Internet crowdfunding campaigns are generally undertaken by people who want to build a flame-shooting Burning Man art car or by quirky entrepreneurs who dream of opening a kitty cafe. They are generally not for established medical care services traditionally financed by Department of Health and Human Services agencies and the Centers for Disease Control.
But in Donald Trump’s America, that’s what it’s come to for the Clinician Consultation Center, a San Francisco service that provides cold, hard facts and emotional support to doctors, nurses, and pretty much anyone whose occupation brings them into risky contact with the transmission of HIV and hepatitis. The center’s Post-Exposure Prophylaxis Hotline (PEPline) is the only clinical advice center in the U.S. that provides free advice on workplace HIV questions.
But this year, the PEPline is experiencing such profound federal funding cuts that it’s been reduced to crowdfunding its own survival.
“We’ve been around for 25 years,” Brenda Goldhammer, the center’s program manager, says. “This is the first time we’ve entered a new administration where we feel pretty nervous.”
Established in 1993, the Clinician Consultation Center at Zuckerberg San Francisco General Hospital answers HIV-related questions from doctors wondering about medications’ shelf lives as well as janitors who may have been accidentally poked with a used needle.
“This current fiscal year, we realized a $300,000 cut. Then we realized a second, $160,000 cut. Both of these came as a great surprise to us,” Goldhammer says.
These cuts led to the layoffs of seven full-time employees, a drastic reduction of the PEPline hours of operation, and the possible elimination of weekend service for the hotline that currently operates seven days a week.
“These are urgent calls,” Goldhammer says, noting that many emergency room HIV exposures happen during late-night hours, leading to panicked phone calls from busy doctors and nurses. “When people call us, they’re scared. We continue to see an increase in volume of calls, year after year after year.”
Averaging 75 daily calls, the Clinician Consultation Center handled around 18,000 last year. The program is written into Centers for Disease Control (CDC) guidelines for hospital employees who may encounter workplace HIV and hepatitis transmissions, and federal prison workers are required to call the center when they encounter any HIV risks.
Bay Area nurse Tricia Cerone says she relies on the PEPline to navigate a constant stream of unusual cases that carry a risk of HIV exposure.
“The PEPline helped me manage exposures that were a gray area,” she says. “Very often, the CDC has clear guidelines on ‘If A happens, do B. If C happens, do D.’ In life, there are many other letters. Sometimes, I would need a little bit extra assistance.”
Cerone mentions the example of one worker who was exposed to a scalpel that had been used on an HIV-positive cadaver.
“It was a scary time for the employee,” she says. “As unique and special as that was to me, [the PEPline operator] had already had this experience.
“You can’t get information that’s accurate and consistent and trustworthy, really, anywhere else,” Cerone adds.
The PEPline takes calls from doctors, nurses, prison guards, and even veterinarians or lab workers handling HIV or hepatitis-infected animals.
“These are not just health-care work environment exposure calls that we’re taking,” Goldhammer says.
“We also work with and provide advice to clinicians that are taking care of safety officers,” she explains. “Police officers that might have been exposed in the field, the fire department, paramedics, correctional officers, and then people in the hospitality industry such as custodial workers, janitors, and people that are providing cleaning services. Our definition of ‘occupation’ is quite broad.”
“For 25 years, if you were to look at our funding, we’ve been pretty flat-funded since our inception,” Goldhammer adds. “There’s been no accounting for inflation or cost of living increases, even here in the Bay Area.”
That was a problem even before that latest round of federal budget cuts, initiated during the Obama era. Under the Trump administration, the public-health sector is already anticipating much deeper and more severe losses in federal funding.
This has forced the Clinician Consultation Center to get creative. They’ve made the extremely unorthodox move of establishing an online crowdfunding campaign to counter the loss of hundreds of thousands of dollars in government funding. With a goal of $200,000, the center hopes not only to survive, but to return the PEPline to its 24/7 basis.
“We’re moving into the world of crowdfunding because it really is a great way to draw attention to an issue that we’re facing,” Goldhammer says. “While it may be a little bit unusual, we’re hopeful that because we’re a 501(c)(3) nonprofit that perhaps this might be something that people would consider as part of their tax planning. We are a tax-deductible organization.”
Still, it seems a little ironic that a healthcare nonprofit at a hospital named after Mark Zuckerberg has to go around, hat-in-hand, asking for donations in order to survive. After all, the Facebook founder and his wife, Dr. Priscilla Chan, donated a whopping $75 million to S.F. General Hospital in 2015, which is why the hospital now bears his name. So why is a program at Zuckerberg Hospital asking for your online donations?
“What most people don’t recognize is that what is now called Zuckerberg San Francisco General is a joint venture between both UCSF and the county of San Francisco,” Goldhammer explains. “The funding that was received was to allow us to have a new acute care facility, which is something that the hospital desperately needed. But that funding was never meant to sustain programs such as ours, and we haven’t seen any pennies from that.”
“We’re kind of our own orphan project,” she says. “While we are housed here at Zuckerberg San Francisco General, this is really just because of pure and simple logistics.”
So while San Francisco is awash in tech money, critical health care and infrastructure programs worry whether they can even survive. The Clinician Consultation Center sees its work as too important to be another casualty of federal budget cuts.
“We see ourselves as part of the fabric of how medical provision happens in the United States, and we are not going to go down without a fight,” Goldhammer insists.
You can support the Clinician Consultation Center’s online crowdfunding campaign at generosity.com/medical-fundraising/help-the-pepline