Minutes of the Health Commission Meeting
Tuesday, December 3, 2002
At 3:00 p.m.
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The meeting was called to order by President Chow at 3:20 p.m.
- Commissioner Edward A. Chow, M.D., President
- Commissioner Roma P. Guy, M.S.W., Vice President
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner Michael Penn, Ph.D.
- Commissioner David J. Sanchez, Ph.D.
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF NOVEMBER 19,
Action Taken: The Commission approved the minutes of the November 19,
2002 Health Commission meeting with one amendment. Commissioner Chow’s
comments on Page 7 were amended to read “Commissioner Chow, on behalf of
the Commission, acknowledged Matisse Enzer and Alejandro Levins, who
donated their time and resources to develop and implement an innovative
pager system for the Action Point Project, and presented Certificates of
Appreciation to these two individuals.”
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Monfredini chaired, and Commissioner Umekubo and
Commissioner Penn attended, the Budget Committee meeting.
(3.1) CHN-Primary Care - Request for approval of a retroactive sole
source contract renewal with Lyon-Martin Women’s Health Services, in the
amount of $96,024, to provide comprehensive primary medical care services
to low-income women and transgender residents of San Francisco, for the
period of July 1, 2002, through June 30, 2006. This contract is
retroactive because of extended contract negotiations. There is no interim
agreement currently in place.
The Department requested that this contract be modified to a one-year
term and an amount of $24,006. Fred Milligan, DPH Program Manager, said
that because of the uncertainties in the budget, they felt it was best to
have a one-year contract rather than a multi-year contract.
- Commissioner Monfredini emphasized to the agency that the reduction
in the term of the contract is not a reflection of the Health
Commission’s unhappiness with the agency, but rather a result of the
reality of the budget. Ms. Williams-Flournoy, executive director, said
she understands the realities of the budget cuts.
- Commissioner Umekubo asked that staff report on how the upcoming
audit compares to the previous audit, in terms of addressing previous
quality assurance findings.
(3.2) CHN-Primary Care - Request for approval of a retroactive sole
source renewal contract with Shanti Project, in the amount of $75,750, to
provide LifeLines Project services that support women living with breast
cancer, for the period of July 1, 2002 through June 30, 2003. This
contract is retroactive due to reductions in funding and negotiation of
related program reductions. Shanti is currently not receiving payments
through an interim agreement.
- Commissioner Monfredini asked the status of the search for a
permanent executive director. Kevin Burns, Shanti program manager,
replied that they have selected a new executive director who will
begin on December 16.
- Commissioner Umekubo commended the agency for its excellent
(3.3) PHP-AB75 Project - Request to authorize adoption of the County
Description of Proposed Expenditure of California Healthcare for Indigents
Program (CHIP) funds for FY 2002-03.
(3.4) PHP-Behavioral Health Services - Request for approval of a
retroactive contract renewal with Family Service Agency of San Francisco,
in the amount of $5,573,291, to provide children’s mental health, adult
care management, geriatric, substance abuse and fiscal intermediary
services, for the period of July 1, 2002 through June 30, 2003. This
contract is retroactive due to the need for the contractor to revise
contract documents to incorporate a COLA after finalization of the
Department’s FY 2002-03 budget. The contractor has continued to provide
services and receives payment under a six-month interim agreement approved
by the Health Commission on April 16, 2002.
- Chuck Collins, Executive Director of the Family Services Agency,
expressed his appreciation for the years of partnership with DPH. He
is proud of the ratings the agency has received. The agency has been
working with staff in preparation from next year’s budget.
(3.5) PHP-Behavioral Health Services - Request for approval of a
retroactive contract renewal with Homeless Children’s Network, in the
amount of $228,285, to provide quality child care services targeting
center-based and family child care providers and to provide therapy to
homeless children in shelters, for the period of July 1, 2002 through June
30, 2002. This contract is retroactive due to the need for the contractor
to revise contract documents to incorporate a COLA after finalization of
the Department’s FY 2002-03 budget. The contractor has continued to
provide services and receive payment under a six-month interim agreement
approved by the Health Commission on April 16, 2002.
