Minutes of the Health Commission Meeting
June 19, 2001
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 Roma Guy, M.S.W., at 3:10 p.m.
All Commissioners were present:
- President Roma P. Guy, M.S.W., President
- Vice President Edward A. Chow, M.D.
- Commissioner Arthur M. Jackson
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner John I. Umekubo, M.D.
- Commissioner David J. Sanchez, Jr. Ph.D. arrived at 4:00 p.m.
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JUNE 5, 2001
Action Taken: The Commission adopted the Minutes of June 5, 2001.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Monfredini chaired the Budget Committee, with Commissioner
(3.1) DPH - Request for approval of a proposed ordinance to revise
patient rates for the Department of Public Health for FY 2001-02.
(3.2) DPH-Central Administration/MIS - Request for approval of a
contract modification to the product and services agreement with Siemens
Medical Solutions Health Services Corp to add $800,000 for a Patient
Access Systems and Process Integration project, for a total revised
contract amount of $7,167,691, for the term January 1, 1999 through June
30, 2002. (DPH contracted with Siemens for services totaling $4,872,954
during FY 2000-01).
(3.3) AIDS Office - Request for approval of a sole source and new
contract with University of California at Berkeley (UCB), Survey
Research Center, in the amount of $169,362, to provide piloting,
planning, programming and telephone interviewing services for the San
Francisco Behavioral Risk Factor Survey services that will target San
Francisco residents, for the period of June 1, 2001 through December 31,
(3.4) AIDS Office - Request for approval of a contract modification
with Mobilization Against AIDS International (MAAI) in the amount of
$46,967, for a new contract total of $90,467, to provide additional HIV
prevention interventions to transgender individuals, for the period of
January 1, 2001 through December 31, 2001. (DPH Contracted with MAAI for
services totaling $289,204 during FY 2000-01).
(3.5) CHPP-Promotion - Request for approval of a contract renewal
with Polaris Research and Development, in the amount of $150,000, to
provide evaluation services for the Tobacco Free project, for the period
of July 1, 2001 through June 30, 2002. (DPH contracted with Polaris for
services totaling $434,516 during FY 2000-01).
(3.6) CHPP-Promotion - Request for approval of a contract renewal
with O’Rorke Public Relations and Advertising, in the amount of
$85,000, to provide media services to the Tobacco Free Project, for the
period of July 1, 2001 through June 30, 2002. (DPH contracted with O’Rorke
for services totaling $109,200 during FY 2000-01).
(3.7) CHPP-Promotion - Request for approval of a contract renewal
with San Francisco Study Center (SFSC), in the amount of $708,856, to
provide fiscal agent services for the Community Capacity Building
Training Center for the Tobacco Free Project, for the period of July 1,
2001 through June 30, 2002. (DPH contracted with SFSC for services
totaling $2,448,129 during FY 2000-01).
(3.8) PHP-Substance Abuse - Request for retroactive approval of a
modification for SAGE Project, Inc., for capital expenditure in the
amount of $75,000, to complete the renovation of the building begun in
FY 1999-00, specifically the building-wide sprinkler system, for a total
contract value of $483,699, for the period of June 1, 2001 through June
30, 2002. (DPH contracted with SAGE for services totaling $397,915
during FY 2000-01).
(3.9) PHP-Mental Health - Request for approval of a modification to
the multiyear contract with Ramsell Corporation doing business as
Professional Management Development Corporation, in the amount of
$130,000, to provide fiscal intermediary services under the San
Francisco Mental Health Plan, and to extend the term of the existing
contract for the period of July 1, 2000 through June 30, 2002, for a
total contract value of $1,544,020. (DPH contracted with Ramsell for
services totaling $707,010 during FY 2000-01).
(3.10) PHP-Mental Health - Request for approval of a retroactive
contract modification with Recreation Center for the Handicapped (RCH),
in the amount of $136,552, to provide behavioral day treatment services
for dually diagnosed, mentally ill and developmentally challenged
clients, for a total contract value of $337,924, for the period of July
1, 1997 through June 30, 2001. (DPH is in the process of contracting
with RCH for services totaling $84,481 during FY 2000-01).
(3.11) PHP-Mental Health - Request for approval of a retroactive
contract modification with Regents of the University of California San
Francisco (UCSF) Center on Deafness, in the amount of $294,791, to
provide mental health services and case management for adults, substance
abusing clients, HIV/AIDS clients and a special education program for
children targeting the deaf and hard of hearing population, for a total
contract value of $1,344,135, for the period of July 1, 1997 through
June 30, 2001. (DPH contracted with UCSF for services totaling
$10,581,353 during FY 2000-01).
(3.12) PHP-Mental Health - Request for approval of a retroactive
contract modification with Support for Families of Children with
Disabilities (SFCD) to increase funding in the amount of $99,000, to
cover the period of April 1, 2001 through June 30, 2001, to continue to
provide a variety of mental health services targeting families of
children with mental health issues and special needs, for a total
contract amount of $369,000 for the period of April 1, 2000 through June
30, 2001. (DPH contracted with SFCD for services totaling $270,000
during FY 2000-01).
Action Taken: The Commission approved the Consent Calendar of
the Budget Committee.
- Jaime Arisilla works as a consultant Support for Families for
Children with Disabilities and the Department of Mental Health. He
stated that he recently received a letter concerning the cancellation
of his consulting contract, and that he was concerned about his
- In response, Sai-Ling Chan-Sew, Director, Children’s Services,
discussed the funding difficulties. She stated that the speaker had
options open to him to work on other contract aspects.
4) DIRECTOR’S REPORT
(Mitchell H. Katz, M.D., Director of Health)
In an effort to move us further toward
implementation of the Department's Strategic Planning goals and
objectives, Dr. Katz made some changes to the organizational structure. As
the Department has continued to evolve over the past several years, these
changes reflect the nature of who DPH is and what it does.
The reorganization reinforces the Department's strategic direction in
four major ways: First, the new structure integrates primary care,
behavioral health, housing and maternal and child health into one
division. This will enhance service integration and enable the Department
to improve access to care for multiple service users. Second, the
reorganization creates a Hospital Systems division, which combines
oversight of the rebuilds of both Laguna Honda Hospital and San Francisco
General Hospital with the Department's quality management and managed care
activities. This will allow the Department to focus on critical
institutional infrastructure activities in a coordinated and comprehensive
manner. Third, the new structure more evenly weighs the major activities
of the Department, thereby creating a flatter management structure and
enhancing the Department's ability to create a fully integrated service
system. Fourth, by creating a single planning office we move ourselves
closer to functioning as a single department.
This new structure will enable the Department to be more responsive to
the needs of our clients and assist us in achieving the goals and
objectives set forth in the Strategic Plan. Attached is a copy of the new
organizational chart and more detailed information about the
reorganization for your review.
COMMUNITY HEALTH NETWORK
World Birth Day Project
The New York Times Television has solicited the participation of both
the Birth Centers of SFGHMC and UCSF to represent births in the United
States for a special "World Birth Day" production. This project
will film the births of infants at nine locations around the world, all
born at about the same time on July 2nd and 3rd. Other filming sites are
China, India, Ethiopia, Egypt, Germany, England, Brazil and Mexico. The
documentary will air on New Years Day 2002 on the Learning Channel in the
USA and the Discovery Channel around the world. The long-term goal is to
follow this piece with additional programs over time, showing the
different lives these children lead as they grow up in different parts of
SFGH Receives NAPH Award for Integrated Soft Tissue Infection
Dr. Katz announced that San Francisco General
Hospital’s Integrated Soft Tissue Infection Service (ISIS) has received
honorable mention award from the National Association of Public Hospitals
(NAPH) in the category of the "Safety Net Health Innovation."
Over 26 public hospitals across the nation submitted nominations for three
award categories. Gene O’Connell and Gayling Gee will be in attendance
at the June 28th conference in Santa Fe to accept the award on behalf
of San Francisco General Hospital.
Congratulations to the ISIS Team: Gayling Gee, Hobart Harris and David
Young, and Jacquie Caesar, for their enthusiasm and commitment to the ISIS
LHH Executives Receive Recognition
Dr. Katz reported that Mary Louise Fleming, Laguna Honda Director of
Nursing, has been selected for the Robert Wood Johnson Executive Nurse
Fellows Program. Only 20 nurses nationwide were selected for this
prestigious 3-year program. The award provides for research projects at
Laguna Honda as well as the opportunity for more educational program
development and national exposure for Mary Louise, our resident care
programs, Laguna Honda Hospital and the Department of Public Health.
Dr. Katz reported that Dr. Terry Hill had been voted President elect of
the California Association of Long Term Care Medicine, an organization
representing the Long Term Care Continuum in California. This organization
is the state affiliate of the American Medical Directors Association. Dr.
Hill’s leadership capabilities in Long Term Care are impressive and have
been duly recognized by this progressive statewide organization.
- Commissioner Monfredini asked about the burden placed upon the
Director when so many different people report directly to him
- Commissioner Parker asked about items not on the chart. Dr. Katz
responded that those units still exist, but that the goal was to list
everything on one page
- Vice President Chow stated that, under the new chart, organizations
can focus on things important to them, and is more a reflection of the
ways the Department operates today
- President Guy stated that she supports the reorganization, and that
it reflects transitions that the Department has experienced
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEES
RECOGNITION AWARDS FOR THE MONTH OF JUNE
Commissioner Umekubo presented the following Employee Recognition
Housing and Urban Health, Population Health and Prevention, Housing and
- Marc Trotz
- Margot Antonetty
- Daisy Leyva
Community Health Network/ San Francisco General Hospital, Emergency and
- Renee Cibulka
- Bobbie Earsey
- Arla Escontrias
- Linda Henson
- Kitty Mah
- Gloria Rodriguez
- Ann Stangby
The Commissioners thanked each of these teams for their contributions.
6) UPDATE ON EMERGENCY MEDICAL SERVICES (EMS) SYSTEM ACTIVITIES
John Brown, M.D., Medical Director, Emergency Medical Services, updated
the Commission on the Emergency Medical Services Section. He spoke about
the strategic plan for EMS to focus on core EMS functions. He stated that
in the year 2000, the EMS system received over 67,000 calls for emergency
assistance. Dr. Brown stated that the EMS Section recently approved a
large scale pilot program, entitled the “Rapid Paramedic Response
System.” He stated that, under this system, the SFFD would staff 25 ALS
(advanced life support) engines and 19 one-paramedic and one-EMT
ambulances. Dr Brown told the Commission that statistically and clinically
relevant data would be used to evaluate the program. He also stated that
the program would increase the number of ALS units available, and decrease
the time for response.
Dr. Brown also highlighted the Disaster Registry Program, the Public
Access Defibrillator Program, and emergency department overcrowding and
diversion. He stated that total diversion suspension was three times
higher overall in the year 2000 than in 1999. Dr. Brown also discussed the
Trauma Systems Plan, which calls for a new approach towards the care of
critically injured patients, and all who are injured within the City.
The Executive Summary for each of Dr. Brown’s presentations, “San
Francisco Department of Public Health, Emergency Medical Services Section,
Annual Report, Year 2000,” and “Ambulance Diversion and Emergency
Department Overcrowding in San Francisco” were enclosed as was
enclosed as attachments.
Dr. Marshal Issacs, EMS Director of the San Francisco Fire Department,
spoke to the Commission. He discussed the recent history of San Francisco’s
EMS system. Dr. Issacs also spoke about the Rapid Paramedic Response
System. He stated that the program is the single most important
development in modern EMS history in San Francisco, and will result in the
most rapid, high quality, out of hospital emergency medical care. Dr.
Issacs stated that the program contains some controversy, and the Fire
Department is doing its best to address concerns.
- Nora Roman appeared on behalf of Larry Bradshaw, a City paramedic.
He believed that the rapid paramedic response proposal traded quality
for faster response time, and this choice placed quantity over
quality. Ms. Roman stated that City data does not track patient
- Nora Roman, Emergency Coalition to Save Public Health, is actively
involved in the pre-hospital system. She stated that there is no
community advisory board advising the EMS system. Ms. Roman stated
that the Coalition opposes the plan as it now stands, and that she is
concerned about paramedics working 24-hour shifts. She asked the
Commission not to rush into this proposal.
- Jonathan Meade has worked as a City paramedic for over 21 years. He
stated that Dr. Brown’s and Dr. Issac’s presentation was sugar
coated, public relations presentation. Mr. Meade spoke about 60
paramedics who have left the job over the last three years. He stated
that the Fire Department grinds its paramedics into the ground.
- Dale Butler, SEIU 790, stated that he has never witnessed a more
self-serving spin on facts by management. He stated that dozens of
paramedics have quit, and four have died, because the Fire Department
insists on 24-hour shifts. Mr. Butler stated that paramedics go out on
more calls than other firefighters. He stated that he opposes the
proposal because it is bad for the residents.
- Dr. Thomas Pikes, President of San Francisco Emergency Physicians
Association, stated that he had received the presentations from Drs.
Brown and Issacs. Dr. Pikes stated that most calls only require one
paramedic at a time. He added that it is necessary to get ALS to
patients as soon as possible, and that one paramedic on the engine
will meet that goal.
- Vice President Chow asked about the approval process. In response,
Dr. Brown described three different advisory committees, which include
members of the general public and providers. He stated that all
policies go out with a public announcement and through a web site.
- President Guy reminded that the agenda item consisted of an update
and a review of the annual report, and was not an action item.
- Commissioner Monfredini asked about paramedic staffing. Dr. Issacs
stated that there are very few open slots within the Fire Department
- Commissioner Jackson stated that the main concerns are about whether
the person lives. He asked whether a paramedic arriving five minutes
earlier will improve patient outcomes. Dr. Brown stated that outcome
data today only shows whether patient lived to hospital, but that the
pilot program contains better outcome measures.
- Commissioner Sanchez asked questions concerning collecting data on
attrition and recruitment, and whether these issues are factors in
patient health and safety.
- Commissioner Parker inquired whether the 24-hour shift issue is a
health or labor issue. Dr. Issacs stated that the vast majority of
paramedics support the 24-hour issue.
Dr. Katz articulated a brief history of the paramedic issues. He
then identified the advantages of placing paramedics on fire engines.
Dr. Katz stated that the report was silent on whether an ambulance
should have one or two paramedics. He stated that a superior system is
transports at least one paramedic to the patient sooner, and with the
existing workforce, the only way to do that is through the one
paramedic on the engine and one paramedic in the ambulance proposal.
- Vice President Chow suggests that the JCCs look at these issues
- President Guy stated that she looks forward to the Trauma System
Report next month, and for the JCCs to review these issues. She stated
that the agenda could be reviewed for the next several months.
7) MINIMUM STANDARDS OF HEALTH INSURANCE COVERAGE FOR THE HEALTH
CARE ACCOUNTABILITY ORDINANCE
The Commission continued its consideration of the minimum standards of
health insurance, and the Proposed Resolution that it began during the
meeting of June 5, 2001.
Dr. Katz provided an overview of new issues for the Commission. He
discussed mental health coverage in the Proposed Resolution. Dr. Katz also
suggested two changes to the Proposed Resolution: 1) to make the effective
date of coverage begin be no later than 30 days following the start of
employment by the employee (to comport with the Health Care Accountability
Ordinance), and 2) to change the language of the Proposed Resolution to
state that employers must offer (instead of provide) insurance. Dr. Katz
also stated that the insurance product required by the Proposed Resolution
is available in the marketplace.
- Dale Butler, SEIU, Local 790, invited Larry Winston of Dublin
Insurance, Inc., to speak. Mr. Winston stated that his company
provides pooled insurance at a favorable rate to management. He told
the Commission that his company provides an insurance plan with a $10
co-pay that mirrors or is better than the plan in the Proposed
Resolutions good as outlined plan
- Elizabeth Frantes stated that the insurance program is a joke and an
insult. She said that HMO systems do not work. Ms. Frantes added that
employee-based insurance does not work, there is no job security. She
further stated that the proposal does not cover San Francisco
residents and was rushed through.
- Nathan Nayman is with the Committee on Jobs. He stated that the
business community supports the provision of health insurance to
individuals, but that the process for implementing the Ordinance was
flawed. Mr. Nayman stated that the process was not inclusive, and a
rush to pass the Ordinance and approve the basic benefit package. He
told the Commission that they are creating a two-tiered health
insurance program, and an elite group of employees who will not have
to pay a share of premiums.
- Glynn Washington, Human Services Network, stated his strong support
for the proposal. He stated that the ordinance has serious flaws. He
asked about possible ERISA violations in the implementation of the
Ordinance and the Health Commission minimum standards. Mr. Washington
asked for a body to be created that understands non-profit and small
business concerns, and which could respond to questions with real
- Debbie Lehrman, Human Services Network, echoed Mr. Washington’s
support for the Ordinance. She stated that it is vital to have some
one to provide policy expertise and technical assistance in the
construction and implementation of the regulations. She asked the
Commission to ensure the involvement of informed policy staff to make
the Ordinance a success.
After public comment, Dr. Katz stated that the Ordinance assigns
specific roles, and that the Health Department and Commission have tried
to fulfill their role. He said that the person responsible for the
administration of the Ordinance is the Director of Purchasing. Dr. Katz
added that the City is committed to training.
- In response to Commissioners’ questions, Dr. Katz clarified that
the Proposed Resolution called for a maximum co-payment for skilled
nursing care of $100 per admission
- President Guy and Vice President Chow requested quarterly updates
from the Department
- Commissioner Monfredini raised the issue of different levels of
health insurance coverage, depending on whether the employee is
working on a City Contract. Dr. Katz replied that the employer does
not have to provide health insurance to the worker who is not a
covered employee under the Ordinance, or could provide a different
benefit package or higher deductible
- Commissioner Jackson questioned whether it is legal to provide two
employees of the same firm with different levels of health insurance.
In response, Aleeta Van Runkle, Deputy City Attorney, stated that the
Office of the City Attorney has reviewed the Ordinance for ERISA
issues, and that the Office believes that the Ordinance would survive
a legal challenge brought under ERISA.
The Commission amended the language of the Proposed Resolution in two
ways, to read:
“RESOLVED, that the effective date of
coverage be no later than 30 days following the start of employment by
the employee on a covered contract, subcontract, lease, or sublease”…
and to read, under the co-payment schedule:
“Skilled Nursing Services $100/admission” (minimum 100 days/year)
On the motion to accept the Amended Resolution, seven Commissioners
(Guy, Chow, Jackson, Monfredini, Parker, Sanchez, and Umekubo) voted aye.
The motion passed.
The Resolution approved by the Commission was
enclosed as an attachment.
8) PROGRAM REPORT ON WELLNESS CENTERS
Sai-Ling Chan-Sew, Director, Children’s Services, Community Mental
Health, presented an update on the High School Wellness Program. She was
accompanied by: Trish Bascum, Director of the School Health Program of the
San Francisco Unified School District; Nani Coloretti, Fiscal Manager for
the Department of Children, Youth and their Families; and Deborah
Rodriguez-Alvarez, Director of the Department of Children, Youth and their
According to Ms. Chan-Sew, the program is in effect in seven high
schools, and approximately 4000 students have sought services, and was
created in response to student feedback. According to the report, the
program provides students access to health education, reproductive
counseling, substance abuse counseling, mental health services, and
referrals to primary health care, all through the school sites.
The PowerPoint presentation made to the Commission was
enclosed as an attachment.
- Commissioner Monfredini asked about a student’s first interaction
with the wellness team, and how quickly the team can react to a crisis
(possible suicide or abuse) situation. The Commissioner described the
program as wonderful.
- Commissioner Sanchez congratulated and thanked all of the partners
involved in the wellness program, and asked all to continue to work
together to expand options.
- Commissioner Umekubo also complimented the program leaders. He asked
specifically about the Balboa Teen Clinic. Sai-Ling Chan-Sew stated that
the clinic was fully staffed.
- Vice President Chow asked about the plans for reaching the high schools
not yet included in the program. Ms. Chan-Sew responded that she was not
sure, and was working on staffing the present centers. Vice President Chow
asked if the identified priorities extended throughout all schools, and
Ms. Chan-Sew responded that they did. Vice President Chow also asked about
the timetable for evaluating the program. Deborah Rodriguez-Alvarez,
Director of the Department of Children, spoke in more detail concerning
the evaluation strategy.
- President Guy thanked Ms. Rodriguez-Alvarez for the key leadership that
she provided to make the program possible.
9) OTHER BUSINESS/PUBLIC COMMENTS
10) CLOSED SESSION
A. Public comments on all matters pertaining to the closed session
B. Vote on whether to hold a closed session pursuant to Government Code
Section 54957 and San Francisco Administrative Code Section 67.10(b)
Action Taken: The Commission voted to hold a closed session. The closed
session began at 6:30 p.m.
C. Closed session pursuant to Government Code Section 54957 and San
Francisco Code Section 67.10(b)
Public Employee Hiring: 1551 Executive Secretary to the Health
D. Reconvene in Open Session
- Possible report on action taken appointing the Executive Secretary to
the Health Commission (Government Code Section 54957.1(a)(5), and San
Francisco Administrative Code Section 67.14(b)(4))
- Vote to elect whether to disclose any or all discussions held in closed
session (San Francisco Administrative Code Section 67.14(a))
Action Taken: No report issued. The Commission voted not to disclose
any discussions held in closed session. The closed session ended at 6:40
The Commission adjourned the meeting at 6:40 p.m.
Arthur R. Greenberg, Interim Executive Secretary to the Health