OAKLAND -- Less than two months before Alameda County voters decide whether to renew a half-cent sales tax bolstering the health care safety net, a new report questions how county supervisors are spending some of the money.

The Measure A tax, approved by voters a decade ago, generated $112.5 million last year to provide medical care to indigent and low-income residents. Three-quarters of the revenue go to a consortium of public hospitals, the Alameda Health System. The county Board of Supervisors allocates the remaining $28 million, and each of the five elected supervisors gets a $150,000-a-year discretionary fund to award grants to chosen programs.

The new wing of Highland Hospital, still under construction, photographed Monday, Feb. 3, 2014 in Oakland, Calif. (D. Ross Cameron/Bay Area News Group)
The new wing of Highland Hospital, still under construction, photographed Monday, Feb. 3, 2014 in Oakland, Calif. (D. Ross Cameron/Bay Area News Group)

But how the supervisors' hand-picked programs serve Measure A's target population is often unclear, according to a report delivered to supervisors this week by an oversight group.

There should be "a more fair and equitable process of distributing the money," said John Becker, chairman of the Measure A Oversight Committee and Newark's city manager.

Many of the supervisors' favored programs do not provide direct health services and some of the providers have failed to explain how they help Measure A's intended clients, described in the 2004 ballot measure as "indigent, low-income and uninsured adults, children, families, seniors and other residents of Alameda County."


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The $750,000 discretionary pot accounts for less than 1 percent of Measure A spending, but the grants awarded by individual supervisors attracted the most concern from a 17-member oversight committee that reviews the health care expenditures each year.

The report questioned why Supervisor Nate Miley awarded about $35,000 of Measure A money to an Alameda-based marketing consultant, Hill & Company Communications, to provide "organization development leadership" to an anti-violence coalition in the unincorporated Ashland-Cherryland area. Miley also allocated about $138,000 over two years to an Oakland think-tank, the Urban Strategies Council, to provide data analysis on two health initiatives and he gave smaller grants to two organizations -- the California Product Stewardship Council and the Teleosis Institute -- that helped set in motion a new county ordinance for the safe disposal of prescription drugs.

While safer drug disposal is commendable, the oversight committee said it "questions whether this meets the letter or spirit of the Measure A statute." It raised similar questions about the other grants.

Miley strongly defended the allocations. All of them "aided in the delivery of health care services" and addressed grave health disparities in East Oakland and unincorporated areas, he said.

"It's regrettable that the oversight committee looks at it so narrowly," Miley said. "That was never, ever the intention that (Measure A) would be so narrowly interpreted."

The oversight committee, made up of a revolving crew of city officials, union representatives, physicians and civic groups, has been raising similar concerns about how supervisors spend their money since its first annual report was published in 2006.

Months after 71 percent of Alameda County voters approved the half-cent sales tax in 2004 to fortify the then-cash-strapped Highland Hospital in Oakland and other health facilities of last resort, supervisors voted to give themselves a $100,000-per-district discretionary fund to complement the larger allocations the board approves every three years. The board doubled the annual pot to $200,000-per-supervisor in 2007, then cut it to $150,000 in 2010 because of declining sales tax revenue.

There is no competitive bidding for the supervisors' grants. Supervisors can award them at any time, raising questions from the oversight committee about who gets picked and how. "From the committee's perspective, we know intuitively that there are probably others out there just as deserving," Becker said.

Supervisor Scott Haggerty, who spent the most after Miley on discretionary programs in recent years, gave $30,000 on top of more than $300,000 already awarded by Measure A each year to the Tri-City Health Center, a Fremont organization flagged by the oversight report for not explaining how it met Measure A goals. Haggerty also gave $20,000 to Fremont's Washington Hospital so it could create new labs for chemotherapy and stroke patients.

Haggerty's health policy aide, Josh Thurman, said the discretionary fund is well-known to local health providers who come to the supervisor for help.

"One of the important things is having flexibility," Thurman said, adding that the oversight group "wants to kind of take away some of that flexibility and we would rather not."

Also defending the allocations this week was the director of Alameda County's Health Care Services Agency, Alex Briscoe, who said his staff and county lawyers review all of the supervisors' grants to ensure "they are consistent with the intent, purpose and language of Measure A."

County officials are sensitive to any criticism of Measure A expenditures as they push for passage of a renewal measure, Measure AA, on the June 3 ballot. Measure A expires in 2019, but Measure AA would extend it for another 15 years. It requires two-thirds support to pass.

Supervisors Wilma Chan and Keith Carson spent the least on hand-picked programs in recent years, but Chan several years ago awarded a public relations consultant, Full Court Press Communications, $8,000 for strategic communications. A write-up by the group explaining its work showed "no numbers to indicate the clients they served, their location or the benefit of the communications," according to the oversight committee's report last year.

Becker cautioned that concerns raised by his oversight committee do not signal improper use of Measure A money. The entire committee, he said, agrees that Measure A has been a critical source of funding for the county's health safety net.

"At no time did the committee think that any of the funding was improperly allocated," Becker said. "I think it's a philosophical discussion. ... Everybody has a slightly different perspective on how this funding should be used."