- Commissioner Monfredini asked if the corrective action plan is being
implemented and monitored. Carla Weiss, Ph.D., Executive Director,
said the agency is implementing the four-part plan detailed in the
Plan of Correction and the results will be reflected in the 2001-2002
(3.6) PHP Behavioral Health Services - Request for approval of a
retroactive contract renewal with San Francisco Pretrial Diversion
Project, Inc., in the amount of $68,601, to provide substance abuse
prevention services targeting adult Superior Court defendants, for the
period of July 1, 2002 through June 30, 2003. This contract is retroactive
due to the need for the contractor to revise contract documents to
incorporate a COLA and other allocation changes after finalization of the
Department’s FY 2002-03 budget. The contractor has continued to provide
services and receive payment under a six-month interim agreement approved
by the Health Commission on April 16, 2002.
- Commissioner Penn asked why the agency received a low score for
client satisfaction. Mr. Leong said that the problem has been that
they do not provide direct services, but referrals. They are working
with DPH to develop an appropriate satisfaction survey in the next
three months. The Budget Committee wants this survey implemented in
the next six months and requested a follow-up report in six months.
- Commissioner Umekubo asked if the cultural competency plan has been
submitted. Mr. Leong said it has not been submitted but will be in the
next two weeks.
(3.7) PHP-Behavioral Health Services - Request for approval to accept
and expend a grant from the Substance Abuse Mental Health Services
Administration (SAMHSA), in the amount of $8,873,683, for the support of a
six-year project to expand our local children’s system of care, for the
period of September 30, 2002 to September 29, 2008.
- Commissioner Penn asked about how the UCSF Child Services group was
selected to evaluate the program. Esperanza Echavarri replied that
they were selected through a review process.
(3.8) PHP-CHPP - Request for approval of a retroactive sole source
contract renewal with NICOS Chinese Health Coalition, in the amount of
$60,600, to provide problem-gambling prevention services in the Chinese
community, for the period of July 1, 2002 through June 30, 2003. This
contract is retroactive due to the reserve status of funding, which was
only recently released by the Controller’s Office in November 2002.
NICOS is currently not receiving contract payment through an interim
- Commissioner Umekubo asked if the agency addresses the close
connection between compulsive gambling and domestic violence. Mr. Woo
said that NICOs works closely with the Cameron House to tackle this
- Commissioner Penn asked to what the agency contributes it success.
Mr. Woo said probably the media campaign.
- Commissioner Chow abstained from voting on this item.
(3.9) DPH-Central Administration - Request for approval of a new
contract with P.B. Strategies, in the amount of $85,000, to provide
strategic planning and project management services for ongoing primary
care capital improvement projects, for the period of December 1, 2002
through June 30, 2003.
(3.10) SFGH - Request for approval of a resolution approving the
transfer of the Department of Public Health's Institutional Police to the
San Francisco Sheriff's Department and Authorizing the Director of Health
to enter into a Letter of Management Agreement regarding this transfer.
Health Commission Discussion
- The Health Commission discussed item 3.10 separately. Dr. Chow
welcomed Sheriff Hennessey, who said that this has been a long process
working through a pilot program. The two departments have a good
working relationship and have worked together on many efforts over the
year, particularly jail health services. Commissioner Chow said this
partnership would lead to an even more professional force than we
currently have for and on behalf of the patients. Commissioner Sanchez
expressed his excitement at this transition and hopes that this new
partnership will provide opportunities for young people to pursue law
enforcement careers within the context of the DPH institutions.
Commissioner Monfredini said that this issue has been deliberated
through the San Francisco General Hospital Joint Conference Committee
and she looks forward to its implementation.
(3.11) SFGH - Request for approval of an ordinance amending the
Administrative Code, authorizing the Department of Public Health to
procure and enter into maintenance and repair contracts for the
preservation and protection of public health facilities.
