Minutes of the Health Commission Meeting
Tuesday, June 18, 2002
At 3:00 p.m.
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The Health Commission meeting was called to order by Commissioner
Edward A. Chow, M.D. at 3:10 p.m.
- Commissioner Edward A. Chow, M.D., President
- Commissioner Roma P. Guy, M.S.W., Vice President
- Commissioner Arthur M. Jackson
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Ph.D.
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF JUNE 4, 2002
Action Taken: The Commission (Chow, Guy, Jackson, Monfredini, Parker,
Sanchez) approved the minutes of the June 4, 2002 Health Commission
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Jackson chaired and Commissioner Monfredini attended the
Budget Committee meeting. Commissioner Umekubo was absent.
(3.1) Central Administration-MIS - Request for approval of a sole
source software maintenance agreement renewal with The Echo Group in the
amount of $411,597, to provide ongoing system maintenance and
application support services for the INSYST software application used by
Community Mental Health Services, for the period of July 1, 2002 through
June 30, 2003.
(3.2) Central Administration-MIS - Request for approval of a sole
source software maintenance agreement renewal with InfoMC in the amount
of $254,160, to provide ongoing system maintenance and application
support services for the CCURA3 software application used by Community
Mental Health Services, for the period of July 1, 2002 through June 30,
(3.3) CHN-SFGH Pharmacy - Request for approval of contract renewals
with the following two firms: Asereth Medical Services, Inc. and
Rxrelief, for a combined total amount of $1,200,000 to provide as-needed
supplemental pharmacy personnel services to the Community Health Network
for the period of July 1, 2002 through June
- Commissioner Jackson asked why Rxrelief charges more for licensed
pharmacists than Asereth. Dr. Kotable replied that Rxrelief
requested an increase because of the difficulty of recruiting
pharmacists. Commissioner Jackson said that the next time these
contracts come before the Commission for approval he wants to see
the same rates for both. Commissioner Monfredini concurred.
(3.4) CHN-SFGH Radiology - Request for approval of a contract
modification with The Registry Network, Inc. to reduce the amount of the
contract from $700,000 to $395,000 to
provide as-needed, professional radiology technologists, with on-call
availability 7 days a week for the period of September
1, 2001 through August 31, 2003.
Items 3.4 and 3.5 were discussed together.
- Commissioner Monfredini asked if it was difficult to recruit and
retain radiology staff because there is not the pool to recruit from
or because salaries are not high enough. Mr. Sass replied that they
are difficult to recruit for even with high salaries. Ms. Zmuda
added that in this fiscal year the Department increased salaries for
radiology technology classes by roughly 15 percent. Once this more
competitive salary is in place, staff can better recruit and there
will not be as high a turnover rate. And while there is a selective
hiring freeze, this will not apply to this class of employees
because of the lengthy waiting lists for radiological procedures,
such as mammograms.
(3.5) CHN-SFGH Radiology - Request for approval of a new sole source
contract with Medical Contracting Services, Inc., to provide
intermittent, as-needed, traveling professional radiology technologists
in the amount of $175,000 for the period of July 1, 2002 through June
(3.6) CHN-Facilities Management - Request for approval of contract
modifications with the following fourteen (14) firms: Acker &
Guerrero Roof Co., Inc., Adolph Schmidt General Contractors, Agbayani
Construction, Inc., Anderson Carpet & Linoleum Sale Co., Inc.,
Angotti & Reilly, Inc., Ayoob & Peery Plumbing, Baca & Sons
Painting, Floortrends Inc., McClure Electric, Inc., Monticelli Painting
& Decorating, Inc., Robert Poyas, Inc., Sabel Painting Co., Sierra
Electric Co. and The Shooter Co., to increase the combined contract
amount by $2,000,296 from $5,987,500 to $7,987,796, to provide
intermittent, as-needed facility maintenance services above baseline
civil services staffing and extend the current contract period of July
1, 2000, through June 30, 2002, by six (6) months through December 31,
(3.7) CHN-Office of Managed Care - Request for approval of a contract
renewal with San Francisco Health Plan in the amount of $3,900,000, to
provide universal health insurance coverage for San Francisco children
for the period of July 1, 2002 through June 30, 2003.
(3.8) CHP - Community Mental Health Services - Request for approval
of a retroactive new contract with Alta Bates Summit Medical Center in
the amount $15,000 for the first year and $80,000 per year thereafter in
non-MediCal funds, and to share in a pool of MediCal funds of up to
$4,300,000 per year, to provide inpatient psychiatric services for
adults and adolescents and transitional outpatient services for
adolescents for a total contract amount of $255,000 in non-MediCal
funds, for the period of July 1, 2001 through June 30, 2005.
(3.9) CHP - Community Mental Health Services - Request for approval
of a new contract with Bay Area Bookkeeping in the amount of $625,000,
to provide check writing services for payment to non-contract providers
of the San Francisco Mental Health Plan (SFMHP) and Family Mosaic
Project (FMP), for the period of July 1, 2002 through June 30, 2003.
(3.10) CHP-Primary Care - Request for approval of a contract renewal
with St. Mary Prescription Pharmacy, in the amount of $135,000, to
provide as-needed pharmacy services for clients of the Youth Guidance
Center and associated programs, for the period of July 1, 2002 through
June 30, 2003.
(3.11) CHP-Primary Care - Request for approval of a sole source
contract renewal with North of Market Senior Services, in the amount of
$202,685 per year, for a total four-year amount of $810,740, to provide
comprehensive primary care services to seniors, for the period of July
1, 2002 through June 30, 2006.
(3.12) CHP-Primary Care - Request for approval to accept and expend a
new one-year grant from the Franklin Benevolent Corporation, in the
amount of $75,000, to support enhancement and expansion of Podiatry,
Nutritionist, and Diabetic Nurse Educator services for the period of
July 1, 2002 through June 30, 2003.
(3.13) PHP-Bureau of Environment Health Management - Request for
approval to accept and expend retroactively a new grant from the State
of California Department of Health Services, in the amount of $204,352,
to develop and implement plans for public health preparedness and
response to bioterrorism for the period of February 15, 2002 through
August 31, 2003.
(3.14) PHP-Bureau of Environment Health Management - Request for
approval of a contract renewal with Romic Environmental Technologies, in
the amount of $250,000 per year, for a total contract value of $500,000,
to provide hazardous waste management and transportation services for
the period of July 1, 2002 through June 30, 2004.
(3.15) CHPP - Health Promotion Section - Request for approval of a
contract renewal with Polaris Research and Development in the amount of
$150,000, to provide project evaluation services for the Tobacco Free
Project, for the period of July 1, 2002 through June 30, 2003.
(3.16) CHPP - Health Promotion Section - Request for approval of a
contract renewal with the San Francisco Study Center in the amount of
$596,752, to provide fiscal sponsor services for the Community
Capacity-Building Training Center for the Tobacco Free Project, for the
period of July 1, 2002 through June 30, 2003.
Action Taken: The Commission (Chow, Guy, Jackson, Monfredini, Parker,
Sanchez) approved the Budget Committee consent calendar.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
Funding to Expand Services at Potrero Hill Health Center
The Franklin Benevolent Corporation has awarded a grant of $75,000 to
Potrero Hill Health Center to support additional clinical staff in
podiatry, diabetes, nurse education, and nutrition.
Protocol Approved for Clinical Pharmacists
A new law (AB 826) passed in January 2002 expands pharmacists’ scope
of practice in outpatient settings to include initiating and adjusting
drug therapy under protocols developed by a multi-disciplinary group of
health professionals, including physicians. A new procedure and protocol
was recently approved by Community Mental Health Services to formally
recognize the expanded role of clinical pharmacists in providing increased
support to medical staff.
Community Mental Health Services Consumer Fair
CMHS Cultural Competence and Consumer Relations held its first annual
Mental Health Fair at the Main Public Library on May 31, 2002. It was held
to commemorate May as Mental Health Awareness Month. The fair was
coordinated, planned and held by consumers for consumers.
Historic Photos Donated to DPH
A Millbrae resident, Keith Collins, recently acquired a box of old San
Francisco Department of Public Health photos from an estate auction and
has donated them to the Department. The subjects range from a 1908 School
of Nursing shot, some 1920's Health Clinics when Public Health was located
on Mission Street, and a broad collection of 1940's public health nursing
and child health exams. Many of the later photos were taken here at 101
Grove Street. One photo of special interest depicts a technician cleaning
hypodermic needles. The collection was put into an album until it is
decide the best use for them, which will include public display and
appropriate archival treatment. Mr. Collins is here today to officially
present these photos to the Health Commission.
Eileen Shields gave a slide presentation of a sampling of the historic
photographs that were donated to the Department of Public Health by Keith
Collins. The photographs will be scanned and placed in the archives at San
Francisco General Hospital. Mr. Collins also showed the Commission a San
Francisco Hospital medical yearbook from 1929. The Health Commission
thanked Mr. Collins for these irreplaceable photographs.
Commissioner Chow presented a certificate to Lois Borgmann for her 38
years of service to the Department of Public Health as a public health
nutritionist. The Commission wished her well in her retirement.
- Commissioner Chow asked Dr. Katz to clarify whether AB 826 allows
pharmacists to prescribe medication. The law does allow that if a
multidisciplinary group of physicians, pharmacists and nurses have
agreed that a certain patient should start on a certain medication if
certain conditions exist, the pharmacist can prescribe. Dr. Katz said
that everything has to be set via protocol. Dr. Chow wants a follow-up
report at the Community Health Network Joint Conference Committee to
see how CMHS is utilizing this new procedure protocol and if it has
enhanced the services.
5) HEALTHY KIDS UPDATE
Jim Soos, Department of Public Health Policy and Planning, introduced
Jean Fraser, Executive Director of the San Francisco Health Plan (SFHP),
who presented the Healthy Kids Program update.
The Healthy Kids program provides complete health insurance, including
dental and vision care, to San Francisco residents aged 0-19 who are
ineligible for the Medi-Cal or Healthy Families and whose family earns
less than 300 percent of the Federal Poverty Level (FLP). Children are
eligible regardless of immigration status. Families pay a $4 per month
premium. The Healthy Kids Program opened for enrollment January 1, 2002
and coverage began February 1, 2002.
Ms. Fraser said that are approximately 5,000 children in San Francisco
are eligible for the Healthy Kids program. This number was based on data
that there are 9,000 uninsured children in San Francisco, 1,000 of who are
from families earning more than 300% of FLP. Another 3,000 children are
believed to be eligible for Medi-Cal or Healthy Families.
After five months of enrollment, 25% of total target population has
been enrolled-1,243 as of June 1, 2002. In addition the San Francisco
Health Plan has processed children who are eligible for Healthy Families
Marketing and Outreach efforts included collaboration with community
and faith-based organizations to launch Healthy Kids via three citywide
enrollment events on Healthy Kids Day (January 13), attended by 2000
people. Efforts are focusing first on clinics and hospitals servicing
uninsured. SFHP is partnering with schools and others targeted CBOs and
there is an on-going public relations and media campaign.
While the SFHP is the primary enroller for the program, the
neighborhood and DPH clinics are also doing enrollment.
Jim Soos presented demographic data on current enrollees:
- Age - One quarter under age 6, one third between 6 and 10 and 40
percent are between 11 and 19. One surprising fact has been the
enrollment of adolescents, approximately 12% thus far. This is one
population they were told would be difficult to reach.
- The largest ethnic population, at 63%, is Latinos followed by 34%
Asian Pacific Islanders. These are followed by Whites, African
Americans and Native Americans
- Language is reflective of the ethnic breakdown of members. 62% speak
Spanish and 25% speak Chinese.
- The average family income is $2,023 per month, average family size
is 3.55 members, average percentage of FPL is 145%. Staff estimates
that 79% of enrollees are undocumented, because this percentage of
families earns less than 250% of FLP. They would be eligible for
Healthy Families or Medi-Cal if they were citizens.
- One half of enrollees have chosen CHN as their provider.
- San Francisco is the first city in the nation to make a commitment
to fund universal health care for children from the city budget. While
other city’s have similar programs, they are not supported with
general fund dollars.
- The cost for FY 02-03 is approximately $3.9 million, including
- Two sources of funding are the City’s general fund and a
limited-term contribution from the Tobacco Tax/Proposition 10 fund for
the ages 0-5 population.
The Department felt that premiums were important. They help the health
plan keep in contact with the families and allow them to see if families
still live in San Francisco. In addition families have indicated that they
want to pay for their children’s coverage because research has shown
that families believe they get better health care if they pay something
for it. The Health Plan has worked to overcome barriers to premiums,
including quarterly billing and a hardship assistance program.
- Meeting the Strategic Plan
- Expands health care coverage to the uninsured
- Focuses on target populations: children, youth and low-income
- Reaches target neighborhoods
- Addresses social and economic determinants of health
- Enhances revenue for providers including CHN
- Fosters partnerships with other community organizations
- Great community support and media support
- 115 certified application assistors trained.
- Enrolled 25% of target populations in only 5 months
- One step closer to universal health care and fulfilling the SFHP
- Enrolling more children in Medi-Cal and Healthy Families;
message to families is much clearer
- San Francisco is inspiring other counties to develop similar
- Difficulty with African American enrollment. Currently there are
only three African American enrollees. One of the reasons may be
Medi-Cal eligibility. Second, the target thus far has been the
undocumented populations and far fewer African Americans in San
Francisco are undocumented. Also, according to census data there
has been a steady drain of African American families out of San
Francisco. Finally, outreach messages may be different for this
In looking at the data for the Universal Task Force Blue Ribbon
Committee, staff estimates that 0.5% of uninsured African American
ages -17 fall within the 200%-300% of FLP. Despite these low
numbers, SFHP is working actively to do outreach in the African
American Community. Dr. Katz asked if staff could get data about
the number of African Americans who apply for Healthy Kids but are
enrolled in Medi-Cal because this is a victory.
- Efficiency of the dental access component. It has taken Delta
Dental longer than they had hoped for Delta Dental to develop this
- Overcoming cultural competency issues. They found two
significant issues. First, for many people who come from outside
the American medical system, it is not culturally relevant to take
a child to the doctor if he or she is not sick. Second, people who
are ill go to a clinic without an appointment. SFHP has been
calling members to encourage them to make an appointment and are
supportive of the move toward same day appointments at DPH
- Looking forward
- Targeting 4,000 members by the end of FY02-03
- Access federal and state funds
- Retention strategies - continuous contact with families; phone
contact for re-enrollment
- Development and implementation of evaluation program.
- Commissioner Parker asked if a family moves out of the city is
automatically disenrolled and if they get a refund if they have
prepaid for a year. Ms. Fraser said the State only allows them to
serve people who live in San Francisco. Two other counties-Alameda and
Santa Clara-have similar programs, which families moving to those
areas are referred to. They would probably refund a portion of their
premium if the family requested it. Commissioner Parker asked how many
African American children would be eligible for this program. Mr. Soos
said they estimate between 13 and 25 children. Commissioner Parker
asked if it makes economic sense to go forward with a large
promotional program for this number of people. Mr. Soos replied that
the outreach programs educate and connect people to all the insurance
programs, including Medi-Cal and Healthy Families, so there is a
benefit. Commissioner Parker asked about the revenue impact of Healthy
Kids. Ms. Zmuda said staff has estimated $500,000 in revenue resulting
from premium, with the majority of revenues going into primary care.
Commissioner Parker said that the health disparities in the African
American population would not only continue but also get larger, if we
cannot address these issues.
- Commissioner Chow re-emphasized that regardless of which program the
children are enrolled in, the fact that African American families are
getting connected to insurance programs is an accomplishment.
Commissioner Chow requested demographic data about African Americans
in San Francisco, including income, as well as data on enrollment in
Healthy Families by ethnicity. He stated that the Commission needs a
follow-up report to ensure that the program is reaching the right
people with the right project, and to see if the African American
population is adequately insured. In addition to the October joint
report with Healthy Families, Commissioner Chow would like a report in
February 2003, which would mark the one-year anniversary of the
- Commissioner Guy said that this is very important because African
American families have higher risk factors and a higher burden of ill
health, and we need to make sure they are getting preventive care. It
would be helpful if the Commission had written information about plans
to address this issue, as well as the number of people who are
enrolling in Medi-Cal. She asked if the Department and SFHP are
working with children in family day care programs. DPH is working with
the Children’s Council and Wu Yee. Commissioner Guy said that there
are other populations that carry higher health burdens, for example
Filipinos and Samoans. Mr. Soos said SFHP is tracking these
- Commissioner Monfredini asked if children must have a parent to
enroll in Healthy Kids. Ms. Fraser said no. Commissioner Monfredini
asked how we are outreaching to adolescents between 16 and 19 who live
independent from their parents. Ms. Fraser said they would reach these
youth if they go to a clinic, go to a school that the health plan has
worked with and via advertising in the Bayview. Ms. Fraser added that
most likely these kids will be eligible for Medi-Cal.
- Commissioner Jackson suggested that information about Healthy Kids
be placed in emergency rooms, since many African Americans receive
care there. He also asked what percentage of African Americans fall
between 100% to 250% of FPL. Mr. Soos said that less than 2% of
African Americans are enrolled in San Francisco’s Healthy Families
program, which covers people in this income bracket. Commissioner
Jackson said it is incredibly tragic that so many African American
families live below 100% of FPL.
- Commissioner Sanchez said one of the major concerns statewide was
the under enrollment of the Hispanic population and undocumented
children. San Francisco has done a great job in enrolling this
population. Additional data will allow us to chart new pathways to
reach the uninsured.
6) PUBLIC COMMENTS
Elizabeth Frantes - She almost was bitten by a pit bull at Sutro Park.
The park police are ineffective. Children need to be protected from
unleashed dogs. Animal Care and Control needs to reform what is going on.
The judge’s ruling this morning was ludicrous. The Police Department and
National Park Service does not enforce the leash laws. Everybody is
passing the buck on who’s responsible.
The meeting was adjourned at 4:40 p.m.
Michele M. Olson, Executive Secretary to the Health Commission