Minutes of the Health Commission Meeting
August 21, 2001
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The meeting was called to order by President Roma P. Guy, MSW, at 3:10
- President Roma P. Guy, M.S.W.
- Commissioner Arthur M. Jackson
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sánchez, Jr., Ph.D.
- Vice President Edward A. Chow, M.D.
- Commissioner Lee Ann Monfredini
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF AUGUST 7, 2001
Action Taken: The Commission (Guy, Jackson, Parker, Sánchez) approved
the minutes of August 7, 2001.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Sanchez chaired, and Commissioner Jackson attended, the
(3.1) PHP-AB 75 CHIP Application - Request for approval to accept and
expend retroactively a grant allocation in the amount of up to
$4,826,945 from the State Department of Health Services, through its
California Healthcare for Indigents Program (CHIP), to provide
reimbursement for health services delivered to indigent persons for the
term FY 2001-02.
(3.2) PHP-AIDS Office - Request for approval of a contract renewal
with Haight Ashbury Free Clinics, Inc. (HAFC) in the amount of $339,019
to provide HIV prevention services, for the period of July 1, 2001
through June 30, 2002. (DPH contracted with HAFC for services totaling
$8,591,737 during FY 2000-01).
- Commissioner Jackson asked where venue based individuals outreach
services take place. Cheryl Foston and Tracy Douglas Neil, both from
Haight Ashbury Free Clinics, responded that they have done
venue-based events with New Leaf, the Women’s Building, and Ark of
Refuge, among others.
(3.3) CHN-SFGH Nursing Operations - Request for approval of contract
renewals with the following firms for a combined total of $1,050,000:
HRN Services, Inc., Nurse Providers, Inc. and United Nursing
International. A combined total amount of $787,500 to provide
supplemental, temporary per diem nursing personnel services and a
combined total amount of $262,500 to provide supplemental, temporary
traveling nursing personnel services, for the period of September 1,
2001 through August 31, 2002.
(3.4) CHN-Office of Managed Care - Request for approval of a new
retroactive contract with San Francisco Health Plan, in the amount of
$2,346,925, to provide universal health insurance services targeting San
Francisco children, for the period of July 1, 2001 through June 30,
- Commissioner Sánchez stated that this is one of the most critical
demonstration projects the Health Department is undertaking, and it
represents a fantastic opportunity for the Department to work with
teachers and school administrators at the school site. Commissioner
Sánchez then introduced Jean Fraser, Director of the San Francisco
Health Plan. Ms. Fraser stated that all of the entities involved
will be able to convey a simple message to families, children and
teachers: San Francisco is committed to providing health care to
- Commissioner Guy said that Universal Health Insurance for Children
is a breakthrough program. Commissioner Guy stated that there have
been challenges in enrolling eligible children in the Healthy
Families Programs, and that these challenges will exist with this
effort as well. She asked that as this program progresses, the San
Francisco Health Plan communicate with the staff and the Commission
what is working and what is not in terms of outreach and enrollment.
Action Taken: The Commission (Guy, Jackson, Parker, Sánchez)
approved the Consent Calendar of the Budget Committee
4) DIRECTOR’S REPORT
(Mitchell H. Katz, M.D., Director of Health)
Diana Bonta, DrPH, Director of the California Department of Health
Services, will visit San Francisco later this week and meet with local
health officials. I will personally escort Dr. Bonta on a tour of Laguna
Honda and San Francisco General. We will take the opportunity to highlight
a number of programs and issues for her, including the ISIS Clinic,
Emergency Room overcrowding and the LHH Community Transition Program. In
addition, she will be meeting with the Hospital Council and Consortium
Clinic members to discuss reimbursement rates and integration of physical
and behavioral health services. Attached is Dr. Bonta’s complete
itinerary for the two-day visit.
Possible Reduction to Federal MediCal for SFGH in FY 01-02
Our staff have been actively involved in advocating against a rule
being developed by the federal Centers for Medicare and Medicaid Services
that would result in lower emergency services supplemental funding for
California's public hospitals. The current rule, called the Upper Payment
Limit (UPL), provides that public hospitals and health systems may in the
aggregate receive Medicaid payments up to 150 percent of what Medicare
would otherwise pay for similar services. However, to eliminate abuses of
this rule that are occurring in several states other than California, the
Administration is proposing to lower this limit to 100 percent. For San
Francisco General Hospital, approximately $22 million of the hospital's
SB1255 and MediCal GME payments would be subject to this new rule and it
could result in a loss of more than $10 million for the hospital. Staff
are working closely with the City's federal lobbyist, the National
Association of Public Hospitals and the California Association of Public
Hospitals to prevent this proposed rule from being implemented and to
mitigate the impact of any new rule on California. The Department will
keep the Commission informed of any final decisions or changes to the
projected revenues over the next few months.
Capp Street Fire
A fire broke out at 4:15 AM August 16th at Capp and 20th Streets,
destroying five residential buildings. An eight year old boy smelled the
smoke and alerted his parents who woke up the surrounding neighbors.
Seventy-five individuals (7 children) lost their homes and possessions in
the fire. The EMS section was notified of the fire and the DPH response
team was activated. No injuries were reported and it appears there are no
serious health issues. Most of the tenants were monolingual Spanish
speakers, so both DPH and DHS called on bilingual staff resources for
follow-up casework. Red Cross established a service center at 580 Capp
Street; and all victims were vouchered into hotels. The challenge now for
the City response team is to find alternative housing for the victims.
Treatment on Demand Funds
CSAS has received $1,105,000 from CSAT to fund three special programs
developed in response to Treatment on Demand:
- OBOAT (Office Based Opiate Addiction Treatment). This is a one-year
pilot program, which will provide treatment of opiate dependence by
physicians, counselors, and pharmacists working from their regular
clinical practices. These treatment providers may be based in
hospitals, in medical clinics, or in private practice. Treatment sites
participating in the program will include city-run health centers, the
City and County of San Francisco jail health services, local methadone
clinics, and community pharmacies. This program seeks to supplement
the current 2500-methadone maintenance slots in local methadone
clinics. One hundred patients will receive treatment through this
- Funds will also support the Pharmacotherapy Project, which builds
upon an existing provider education initiative designed to increase
the use of pharmacotherapy in substance abuse treatment programs. The
project will provide funding for indigent and low-income patients to
access medications prescribed as a component of their substance abuse
- Funds will also support the continuation of the on-going TOD
Medically Supported Detox
We now have three medically supported detoxes in operation within the
City and County of San Francisco. Capacity has increased by 200% after the
recent openings. Fremont Street Detox, operated by Baker Places, Inc.
opened on April 23rd (capacity 16), and Howard Street Detox operated by
St. Vincent de Paul in partnership with the CHN opened June 25th (capacity
The Howard Street Detox converted some of its social model detox beds
to medically supported status, signifying a strong relationship between
the St. Vincent de Paul Society and the CHN in transforming one of the
City's long established detox facilities into one that provides medical
overlay. The two new facilities compliment the existing Baker Places 4th
Avenue Detox, opened in 1995, and with a current static capacity of 10.
2001 National HIV Conference
Seven STD Program abstracts were accepted for presentation at the 2001
National HIV Conference in Atlanta, Georgia. The abstracts were as
- Wanted a Few Good Young People; Sustaining a Youth Peer-Led HIV
- Sexually Transmitted Disease Screening in an Anonymous HIV Testing
- Higher Levels of Drug Use and Patterns of Anonymous Sex Among MSM
Diagnosed with Rectal Gonorrhea in SF, 2000
- Higher Levels of STDs and Risk Behavior Among Men Using Viagra, SF
- Learning the Ropes: Training Community Based Agencies to Integrate
and Conduct STD Screening in HIV Prevention Programs
- Sex Worker Health, San Francisco Style: A Peer Based Specialty
Clinic in San Francisco
- Are HIV Drug Advertisements Contributing to Increases in Risk
Behavior Among Men in San Francisco?
Several programs within the STD unit have been featured this past month
on websites and national newsletters for their innovative programs.
CHN/SFGH CREDENTIAL REPORT (from August 13, 2001 to Aug 21,
Changes in Privileges
- Commissioner Guy congratulated the Department on receiving funds for
the Office Based Opiate Treatment (OBOAT) proposal, and the
establishment of three medically supported detoxes in the community.
Commissioner Guy acknowledged the work of the staff who took the
policy direction of the Health Commission and developed programs that
have been successful.
- Commissioner Parker asked how many residential units were involved
in the Capp Street fire. Anne Kronenberg responded that there were 13
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEES
RECOGNITION AWARDS FOR THE MONTH OF AUGUST
Action Taken: The Commission (Guy, Jackson, Parker, Sánchez) continued
the presentation of the Employee Recognition Awards for the month of
August to the September 4, 2001 Health Commission meeting.
6) RESOLUTION SUPPORTING SAN FRANCISCO’S COMMUNITY HEALTH CLINICS AND
DECLARING AUGUST 19-25, 2001 AS “COMMUNITY HEALTH CLINICS WEEK”
Barbara Garcia presented the resolution commending San Francisco’s
Community Health Centers, and stated that they are essential to providing
health care services in San Francisco, and complement the good work of the
Department of Public Health’s Health Centers.
Dick Hodgson, Director of Policy and Planning for the Community Clinic
Consortium thanked the Commission for the resolution.
Mr. John Gressman, Executive Director of the Community Clinic
Consortium, also thanked the Commission, and said that the partnership
between the Consortium and the Department of Public Health has been a
- Commissioner Sánchez stated that community clinics are a critical
part of the safety net, and the partnership with the Community Clinic
Consortium is one of the unique elements of San Francisco’s health
care delivery system.
- Commissioner Guy commended Mr. Gressman for his leadership over the
past years in bringing the community clinics together and his
contribution to strengthening the safety net.
- Elizabeth Frantes stated that she did not receive good care at the
community clinic she went to.
Action Taken: The Commission (Guy, Jackson, Parker, Sanchez)
unanimously approved Resolution #15-01, titled “Supporting San Francisco’s
Community Health Centers and Declaring August 19-25, 2001 as “Community
Health Centers Week.”
7) YEAR END EXPENDITURE REPORT 2000-01
(Monique Zmuda, DPH, Chief Financial Officer)
Monique Zmuda, Chief Financial Officer, presented the Revenue and
Expenditure Report for the 4th Quarter of Fiscal Year
2000-2001. The report presents the preliminary estimates on the year-end
financial projection of revenues and expenditures for the Department of
Public Health for Fiscal Year 2000-2001. Based on this data, the
Department of Public Health is projecting a year-end surplus of $19.8
million. This surplus represents 2% of the $956 million adjusted budget of
Projected FY 2000-01 Year-End Surplus/Deficit Table
Ms. Zmuda stated that the surplus is primarily due to three factors.
First, the Disproportionate Share Hospital (DSH) program ended the year
with $6.8 million over the budgeted amount. Second, a $4.5 million Federal
MediCal match for Laguna Honda Hospital. And third, $4.7 million in
additional realignment funds.
Ms. Zmuda stated that since the report was completed, she met with the
Controller’s staff and discussed a potential $2.5 million grant
disallowance in PHP retroactive to fiscal year 1991-92. The Controller has
agreed to let the Department set aside $2.5 million of the surplus in the
event the Department is unsuccessful in its appeal of the disallowance.
Subsequently, the Department projects that the year-end close will result
in the return of up to $17 million to the City and County General Fund.
- Commissioner Parker asked for a breakdown of the money that has been
set aside for past years’ risks and liabilities. Ms. Zmuda provided
the following breakdown: In Mental Health, $3 million for a FY 1994-95
disallowance and almost $2 million for the subsequent year that has
not yet been audited but will likely be disallowed; $1.2 million
assumption of payback for State-funded TB program; and $2.5 million
for the fiscal year 1991-92 grant disallowance. If these funds are not
used, they are returned to the General Fund. Commissioner Parker then
asked if there is any way to predict what will happen to the surplus
money that is returned to the General Fund. Ms. Zmuda responded that
the Mayor and the Board of Supervisors will make the decision how to
appropriate these funds.
8) CONTINUUM OF CARE FOR INJECTION DRUG USERS IN SAN FRANCISCO
(Barbara Garcia, PHP Director)
Barbara Garcia, Deputy Director for Community Programs, began the
presentation by acknowledging Gene O’Connell, Dr. Josh Bamberger, Dr.
David Young and Dr. Hobart Harris for their leadership in the development
of the ISIS Clinic and the community needle exchange programs. Ms. Garcia
also recognized the Treatment on Demand Planning Council and the Heroin
Subcommittee, which provided critical input. Ms. Garcia stated that the
focus of today’s presentation was on soft tissue infections and the
Department’s innovative approach to prevention and treatment. Future
Health Commission presentations will address other health effects of
injection drug use, including overdose prevention, addiction, and HIV/HCV
infection, and the Department’s responses to these health effects.
Dr. Josh Bamberger, the Medical Director of Housing and Urban Health,
continued the presentation by providing background on soft tissue
infections in San Francisco. Soft tissue infections accounted for
approximately 3,000 Emergency Department visits, 2,400 admissions and
1,000 Operating Room cases annually.
Dr. Bamberger said that the Department started two soft tissue
infection initiatives: expansion of medical care at needle exchange sites
and opening the ISIS clinic.
Medical Care at Needle Exchange Sites
- Soft tissue infection treatment is provided at 13 of the 15 needle
- On average, 70 unduplicated clients are cared for each week. In
addition, a full range of urgent care services is provided at the
- Services are provided as a collaboration between the Department of
Public Health, Haight Ashbury Free Clinics, and UCSF.
Dr. Bamberger stated that the next steps for the community needle
exchange program include expanding to provide medical services at all
needle exchange sites, integrating Hepatitis C prevention services and
drug addiction referrals to services provided, and providing urgent care
services at Mission Resource Center.
Dr. David Young presented the Integrated Soft Tissue Infection Services
Dr. Young stated that the basic goal of the program is to provide
compassionate, efficient and cost-effective care to patients with soft
tissue infections in a user-friendly, non-judgmental environment. ISIS is
staffed by attending surgeons, nurses, substance abuse counselors, social
workers, pain management specialists, rehabilitation therapists and other
Dr. Young stated that majority of patients are heroin users. At the
time that these patients were seen at the clinic with their infection, 23
percent were on methadone. Dr. Young continued that the remainder of the
patients was not on methadone, but when asked if they would like to be 74
percent said yes. Only 3% refused methadone treatment.
Dr. Young stated that the majority of the patients come from the
Emergency Department, and the second largest number are walk-ins, which
indicates to staff that the clinic is a success.
Dr. Young presented graphs that showed the impact of the ISIS Clinic on
hospital admissions, operating room volume and Emergency Department
visits. Dr. Young stated that prior to the inception of ISIS, soft tissue
infections accounted for 500-600 bed-days per months. After the opening of
the clinic, this has dropped to half that amount. In addition, after the
opening of the ISIS Clinic, there are less than 20 cases a month in the
operating room, which has decompressed the operating room. Dr. Young
continued that, with regard to the impact on the Emergency Department,
there has been a decrease in visits of several thousand visits a year,
which directly correlates with the number of procedures done in the ISIS
Dr. Young then discussed the substance abuse counseling component of
the ISIS program. Over 1,000 patients were referred to methadone detox
programs, and 310 enrolled in the San Francisco General Hospital program.
The ISIS Clinic budget includes 30 Methadone maintenance slots, and 33
patients have been enrolled.
Dr. Young presented the following conclusions:
- ISIS is successful and exceeds twice the estimated patient volume.
- To maintain this effort, ISIS needs:
- More space
- More nursing staff
- Additional funding
- Commissioner Guy stated that this program is the result of the
Department of Public Health being willing to take risks. She asked if
the ISIS Clinic experiences peak hours. Dr. Hobart Harris responded
that there is no way to predict when the busy times will be.
Commissioner Guy then recommended that there should be further
discussions about these programs, and their future needs, at the
Community Health Network Joint Conference Committee.
- Commissioner Sánchez congratulated the team. He then asked how, if
the program expands, the Department could disseminate the important
health information to communities who are at greater risk.
Commissioner Sánchez suggested that the information be given to
teachers, counselors, and school children.
- Commissioner Jackson asked if San Francisco’s Health Department is
unique in its patient-focused approach to health care. Dr. Katz
responded that, while San Francisco is not unique, the Commission has
supported access to services and cultural competency that lead to the
- Colin Eaton, Chairperson for of the Treatment on Demand Planning
Council’s Heroin Committee, said that the Heroin Committee met once
a month for six months and developed recommendations related to health
consequences of heroin use, including: overdose prevention, Hepatitis
C, and soft tissue wound treatment. Mr. Eaton conveyed the Heroin
Committees’ thanks to the Department of Public Health for its
dedication to responding to the committee’s recommendation.
9) OTHER BUSINESS/PUBLIC COMMENTS
The meeting was adjourned at 4:30 p.m.
Michele M. Olson, Executive Secretary to the Health Commission