Joint Meeting of Alameda County Board of Supervisors and Alameda Health System Board of Trustees - October 29, 2026

Note: The printed agenda lists the meeting date as Tuesday, October 27, 2026, which conflicts with the date specified for this summary.

The Alameda County Board of Supervisors and the Alameda Health System (AHS) Board of Trustees held a joint special meeting to review AHS finances, operational updates, and immigration enforcement protocols following a controversial incident at Highland Hospital. The discussion heavily focused on the fiscal outlook for AHS and its affiliate St. Rose Hospital, the transfer of the IOP/PHP program, and community backlash over the handling of an ICE detainee. Item IV on the agenda, concerning AHS Governance and SB 1400, was postponed due to time constraints.

Public Comments & Testimony

• Item II (Budget): No in-person speakers testified. One online speaker, Howard D., addressed the board.
• Item III (IOP/PHP Operations): Nettie Washington (representing IOP program staff) expressed significant frustration over the chaotic nature of the move to Fairmont, stating staff and patients were not logistically, professionally, or clinically prepared. She questioned why the Oakland community was losing behavioral health services at Highland when all wraparound services are located there.
• Item V (Immigration Response Protocols): The overwhelming majority of public comment focused on this item, with over 30 speakers. Speakers included hospital staff, union representatives (SEIU 1021), community legal observers, clergy, and patient advocates.
  • Nico (Attorney, SEIU): Stated his client was arrested without a judicial or administrative warrant, suffered six fractured ribs, and was discharged back into ICE custody. He requested immediate activation of legal resources (CLIP) for future detainees.
  • Claire Chalmers (RN, Highland ICU): Stated staff were unprepared and that AHS facilitated a staging area for ICE in the hospital loading dock, which she argued violated the county's ICE-free zone policy.
  • Dr. Sushida (Sudo for Solidarity): Drew parallels to the incarceration of Japanese Americans during WWII. Urged enforcement of SB 81 and opposition to a proposed ICE detention center in Dublin.
  • Carrie Schiff (NP, La Clinica): Reported a 50% no-show rate at her clinic during the ICE presence, stating fear is driving patients away from necessary care, creating both a public health and financial issue for the strained system.
  • Multiple healthcare workers (Marina, Comney, and others): Expressed feeling unsafe and unprotected by AHS administration. They stated real-time scenario-based training for dealing with ICE is urgently needed, and criticized the AOC for failing to verify a warrant.
  • David (Healthcare Worker): Characterized the use of the Sally Port and Sheriff's deputies to facilitate ICE shift changes over six days as a clear violation of the county's ICE-free zone.
  • Community Members (Laura Troop, Kip Waldo, Marla Kamiya): Refuted the description of protesters as dangerous, stating they were peaceful community observers offering support. They urged the boards to stop collaborating with what they described as a lawless federal agency.

Discussion Items

• AHS Budget, Financial Reports & County Line of Credit (Item II):

  • Kim Miranda (CFO) presented FY25/26 results showing a $62.3M net income (budgeted loss was $10.2M), thanks to one-time settlements (FQHC settlement $109.5M gain, Realignment $49.5M, MCO tax $10M). The FY26 audit will be delayed until December.
  • Q1 FY27 shows a $9.2M net income vs a $22.8M budget. A key variance is the non-receipt of $19.3M in county funding. Labor is positive ($5.4M) due to unfilled positions, but leading to short-staffing and overtime.
  • Projections show a manageable Net Negative Balance (NNB) for FY27, but FY28 projects a $95M loss and FY29 a $123M loss, driven by HR1 impacts and the expiration of one-time state funds.
  • St. Rose Hospital: Needs the IGT ($38M) to break even. Cash flow is critical; without the IGT, St. Rose will run out of money by February/March 2027. AHS has extended its line of credit to $25M.
  • Pat O'Connell (former Auditor) reviewed the history of the County Line of Credit, noting AHS has moved from over $200M in negative cash to a positive net worth.
  • Supervisors acknowledged the positive cash position bought time but warned against over-optimism given the grim FY28/29 projections. Supervisor Fortunato Bas asked about stakeholder participation in the budget process and contingency plans for St. Rose, to which AHS answered that no formal contingency plan currently exists beyond the line of credit.

• Operational Updates (Item III):

  • IOP/PHP Program: Jet Chapman (CHRO) confirmed the program was preserved through an ad hoc committee process. All 11-12 employees have been reassigned to the Fairmont campus. The physical move of services is scheduled for November 1st to 15th.
  • Lease Modification: James Jackson (CEO) and Kimberly Gasway (GSA Director) outlined a fast-tracked renewal of a 30-year lease for Highland and Fairmont (at $1/year) tied to a TIFFA grant for a dental clinic.
  • Efficiency Study RFP: Jeanette Dong reported the scope is drafted and a selection committee, including labor representatives, is forming. Supervisor Miley strongly expressed urgency and dismay at the timeline, emphasizing that the public needs to see proactive financial management. CEO Jackson assured the board the funds are secured and the RFP will move expeditiously. Dr. Lillian Lilker noted that frontline operational improvements are already underway.

• Immigration Response Protocols (Item V):

  • James Jackson (CEO) opened the discussion by reading a letter from a staff member who felt unsafe due to protests, setting a tone of concern over hospital security disruption.
  • Caleb Owen (AHS General Counsel) presented the existing SB81 protocols, emphasizing the escalation path to the Administrator on Call (AOC). He justified the decision to move ICE vehicles to the Sally Port as a measure to ensure safe hospital operations, minimize patient/staff interaction with ICE, and manage protest access.
  • Supervisor Fortunato Bas pressed AHS on whether a warrant was requested and why legal resources (CLIP) were not immediately activated. She stated she was “extremely upset” to learn the arrest was potentially warrantless, contradicting information she had been given previously. She called for a full debrief.
  • Supervisor Miley stated he did not know the facts and demanded a written report of what happened, why it happened, and what corrective actions would be taken.
  • President Haubert cautioned against reacting in a way that unintentionally deters ICE from bringing injured detainees to the hospital for care, but agreed the protocols must be reviewed and strengthened.

Key Outcomes

• Critical Incident Review: The boards agreed to an immediate critical incident review of the Highland Hospital ICE incident. A written report of the facts and recommendations is to be completed within 30 days. The findings are expected to be presented publicly to the Alameda County Together committee.
• Protocol Reinforcement: AHS committed to strengthening and publicly clarifying its SB81 and immigration response protocols. This includes mandatory immediate notification of legal partners (CLIP), ensuring clear processes for requesting warrants, eliminating automatic opt-out for civil detainees, and implementing scenario-based training for clinical and security staff.
• Efficiency Study: AHS was directed to proceed with awarding the Efficiency Study RFP without further delay, with the results expected in the spring of 2027.
• Continued Collaboration: The board agreed that the collaborative ad hoc process was successful for the IOP/PHP program and should serve as a model for tackling the budget challenges ahead, particularly for FY28/29.
• Budget & Lease: The FY26 audit is delayed. The Lease Modification will be presented to the AHS board in November and the county board in December.