organizations to work with district health of- most of the next 13 months doing little else.
He
ficers in seeking federal funding for local health
programs (5).
Since 1974, however, under the leadership of
Commissioners Lowell E. Bellin and Pasquale J.
Imperato, this trend has been almost complete-
ly reversed. Their belief that the DOH should not
deliver direct personal services, coupled with the
severe demands of the fiscal crisis, has resulted
in the widespread curtailment or elimination of
many of the Department's most vital services.
The Fiscal Crisis
The fiscal crisis first received widespread
attention in November, 1974. In response to the
City's severe financial condition, New York State
set up the Emergency Financial Control Board
in September, 1975 to oversee the City's financial
plans. In one such financial plan that the City was
required to submit to the Board, the expense
budget was cut by $200 million for the fiscal
years ending June 30, 1976, 1977, and 1978 (6).
In 1975, the City's total expense budget was
slightly over $13 billion, of which 31% went
into human services. From this $13 billion, DOH
received a modest $90 million, of which only $50
million was raised from City tax levy funds. Most
of the City's operating expense budget is con-
trolled by law, funding such entitlement programs
as public assistance and Medicaid, or paying past
obligations such as debt service and pension
contributions. Budget cuts, therefore, had to
be implemented in those parts of the budget
that the City could control. These "controllable
expenses" made up $2.4 billion or 26% of the
1975 total operating expense budget (6). Virtually
all of the Department of Health's budget fell into
this category. (See "NYC Public Hospitals,"
Health/PAC BULLETIN, No. 69, March/April
1976)(7).
As early as November, 1974, the City's Office
of Management and Budget (OMB) requested that
the Department of Health terminate 57 employees
for a $1.5 million savings in tax levy money. This
request was part of an overall effort by the City to
quickly demonstrate its determination to balance
the budget in the face of possible default, and the
Department was asked to respond within 24 hours.
Commissioner Lowell E. Bellin designated First
Deputy Commissioner Pasquale J. Imperato to
10 supervise the requested cuts. Dr. Imperato spent
immediately began meeting with the Department's
top administrative staff which included Anthony
C. Mustalish, Deputy Commissioner for District
Health Services, Gerald Flanders, District Health
Services Administrator, and various bureau chiefs
to formulate a response. It was decided that the
reductions would come by virtually eliminating
such bureaus as Social Work, Nutrition and Public
Health Education, by reducing funding to the
Health Research Council, by closing three District
Health Centers, and by leaving vacant positions
unfilled.
In order to avert an administrative crisis and to
anticipate further cuts during the fiscal crisis,
Dr. Imperato and his staff formulated a com-
prehensive policy on future budget reductions.
Since 1974, under a succession of
three commissioners, the Depart-
ment of Health has been virtually
destroyed. The District Health Ser-
vices have been cut bach and rele-
gated to the status of an 'unwanted
child' while the regulatory functions
have slowly been 'adopted' by the
state
Department of Health activities were reclassified
into two categories: "life preserving" and "life
enhancing." Infectious disease control was con-
sidered to be life preserving; dental public health
was considered life enhancing. Life enhancing ac-
tivities, underutilized services and services for
which there were alternative (non-DOH) resources
received lowest priority.
For several reasons most of the proposed cuts
were in District Services, which then consumed
approximately 30% of the Department's bud-
get, about $15 million of the total tax levy,
and about half of the Department's personnel.
One significant reason was that tax revenues
could be maximized by cutting the District Ser-
vices budget since it is matched on a 1:1 ratio by
state and federal funding whereas other Depart-