September 1, 1998, 3:00 p.m.
The regular meeting of the Health Commission was called to order by President Lee
Ann Monfredini, at 3:03 p.m.
2) APPROVAL OF
MINUTES OF THE MEETING OF AUGUST 18, 1998
Action Taken: The Commission adopted the
minutes of August 18, 1998.
President Monfredini, on behalf of the Commission, made a special presentation to
Martha Henderson upon her retirement from Community Substance Abuse Services for 19 years
of service to the Department.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner David J. Sanchez, Jr. Ph.D.)
(3.1) PH&P-CHP&P-HIV Prevention Services Request for approval of
retroactive renewal contract with Larkin Street Youth Center (LSYC) in the amount of
$108,477 for the provision of HIV prevention services targeting behavioral risk
populations for the period of July 1, 1998 through
June 30, 1999. (DPH contracted with LSYC for services totaling $1,064,019 during
PH&H-CHP&P-Health Promotion Request for approval of retroactive new
contract with Polaris Research and Development, Inc., in the amount of $150,000 for the
provision of Perinatal Outreach and Education support services, for the period of July 1,
1998 through June 30, 1999. (DPH contracted with Polaris for services totaling
$782,955 during FY 1997-98).
Commissioner Sanchez commended the contractor for its compliance to Board diversity.
(3.3) PH&P-CHS-HIV Services Request for approval of retroactive
renewal contract with San Francisco AIDS Foundation (SFAF), in the amount of $231,436, for
the provision of housing wait list services for people with HIV, for the period of July 1,
1998 through June 30,1999.
(DPH contracted with SFAF for services totaling $5,204,521 during FY 1997-98).
(3.4) PH&P-CHS-HIV Services Request for approval of retroactive
renewal contract with San Francisco AIDS Foundation (SFAF), in the amount of $200,000, for
the provision of partial rental subsidy services for people with HIV who are imminently
homeless, for the period of
July 1, 1998 through June 30, 1999. (DPH contracted with SFAF for services
totaling $5,204,521 during FY 1997-98).
(3.5) PH&P-CHS-CMHS Request for approval of retroactive multiyear
contract renewal with Community Vocational Enterprises, Inc. (CVE), in the amount of
$830,725 per year, to provide vocational rehabilitation services for the period of July 1,
1998 through June 30, 2002. (DPH contracted with CVE for services totaling
$1,058,513 during FY 1997-98).
(3.6) PH&P-CHS-CMHS Request for approval of retroactive modification
to multiyear renewal contract with Volunteer Center of San Francisco (VCSF), increasing
the contract in the amount of $33,797 per year, to provide community outreach services for
the period of July 1, 1998 through
June 30, 2001. The total contract amount, including this modification, is
$188,694 for the fiscal year 1998-99. (DPH contracted with VCSF for services
totaling $154,987 during FY 1997-98).
This item had previously been approved by the Commission.
Action Taken: The Commission approved the Consent Calendar of the Budget Committee,
4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).
On August 21, 1998, the Governor signed a $72 billion State budget for fiscal year
1998-99. The Governor vetoed $1.52 billion in spending approved by the
Legislature. The vetoes were necessary to accommodate the $1.4 billion tax reduction
package and to provide a $1.25 billion State reserve.
As I stated in my last Director's Report, the Department supported a number of the
Legislature's health-related funding proposals particularly those that sought to
increase funding for county services. The following health-related items were
approved by the Governor and budgeted for 1998-99:
- $40 million reduction of the Disproportionate Share Hospital (DSH) administrative fee;
- Elimination of the 33 1/3 percent "takeback" in the Medi-Cal Administrative
Activities/Targeted Case Management (MAA/TCM) program, representing an annual savings to
counties of approximately $12 million statewide;
- $1.2 million to expand transitional Medi-Cal for CalWORKs families from 1 to 2 years;
- Medi-Cal rate increases for primary care and preventive services (10% for adults, 20%
for children), Home Health nursing services, and emergency ambulance services; and
- $1.1 million augmentation for local assistance grants to support long-term care local
planning efforts under AB 1040.
