Joint Meeting of Alameda County Board of Supervisors and AHS Board of Trustees - October 30, 2026

On October 30, 2026, the Alameda County Board of Supervisors and Alameda Health System Board of Trustees held a joint special meeting at the Alameda County Training & Education Center. The meeting covered the AHS financial status, operational updates, and a highly contentious discussion on the health system's immigration response protocols following an ICE enforcement incident at Highland Hospital.

Public Comments & Testimony

• AHS Budget & Financial Reports (Item II): No speakers.
• Operational Updates (Item III): Nettie Washington (IOP program) expressed that the move from Highland to Fairmont was chaotic, poorly communicated, and detrimental to clients, requesting a delay. Nicholas (Nico) (attorney for the ICE detainee patient) was allowed to speak on Item V early due to scheduling constraints.
• Immigration Response Protocols (Item V) - Over 30 Speakers: Speakers overwhelmingly condemned AHS and the Sheriff for facilitating ICE enforcement. Key testimony included:
  • Douglas Yoshida (HCH physician) demanded full enforcement of SB81 and an ICE-Free zone.
  • Claire Chalmers (RN, Highland ICU) stated staff were completely unprepared, witnessed security escorting ICE, and described county property used for vehicle staging.
  • Iman Khalil (RCP, AHS) criticized the administration for protecting ICE and failing to support staff.
  • Carrie Schiff (NP, La Clinica) reported a 50% patient no-show rate due to ICE fear and called the hospital's actions collusion.
  • David (County health worker) stated 23 ICE vehicles were logged across 30 shift changes facilitated by deputies, violating the ICE-Free Zone policy.
  • Multiple healthcare workers, community observers, and legal advocates demanded scenario-based training, immediate CLIP contact, and a policy strictly prohibiting ICE access without a judicial warrant.

Discussion Items

• AHS Budget & Financial Reports (Item II):

  • FY26 Results: CFO Kim Miranda reported a net income of $62.3 million, outperforming the budget by $62.5 million. This was largely driven by a $109.5 million FQHC settlement ($51.8M cash received) and favorable pension adjustments.
  • FY27 Q1: Net income of $9.2 million against a budget of $22.8 million, primarily due to a $19.3 million variance from un-received county funding.
  • Line of Credit / NNB: Pat O'Connell reviewed the agreement history. AHS now has a positive net worth for the first time in over 15 years.
  • FY28/29 Projections: Grim long-term outlook. FY28 projected loss of $95 million and FY29 at $123 million due to expiring supplemental state funds and HR1 impacts.
  • St. Rose Hospital: In critical financial condition, requiring a $38M IGT to break even. AHS extended its line of credit to $25M, with cash flow projections showing exhaustion by February 2027 if the IGT is not received.

• Operational Updates (Item III):

  • IOP/PHP Program: The closure was averted. The program is moving to Fairmont. All employees reassigned. Move scheduled for November 2026.
  • Lease Modification: A 30-year lease extension is being fast-tracked to support a TIGTA grant for a dental clinic.
  • Efficiency Study: RFP is being drafted with a selection committee including labor. Results expected by Spring 2027.

• AHS Governance / SB 1400 Update (Item IV): This item was not discussed and the meeting was adjourned before it could be addressed.

• Immigration Response Protocols (Item V):

  • AHS Presentation: CEO James Jackson read a staff letter expressing fear of protesters. General Counsel Caleb Owen outlined SB 81 protocols, defending the decision to move ICE vehicles to a gated loading dock as necessary to minimize disruption to patients and maintain safe hospital operations. He stated that AHS is not responsible for adjudicating the legality of an arrest.
  • Supervisor Questions: Supervisor Fortunato Bass led the questioning, revealing that the ICE agents did not present a judicial or administrative warrant, a fact she was not made fully aware of in prior briefings. She expressed profound concern and demanded stronger transparency and accountability.
  • All Supervisors (Miley, Marquez, Tam, Fortunato Bas) agreed a comprehensive, factual public report on the incident is required.

Key Outcomes

• Budget: AHS will provide final FY26 audit reports by December 14, 2026. The County Administrator assured that the $19.3 million for the efficiency study and operations will be made available.
• IOP/PHP: Program preserved. Relocation timeline confirmed.
• ICE Incident Review: The AHS Board of Trustees will conduct an internal critical incident review.
• Public Report: The Board of Supervisors unanimously directed that the incident review be made public and presented to the Board of Supervisors Health Committee within 30 days.
• Protocol Revisions: AHS committed to the following actionable reforms based on the discussion:
  • Immediately contacting CLIP when an ICE-detained patient is admitted.
  • Explicitly requesting judicial warrants from ICE agents.
  • Ensuring ICE agents do not remain in patient rooms or interfere with clinical care.
  • Enhancing training with scenario-based modules for frontline staff.