How Do You Run a Safety-Net Hospital During a Hiring Freeze?
Mayor Lurie Freezes Laguna Honda Hospital’s Hiring
Punished With Hiring Freeze, Laguna Honda Hospital Victimized by Decades-Long Mayoral Hiring Binge of Senior Managers
Including Four Balooning Departments That Need A Trim
Monette-Shaw
• • • • • • • • • • February 2025 • • • • • • • • • •
Mayor Lurie imposed a hiring freeze to close an $800 million plus budget deficit he’s facing, San Franciscans belatedly learned when the Health Commission’s Laguna Honda Hospital Joint Conference Committee (LHH-JCC) met on Monday, February 3.
Laguna Honda Hospital’s (LHH)current 85.5 vacant positions have been frozen temporarily, healthcare advocates assume. A separate “Vacancy Report with Notes by Job Code” background file, posted online, shows LHH has a minimum of 49 vacancies across 36 separate job classification codes that are frozen, including five Activity Therapists, one Activity Therapy Supervisor, one Clinical Neuropsychologist, one Clinical Psychologist, one Senior Psychiatric Physician, one Senior Occupational Therapist, and two Physical Therapist positions — all listed as “positions frozen” and all of which provide direct patient care. Why are direct patient care positions frozen?
The 49 vacancies were listed because they exceeded the 10% threshold for inclusion in the report. Most likely, all 85.5 vacancies are probably frozen, including ancillary jobs and non-clinical staff necessary to run a hospital as large as LHH.
Additionally, the report includes one “Manager VI” — presumably an Assistant Nursing Home Administrator (ANHA) position vacated by Diltar Sidhu when he was promoted to CEO and Nursing Home Administrator (NHA). Lurie may be making a huge mistake if the ANHA position is also frozen because the Centers for Medicare and Medicaid Services (CMS) had essentially ordered LHH to hire a NHA and two AHNAs as a precondition to ending its 26-month decertification and a condition for obtaining re-licensure.
Unfortunately, we don’t know yet whether additional direct patient care vacancies — including 17 Certified Nursing Assistants, 8 Licensed Vocational Nurses, 5 Registered Nurses, one Nurse Manager, and one Senior Physician Specialist — among other vacancies, are also frozen because their vacancy rates are all below 10%.
Will we find out those positions are also “frozen” only when they pass the 10% threshold? Or after LHH receives more “Immediate Jeopardy” citations from CMS threatening LHH’s license all over again?
When hiring is frozen, it typically makes patient care worse off. How do you run a hospital when these direct patient care clinical staff positions are frozen — however temporarily — to solve a City budget deficit?
What’s Lurie thinking? Is Lurie angling to get LHH decertified for the second time? Why doesn’t the Health Commission stand up to the Mayor and forcefully tell him he can’t continue adversely affecting and compromising direct patient care?
Lurie should instead be retroactively cutting massive “management fat” that has sprung up in every City department.
Mechanics of Lurie’s Hiring Freeze
The Westside Observer learned that Mayor Lurie’s Office implemented the hiring freeze on Wednesday, January 9, canceling all City employee position hiring requests previously approved, which now may not be filled unless re-approved by the Mayor’s Office. That’s a good start.
News sometimes travels slowly in San Francisco City government.
Admirably, Mayor Lurie wants to address the City’s structural fiscal deficit while ensuring the City provides excellent service to San Franciscans and, apparently, to our tourist industry that the City relies on so heavily for revenue.
Going forward, all positions will require the Mayor’s Budget Office review and approval. The hiring freeze instructions to City Department Heads outline how the process works going forward.
The Mayor’s four new Policy Chiefs and the Mayor’s Budget Office will review requests for exemptions to the hiring freeze once per month. City Departments were instructed to prioritize and submit all positions each department would like approved for the next two months by Friday, January 31. The prioritized requests will be reviewed and decided during the first two weeks of February. The next additional approvals to fill positions will be February 28. Thereafter, requests for exemptions to the hiring freeze will be reviewed once per month.