In spite of these gains, there were a number of public health and health care funding
initiatives that the Governor vetoed. In total, over $52 million in augmentations
were not put into the approved budget. The following are not in the 1998-99 State
- $7.7 million augmentation for communicable disease control efforts;
- $8 million augmentation to expand the drug court program;
- $3 million augmentation to expand the number of children eligible for the Healthy
- $6 million augmentation for HIV/AIDS services and programs (namely, AIDS Drug Assistance
Program, anonymous HIV testing at family planning clinics and organ transplant research
for people with HIV)
- $794,000 for the Breast Cancer Early Detection program (the Governor indicates that he
will sign legislation to fund the program from Prop 99 funds); and
- $5 million for the California Statewide Supportive Housing Initiative.
In addition, the Governor reduced Medi-Cal rate increases proposed by the Legislature
for hospital outpatient services (10% increase reduced to 5%), and optometry services (25%
increase reduced to 12.5%). The Governor did not approve a Medi-Cal rate increase
for non-emergency transportation.
The Governor vetoed $36.8 million for prenatal care to undocumented women beginning
January 1, 1999. However, this does not mean that the State will not cover the
costs of prenatal care after that date. Undocumented women will still be eligible
for this State-funded program. The Governor has placed $36.8 million in a State Reserve
Account that will continue to pay for the costs of providing prenatal care to undocumented
women after January 1, 1999 until the State litigation is resolved.
The Department is concerned by the Governor's decision to veto mental health funding
under CalWORKs. In 1997-98, San Francisco received $300,000 to provide mental health
services to CalWORKs participants. The proposed 1998-99 budget allocated $21.9
million in State funds needed to match $22.6 million in federal funds to provide mental
health services for CalWORKs recipients. The Governor's veto of this initiative
results in unspecified funding for mental health services in the CalWORKs program.
It is critical that families transitioning from welfare to work have access to a full
array of support services if they are to be successful in this transition. The
Department is working with the State, County Welfare Directors Association of California
and the California Mental Health Directors Association on this issue.
Municipal Fiscal Advisory Committee Award
I am extremely pleased to announce that Monique Zmuda, our Chief Financial Officer,
was one of five City winners of the Municipal Fiscal Advisory Committee Award. This
very well deserved award acknowledges the tremendous contribution Ms. Zmuda made to the
Health Department during the prior year. These contributions include:
centralizing fiscal reporting in the Department, developing user-friendly financial
reporting for the Department and the public, redesigning the Medi-Cal Administrative
Claiming Program, managing a revenue maximization program in Short-Doyle Medi-Cal revenues
for Mental Health and recommending and receiving approval to secure a revenue contingency
reserve for the Department.
I also want to take this opportunity to again acknowledge the Department's other award
nominees. They were:
- Tangerine Brigham, Director of Policy and Planning
- Barbara Garcia, Director of Community Substance Abuse
- Health at Home Management Team:
- Kathy Eng, MPH; Pam Bohman, RN; M.K McKown, RN NP; Lisa Johnson, MD;
- April Lax, MSW; and, Mary McCutcheon, RN
- Yuki Kubo-Hendricks, Supervising Pharmacist, Jail Health Services
- Nancy Presson, Associate Director/Managed Care, Mental Health Services
POPULATION HEALTH PREVENTION
Breast Cancer Study
Today the Center for Disease Control and Prevention (CDC) is holding a public
meeting in San Francisco to present and discuss their Congressional report entitled CDC
Review of the Northern California Cancer Center Report: "Status of Breast Cancer
Research in the San Francisco Bay Area." Our Community Health Epidemiology
and Disease Control Branch, under the direction of Dr. Tomás Aragon, has been involved in
the project. In addition to Department staff attending the meeting, Dr. Daramola
Cabral-Evins and Karen Pierce are participating in the community panel to respond to
questions and answers.
Breast cancer is the most common cancer among women. As you are aware, over the
past several years concern has been raised that the rate of breast cancer is higher in the
Bay Area than in other regions. There is also concern that the mortality rate of
breast cancer among African-American women is higher than for other women. Finally,
within the Bayview Hunters Point community there has been longstanding concern over the
relationship between environmental toxins and the incidence of disease, cancer being one
Congress instructed the CDC to work with the Agency for Toxic Substances and Disease
Registry to review breast cancer incidence and mortality in the San Francisco Bay Area
(SFBA). Their findings and recommendations are as follows:
- The incidence of invasive breast cancer in SFBA has decreased since 1987 and is
comparable to the rates in other areas of the United States,
- Higher rates of breast cancer in SFBA were due in part to higher use of mammography, a
greater number of women screened and a greater number of cancer being detected. In
addition, the higher prevalence of known risk factors in the SFBA may have contributed to
the elevated rates,
- Incidence of invasive breast cancer is decreasing in SFBA,
- Death rates for breast cancer in the SFBA have decreased since 1991 and are now
comparable to the United States rates,
- Nearly 40 research studies are under way in the SFBA to better understand the occurrence
of breast cancer, and
- Cancer surveillance in the SFBA has included very complete case identification and high
quality case information.
- The following is being recommended:
- Continue to closely monitor cancer surveillance,
- Analyze mammography utilization since 1991,
- Develop a broad-based approach to breast cancer research given the multiple potential
causes of the disease, and
- Have the CDC develop a field-test and implement a Cancer Inquiry Response System.
The public meeting is still in session. I will be able to provide the Health
Commission with more insight into the community's response to the CDC report at a later
date. The Department will continue to work with others to track the incidence of
breast cancer and provide health care services to those who have the disease.
I am happy to announce the appointment of Rajiv Bhatia, M.D., as Medical Director
of Environmental Health and Occupational Safety. This new position was created from
my prior position of Director, Health and Safety. The decision to fill the position
in this way was my perception that the Health Department needed more expertise in the area
of environmental and occupational health, especially given the concerns of various
community groups about environmental exposures in their neighborhoods. Dr. Bhatia
will also provide supervision to the Occupational Safety staff at San Francisco General
Hospital, Laguna Honda Hospital, and the Community Clinics.
Dr. Bhatia is a graduate of Stanford Medical School, received an MPH from the
University of California at Berkeley, was a postdoctoral fellow in the Division of
Occupational and Environmental Medicine at UCSF. He has completed several important
research projects in environmental health. In addition, Dr. Bhatia has provided care
to patients at Tom Waddell Clinic for several years, and intends to continue to provide
primary care within the Community Health Network. Please join me in welcoming Dr.
Bhatia to the Department.
Tobacco Free Project
The Department's Tobacco Free Project has been selected as a runner-up for the 1998
National Association of County and City Health Officials (NACCHO) Champion for
Tobacco-Free Youth Award. This is the second year that the association is making
awards to give national recognition to outstanding, significant and creative initiatives
by local health departments to reduce youth access to and use of tobacco. The awards
will be presented at the NACCHO Annual Meeting in St. Louis, Missouri, on September 25.
COMMUNITY HEALTH NETWORK
LHH Pharmacy Research Protocol Presentation
A research protocol developed by the LHH Director of Pharmacy and Clinical
Pharmacists, Sharon Kotabe, Michelle Fouts, and Eunice Lo was accepted for presentation as
"research in progress" at the Midyear Clinical meeting of the American Society
of Health-Systems Pharmacist. The research protocols are used to evaluate the
predictive validity of risk factors for drug related problems in elderly long-term care
residents. The meeting takes place December 6-10, 1998 in Las Vegas. The
study will assess residents of LHH over the age of 65 for the presence of risk factors and
follow them for drug-related outcomes over the course of one year. The results of
the study will help identify at risk residents who may benefit from intensified
pharmaceutical care services.
The Community Health Network (CHN) is proceeding with an extensive evaluation of
the operation and finances of the SFGH Pharmacy. Ken Jensen, the new Chief Financial
Officer of the CHN, will be looking at all aspects of pharmacy finances including billing,
purchasing, and labor budgets. Sharon Kotabe, Pharm.D., Pharmacy Director of Laguna
Honda Hospital, will provide valuable expertise in assessing aspects of both inpatient and
outpatient operations. Sharon is also a member of the CHN Pharmacy Council and will
work with the Council to analyze the clinical implications. The evaluation will be
presented to the CHN Joint Conference Committee at the end of September.
1998 Consumer Friendly Business Award
On August 27, the Mental Health Board of San Francisco presented the "1998
Consumer Friendly Business Award" to Walgreens and to Roses Deli and Grocery. A
reception and awards ceremony was held at the Mental Health Rehabilitation Facility.
The San Francisco Health Commission and the San Francisco Board of Supervisors also
presented Certificates of recognition. The awards were made in recognition of the
"warmth, patience and respect" these Potrero Avenue businesses have demonstrated
to the residents of the Mental Health Rehabilitation Facility while they shop at their
The award ceremony was attended by the residents and staff at the MHRF, members of the
Mental Health Board, Supervisor Amos Brown, and staff from Community Mental Health
Services. Owner, Andy Ateyeh, accepted the award for Roses Deli and Grocery.
The award for Walgreens was accepted by Luis Padilla, local manager, he was accompanied by
other staff and by representatives of the district office.
President Monfredini, on behalf of the Commission, congratulated Monique Zmuda on being
one of the five winners of the Municipal Fiscal Advisory Committee Awards.
Commissioner Chow requested a presentation of the CDC Congressional Report on Breast
Cancer in the Bay area.
RECONSIDERATION OF A RESOLUTION UPDATING THE DEPARTMENT OF PUBLIC HEALTH MISSION
Dr. Katz reported the following:
On August 4, 1998, I presented an updated Mission Statement to the Health
Commission for consideration. The department believes that it is important to ensure
that its Mission Statement accurately communicates and describes our role and
Our Mission Statement must acknowledge the valuable role that the Department plays as
both the agency overseeing the public's health and as a provider of care.
At the last Health Commission meeting, Health Commissioners provided feedback on the
Mission Statement. The Department has attempted to incorporate those comments.
With that in mind, the Department thought it might be helpful to reaffirm the
Department's Vision Statement as it considers updating the Mission Statement. We
believe that the Vision Statement provides the context for how the Department carries out
its mission it constitutes our guiding principles and values. I believe that
it is important for any mission statement to be understandable to not only by our staff
but also the public. As I indicated at the Health Commission hearing, the Mission of
the Department remains the same. However, we believe that the proposed version more
succinctly describes our fundamental role.
Action Taken: The Commission unanimously adopted Resolution #30-98, "Reaffirming
the Department of Public Health's Vision Statement and Restating the Mission
PRESENTATION ON PREPARATION FOR THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE
ORGANIZATIONS (JCAHO) SURVEY AT SAN FRANCISCO GENERAL HOSPITAL
Mr. Robert Christmas, Special Assistant for Accreditation Services, presented the
Every three years San Francisco General Hospital is surveyed for JCHO
accreditation. In preparation, members of the Commission are oriented in small
groups to inform them of their responsibilities as members of SFGH's Governing Body.
Today's presentation will serve as an orientation for all Commissioners.
The presentation will give you a status report on the readiness of SFGH for the survey
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is a private,
not-for-profit organization, which evaluates and accredits nearly 18,000 health care
organizations and programs in the United States, including more than 11,000 hospitals and
home care organizations, and over 7,000 other health care organizations that provide long
term care, behavioral health care, laboratory and ambulatory care services.
The Joint Commission also accredits health plans, integrated delivery networks, and other
managed care entities. In addition, the Joint Commission provides a broad array of
educational and consultative services and products to accredited organizations. More
than 5000 employees work in the JCAHO Central Office, and approximately 690 surveyors
perform the surveys of health care organizations.
The Consolidated Accreditation and License Survey (CALS) combines three required
surveys into one five-day survey. These three surveys are: JCAHO, Department
of Health Services (Title 22), and the California Medical Association (CMA).
The purpose of accreditation surveys is to ensure that the quality of care provided by
health care organizations meets the standards set by accrediting organizations. Our
facilities stand for accreditation surveys primarily for three purposes: 1) to
improve the quality of care provided to the public we serve; 2) to ensure we receive
reimbursement from Federal, State and private payors, and 3) support an approved
residency teaching program.
There are eight accreditation decision categories: Accreditation with
Commendations, Accreditation, Accreditation with Recommendations for Improvement,
Provisional Accreditation, Conditional Accreditation, Preliminary Non-Accreditation, and
Not Accredited. It is our goal to receive an Accreditation with Commendation
The Joint Commission will make available, upon request, an organization's
Performance Report, which includes organization-specific performance data. The
Accreditation Decision Report remains confidential unless otherwise provided by law.
Although we are now a network, only components covered by SFGH's license will be
surveyed. Those components include the following areas:
- General Acute Care
- Intensive Care
- Intensive Care New Born Nursery
- Coronary Care
- Unspecified General Acute Care (M/S)
- Acute Psychiatric
- Other Services
- Cardiac Cath Lab
- Emergency Services
- Speech Pathology
- Respiratory Care
- Physical Therapy
- Occupational Therapy
- Nuclear Medicine
- Outpatient Services
- Skilled Nursing
- Mental Health Rehabilitation Facility
- Ward 4-A
The responsibilities of leadership at SFGH are defined by the CALS Survey
Process. The following groups and individuals are defined as leadership: The
Health Commission, the Director of Health, the Chief Executive Officer of the CHN, and the
Chief Executive Office of SFGH. Their responsibilities are listed below:
- Health Commission
- Set Policy
- Strategic Planning
- Promote Performance Improvement
- Approve Medical Staff Appointment/Reappointment
- Establish/Maintain Staff Competency
- Assure Compliance with Applicable Laws and Regulations
- Approve Resources (Budget)
- Provide Focused Governance (JCC)
- Director Public Health
- Implement Policy
- Develop Budget
- Appoint CEO/CHN and Delegates Appointment Responsibilities
- Approve Medical Staff Appointment/Reappointment
- Strategic Planning
- Implement Policy
- Strategic Planning
- Appoint CEO-SFGH, CEO-LHH, CMO-CHN
- Develop Budget
- Implement Policy
- Strategic Planning
- Appoint Senior Leader
- Develop Budget
There are a number of CALS and JCAHO preparation activities to be accomplished prior to
the CALS and the JCAHO Accreditation Surveys. Those activities include: Mock
Surveys of Patient Care Areas; Function Interview; Education/Staff Impact Sessions and
Focus Group Interviews; Professional Consultations and Audits. I am pleased to
report SFGH is doing well in these preparatory activities. Currently, 63% of these
activities have been accomplished. The remaining activities will be concluded by
The Mock Surveys will be held November 2, 3 and 4. The full CALS Survey will be
held in March 1999.
Mr. Christmas reviewed the following areas:
- Overview of Joint Commission
- Consolidated Accreditation and License Survey (CALS)/Accreditation Decision Process
- Standards and Survey Process
- 1998 JCAHO Leadership and Governance Standards
- Survey Readiness/Activities
- Official Accreditation Decision Report
- Memo on Most Frequently Cited Standards
- Given the recent stringent HCFA oversight of Laguna Honda Hospital, is there a concern
for this survey?
- Are physical facilities an issue?
- Clarification was requested on what encompasses a review for medications management for
inpatients and outpatients.
- In the context of managed care, is there capacity in the Emergency Department, Pharmacy,
in relation to the demand in these areas? How is this evaluated through the survey
- It is better to inform the Commission of any problem areas to avoid surprises to the
- The governing body, through the Director of Health, approves the medical staff
appointments and is the appeal body for the physicians.
- The Competency Report for 1998 would come to the Commission in December 1998.
- Consumer and Commission involvement would be included in strategic planning.
Mr. Christmas stated that the hot issues for JCAHO surveys include patient rights, ADA
access, environment, facility safety, and life safety.
President Monfredini and Commissioner Barnes commended the Department for a
comprehensive, well laid out plan for the JCAHO survey.
7) OTHER BUSINESS/PUBLIC COMMENTS
The meeting was adjourned at 4:55 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission