Minutes of the Health Commission Meeting
April 17, 2001
101 Grove, Room 300
San Francisco, CA 94102
1) CALL TO ORDER
The regular meeting of the Health Commission was called to order by
President Roma Guy, MSW, at 3:10 p.m.
- President Roma P. Guy, M.S.W.
- Vice President Edward A. Chow, M.D.
- Commissioner Arthur M. Jackson
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Jr., Ph.D.
- Absent: Commissioner Lee Ann Monfredini
- Commissioner John. I. Umekubo, M.D.
2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF APRIL 3, 2001.
Action Taken: The Commission adopted the minutes of March 20, 2001.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner David J. Sanchez, Jr., Ph.D.)
(3.1) PHP - Housing and Urban Health Services - Request for approval
of a new contract with John Stewart Company, in the amount of
$1,005,375, to provide property management services and related start-up
costs for the new Direct Access to Housing Programs at the Star and
Camelot Hotels, which will provide 105 supportive housing units, for the
period of May 1, 2001 through June 30, 2002.
Commissioner Sanchez asked about funding streams in the housing
(3.2) PHP - Substance Abuse Services - Request for approval of Phase
I of the implementation of the Proposition 36 Substance Abuse Crime and
Prevention Act, to authorize expenditures of $2.3 million in FY
(3.3) AIDS Office - Request for approval of St. Mary’s portion of
the FY 2001-2002 Ryan White Comprehensive AIDS Resources Emergency
(CARE) Act of 1990 Title I, for the period of March 1, 2001 through
February 28, 2002, for Title I programs, in the amount of $1,234,862
consisting of $776,854 for Integrated HIV Health Services and $458,008
for AIDS Dementia Care.
Jimmy Loyce, Director of DPH’s AIDS Office, described the more
recent visits and meetings in which his office has engaged concerning
St. Mary’s AIDS Dementia Unit (ADU), in response to concerns raised by
President Guy and other Commissioners
Shareen Salem, Executive Director of Inpatient Nursing Services at
St. Mary’s, stated that the administration will work with the CNAs,
and will conduct training within one month. She also stated that
administration will work on communication issues.
- Allen Fitzpatrick, R.N., St. Mary’s stated that the skilled
nursing unit nurses are still concerned about the ADU, but
encouraged by recent events. He supports continued funding for St.
- Marcy Fraser works with HIV community programs. She stated that
the rest of the community values the services provided by St. Mary’s
- Commissioner Sanchez, on behalf of the Budget Committee, stated
that the recent Proposition Q hearings provided dialogue concerning
site and quality of care issues
- Commissioner Jackson acknowledged that St. Mary’s CEO had been
present throughout the meetings
- In response to Commissioners’ concerns, Mr. Loyce stated that
his office will continue to conduct site visits and monitor the
Action Taken: The Commission approved the Consent Calendar of
the Budget Committee.
4) DIRECTOR’S REPORT
(Mitchell H. Katz, M.D., Director of Health)
2001 State of the City Public Health Address
Last week I delivered the State of the City Public Health Address
before the Board of Supervisors. All members of the Health Commission have
been provided copies of the report. The Department has provided this
Address for the last six years to provide the public and our elected
officials with information on the health status of the community. My
remarks focused on expanding community-based services, prevention,
environmental health, communicable diseases, substance abuse and mental
health services. I would like to acknowledge the tremendous work done by
Frances Culp of the Office of Policy and Planning in working on this
report. As the Health Commission is aware, Population Health and
Prevention compiled the overview of San Francisco’s health status. The
report will be available on the Department’s web site at www.dph.sf.ca.us.
Raymond Hotel Fire
A fire broke out at 6:15 a.m. Easter morning at the Raymond Hotel, 1011
Howard Street. Red Cross established a temporary shelter at the South of
Market Recreation Center at 6th and Folsom. The fire displaced
seventy-eight individuals. Three residents suffered minor injuries, no
fatalities occurred. The Health Department, Department of Human Services,
Mayor’s Office of Homelessness, Animal Care and Control, Recreation and
Park were all on hand to strengthen and enhance Red Cross response
efforts. Many residents of the Raymond are DPH patients, and have fairly
high medical needs. Dr. John Brown responded to the site and was able to
provide medications for 34 residents. Barbara Garcia, LaDonnis Elston and
the MOST Team all responded and triaged clients. The shelter will remain
open until Wednesday when it is hoped that temporary housing will be
secured for all those displaced residents.
