensure that those that still receive Medication through our patient assistant program would still receive those. Yes, there will be a need for them to come and pick it up at our clinic but they already come and take it from our clinic so that is not going to be a major issue.

Okay thank you.

All right thank you Supervisor Caput, Supervisor Lavinino

Thank you, Mr. Chair and I think that Supervisor Capps hit on the main thing for me is that from your answers this obviously understand this so this for us we feel like this list needs to be really managed with case management like to get a report back to see how we're doing. I mean you have a firm grasp in the numbers right now of how many people you know what the universe is and then who's going where?

This is something obviously we got to keep our eye on the ball as well, so that we don't find out a year from now that 20% of the people never got covered. I think the pharmacy makes a lot of sense to me is that there's better access now. People will still be coming into the clinic to get their medications. The phlebotomy makes a ton of sense to me. There's so many places you can go and get your blood drawn.

So I just, a report back to me would be the most important as far as continuing the outreach and then seeing how successful we are with that outreach. So just trying to make sure no one falls through the cracks.

And if I may add Mr Chair and Supervisors by Eliminating or not offering these four specialties, that does not mean that we are not looking at different models. Maybe different partnerships where we can offer a better service with more access but with less burden on us from an operational cost and these stocks have been explored and they're already in place.

All right thank you. I think it's important just to remind us all that this is not happening in a vacuum. You know, you have a budget that you're trying to balance here and so these cuts didn't come just because you were looking for efficiency measures. You had choices as a department on how to balance your existing staff, your existing services, patient care and still have a balanced budget.

Can you just speak a little bit more to just that whole process that your department went through in evaluating and finding these areas for efficiencies?

Yes. Thank you, Mr. Chair. As we presented at the budget workshop, we have been for the past several years experiencing a structural deficit and that structural deficit has been supplemented by our fund balance which is now at its lowest and probably will not be able to support our operations. Added to it some of the changes that are happening on the federal and at the state level which added insult to injury, and our deficit is too much to handle.

So whenever you're faced with that then you look at some of your operations where you can provide alternatives. Some of our costly operations that are too costly to offer and there are other alternatives that might be more affordable. And this is where you start looking at areas to balance the budget So pharmacy was definitely number one because of the rising cost of operating three pharmacies and also some of the changes that the Medicare renegotiated rates for drugs, 10 drugs this year, 25 the year after and so forth. That are going not only to add deficit to our operations this year in the pharmacy but also put our operations more at risk in the years to follow to the tune of 1.5 million if not more. So these are some of the unfortunate decisions that we had to do in order to preserve access to all our health centers.

I think mistakenly, some of the last speaker said we are closing health centers. We are not closing any of our health centers. Our health centers remain open. We are only reducing the four specialties at Santa Barbara and the two pharmacies in Santa Barbara and in Santa Maria. And lab services.

I think it's important to recognize that you guys have been eating away into your savings for quite some time, just like in anybody's household and this is going to be a theme throughout today. This is not the only department that's working through this. And I think it's also important for the public to understand that we are coming in with additional general fund this year in your department, right? So typically you're funded by state and federal dollars that are going towards public health programs. But this year we're actually gonna take general fund dollars to help supplement those programs this year. Is that correct? Yes and we appreciate the board for that.

Taking any of this lightly, I think is the point and the message that needs to get out there for the public to understand that these are hard decisions. These are efficiency measures that need to take place for us to have a balanced budget which we're obligated to do. And so again, that's going to be an ongoing theme throughout today. Supervisor Caps and then back to Supervisor Labanino.

Well, thank you. I appreciate the context setting that you just did and I also appreciate the tough decisions that are being made. I know that you came from an extremely big system prior to this. I kept a number in my head. I believe you had what was it either 9 or 15 county supervisors that you had to deal with? Something with 15, is that right? Yeah. So and many, many health centers and I know that you don't have to speak to this but you're also looking at productivity rates as well because that means more reimbursement to the clinics. And so this isn't just the only system systemic changes that you're looking at it to improve efficiencies. And, and so if you do want to speak to any other strategies, you're welcome too. I don't want to put you on the spot but I know that this is a painful one, a painful piece of it but not the entirety of the ways in which you're looking at the clinics

Yeah, thank you Supervisor. Absolutely this is a great point. I think one comment said that we needed more analysis or we should take our time. We absolutely did. And our analysis has exposed a lot of areas where we can improve such as productivity, such as schedule maximizing, such as no-show rates, such as cancellation of appointments. All these are being addressed as we speak but it also showed that 75% of our costs is through May be a little bit over relaxed staffing matrix and we had to take that into consideration. We also looked at the services that are most costly and can be provided by others, and will not cause any interruption or discontinuity of care. And these are some of the decisions that went, the factors that went into our decision and into our budget.

Thank you and I just know first and foremost the patients are on all of our minds as well as the providers many of whom we've heard from, our partner providers. And I know this is not easy and everybody is served so if they're not served in these clinics they go elsewhere and we're all very mindful of that and that is never lost on us. So thanks for the explanation.

Thank You Supervisor Kapp, Supervisor

Labadino? Thank you Mr. Chair and just kind of put things into a little perspective as well, this was actually proposed almost 10 years ago by Dr. Wada and at the time the board said well you have fund balance we know we're operating in a loss Let's go ahead and continue moving forward. And I think maybe the right decision back then, but at this point the fund balance is gone. We're still operating in a deficit and for me, and I think for all of us we're looking at this as cannot keep working in a deficit in this manner. We need to do the right thing so that we protect the other essential services that we all provide. So again nobody's doing this Haphazardly, this is well thought out by our public health department and I know we're going to keep our eye on the ball so.

Thank you Supervisor Labadino And I think this is just for the public that's watching out there. This is the same process has gone through with our other 21 departments as well, so I think this is a this one Public Health needs to have this public hearing as we talk about these cuts but just to know that we've gone through this painstaking process with all of the other departments as well as we try to balance our budget this year in a rather tough fiscal year. So with that seen and no additional lights, I'll go ahead and take a motion for the recommended actions A-C So

moved.

And I will second.