Commissioners’ Comments - Health Commission
- Commissioner Monfredini emphasized that she takes very seriously the
issue of executive directors attending the Budget Committee meeting
when they have contracts before the Commission. She asked the Health
Commission to request that the Department fully explain to all
contractors that importance of executive directors attending the
meetings when their contract is up for approval. Anne Kronenberg said
staff would certainly convey this message.
Action Taken: The Commission approved Items 3.1 - 3.9 and 3.11 of the
Budget Committee Consent Calendar with the amendment to Item 3.1 to change
the term of the Lyon Martin contract to one year and an amount of $24,006.
Commissioner Chow abstained from voting on Item 3.8. After separate
discussion, the Health Commission approved Item 3.10 and adopted
Resolution #13-02, “Approving the Transfer of the Institutional Police
to the San Francisco Sheriff’s Department and Authorizing the Director
of Health to Enter into a Letter of Management Agreement Regarding this
Transfer”, (Attachment A).
4) DIRECTOR’S REPORT
The Director’s Report was presented after Item 5.
5) PRESENTATION OF THE ANNUAL AIDS UPDATE
Dr. Susan Buchbinder introduced artist Rob Anderson, who created the
multi-media presentation “Rattlesnake Inside a Moving Car,” which was
displayed outside of the Health Commission meeting room. The exhibit
presents the personal sound recordings and images of individuals who have
been HIV positive for 20 years or more. Commissioner Chow, on behalf of
the Health Commission, presented Mr. Anderson with a Certificate of
Jimmy Loyce, Deputy Director of Public Health for AIDS Programs,
presented the AIDS Office Annual Report. He gave a brief overview of the
AIDS Office organization, which includes HIV/AIDS Statistics and
Epidemiology, HIV Prevention, HIV Research, HIV Health Services and
Prevention Research and Evaluation and HIV Health Services. The AIDS
Office has 157 employees and its budget consists of general funds, federal
funds and grants, state funds and private foundation grants. Two community
planning councils advise the Department and the Mayor: the HIV Prevention
Planning Council and HIV Health Services Planning Council.
Dr. Susan Schwarcz, co-director of HIV/AIDS Statistics and
Epidemiology, presented the epidemiological data. Dr. Schwartz’s section
is responsible for gathering the data that is used by others to understand
what is happening with the epidemic. They use a variety of data to help
understand the magnitude and direction of the epidemic, the backbone of
which is AIDS case reporting. This data is augmented with a variety of HIV
prevalence and incidence studies, behavioral surveys and other indicators
such as STD rates. DPH has just implemented HIV case reporting so future
presentations will include this data.
AIDS cases peaked in 1992 and have declined since then. Deaths due to
AIDS have declined since 1996 due in large part to the availability of
effective treatment. Although there is a decline in AIDS cases, there is
an ever increasing number of people living with AIDS in San Francisco. San
Francisco has had approximately 28,000 people diagnosed with AIDS.
Currently approximately 9,000 people are living with AIDS.
Dr. Schwarcz discussed the rates of AIDS among men by race. In 1992
whites were disproportionately infected. By 1996 the rates of African
American men had caught up with the rates of white men and in 1998 the
rates of African American men surpassed that of whites. However, the rates
in all ethnicities have declined. For women, throughout the epidemic
African Americans have accounted for the majority of infected women.
The proportion of the percent of homeless AIDS cases has been
Rates of HIV peaked in 1982 then declined, and in the mid-1990s rates
were stable. However, in the late 1990s and continuing to the present, HIV
infection rates are increasing in San Francisco. Dr. Schwarcz discussed
the estimated rates of HIV seroconversion in San Francisco in 1997 and
2001 for specific risk groups. Rates have increased for MSM and MSM-IDU.
Rates in non-MSM IDUs have decreased, in large part due to the very
effective needle exchange programs. Rates for heterosexuals are extremely
low. Rates in transgendered individuals were very high.
Survival for people with AIDS has been improving, but less so for
African Americans than for other groups. They have done analysis that
demonstrates that there is not a racial difference that cannot be
accounted for by treatment. They looked at HAART use by neighborhood, and
the neighborhoods that had higher survival had higher HAART use.
She recapped prevention and care successes:
- New AIDS diagnosis and AIDS deaths continue to decline in all
racial/ethnic, risk and gender groups
- No child under 13 diagnosed with AIDS
- Risk of AIDS due to transfusion now 1 in a million
- HIV transmission among non-MSM IDU is stable
- HIV among pregnant women is low and treatment to prevent
transmission to infants is high
- HIV transmission among heterosexuals is rare
Dr. Steven Tierney presented the HIV Prevention Section. The types of
services they offer include outreach, workshops, social marketing, risk
reduction counseling, HIV testing, prevention case management, media
development and needle exchange. Behavioral risk populations are used to
prioritize and target services to those at the highest risk of HIV
Dr. Tierney highlighted the Community Action Forum on Gay Health and
three new initiatives to address prevention needs in the young African
American MSM community.
New Initiatives in HIV Prevention
- Provider capacity assessment for prevention for positives
- Systems Capacity Assessments by Neighborhood (SCAN) in the Bayview
- Needs assessments with Native American Two Spirit communities,
heterosexually identified MSM, recently seroconverted men
- Expansion of prevention with gay men who use methamphetamines
- Condom social marketing
- HIV prevention for gay men over 45
Innovation in HIV Prevention
- Web infrastructure development (SFHIVPrevention.org)
- Evaluating Local Interventions data collection system
Michelle Long Dixon presented HIV Health Services. Services include
primary medical care, home health care, dental care, housing, substance
abuse treatment, mental health care, case management, peer and treatment
advocacy, benefits counseling, food, legal assistance, child care and
transportation. HIV Health Service priorities are to:
- Ensure access to care and eliminate disparities in care
- Assure comprehensive, high quality, culturally competent services
- Increase integration of services
- Bring those who know that they are HIV positive but are not into
care into care
Ms. Long Dixon presented information on quality management initiatives
and the development of standards of care. One of the features of this
effort has been to include clients in the development process.
Epidemiological Trends - HIV transmission appears to be increasing
among MSM, MSM-IDU and possibly transgendered persons. Increases in HIV
transmission are associated with amphetamine use in MSM. Declines in AIDS
deaths and increases in new HIV infections results in an increase in the
number of persons living with HIV/AIDS.
Prevention Challenges - Increased need to shift and focus prevention
messages to be effective for higher risk populations. Federal policies
regulating prevention messages limit the effectiveness with those
populations. Increased data collection requirements from State and Federal
government puts focus on evaluation rather than client services.
Care Challenges - Service increasing numbers of people living with
HIV/AIDS; addressing the complexity of care, including multiple diagnoses,
homelessness, Hepatitis C and other medical conditions. Expanding cultural
competency and capacity to address needs of emerging populations,
including the transgender community. Linking prevention, health services
and research to improve services to clients.
Resource Challenges - $2.2 million cut in CARE Title I for FY 2002 and
a larger cut projected for FY 2003. The Office of Minority Health grant
for technical assistance will end in 2003.
- Commissioner Penn asked if the Department really understands what is
going on in the African American community that leads to higher rates
of infection and lower survival rates. Mr. Loyce said that they do not
have their hands around this problem, and that there are likely
multiple answers. It is partially due to institutional racism.
Partially because MSMs in the African American community tend not to
consider themselves gay and do not respond to or identify with the
messages about HIV prevention. The one thing they can do is continue
to interact with the community and ask for messages that resonate. The
AIDS Office will be rolling out multiple campaigns based on some focus
groups. Commission Penn emphasized that these efforts need to be
constantly evaluated to see if they are working, so that we do not
continue to miss the core of the problem.
- Commissioner Parker said that even if we knew the avenues to take to
address health disparities in the African American community, we would
have to decide if we are willing to spend the majority of the funds to
correct this disparities, because that is what it would take. He asked
how people access the HAART program and where are these services
geographically located. Ms. Long Dixon said that HAART therapy is
available at all primary care sites. They have also instituted early
intervention programs in the Mission and Bayview Hunters Point to try
to increase the access to African Americans and Latinos. Another
important element is the outreach workers who help clients adhere to
the HAART program. Dr. Schwarcz added that among individuals who are
diagnosed with AIDS, the survival of African Americans is worse
because their use of HAART is worse. They are doing research now on
the reasons for not using HAART therapy and expect to have sufficient
data by March.
- Commissioner Umekubo said that although the rates of infection have
decreased, and this is positive, he is concerned that something might
change, such as the biology of the disease or the efficacy of the
medication that would cause the rates to increase again. And the
success could also lead to complacency and funding reductions. Our
prevention funding has already been decreased and this presents a huge
- Commissioner Monfredini said that the information in the report
pertains to San Francisco, that San Francisco’s rates have
dramatically decreased because of the work San Francisco has done so
it is not surprising that the Ryan White funding has decreased. She is
concerned that the fact that heterosexual transmission rates are
almost non-existent will lead to complacency. Another concern is that
the funding will continue to decrease. Ms. Long Dixon said that the
funding for AIDS care throughout the country is not increasing but the
number people getting infecting is increases. So instead of being able
to continue the level of services, San Francisco’s funding was
- Commissioner Chow asked if there is data that compares San Francisco’s
rates to the national rates. Dr. Schwartz said the trends across the
nation in AIDS incidence and AIDS deaths are the same as San Francisco’s.
The difference is that the epidemic peaked earlier in San Francisco
and we began the use of HAART earlier. What is not known is what is
happening nationwide with new HIV infections. San Francisco does have
these estimates already. Commissioner Chow said there are numerous
challenges. It is important that we understand how our primary care
clinics operate and how they can be incorporated into the continuum of
AIDS services. He would like the Commission to get a progress report
both the epidemic and the various initiatives.
- Commissioner Guy said that there are numerous national issues that
are impacting San Francisco, including funding. She asked if the AIDS
Office is planning to hold another consensus meeting and if there will
be information about race. Dr. Schwartz said that in 2003 they will
poll their colleagues to find out what studies they are doing and
evaluate the possibility of having a consensus meeting. Also, at the
last meeting there was harassment of researchers and we have prevent
this from happening again. Commissioner Guy said we have to emphasize
the connection between HIV and other STDs and asked how Southeast
Health Center is involved in all the initiatives. Patricia Perez Arce
replied that the Southeast Health Center has an early intervention
program funded by the AIDS Office. The Health Center in conjunction
with the community undertook a needs assessment to find out what
health programs should be emphasized in the community and AIDS
services were one emphasis. Commissioner Guy said she read that said
the national government is going to frown upon harm reduction and
condom use, and asked if this is true. Mr. Loyce said he learned at a
recent meeting with the CDC that the abstinence model is going to
receive more funding. He is not sure where the CDC will ultimately go
with this but will monitor the issue carefully. He added that the
Mayor’s Office called a regional summit on African American HIV
Prevention and Health. They are actively pursuing a regional approach
to African American AIDS prevention. Commissioner Guy recommended that
the Population Health and Prevention JCC look at the timelines for the
various initiatives, incorporate this topic into the discussion about
men’s health, and report to the Health Commission in six to eight
- Commissioner Sanchez said that the degrees of freedom researchers
have has peaked, and he believes we will begin to see limitations. The
impacts of the budget reductions, both State and Federal, will have a
severe impact on prevention and health services. We will need to
revisit our priorities both in the research and clinical communities
so that we can sustain critical initiatives and stay the course. He
congratulated staff for getting grants in this environment.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
Governor’s Health Care Proposal to CMS
Last Wednesday, the Governor announced that his Administration was
forwarding to the Centers for Medicare and Medicaid Services (CMS) a
package of proposals to strengthen California's health care system,
support the State’s critical safety net hospitals, and assist Los
Angeles County during its health care crisis. The plan has three key
The package relies primarily on CMS approval of the pending Selective
Provider Contracting Program (SPCP) federal waiver. The SPCP waiver
provides funding under the SB 1255 program to disproportionate share
hospitals (DSH), such as San Francisco General Hospital, which relies on
this program for approximately $19 million in revenue each year. The State
reports that if the SPCP waiver is approved as submitted, it will be
possible to provide $100 million in additional federal funds to Los
Angeles County for each of the three State fiscal years to be covered by
the pending SPCP waiver without disadvantaging the rest of the State.
The second component of the State’s health care proposal is intended
to improve the fiscal stability of safety net providers. This component of
the proposal would use county and University of California funds to draw
down additional federal funds for Medi-Cal managed care plans at levels
more comparable to that of the private sector. This is intended to assist
counties with public hospitals and government-operated Medi-Cal managed
care programs, but the details have not yet been released.
The third component of the proposal is intended to promote
cost-effective outpatient care and reduce costly inpatient care. Under
this component, any California public hospital system currently receiving
DSH funds and meeting certain conditions to reform their health system
would continue to receive DSH funding at their current level, even if they
decrease their volume of inpatient care.
In late November, Governor Davis announced that he expects that the
2002-03 State budget shortfall will be even more serious than the $21
billion shortfall estimated by the Legislative Analyst. The Governor has
called for a special legislative session to address budget shortfalls
projected for both the current and upcoming fiscal years. Beginning next
Monday, December 9th, the special session will meet to enact $5 billion in
current year budget reductions, as well as other budget changes for the
current year and the budget year combined.
Naloxone for Heroin Users
Results are now available from a pilot program funded by the Department
to help reduce the number of deaths attributable to heroin overdoses.
Between May 2001 and February 2002, participants in the program were
trained to identify signs of an overdose and to administer Naloxone, which
floods the body with a chemical that blocks the action of opiates on nerve
and brain cells and triggers instant heroin withdrawal. More than 20
overdoses were documented during the pilot program period. One participant
in the study died, however, the death was a result of a bacterial
infection, unrelated to a heroin overdose. Two-thirds of the overdoses
were treated with the antidote and the remaining interventions were use of
CPR or a telephone call to 911. In addition, a large number of
participants went into drug treatment and some documented a significant
decrease in the number of injections per day. We will further evaluate the
data from the trial program over the course of the next few months.
Syphilis Testing Incentive Program
The STD Program has recently implemented a new incentive program for
syphilis testing. Men who go to the STD Program or the Healthy Penis
website can get a coupon which can be exchanged for a Castro movie pass or
a gift certificate to A Different Light Bookstore after getting a syphilis
test at City Clinic. This program is being sponsored by the Internet
Sexuality Information Services, one of the community agencies that have
been working closely with the STD Program to try to eliminate syphilis in
LHH Publishes Monthly Quality Newsletter
The Laguna Honda Quality Management Department is now publishing a
monthly quality assurance newsletter. The newsletter is distributed in
hard copy and is posted on the Department’s Website under LagunaNet. The
purpose of the newsletter is to further advance the importance of quality
improvement while educating the staff on trends and innovations in quality
improvement, particularly in long term care.
Celebration of National Hospice Month
In conjunction with the Proclamations issued by Mayor Brown and
President Bush recognizing November as Hospice Month, the Department of
Public Health recognizes Laguna Honda Hospital’s Hospice and Palliative
Care Service. Since its opening in December 1988, Laguna Honda has
successfully combined professional expertise, community volunteerism and
administrative leadership to provide outstanding end-of-life care for
nearly 1,400 terminally ill San Franciscans and their loved ones. The 25
bed Hospice and Palliative Care Service has upheld the Department’s
customer service philosophy and has become a model for
patient/family-centered care giving.
CHIPPS Program Recognized
The Department's Community and Home Injury Prevention Program for
Seniors (CHIPPS) was highlighted and recognized as a model program in a
recent article on "Preventing Elder Falls". The article, which
appears in the November/December 2002 issue of Every Second Counts, the
national emergency response magazine, describes growing interest and
concern at the Federal and State levels in elder fall prevention.
December at SFGH
As in past years, Dr. Katz is attending on the medical service at SFGH
for the month of December. Dr. Katz takes great pride to practice medicine
in a hospital that provides high quality care in a compassionate manner to
persons regardless of their income or social situation. Dr. Katz couldn't
help but note when he picked up his new service on Sunday, that of the 11
medicine patients, 7 were homeless, 2 were living in supportive housing
funded by the Department of Public Health and one was in jail. All but one
of the patients were in the hospital because of the direct or indirect
consequence of substance use. DPH must continue to develop both preventive
and daily treatment options to prevent the devastating consequences of
- Commissioner Parker said he has had the opportunity to visit the
hospice ward at Laguna Honda Hospital on many occasions and has always
been impressed. He congratulated Laguna Honda for its many years of
6) PRESENTATION OF A PROPOSAL FOR A REVISED FY 2002-03 BUDGET, AND
CONSIDERATION OF A RESOLUTION SUPPORTING THE PROPOSED REVISIONS
Gregg Sass, DPH Chief Finance Officer, presented the General Fund
reduction plan for FY 02-03.
In November the Mayor’s Office projected a $170 million shortfall in
the City’s budget for the next eighteen months. As part of the FY 03-04
budget instructions, Departments have been asked to submit a plan to
reduce general fund by three percent in the current year as one of three
steps to balance the FY 02-03 and FY 03-04 budgets. The three steps are:
- Current Year: Reduce General Fund by 3% in 2002-2003
- Budget Year: Absorb cost increases for 2003-2004 within the reduced
3% General Fund
- Contingency plan: Prioritized 5% General Fund contingency plan for
DPH has developed a plan to reduce general fund by three percent in the
current year for a total reduction of $8,662,460. The plan is achieved
through increases to revenues as well as reductions to expenditures. No
service reductions will be made with these decreased to the General Funds.
Details of the reduction plan are listed in Attachment B.
- Commissioner Penn said that at a prior Health Commission meeting Dr.
Katz said there was a pool of money that could be drawn from to meet
the current year budget reduction and asked if these are reflected in
the reduction plan. Dr. Katz said that the plan includes a number of
one-time dollars, primarily because it would have been difficult for
the Commission to decide on on-going cuts without the context of the
entire budget. So the really painful decisions will be before the
Commission in February.
- Commissioner Guy acknowledged that the budget deliberations are
going to be very tough. The Commission and Department need to be
honest so that the people of San Francisco understand the consequences
of these budget reductions. The addbacks will present a new challenge.
- Commissioner Chow said that the addbacks should be considered part
of the base budget and deliberated during the budget process in the
same context as the rest of the base budget.
- Bryan Uyeno spoke in opposition to contracting out the laundry at
Laguna Honda Hospital. Having laundry on site provides an important
service. If it is contracted out it will cost the city more than it
- Dominic Chan, SEIU, spoke in opposition to contracting out the
laundry at Laguna Honda Hospital. The laundry workers are the working
poor. Contracting out means we are having the work done by people who
make seven or eight dollars an hour. At Laguna Honda people earn a
living wage. The union is happy to work to find other solutions rather
than eliminating 70 jobs. The union also believes that this
contracting out violates the contract.
Action Taken: The Commission approved Resolution #14-02, “Approving a
3% General Fund Reduction to the Department of Public Health’s Budget
for FY 2002-03”, (Attachment C).
7) PUBLIC COMMENT
Elizabeth Frantes spoke in support of medical marijuana. The criminal
suppliers control medical marijuana. There is artificial scarcity. The
Department of Public Health should be in control of the supply. We have to
grow as much as we can.
The meeting was adjourned at 5:55 p.m.
Michele M. Olson, Executive Secretary to the Health Commission