Audit the Health Department
San Francisco Business Times - November 16, 2007
by Arthur Bruzzone
With just a quarter of Chicago's population, San Francisco's $6.4 billion budget is $400
million greater than that of the "Windy City."
Of San Francisco's huge budget, only about $1.5 billion is discretionary, and, of that, two
thirds goes to the Department of Public Health -- a billion-dollar department that has
never been audited.
That's correct. Nearly $1 billion goes to a department that has never been audited, at least
not in the memory of DPH spokeswoman Eileen Shields, not in the memory of Controller
Ed Harrington, and not in the memory of Budget Analyst Harvey Rose since Rose took
office in 1971.
We're not talking about a performance audit, just a study of where and how the $1 billion
is spent. Now a performance audit would show much more. Performance audits uncover
whether a private or government entity is "achieving economy, efficiency and effectiveness
in the employment of available resources," in the words of Wikipedia. Because nonprofit
entities provide a significant and indeterminate array of services for the health
department, any performance audit must include how efficient and how successful outside
contractors have been in carrying out the functions of the DPH.
For example, in 1995, the voters mandated a performance audit of Muni, the city's transit
system. Many of the findings uncovered inefficiencies. On-time performance was a key
benchmark. We learned that while our transit system drivers enjoy nearly the highest
salaries in the country, the system had one of the worst on-time performance records --
still the case 15 years later.
An audit of the DPH would have surprises. That's predictable for an agency that's never
been audited. Since voters next November will be asked to approve a $800 bond measure
to rebuild the city's General Hospital, they deserve a full performance audit of DPH. In
fact, let's go a step further: If the hospital bond measure passes, voters should mandate
that the bond proceeds can't be expended until an outside contractor completes the audit.
City taxpayers pay for America's most expensive per capita city government. With rising
health care costs and an aging population, they deserve to know how efficiently DPH
expends it's $1 billion budget -- before we hand over another $800 million.
Audit San Francisco's health department
Arthur Bruzzone is host and producer of the weekly Comcast/SF TV series "San Francisco/unscripted."
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