While this represents a good start, Mayor Lurie’s team needs to retroactively review and begin eliminating the bloat in City employee hiring — starting with the glut of senior manager hiring — since Fiscal Year 2010–2011, which began on July 1, 2010.
Combined, the four departments added a total of 367 additional senior managers at an increased cost of $88.5 million ... 21 senior managers each make more than the President of the United States, whose salary is currently capped at $400,000.”
City Employee Hiring Spree
The total number of City employees added to the City’s payroll since FY 10–11 has mushroomed by 8,605 (to a total of 42,584 full and part-time employees), excluding San Francisco Superior Court employees, per the City Controller’s annual payroll databases — at an increased cost of $2.4 billion, which payroll totaled $4.88 billion as of June 30, 2024 (nearly doubling since July 2010 and representing a 95% change increase). The City likes to claim it has approximately 34,000 employees, which the City creatively claims are so-called “full-time equivalents” (FTE’s). One employee working 40 hours weekly for 52 weeks equals 2,080 hours, deemed to be a 1.0 FTE.
But, there were actually 42,584 named employees on the payroll as of June 30, 2024, including some named employees who work in two different job classification codes. Converting the total “regular pay” hours worked by the 42,584 employees to “full-time equivalents” yields 32,786 FTEs. But adding in the total “overtime pay” hours worked by the 42,584 named employees yields an additional 2,352 FTEs, bringing the total FTEs to 35,138 FTEs, not the 34,000 the City likes to claim.
Lurie should consider a retroactive review and scale back, or “claw back,” the glut of City employees hired since Fiscal Year 2010–2011 in specific areas.
Lurie Should “Claw Back” City Employee Bloat
Mayor Lurie and his budget team need to take a serious look at the increased bloat in City hiring under Mayor Ed Lee and Mayor London Breed, particularly starting in Fiscal Year 2010–2011, which started on July 1, 2010. Then, begin rapidly eliminating that bloat.
City Controller payroll database records show San Francisco had 33,979 employees on the City payroll in FY 10–11, which grew to 42,584 employees at the end of FY 23–24 (ending June 30, 2024), an increase of 8,605 employees — a 25.3% change increase. Their combined total pay (excluding fringe benefits )skyrocketed by 94.8%, from $2.5 billion to $4.9 billion, a whopping $2.4 billion increase.
A granular analysis of the payroll database records shown in Table 1 suggests nine areas of interest that Mayor Lurie should consider scaling back, imposing “claw backs” to reduce the size of City government. Imposing a hiring freeze will not solve the root cause of the increased bloat.
The nine areas include increases to staff in the Mayor’s Office, massive increases in senior city managers across all City departments, public relations (PR) staff across all City departments, “public service aides” citywide, community police service aides, and three areas within SFMTA: mid-level MTA managers, MTA administrative analysts and management assistants,” and MTA transit planners and operations staff.
Of note, the three SFMTA subcategories include an additional 470 employees (a 264% change increase) at an increased payroll cost of $301.5 million (excluding fringe benefits) — representing a staggering 406.3% change increase.
Those initial nine areas involve an increase of 1,317 additional employees (a 45.3% change increase) at an increased payroll cost of $301.5 million (excluding fringe benefits) — a whopping 192.4% change increase!
Table 1 also shows a separate Department of Public Health category of an additional 1,875 psychiatric staff, medical MDs, and nursing staff, at an increased cost of another $300 million, representing a 103.8% change increase in payroll. That category may also be worth Mayor Lurie’s budget staff review, given that it is completely separate from SFDPH’s external non-profit sector contracting for similar external staff and service provision.
Specifics about the nine main categories follow.
Citywide Senior Manager Bloat
Table 2 shows the increase in Senior Managers by job classification code number between FY10–11 to FY 23–24, with an increase of 770 senior managers (a 94.8% change increase) from 812 senior managers in FY 10–11 to 1,582 in FY 23–24 at an additional cost of $190.4 million (excluding fringe benefits), again for a staggering 173.9% change increase.
What has changed over the 14 fiscal years that required hiring another 770 senior managers to run the same number of City departments? And why have there been eight additional job classification codes for senior managers since FY 10–11?
Table 3 shows the increase of the 770 additional Senior Managers among the 56 City departments. Table 4 is an extract from Table 3, showing the increase in Senior Managers in the top 14 City Departments. Of note, the 14 top departments account for 647 (84%) of the additional 770 city managers, at an increase of $157.2 million (82.3%) of the total pay increase of $190.8 million.
Four of the 14 departments shown in Table 4 include:
The Department of Public Health, which added 138 additional senior managers at an increased cost of $32.2 million,
- The Public Utilities Commission added 111 additional senior managers at an increased cost of $25.4 million,
- The SFMTA added 67 additional senior managers at an increased cost of $18.5 million, and
- The Human Services Agency added 51 senior managers at an increased cost of $12.2 million.
Combined, the four departments added a total of 367 additional senior managers at an increased cost of $88.5 million. What essential job functions had changed at those four City departments so much since FY 10–11 to justify the need for so many more senior City managers?
Of note, of the Senior Manager job classification codes listed in Table 2, there are now 21 managers who make over $400,000 in total pay (excluding fringe benefits at a combined cost of $7.9 million, compared to none in FY 10–11. These 21 senior managers each make more than the President of the United States, whose salary is currently capped at $400,000. That’s like our little City of San Francisco having 21 Presidents.
Also, by comparison, in FY 10–11, San Francisco had just one senior City manager paid over $300,000. However, as of June 30, 2024, the City now has 72 senior managers paid over $300,000 at a combined cost of $24 million.
And of interest, across all job classification codes (not just senior managers), in FY 10–11, the City had just 5 employees who made more than $300,000 in total pay (excluding fringe benefits), compared to the now 996 City employees who earned more than $300,000 in total pay, at an eye-popping $357.4 million in FY 23–24, ending June 30, 2024.
No wonder Mayor Lurie is facing an $800 million budget deficit!
Are all these 996 employees — paid over $300,000 annually — political patronage hires, or is it just the senior city managers?
Municipal Transportation Agency Bloat
Table 5 primarily shows the increase of mid-level management at SFMTA between FY 10–11 and FY 23–24. At the top of Table 5 is a breakdown by job classification code of the now 175 senior managers at SFMTA, which was included previously in Table 3 (Senior managers by City department). They’re repeated in Table 5 (but not double-counted in the total headcount of senior managers and costs included in Table 1) for convenience.
Transit Supervisors monitor and ensure that the transit vehicles run on time according to schedules. But even with the additional 221 Transit Supervisors, bus and subway runs don’t run on time. Why not?”
They’re broken down by job classification code to examine SFMTA’s need for 66 more Senior Managers, including 35 additional Manager IIs and 21 more Manager IVs.
The main purpose of Table 5 is to focus on the additional 470 mid-level managers, transit planners, Operations staff, administrative analysts, and management assistants at an increased cost of $63.4 million. The addition of the 470 mid-level employees is a 264% change increase (from 178 to 648). The increased $63.4 million cost (from $15.6 million to now $79 million) represents a massive 406.3% change increase. Why were so many more mid-level MTA employees added?
The 470 greatly exceed the increase of just 325 additional Transit Operators and bus drivers.
Knowledgeable insiders at SFMTA believe many of the SFMTA’s mid-level staff hiring binge were appointed under patronage hiring by MTA’s former General Manager Jeffrey Tumlin, Julie Kirschbaum (who rose through the ranks from Transit Planner V in FY 10–11 to Deputy Director II), and by Leda Rozier (a Senior Personnel Analyst in FY 10–11 promoted to Manager VI currently).
Many current MTA employees believe Ms. Kirschbaum is not qualified to be the Acting Director of Transportation for SFMTA.
A long-time, 30-year SFMTA employee notes:
The increase of 34 additional Transit Planners in the 5288–5290 series positions — from 34 in FY 10–11 to 98 in FY 23–24 — needs to be dramatically reduced. They are devoted to creating havoc with the creation of slow streets so people can bicycle, skateboard, etc. Streets are made for cars and transit vehicles, taxis, SFMTA paratransit, etc. We would likely survive with four Transit Planners, at the most.
- The addition of 161 Administrative Analyst and Management Assistant Analyst positions to the total of 243 that MTA presently has (representing a 196.3% change increase), at an additional cost of $19.5 million (a 315% change increase), is unnecessary. The Mayor needs to cut those positions.
- Adding 89 more 8214 and 8216 Parking Enforcement positions at an additional $14.8 million. They aren’t needed.
- Adding 221 Transit Supervisors in job classification 9139 — known colloquially as “Street Inspectors” within MTA — from 30 to 251 (representing a mind-blowing 736.7% change increase) at an additional cost of $30 million (an even higher 816.9% change increase — wasn’t necessary. Clerical employees could be hired to do their work. It is hard to pin down exactly where, what, and how the Transit Supervisors work.
Why did SFMTA add 23 Public Relations staff (a 383.3% change increase from 6 to 29) at an increased cost of $2 million (another massive 429.6% change increase)? What changed that MTA’s PR staff needed to be beefed up so much?”
Transit Supervisors monitor and ensure that the transit vehicles run on time according to schedules. But even with the additional 221 Transit Supervisors, bus and subway runs don’t run on time. Why not? The division runs like a fiefdom. The Transit Operations Division, run by Leda Rozier, is thought to be a “closed shop,” meaning only friends or relatives are hired. Hiring is an incestuous process. Are jobs filled more on a “Who you know, not what you know” basis or those who kiss the ring? That is why there are no real accountability measures, just made-up data.
- Why did SFMTA add 23 Public Relations staff (a 383.3% change increase from 6 to 29) at an increased cost of $2 million (another massive 429.6% change increase)? What changed that MTA’s PR staff needed to be beefed up so much?
The 30-year employee source at MTA notes: “With Julie Kirschbaum taking over as acting Director of MUNI and Rozier running Transit Operations, we just haven’t seen any improvement in service delivery. The two switch Division superintendents on their whim, and there is no continuity. Morale is horrible among the ranks because of poor upper management and no real accountability.”
Public Relations and Public Service Aides Bloat
Table 6 shows a massive $33.7 million increase in the costs for PR staff and various “Public Service Aides” citywide — from $24.4 million to $58.1 million (a 138.2 change increase) between FY 10–11 and FY 23–24.
The Public Information and Public Relations staff increased by 77 positions, to a total of 105, at an increased cost of $9 million, fully a 410.7% change increase in costs. Why?
- The Community Police Service Aides soared by 55, to a total of 241, increasing costs by $14.4 million to $24.6 million. Was this for “Community Policing” and open-air drug dealing and safety efforts in the Tenderloin or, if this was primarily a staffing increase at San Francisco International Airport, which the San Francisco Police Department heavily staffs.
- Separately, Table 6 shows that although there has been a reduction in the number of employees in six other Public Service Aide job classification codes, to a current total of 1,490 such staff, their total pay has increased by an incredible $10.3 million, to a total of $22.3 million. What “value” do these employees bring to the efficiency and operations of City government?
Unfortunately, City departments frequently use other job classification codes to disguise their true number of PR staff. For instance, the Department of Emergency Managements (DEM) counts among its six Public Relations staff one job code 0941 Manager VI with a working job title of “Chief of Staff,” and one job code 0923 Manager II with a working job title of “External Affairs Manager.” Between the two positions, DEM adds another $414,809 in total pay to the costs of its additional four job code 1314 Public Relations Officers at a cost of $380,341. Combined, the six Public Relations staff cost DEM $705,150 in total pay (excluding fringe benefits). How many padded PR staff are spread out in other City Departments using alternative job classification codes at higher pay is unknown.
Mayor’s Office Expansion
Table 7 shows that between FY 10–11 and FY 23–24, the Mayor’s Office has mushroomed by 67 staff, to a total of 159 employees (a 72.8% increase), at an increased cost of $13.6 million to a total of $20.5 million, a hefty 195.4% change increase.
The increase involved 25 additional Mayoral Staff, plus 42 Community Development staff, which more than doubled to 82, presumably in the Mayor’s Office of Housing and Community Development (MOHCD). Although voters have passed several Affordable Housing Bond measures since FY 10–11, it’s not known why MOHCD needed to double in size since the City has not doubled the number of housing projects in its housing portfolio pipeline, as earlier projects have been completed and closed out.
Department of Public Health Bloat
Table 8 also shows at the top a granular breakdown by job classification code of the 138 additional Senior Managers at SFDPH, which was previously included in Table 3 (Senior Managers by City Department). They’re repeated in Table 8 (but not double-counted in the number of total Senior Managers headcount and costs included in Table 1) for convenience.
The Mayor should review the additional $300 million in staffing for the psychiatric, nursing, and medical physician increases — along with reviewing SFDPH’s overall payroll increases of $591 million from the addition of 2,931 employees in SFDPH between FY 10–11 and FY 23–24 to a total payroll of $1.1 billion (excluding fringe benefits)”
It’s not understood why SFDPH needed to add 138 Senior Managers (a 140.8% change increase) at a cost increase of $32.2 million, to a total of $45.4 million (another massive 243.8% change increase), including six new additional job classification codes with 23 additional employees that it didn’t have in FY 10-11, at an increased cost of $7.3 million. It’s thought that many of the 23 additional employees in the six new job classification codes are new hires in SFDPH’s “San Francisco Health Network” (SFHN), first created in 2013 to 2014. We don’t know yet how many total employees are in the decade-old SFHN new division, or at what total additional cost.
Primarily, Table 8 illustrates:
A breakdown of SFDPH’s psychiatric and behavioral health staff that has increased by 254 employees to a total of 504 employees, at an increased cost of $47.3 million, to a revised total cost of $63.4 million ( another massive 293.5% change net increase). This ostensibly augments the external non-profit contractors SFDPH hires to perform substance abuse and behavioral and mental health services under contracts.
- An increase of 1,678 additional nursing staff (between “facility” nursing and “specialty” nursing staff) to a total of 4,316 nursing staff, slightly doubling costs from $244 million to now $490.5 million, which is a fully 113.1% change increase.
Additionally, SFDPH has issued massive contracts for “registry and per diem” nursing staff through external staffing agencies. Costs of those contracts should be examined in light of the increases in Nursing staff hiring. Why have nursing staff expenses soared, although changes to Federal and State laws have mandated higher nurse-to-patient staffing ratios, involving higher nurse-to-patient minimum staffing hours for hospitalized patients?
- A loss of 57 medical physicians, even though the remaining 186 physicians saw a modest $6.7 million increase in total pay.
- The Mayor should review the additional $300 million in staffing for the psychiatric, nursing, and medical physician increases — along with reviewing SFDPH’s overall payroll increases of $591 million from the addition of 2,931 employees in SFDPH between FY 10–11 and FY 23–24 to a total payroll of $1.1 billion (excluding fringe benefits).
It’s not known if Mayor Lurie’s hiring freeze also mandated that there be no “promotion” or “TX-ing” (transfers) of employees from one job classification code to another job class code.
What is clear is that the Mayor’s hiring freeze, which may adversely affect the delivery of care to Laguna Honda Hospital’s patients, should be reconsidered, given the massive increases in senior- and mid-level manager hiring during the past 14 years. Nor should direct patient care to LHH’s residents suffer as a result of Mayor Lurie’s four new “policy chiefs.”
Monette-Shaw is a columnist for San Francisco’s Westside Observer and a member of the California First Amendment Coalition (FAC) and the ACLU. He is a Childless (and catless) Cat Daddy, and voter for 50 years. He operates stopLHHdownsize.com. Contact him at monette-shaw@westsideobserver.com.
Febuary 2025
