Minutes of the Health Commission Meeting
Tuesday, May 4, 1999
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The regular meeting of the Health Commission was called to order by President Lee Ann
Monfredini, at 3:04 p.m.
- Commissioner Edward A. Chow, M.D.
- Commissioner Roma P. Guy, M.S.W.
- Commissioner Ron Hill
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
President Monfredini presented the April Department of Public Health Employee
Recognition Award to Bruce Josloff of the Environmental Health Management Division.
2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF APRIL 6, 1999
- Stephen O. Murray, Ph.D., Instituto Obregon, voiced criticism on the April 6, 1999
minutes, the content of public comments, and will file complaints with the Sunshine
Ordinance Task Force.
- Gil Criswell requested the April 20, 1999 minutes reflect clarification of his
statements. In submitting his Spectrum article, he stands by his article, "Bath
Houses and Sex Clubs." HIV should be treated like any other STD with treatment; and
he is not in favor of HIV surveillance.
- Reid Condit, Ad Hoc Bath House Committee, requested revision of the April 6 minutes
regarding the LGBT Advisory Committee letters, discussion of the regulations for sex
clubs, and the spelling of his first name.
Jean Fraser, Deputy City Attorney, commented that reconsideration of past approved
minutes would need to be an agenda item at a Commission meeting.
Commissioner Chow pointed out the words "any and all" need to be deleted from
Resolution #14-99 in the April 20, 1999 minutes.
Action Taken: The Commission unanimously adopted the minutes of April 20, 1999
with the corrections.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Ron Hill)
(3.1) DPH Administration Annual report of membership organizations and a
proposed ordinance to amend the Citys Administrative Code to add and delete
membership organizations for the next fiscal year.
(3.2) PHP-HIV Prevention Services 60 day progress report on the
Tenderloin AIDS Resource Center as requested at the March 2, 1999 Health Commission
(3.3) PHP-HIV Prevention Services 60 day progress report on California
AIDS Intervention Training Center - Venue-Based Individual Outreach, as requested at the
March 2, 1999 Health Commission meeting.
(3.4) PHP-CHS-Mental Health & Substance Abuse - Request for approval of
retroactive modification to the contract with New Leaf Services for Our Community
- continue the provision of outpatient substance abuse methamphetamine treatment on demand
services as awarded through RFP #019-98 in the amount of $136,663 for the period of
January 1, 1999 through June 30, 1999; and
- replace Ryan White/CARE funds with mental health Short-Doyle/Medi-Cal match funds to
continue the provision of outpatient HIV/mental health services for the period of March 1,
1999 through June 30, 1999 (annual amount of $371,465 to continue both services). (DPH
contracted with New Leaf for services totaling $1,347,911 during FY 1997-98).
Action Taken: The Commission approved the Consent Calendar of the
4) DIRECTORS REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).
Community Budget Hearings
Dr. Katz participated in the community budget hearings organized by Finance Chair
Supervisor Leland Yee. A hearing dedicated to issues of children, youth and their families
was held in the Mission. A number of important issues, including childcare, school health,
recreational services and physical and mental health services for children, youth and
their families were raised. The hearing in the Bayview Hunters Point area was dedicated to
discussion of public health and the environment. Community leaders spoke eloquently about
the serious environmental hazards in the Bayview area, including the Superfund sites,
particulate matter in the air due to industry, asthma, breast cancer and problems with the
sewage treatment plant. Dr. Katz will attend another hearing set for tonight on the issue
of homelessness in the Castro. These hearings have been very well attended and have
provided valuable input into the City budget process.
EEO Directors Departure
After 11 ½ years with the Department of Public Health Gloria Louie is leaving to take
a new job at the Airport. Gloria started with DPH as an EEO specialist moving to the EEO
Director position after 5 years. Under Glorias direction and leadership, the annual
EEO report now clearly delineates the Departments strengths and areas where
improvement is needed.