Proposed Race, Ethnicity, Color or National Origin Classification
University of California Regent Ward Connerly’s American Civil Rights
Coalition has sponsored a new initiative entitled “Race, Ethnicity,
Color or National Origin Classification.” The initiative would prohibit
state and local governments from using race, ethnicity, color or national
origin to classify individuals in government operations (including public
education, contracting or employment operations). Actions taken to
maintain federal funding are exempted, though classification of public
health data is not. The initiative is currently in circulation. If the
required number of signatures is collected, 670,816 by August 31, 2001, it
will appear on the State’s March 2002 ballot. If approved by California
voters, the effective date is January 2005.
Voter approval of such an initiative could significantly impact the
Department’s operations. Currently, the Department collects and reports
race, ethnicity and national origin information through its hiring and
contracting processes. The Department would be stymied in its ability to
collect information on the ownership of contracting businesses, to
evaluate a contractor’s cultural competency and to respond to lawsuits
alleging racial discrimination. Additionally, the Department collects
race, ethnicity and/or national origin to appropriately evaluate the
health needs of San Francisco’s diverse communities and to conduct
program planning. As currently written, the initiative would severely
limit the Department’s ability to analyze and respond to health
disparities based on race, ethnicity and/or national origin.
As in the past, if this initiative is certified for the March 2002
ballot, then the Health Commission may want to consider adopting a
resolution urging the Board of Supervisors to take a position on the
initiative. The Department will keep the Health Commission apprised of
this proposed initiative.
President Bush’s Proposed Fiscal Year 2002 Budget
Last week, President Bush released his fiscal year 2002 proposed
federal budget. The proposed budget is similar in intent to the
President’s budget priorities released in February 2001. The budget is
designed to “moderate recent rapid growth in spending while funding
national priorities, paying down the debt and providing tax relief.” The
debt would be reduced by $2 trillion and taxpayers would get back $1.6
trillion in surplus over the next 10 years through tax relief.
The fiscal year 2002 budget for the federal Department of Health and
Human Services (DHHS) totals $468.8 billion, an increase of $38.3 billion
(8.9%) from the 2001 budget. In the area of health, the President’s
enhancing scientific research
expanding access to health care
protecting public health
increasing access to substance abuse treatment
investing in infrastructure and reforms management
encouraging organ donations
- Immediate Helping Hand: The Immediate Helping Hand proposal will
give immediate financial support to States so that they can provide
prescription drug coverage to beneficiaries with low incomes or high
drug expenses. This will provide coverage for up to 9.5 million
- Medicare Reform: The President proposes to devote nearly $156
billion this year and over the next ten years to improve the financial
condition of the Medicare program and to modernize the benefits
Expanding Health Care Access
- Community Health Centers: The DHHS budget launches a multi-year
Presidential initiative by proposing an increase of $124 million for
Community Health Centers in FY 2002 and supporting 1,200 new or
expanded health center sites over five years. This increase will
expand the delivery of services to up to one million additional
individuals in FY 2002.
- National Health Service Corps: The DHHS budget includes $126 million
in FY 2002 for the National Health Service Corps (NHSC). The NHSC has
placed over 20,000 health care providers.
- Native American Health Services: The FY 2002 DHHS budget provides
$3.0 billion for health care services at the Indian Health Service (IHS),
an increase of $151 million (5.3%) over FY 2001.
- Medicaid and SCHIP: The FY 2002 DHHS budget proposes to stem the
growth of Medicaid costs, ensure the fiscally prudent management of
the Medicaid and SCHIP programs, improve the way these programs
provide health care to the poor and near-poor, and increase State
flexibility in using private insurance coverage and coordinating with
- Public Health Grant Flexibility: The FY 2002 DHHS budget proposes to
give states greater flexibility to transfer funds among public health
grants. The budget also includes the President’s Healthy Communities
Innovation Fund initiative that supports grants to health care
improvement projects in State and local communities. DHHS could make
available approximately $400 million in existing grants for
Increasing Access to Substance Abuse Treatment
- The FY 2002 budget proposes an increase of $100 million for
substance abuse treatment services that will help close the treatment
gap. This includes $60 million for the Substance Abuse Block Grant. An
additional $40 million will support 80 additional Targeted Capacity
Expansion (TCE) grants.
Encouraging Organ Donation
- The FY 2002 budget request includes $20 million, an increase of $5
million, to launch a national campaign to encourage organ donation.
Enhancing Scientific Research
- Enhancing Research at the National Institutes of Health: The FY 2002
budget proposes a total of $23.1 billion for NIH, an increase of $2.75
billion (13.5%) over FY 2001. NIH will expand its focus on four broad
research areas - genetic medicine, clinical research,
interdisciplinary research, and health disparities.
- Supporting Research on Healthcare Quality and Outcomes: The FY 2002
budget provides a total program level of $306 million for the Agency
for Healthcare Research and Quality (AHRQ), an increase of $36 million
(13.5%) over FY 2001.
Protecting Public Health
- Protecting Patient Safety and Reducing Adverse Events: The budget
includes an additional $10 million to increase inspections and
oversight of clinical trials, train clinical trial inspectors, and
allow for follow-up of all complaints concerning clinical trials
within 30 days. The Agency for Healthcare Research and Quality will
spend $53 million to continue its work on reducing medical errors.
- Safeguarding the Nation’s Food Supply: To help safeguard the
nation’s food supply, the FY 2002 budget includes a total of $124
million, an increase of nearly $15 million, for FDA food safety
activities. FDA will expand inspections of food manufacturers, improve
coverage and inspection rates at import entry points, and focus on
illnesses derived from chemicals and pesticides. In addition, $34
million will be provided to the Centers for Disease Control and
Prevention (CDC) for food safety activities.
Investing in Infrastructure and Reforms Management
- Revitalizing Laboratories and Scientific Facilities: The budget
includes $150 million for buildings and facilities at CDC.
- Enhancing Coordination and Reducing Duplication of Operating
Systems: The FY 2002 budget invests to streamline financial management
and other information technology systems to eliminate unnecessary and
duplicate systems. A total of $122.5 million will finance DHHS’s
unified financial accounting system and information technology.
- Redirecting Resources: The FY 2002 budget eliminates $475 million in
earmarked projects and $155 million in funding for activities that
were funded for the first time in FY 2001. The budget shifts $597
million from programs such as Health Professions and the Community
Access Program to higher priority activities.
POPULATION HEALTH AND PREVENTION
Effective July 1, 2001 Proposition 36 requires that certain nonviolent
drug possession offenders receive drug treatment and supervision in the
community, rather than incarceration. As the lead agency for the
implementation of the proposition the Department of Public Health (DPH) is
facilitating a planning process, inclusive of the community and
representatives from both public health and criminal justice. The process
is designed to inform the development of a countywide implementation plan.
On Wednesday, March 28th, the Proposition 36 Steering Committee,
co-chaired by Barbara Garcia and District Attorney Terence Hallinan, met
for the second time to review recommendations made by three subcommittees
(Criminal Justice, Treatment, and Data, Assessment, Monitoring &
Evaluation). The Steering Committee and members of the public provided
valuable input for the subcommittees to consider as they develop their
final recommendations to be presented at the April 18th Steering Committee
DPH will be taking the recommendations developed through this process
to produce an implementation plan, which will be presented to the Health
Commission on May 15th.
Asthma Task Force
Legislation sponsored by Supervisor Maxwell to form a citywide Board of
Supervisors’ Asthma Task Force will be heard by the Rules Committee on
April 19th at 1pm. This legislation represents the efforts of a citywide
group of asthma advocates and service providers and was initiated one year
ago by Supervisor Becerril.
The Task Force will gather and review existing information on the
prevalence, management, and prevention of asthma and will identify
legislative actions and citywide strategies to ensure the highest standard
for asthma management and prevention services for San Francisco residents.
Membership will be balanced among those diagnosed with asthma, community
and advocacy organizations, and academic, public and private health care
professionals. SFDPH will have a representative on the committee, and the
Health Commission will be asked to contribute to the plan’s findings and
recommendations to the Board.
Children's Environmental Health Promotion Program
As an adjunct to World Asthma Day, the YES WE CAN Urban Asthma
partnership is slated to launch a new Poster Campaign beginning mid-April
through May 3rd. The campaign is designed to raise public awareness of the
burden of asthma and promote asthma self -management and clinical
"best treatment." 5500 indoor posters in three languages
(English, Spanish, and Chinese) will be distributed to more than 900 sites
within the City. Next year, the campaign will extend to buses and
The YES WE CAN Urban Asthma partnership is comprised of 11
organizations who advocate for low-income communities on issues of child
health and community wellness.
The Children's Environmental Health Promotion Unit of DPH was a
founding member of this partnership. The Urban Asthma partnership began
implementing a medical/social model at SFGH 6M Pediatric Asthma Clinic as
a pilot program last year which will serve nearly 700 asthmatic children
living in the southeast areas of the City.
Children, Youth and Family Services
Two abstracts from CYFS were accepted for the upcoming 2001 Maternal
and Child Health Conference being held May 30-31 at the Hyatt Regency San
Janet Shalwitz, MD, will conduct a workshop entitled “Think
Globally/Act Locally: Effective Community-Based Planning for
Adolescents.”; Patricia. Evans, M.D., MPH, will conduct a workshop
entitled “Creating Partnerships for Updating a Foster Care HIV Screening
and Testing Protocol.”
COMMUNITY HEALTH NETWORK
Volunteers from both Laguna Honda Hospital and San Francisco General
Hospital will be honored at upcoming Luncheons on April 24th and April
28th respectively. All members of the Health Commission are cordially
invited to attend.
SFGH Honors Mrs. Edna Woods
The l906 Earthquake anniversary offers us a wonderful opportunity to
appreciate what this magnificent City survived 95 years ago. This City and
the nation are well aware of the tremendous loss of lives and the
destruction of neighborhoods from both the quake and fire. This year SFGH
will play a major part in the City's Earthquake Awareness &
On April 10, 2001 Gene O’Connell and staff started by reaching out to
a SFGH neighbor and friend who was born the same year of the l906 quake
and who has lived practically all of her life across the street from San
Francisco General Hospital. (Her first 8 months was in a tent city at
Bryant & l6th Streets.)
Edna Wood, a third generation San Franciscan, was honored during a
special ceremony at SFGH for her enormous spirit and a lifetime supporting
her neighbors and community. At the age of 95, Ms. Wood continues her
activism with the East Mission Improvement Association and St. Peter's
CHN Personnel Updates
I am happy to announce that Diane Jones has been selected as the new
Coordinator of Community Home Care for Health at Home. Ms. Jones comes to
Health at Home with extensive knowledge experience in harm reduction and
AIDS/Oncology. For the last 19 years, She has been with San Francisco
General Hospital, working in various capacities including as a Charge
Nurse the Emergency Department and Nurse Manager for the AID/Oncology
unit. In addition to all of her experience at SFGH, she also serves as a
trainer/consultant for the Harm Reduction Training Institute.
Ms. Jones will work with other members of the Health at Home Management
Team to develop and ensure the quality and delivery of Home Health
services and to provide clinical coordination for CARE Title I home care
contracts and the expansion of other services.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEES
RECOGNITION AWARDS FOR THE MONTH OF APRIL
Commissioner Parker presented the awards to the following:
Michele Friedman, RN, MSc., Head Nurse
PHP - Community Mental Health Services
Gemma Deocampo, Business Analyst
DPH - Central Administration Information Technology
Monique Zmuda, David Counter, Antonia Cardona-Malgieri
Thomas O’Connor, Manager, Systems Group
PH&P - Enterprise Information Systems/Engineering Systems
Christopher Kim, Engineering Group
6) UPDATE ON IMPLEMENTATION OF STRATEGIC PLAN
Tangerine Brigham, Director of Policy and Planning, discussed the
Departmental strategic planning update before the Commission.
Ms. Brigham began by discussing the strategies completed, and those
that will be initiated in future fiscal years. She discussed the staff
resources, Commission policies, resolutions, and recommendations. Ms.
Brigham also highlighted the wide variety of current service integration
initiatives. In addition, Ms. Brigham outlined measures taken to ensure
continued staff involvement in the strategic planning initiative. She
informed the Commission of a series of community town hall meetings, one
in each of the City’s supervisorial districts, to communicate the
adopted strategic plan to the community, and to gather the community’s
input into the process.
She stated that DPH staff will provide regular updates to the
Commission through the Joint Conference Committees (JCCs).
- Commissioner Parker asked about value of Town Hall participation;
Ms. Brigham responded that the meetings provide a “reality check”
for DPH planners, and that the community comments are valuable
- Commissioner Parker asked about increasing the emphasis on
prevention activities; President Guy supported Commissioner Parker’s
interest in prevention. Ms. Brigham responded that the Department has
a multiyear prevention plan
- Vice-President Chow complimented the Department concerning the grid
that it developed to graphically illustrate the strategic plan; Ms.
Brigham stated that the Department will add a “status” column with
updates on each of the proposals
- President Guy stressed the strategic plan as a living document, and
wants to monitor community involvement
- The Commission would like to see more specific strategic plan status
reports, details, and “do-ables” at the JCCs
- The Commission requested the Department to provide another report at
an October Commission meeting
- Each Joint Conference Committee (CHN, LHH, SFGH, and PHP) will
establish on-going reporting mechanisms for the implementation of the
Strategic Plan. On a regular basis, each JCC will discuss their
priorities, progress, and other related issues.
7) PRESENTATION OF THE HOMELESS CONTINUUM OF CARE PLAN AND
CONSIDERATION OF A RESOLUTION IN SUPPORT OF THE PLAN
Anne Kronenberg, DPH’s Director of External Affairs, updated the
Commission concerning the Homeless Continuum of Care Plan. The Commission
also considered a proposed resolution to approve the plan, and to urge the
Board of Supervisors to adopt it.
Ms Kronenberg provided an overview of the plan and its highlights. She
stated that DPH was well represented providing input at committees. Ms.
Kronenberg assured the Commission that the plan was not dealing with just
one slice of homelessness, but was taking a larger approach, to streamline
and integrate services, and to offer other services on site.
During the presentation, Ms. Kronenberg was joined by Rita Semel and
Bob Nelson, co-chairs of the Local Homeless Coordinating Board, described
the plan as a work in progress, and as a five-year, broad-stroke plan.
George Smith, Director of the Mayor’s Office of Homelessness, stated
that the plan looks to prevent homelessness. According to Ms. Kronenberg,
the Health Commission was the first body to review, and then approve, the
- President Guy stated that the planning and engagement had been
rigorous and disciplined, and urged other Commissioners to support the
- Commissioners complimented the document and the dialogue that has
- Commissioner Jackson asked about points of access for the working
poor; Ms. Kronenberg stated that case managed shelters reach out to
the working poor
- Commissioners look forward to hearing again from Ms. Kronenberg
later this summer concerning the Plan and community input
Action Taken: The Commission considered the proposed resolution.
It added the underlined language to the 14th Whereas clause to read: “Whereas,
the Department’s emphasis on prevention, early intervention and primary
care for the homeless and at-risk populations has the positive consequence
of improving health status and reducing emergency room visits . . . .”
On the motion to pass the Resolution, as amended, five Commissioners (Guy,
Chow, Jackson, Parker, and Sanchez) voted aye, none voted no. The motion
8) PRESENTATION ON LONG-TERM CARE INTEGRATION PILOT PROJECT, AND
CONSIDERATION OF A RESOLUTION REVISING THE DEPARTMENT OF PUBLIC HEALTH’S
Anthony Wagner, Executive Administrator of DPH’s Community Health
Network, and co-chair of the Long-Term Care Pilot Project Task Force,
began his presentation by thanking others who were involved in the
planning efforts. These people included: Jennie Chin Hansen, Executive
Director, On Lok, and co-chair of the LTC Pilot Project Task Force; Dr.
Sandra Nathan, Executive Director, Department of Aging and Adult Services
(DAAS); Bill Haskell, Department of Aging and Adult Services; and
Tangerine Brigham, Director of Policy and Planning, DPH.
Mr. Wagner focused on two issues: 1) Whether the City should continue
to participate in the AB 1040 program; and 2) Whether the Task Force
Mission can be pursued by the Department of Aging and Adult Services. He
outlined the various changes that have occurred since AB 1040 was adopted
in 1985. Mr. Wagner then offered several next steps:
- The Long-Term Care Pilot Project should be disbanded for the purpose
of developing a comprehensive plan under AB 1040
- The lead agency responsibilities of DPH to develop and implement a
long-term care integration project under AB 1040 should be terminated
- The activities of the Task Force to plan and oversee implementation
of improvements in San Francisco’s LTC service delivery system
should be transferred to the DAAS Continuum of Care Policy Committee
- DPH should continue to provide technical assistance on LTC to DAAS,
and should participate on the DAAS policy committees that oversee this
- A joint meeting of the Health Commission, the Human Services
Commission, and the Aging and Adult Services Commission will be held
for the Task Force to present: 1) its findings and recommendations
regarding participation in the State’s LTC Long-Term Care Pilot
Program (AB 1040); and 2) the initial administrative oversight for
implementing improvements in San Francisco’s LTC service delivery
- In June 2001, the Task Force will proceed to the Board of
Supervisors with a final presentation to report on AB 1040 and long
term care service delivery of older and disabled adults
Ms. Chin Hansen spoke briefly, supporting Mr. Wagner’s statements,
and emphasizing the City’s commitment to long term care. On behalf of
DAAS, Dr. Nathan accepted the long-term care planning and oversight
responsibilities identified for her organization.
Action Taken: On the motion to pass the resolution, four
Commissioners (Guy, Chow, Parker, and Jackson) voted aye, none voted no.
Commissioner Sanchez had left the meeting before the vote.
The motion passed.
9) OTHER BUSINESS/PUBLIC COMMENTS
The meeting was adjourned at 5:35 p.m.
Arthur R. Greenberg, Interim Health Commission Secretary to the Health