Glorias new position at the Airport begins May 17th. She will be
responsible for developing and implementing the Airport's diversity and EEO programs for
employees and for setting diversity standards for contractors doing business with the
Airport. Jimmy Loyce has agreed to act as the Interim EEO Director and to conduct the
search for Glorias replacement.
City Attorney to Move to Airport
Louise Renne has informed the Department that Paula Jesson will be transferring to the
Airports Legal Division of the City Attorneys Office on May 17th.
Paula asked me to convey her deep appreciation for the opportunity to have worked for the
Health Commission and Department staff for the past eleven years. Paula will be missed by
all of us.
State Director of Health Services
Last week, Governor Davis appointed Diana M. Bonta, R.N, PhD., as the Director of the
Department of Health Services. Ms. Bonta officially starts her position in June 1999. Ms.
Bonta currently serves as the Director of Health and Human Services for the City of Long
Beach. She has held the position since 1988. Prior to that she served as Deputy Executive
Director of the Los Angeles Regional Family Planning Council. During her early career in
health she was a Regional Administrator for the California Department of Health Services.
She is currently Chair of the American Public Health Association. The Senate must confirm
Early Treatment for HIV
Last week House Democratic Leader Representative Richard Gephardt (D-MO),
Representative Nancy Pelosi (D-CA), and Senator Robert Torricelli (D-NJ) introduced
legislation to provide early treatment for HIV -- Early Treatment for HIV Act. The
legislation was introduced in both Houses of Congress and would give States the option to
expand their Medicaid programs to provide treatment for low-income, HIV-positive
individuals who have not yet developed symptoms of AIDS.
As the Health Commission is aware, early treatment for HIV improves the lives of those
infected by the disease. The legislation would extend access to drug therapies and primary
care. Federal HIV treatment guidelines recommend the use of anti-viral therapy early in
the course of HIV infection before development of symptoms. However, Medicaid does not
define individuals with early infection as disabled and, as a result, many low-income
individuals are unable to receive HIV-related drugs and health care through the program.
The Presidential Advisory Council on HIV/AIDS has asked the President to support the Early
Treatment for HIV Act. Fifty-nine other members of the House joined Representatives
Gephardt and Pelosi as original co-sponsors of the bill.
The Department is clearly supportive of these congressional efforts and thanks the
co-sponsors for introducing this much needed legislation.
Central Administration- Y2K Compliance
The Department prepared its quarterly Y2K progress report for the Health
Commissions consideration. Due to the long length of todays Commission agenda,
the Department will not make a formal presentation on Y2K implementation. However, we are
available to answer any questions regarding Y2K compliance. A formal presentation will be
made during our next quarterly progress report in August 1999.
Building a Healthier San Francisco Collaborative
The Department is continuing to work with San Francisco hospitals, the Hospital Council
of Northern and Central California, United Way of the Bay Area, and community-based
agencies in the "Building a Healthier San Francisco (BHSF) Collaborative." The
Collaborative is working to foster broader, more effective partnerships to respond to San
Franciscos health and human service needs. The Collaborative was originally formed
in 1995 as a result of SB 697, which required private, non-profit hospitals to complete a
community needs assessment and develop Community Benefit Plans to address needs.
Last month, the Collaborative presented the findings of its recently completed
"San Francisco Community Assessment" report at three community forums. The
report provides the most comprehensive profile currently available of the health and
social conditions of San Francisco residents, using Healthy People 2000 goals and Bay Area
Partnership indicators as benchmarks. The report is meant to inform community residents
and leaders, advocates, policymakers, and service providers about many of the critical
issues facing San Francisco, and to serve as a springboard for action to address those
issues. The Collaborative will begin focusing on specific priority health issues to
address at the community level. As part of this process, the Collaborative will expand to
include other community representatives in planning and implementation.
The Department will make a presentation on this updated Community Assessment at the
Health Commissions first meeting in June 1999. We will provide the Commission with
complete copies of the report at that time. The public may obtain copies by contacting the
Northern California Council for the Community at (415) 772-4430. The report will also soon
be accessible via the web at www.ncccsf.org.
POPULATION HEALTH AND PREVENTION
Dupont Pharmaceuticals Grant
This morning at the Mayors Office, Dupont Pharmaceuticals announced a $1 million
award to San Francisco for HIV/AIDS prevention. Dupont Pharmaceuticals is inviting other
companies to participate, with an ultimate goal to raising at least $5 million. Mayor
Brown has committed to matching Duponts grant in an effort to inspire other
companies to follow their lead.
The Mayor appointed Thomas Coates, Ph.D., Professor of Medicine and Director of the
UCSF AIDS Research Institute; Sean Sasser, a member of the Presidents AIDS Advisory
Council and a leading community advocate for prevention services for youth; and Dr.
Herminia Palacio from the Health Department, to co-chair a coalition of health, business
and community leaders. The Coalition, which will be known as the S.F. HIV Prevention
Outcomes Coalition, will determine the priorities for spending the award. Programmatically
the Coalition will focus on decreasing seroconversions in San Francisco by replicating
successful models of HIV prevention, as well as developing new models. The San Francisco
HIV Prevention Planning Council has identified a number of unmet needs and research gaps.
This coalition will help to meet these needs, especially for underserved populations. In
this way, the work of the two committees will be closely linked.
May is an important month for women's health. On May 6 and 7, the University of
California National Center of Excellence in Women's Health in collaboration with the
Institute for Health and Aging, have organized a health summit on older women's health.
The summit will bring together researchers, advocates, leadership and media in a unique
dialogue on issues of older women. Several Department of Public Health staff have been
involved in the planning and are attending the summit.
"Time for Healing...Time for Change." May 13, the Department of Public Health
Breast and Cervical Cancer Services (BCCS) program, in collaboration with Network for
Elders, is taking the town hall model developed in the Bayview Hunters Point to women in
the Western Addition. The first breast cancer- focused town hall was held at the Bayview
Opera House and was attended by approximately 130 women. The planning group for this
second town hall anticipates participation from more than 200 women. Funding came from the
Breast Cancer Fund and the Women's Foundation. A wide range of neighborhood organizations
has been involved in the planning process. Maxine Hall Health Center Director has been
particularly helpful in providing meeting space and resources to the group
Community Substance Abuse Services
On May 3-4, Community Substance Abuse Services, the Lindesmith Center and the Harm
Reduction Training Institute hosted a conference on "Bridging the Gap Integrating
Traditional Substance Abuse and Harm Reduction Services." Dr. Katz delivered the
opening remarks at the conference. Numerous federal, state and local organizations
provided funding for the conference. Over 600 people attended the two-day conference. The
conference objectives were:
- To introduce principles for integrating traditional substance abuse treatment and harm
- To provide health professionals with practical strategies to integrate services for
clients in drug treatment, mental health, medical and other service settings;
- To facilitate the development of the harm reduction approach to drug treatment through
the interaction of health professionals and the clients they serve;
- To examine the issues surrounding methadone;
- To facilitate the delivery of self-selected, client oriented drug treatment;
- To make a positive impact on the realities of drug treatment within the criminal justice
- To equip clinical administrators and supervisors with the tools they need to integrate
traditional and harm reduction strategies within the policies and practices of health
- To introduce health professionals to new ways of reaching clients who might otherwise
not access drug treatment.
STD Prevention and Control
In honor of STD Awareness Month, April 1999, the STD Prevention and Control Section
implemented a number of activities to raise awareness about STD screening and prevention.
Throughout the month of April, posters were displayed in 15 bus shelters around San
Francisco, and advertisements for STD screening ran in three weekly papers, on television
and on the radio. The STD Section provided urine based STD screenings in four San
Francisco High Schools, in shelters, community based organizations, at street fairs and in
other locations around the city. In addition, the Community Health Network primary care
centers provided drop-in STD testing throughout the month.
Childrens Environmental Health Promotion
As part of the Department's ongoing effort to prevent asthma, nine staff of the
Children's Environmental Health Promotion Section are currently teaching a 6-week class on
asthma to 3rd - 5th graders at four San Francisco elementary schools. The CEHP were
trained by the American Lung Association and are being hosted by the San Francisco Unified
School District and Healthy Start Family Outreach Workers, to teach the curriculum at
three Bayview Hunters Point elementary schools and one South of Market school. The
students participating in the program will learn how to recognize symptoms, when to ask
for help, how to safely engage in physical activity and how to prevent asthma attacks. The
curriculum has been shown to build the self-confidence of students and help them lead
Community Health Promotion and Prevention Branch
On April 24, 1999 Ginger Smyly, MPH, CHES, Deputy Director of CHP&P, was honored by
the San Francisco Business and Professional Women Inc. with the Professional Woman of the
Year Award for 1999.
COMMUNITY HEALTH NETWORK
Chinatown Public Health Center
On April 20th, the Chinatown Public Health Center participated in a
successful community disaster drill coordinated by NICOS, a coalition of health and mental
health agencies serving Chinatown. This year's drill planning and coordination was
assisted by DPH Health Educator, Wesley Wong. A mock disaster scene occurred at Portsmouth
Square and "victims" were assessed in the field by NERT trained volunteers. The
Cathay Radio Club provided volunteer ham radio operators who helped describe conditions in
the community, as well at the participating health agencies, and sent messages to the
radio coordinating site located at Chinese Hospital. The Chinatown Public Health Center
has been an active member of these drills and their planning for the past 10 years.
Annual Volunteer Luncheon's at SFGH and LHH Great Successes
Mayor Willie Brown spoke at both LHH and SFGH's Annual Volunteer's Luncheons on April
20 and 24th respectively. He thanked the volunteers at both hospitals for their service.
He also gave his full support to the Laguna Honda Hospital Replacement Bond measure
currently winding its way through the City and County's approval process.
The San Francisco Chronicle's Readers' Choice award arrived two weeks ago. If you
recall, SFGH Emergency Department was rated first place in their readers' poll for best
place to go in a medical emergency.
Department of OB/GYN
Dr. Philip Darney, professor and interim chief of OB/GYN, was honored last week with
the Chancellor's Award for Public Service for his efforts to supply women with
contraceptives on the local, national and international levels. He is world renowned for
his significant achievements in research, education and program development in family
planning. Dr. Darney's nominators praised his outstanding efforts to ensure access to
family planning services for vulnerable women in the Bay Areas and highlighted his
creation of the New General Health Center for adolescents.
National Hospital Week
May 9-15 is National Hospital Week, a time of celebration and renewal. Each year,
hospitals and community health centers join together to recognize the people who make it
all possible, health care workers and volunteers. This year's theme, "People Care.
Miracles Happen," recognizes the special contributions of the people who keep
hospital doors open 24 hours a day, 365 days a year.
Celebrate Healthy Babies
Southeast Health Center will participate in "Celebrate Healthy Babies Health
Fair" at Providence Church in the Bayview on Saturday, May 8, from 10;00 a.m. to 3:00
p.m. DPHs Black Infant Health Improvement Project hosts the fair. Dental check-ups,
blood pressure, and STD and pregnancy tests will be offered.
Dr. Katz acknowledged Lynda Frattaroli, LCSW, who did an outstanding job last Friday,
weaving public, private and international agencies to secure help for two tourists who
were attacked in the downtown area.
City Attorney Louise Renne announced that Jean Fraser, Deputy City Attorney, will be
the head of the Health and Human Services Division in the City Attorneys Office. Two
additional new attorneys will be hired in this Division.
Note: Three individuals were escorted out of the meeting after their attempts to
disrupt the meeting.
- Ronnie Barh, Act UP/S.F., encouraged reopening of bath houses.
5. PRESENTATION OF THE VECTOR CONTROL PARTNERSHIP
Ben Gale, Director of the Environmental Health Section, gave an overview of the Rodent
Survey Pilot Program. Due to the loss of Federal funds in the early 80s, the
Department had to significantly modify its rodent control program.
The Mayors Office provided $50,000 to fund a cadre of individuals to be trained
by Environmental Health staff to assist property owners and residents in abating rodent
infestations. Through a cooperative effort with the Department of Human Services, (DHS);
the Department of Public Works, (DPW); the San Francisco Urban League of Gardeners,
(SLUG); and Young Community Developers, Inc. (YCD), the Department was able to recruit ten
candidates to train.
SLUG, under contract with DPW, was identified to be the lead agency. SLUG selected YCD
to be the implementation arm of the contract. DHS provided additional funds to cover the
actual cost of the program and was responsible for putting together the entire package
using DPW, SLUG and YCD. Additionally, DHS provided basic computer training to the
The ten candidates underwent a comprehensive curriculum divided between classroom and
field training. The curriculum focused on basic rodent biology, identification and survey
techniques. In addition, because these individuals will deal with the public, the training
included interpersonal communication skills, writing, basic computer training, and CPR. At
the end of the 18-day training period, six candidates graduated to become the core of this
new program, which began in March of this year. Now, one month later, the four remaining
candidates have graduated.
These individuals are working with Environmental Health staff in neighborhoods with
significant rodent activity complaints. Through their assistance, the Department has
already conducted 235 community/neighborhood surveys, and distributed 8,000 informational
packets (in three languages).
This program addresses the rodent control problem in the City. It also has provided the
trainees with a career path in public health or the pest control industry. DPH has been
working with local pest control companies to develop entry level positions for program
The participants in the Vector Program are Haruna Abubakar, John W. Farrell, Michael
Lewis and Frederick Smith.
Commissioners acknowledged the trainees and complimented the Environmental Health staff
for this innovative training program.
6. CONSIDERATION OF A RESOLUTION ON THE BOND PROGRAM TO REBUILD LAGUNA HONDA
Dr. Katz presented information requested by the Commission in the following areas:
- Information on other counties that own and operate skilled nursing facilities
- Information on the number of individuals who might be served from expanding the
community programs (i.e., adult day health care, senior nutrition, etc.)
- Detailed discussion of the financing mechanisms
- An analysis of the ongoing operating budget of the new rebuilt hospital under scenarios
of both increasing and decreasing Medi-Cal reimbursement rates.
Also included is information of skilled nursing beds within the State by county,
various financial spreadsheets discussing the capital financing options, application of
tobacco settlement receipts (along with the impact on various home values), the City and
Countys overall bond debt capacity, and detailed information on Medi-Cal funding for
Laguna Honda at various assumptions on increases and decreases in reimbursement.
For a copy of the full report, contact the Commission Office at 554-2666.
Monique Moyer, Director of the Mayors Office of Public Finance, discussed the
Citys debt capacity.
Commissioners Comments and Questions:
- Can the Governor use the tobacco funds for other areas?
Yes, but there is support for Laguna Honda Hospital at the State level.
- Thanked staff for comprehensive analysis for the Laguna Honda Hospital bond.
- Would the property tax fluctuate depending on tobacco tax monies actually received?
- If Laguna Honda Hospital uses the facility for less skilled nursing beds, would the
facility be used for other services:
Yes, the mix of patients may show needs for other health services.
- Will the present Laguna Honda Planning Committee remain in place?
Monique Zmuda, Chief Financial Officer, pointed out the projected operating budget and
the impact of less revenues coming to Laguna Honda Hospital.
Supports the Laguna Honda Hospital Bond as recommended by the Laguna Honda Hospital
- Bill Price, Senior Action Network
- Gil L. Thornalley, supporter of LHH
- Kay Bromley, former resident family member
- Sonny Zuniquini, former resident family member
- Frederick Hobson, S.F. Health Plan Board
- Tom Nolan, Project Open Hand
- Anthony Sacco, retired Union member
Stephen Vernon raised the question of allocation of resources to institutional care
instead of community-based services; need for improved integration of services.
Norma Satten, Health Task Force with Planning for Elders in the Central City, expressed
need to have resources allocated into home and community-based services.
Dr. Katz stated the resolution should read: "
at least" 140 assisted
in the first Further Resolved.
President Monfredini requested active support from all of the Commissioners for this
Commissioner Chow requested two amendments to the resolution as follows:
- The third Further Resolved to read: "
that the San Francisco Health
Commission requests that the Department use its best efforts to secure the maximum
reimbursement allowable from payers for the services of a distinct part skilled nursing
- To add another Further Resolved: "
that the San Francisco Health Commission
encourages continued planning on the citywide effort to expand the array of home and
community-based services for elderly and disabled adults."
Action Taken: The Commission unanimously adopted Resolution #16-99, "Supporting Rebuilding Laguna Honda
Hospital and Placing a Bond Measure on the November 1999 Ballot" with
Commissioner Chows amendments.
7A) REVIEW OF THE DEPARTMENT OF PUBLIC HEALTH 9-MONTH REVENUE AND EXPENDITURE REPORT
FOR FY 1998-99
Monique Zmuda, Department of Public Health Chief Finance Officer, reported the
The Department of Public Health is projecting a year-end shortfall of $19.2 million for
FY 98-99 based on estimated expenditures and revenues for the third quarter ending March
31, 1999. Revenue shortfalls of $40.1 million are projected to be offset by expenditure
savings of $20.9 million. The projected shortfall is primarily due to: 1) reduced revenues
at San Francisco General Hospital resulting from patient census that is above the budgeted
level and a higher than expected volume of uncompensated care; and 2) reduced revenues at
Laguna Honda Hospital resulting from reductions in patient census necessary to comply with
the Department of Health Services and Department of Justice Plans of Correction.
This projection assumes approval of $5.6 million in General Funds to offset revenue
losses at Laguna Honda Hospital. It also assumes approval of a $1.1 million supplemental
appropriation for Population Health and Prevention to offset increased pharmaceutical
expense for mental health services.
7B) CONSIDERATION OF SUPPLEMENTAL APPROPRIATION FOR $19.2 MILLION IN GENERAL FUNDS
TO REDUCE THE DEFICIT AT SAN FRANCISCO GENERAL HOSPITAL FOR FY 1998-99
Ms. Zmuda reported:
The Department of Public Health is projecting a $40.1 million revenue shortfall this
fiscal year. Expenditure savings of $20.9 million will offset a portion of the revenue
loss. However, the net remaining shortfall to the Department of Public Health for FY
1998-99 is expected to be $19.2 million based on third quarter projections.
The Department is requesting a $19,187,662 supplemental appropriation to offset revenue
shortfalls in FY 1998-99. If approved, the requested General Funds will be applied to
reduce Medicare and patient revenues at San Francisco General Hospital. This request will
allow appropriation authority to offset revenue losses with General Funds necessary to
balance the budget for the Department of Public Health for the remainder of the fiscal
year. No expenditure appropriations are requested.
Protested public health cuts, SFGH Pharmacy cuts, long wait lines at the SFGH Pharmacy.
- William C. Brady, Emergency Coalition to Save Public Health
- Ed Kinchley, SFGH Emergency Department
- Rev. Ignatius DeGroot, St. Anthonys Catholic Church, submitted a petition with
signatures to reopen the Family Health Centers pharmacy and give medications free of
charge for patients who cannot afford them
- Fern Ebeling, SFGH
In order to hear all of the speakers, President Monfredini limited speakers to one
- Mary Magee, Local 790
- Melchor Bustamante, patient
- Michael Lyon
- Dr. Colleen Townsend, SFIRA
- Taejon Ahn, UCSF/SFGH
- Dr. Pamela Swedlow, SFGH Dept. of Psychiatry
- Jamie Noone, SFIRA
- Rose Montgomery, Transgenders United for Equality
- Pablo Roman-Alcala, Healthworks
- Mark Whitman
- Nora Roman, Emergency Coalition to Save Public Health
- Dr. Jonathan Lee, SFGH
Commissioner Sanchez, after listening to the public speakers, suggested the Commission
revisit the pharmacy issue and review the standards for quality of care. He proposed an
amendment to the requested supplemental with an additional $900,000.
Dr. Katz reminded the Commission to look at the overall priorities of the Commission
and whether the Pharmacy would be the top priority.
Commissioner Guy felt the proposed additional supplemental would be inappropriate for
now. Looking at the overall strategy, she would not want to jeopardize the $19.2 million
supplemental request by this additional $900,000.
Commissioner Hill reminded the public of the Mayors large commitment to cover the
SFGH deficit. He encouraged the community to get real about the overspending at
Commissioner Parker does not presently know how much funding is actually needed for the
Commissioner Umekubo suggested to proceed with the proposed $19.2 million supplemental
but relook at the Pharmacy issue with more data on the waiting times.
After urging the Department to continue looking for other resources and data on the
Pharmacy, Commissioner Sanchez withdrew his proposed $900,000 amendment to the $19.2
Action Taken: The Commission unanimously approved the $19.2 million General Fund
supplemental appropriation to reduce the deficit at SFGH for FY 1998-99.
Commissioner Chow suggested the quality assurance issues around the Pharmacy issue be
on the next agenda for the Joint Conference Committee of the Community Health Network.
Commissioner Guy stated that the Strategic Plan requested by the Commission will help
address the priorities of the Commission.
8) CONSIDERATION OF ADOPTION OF A NEW REGULATION FOR ISSUANCE OF REFUSE COLLECTION
PERMITS FOR NON-FEDERAL FACILITIES AT TREASURE ISLAND AND YERBA BUENA ISLAND (TI
& YBI"); AND ADOPTION OF A REVISION OF AN EXISTING REGULATION FOR ISSUANCE OF
REFUSE COLLECTION PERMITS FOR FEDERAL FACILITIES ("1992 REGULATION")
Dr. Katz presented the following:
The Department of Public Health permits refuse collectors in the City and County to
ensure that waste is collected and disposed of in a sanitary and safe manner. Currently,
we lack a mechanism to issue permits for Treasure Island and Yerba Buena Island because of
their recent change in status. Adopting the proposed TI & YBI Regulation will provide
the City with a means to issue refuse collection permits for refuse collection from
non-federal facilities on Treasure Island and Yerba Buena Island. We are simultaneously
revising the existing Regulation regarding the permitting process for federal facilities
to make it consistent with the proposed TI & YBI regulation. Additionally, the
proposed TI & YBI Regulation and the proposed revisions of the existing Regulation
implement the requirements of the Citys 1932 Refuse Collection and Disposal
Ordinance. The two proposals will provide the Department with a process for the orderly
issuance of refuse collection permits for refuse collection from six federal facilities in
the City and from the non-federal facilities in Treasure Island and Yerba Buena Island.
At the Commissions April 6, 1999 meeting, the Commission solicited and heard
public comments from representatives of two refuse collection companies, Norcal Waste
Systems, Inc., and Bay Cities Refuse Service, Inc. Among the issues raised were Bay Cities
contention that the permit that it currently holds for refuse collection from the Islands
is exclusive; and Norcals assertion that the proposed revision of the existing
Regulation expands the scope of the regulation to all federal facilities within the City.
Regarding the exclusivity of refuse collection permits, it is the Citys long
standing position that refuse collection permits issued by the City are not exclusive.
This position was upheld in a 1992 case before the Superior Court, WRT v.
#943626, and reaffirmed by the San Francisco Board of Permit Appeals in 1994.
Regarding expanding the scope of existing Regulation, EHS recognizes that the language
of the revision may be misconstrued to include other federal facilities located in the
City. It had not been EHS intention to expand the Scope of the existing Regulation.
Hence, EHS is reinstating the original language limiting the scope of the revised
Regulation to the six sites identified in the 1992 Regulation.
Supporting documents submitted were:
- Background document detailing specifics pertaining to the two proposals
- Copy of the proposed TI & YBI Regulation
- Copy of the Departments existing Regulation wherein the proposed revisions are
highlighted.. Additionally, a clean copy of the revised Regulation, which incorporates all
the proposed changes, was included.
- Copy of the Department of City Plannings Certificate of Determination, and a copy
of a January 19,. 1999 letter from EHS to the Department of City Planning.
- Copy of an April 20, 1999 Memorandum from Deputy City Attorney William Chan to the
Health Commission and Dr. Mitch Katz. This memorandum summarizes the rational for the two
EHS proposals and addresses the issues raised by the public at the Commissions April
6, 1999 meeting.
Deputy City Attorney William Chan has reviewed and approved, as to form, the
resolutions, the proposed revisions of the existing Regulation and the proposed TI &
YBI Regulation. The Health Commission is authorized to adopt the two proposals under the
City Charter, Section 3.500. Additionally, these proposals need not go before the Board of
- Alan Sparer, Sunset Scavenger and Golden Gate Disposal, indicated his withdrawal of
- Albert Bianchi, representing Bay Cities Refuse, requested entitlement to exclusivity and
requested his letter to the Commission dated April 1, 1999 be included in the records.
Action Taken: The Commission unanimously approved Resolutions #17-99, "Adopting Regulation for the Orderly
Issuance of Refuse Collection Permit for Non-Federal Facilities at Treasure Island and
Yerba Buena Island" and #18-99, "Revising the Federal Facilities
Refuse Collection Permit Regulation to Harmonize it With Refuse Collection Permit
Regulation for Non-Federal Facilities at Treasure Island and Yerba Buena Island."
9) CONSIDERATION OF THE SAN FRANCISCO GENERAL HOSPITAL QUALITY ASSURANCE PLAN
Dr. John Luce, Medical Director for Quality Management, presented Administrative Policy
#17.1, Quality Improvement Program.
The purpose of the Quality Improvement (QI) Program is to promote organizational
performance improvement in the delivery of patient care. This policy defines the
systematic process used to measure, assess and improve care delivered to patients and the
organizational functions which support the delivery of this care.
Action Taken: The Commission unanimously approved the San Francisco General
Hospital Quality Assurance Plan.
10) PUBLIC COMMENTS
Lincoln Madison expressed his criticism of Dr. Katzs recent statements in the
press regarding bath houses.
President Monfredini offered to meet with Mr. Madison.
11) CLOSED EXECUTIVE SESSION:
A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION
B. VOTE ON WHETHER TO HOLD CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN FRANCISCO
ADMINISTRATIVE CODE SECTION 67.11(a).)
Action Taken: The Commission voted to hold a Closed Session.
The Commission went into Closed Session at 7:20 p.m.
Commissioners Monfredini and Hill left at 8:17 p.m.
C. CLOSED SESSION PURSUANT TO GOVERNMENT CODE SESSION 54956.9 AND SAN FRANCISCO
ADMINISTRATIVE CODE SECTION 67.11(b).
CONFERENCE WITH LEGAL COUNSEL ANTICIPATED LITIGATION
DEPARTMENT OF JUSTICE REVIEW OF LAGUNA HONDA HOSPITAL
The Commission came out of Closed Session at 9:10 p.m.
D. RECONVENE IN OPEN SESSION:
1. POSSIBLE REPORT ON ACTION TAKEN IN CLOSED SESSION. (GOVERNMENT CODE SECTION
54957.1(a)(2) AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(b)(2).)
2. VOTE TO ELECT WHETHER TO DISCLOSE ANY OR ALL DISCUSSIONS HELD IN CLOSED SESSION (SAN
FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(a).)
Action Taken: The Commission voted not to disclose any discussions held in the
The meeting was adjourned at 9:15 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission