Minutes of the Health Commission Meeting
Tuesday, January 7, 2003
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 John I. Umekubo, M.D.
- Commissioner David J. Sanchez, Ph.D.
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF DECEMBER 17,
Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn,
Umekubo) approved the minutes of the December 17, 2002 Health Commission
meeting with two technical corrections.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
(3.1) CHS-Maternal and Child Health - Request for approval to accept
and expend retroactively a grant from the California Department of
Health Services, in the amount of $113,788, to support healthy eating
and childhood overweight prevention services, for the period of August
1, 2002 to September 30, 2003.
(3.2) CHS-Maternal and Child Health - Request for approval to accept
and expend retroactively a grant from the California Family Health
Council, Inc., through a subcontract for a performance agreement with
UCSF School of Nursing, in the amount of $84,328, for the Child Care
Health Linkages Project, for the period of July 1, 2002 to June 30,
(3.3) PHP-Community Health Promotion and Prevention - Request for
approval of a retroactive sole source contract renewal with San
Francisco Study Center, in the amount of $357,299, to provide technical
assistance and support services for the DPH African American Health
Initiative, for the period of July 1, 2002 through June 30, 2003. This
contract is retroactive due to delays in awarding funding to the
contractor and an extended period of document revisions for contract
development. The Study Center is currently not receiving contract
payment through an Interim Agreement.
- Commissioner Penn asked how committed the SFSC is to this new
role. Geoff Link, Executive Director of the Study Center, said they
are fully committed. Commissioner Penn asked if this arrangement is
anticipated to be long term. Ms. Selmar said that Booker T.
Washington will continue to be part of the coalition but will not be
the lead agency, and AACHIE will be assessing what other community
based organization can assume the lead role. They will give an
update in April at the PHP JCC. Commissioner Penn would like to stay
apprised on the long-term integration plan.
- Commissioner Monfredini asked for an earlier, written report in 60
(3.4) BHS-Mental Health/Substance Abuse - Request for approval of a
retroactive contract renewal with New Leaf Services for Our Community,
in the amount of $1,393,902, to provide mental health and substance
abuse outpatient, intensive outpatient and prevention services targeting
the lesbian/gay/bisexual/transgender community and men who have sex with
men, 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 Cost of Living Adjustments and other allocation
changes after finalization of the Department’s fiscal year 2002-03
budget. The contractor has continued to provide services and receive
payment under a 6-month interim agreement approved by the Health
Commission on April 16, 2002.
- Commissioner Umekubo asked if staff is happy with way services are
improving. Mr. Stillwell replied that the agency is heading in the
right direction, but not where we want to be. Commissioner Umekubo
asked if EPSDT is this something they plan to expand. Joseph Neisen,
the Executive Director, said the EPSDT program is larger than what
is indicated by this contract, which is only one funding source. The
challenge with this contract is that they tend to have a high
no-show rate so have adjusted the contract to reduce the dollar
amount to reflect the number of youth they are serving.
- Commissioner Monfredini asked about board development. Mr. Neisen
said the agency has done a lot of board development over the past
five years and did a long-term strategic plan for the board, which
includes quarterly goals. Commissioner Monfredini would like a
report to the CHN JCC in 90 days on the progress of the CSAS
- Commissioner Penn asked if staff turnover was still a problem. Mr.
Neisen said they did have a significant turnover, largely due to the
economy and the inability to pay higher salaries. However, now it is
a slightly different story, and they have been able to increase
wages. Have also allowed access to benefit packages for part time
workers, which is attractive to the workers.
(3.5) PHP-AIDS Office - Request for approval of a retroactive sole
source multiyear contract renewal with Institute for Community Health
Outreach (ICHO), in the amount of $497,558, to provide case management,
client advocacy and health education services to HIV positive
individuals living in the Bayview Hunters Point community, for the
period of July 1, 2002 through June 30, 2004. This contract is
retroactive due to contract negotiations. This contractor has continued
to provide services and receive payment under a 4-month interim
agreement approved by the Health Commission on April 16, 2002.
- Commissioner Monfredini asked if the monitoring report
recommendations were implemented. Deborah Oliver Wilson, Nia project
director, said they have been implemented.
- Commissioner Penn asked how connected and in communication all the
different agencies are. Ms. Oliver Wilson replied that on a monthly
basis there is a providers meeting, which includes BVHPF, Black
Coalition on AIDS and many other agencies serving this community.
She feels that the agencies do a great job supporting each other.
(3.6) PHP-AIDS Office - Request for approval of a retroactive sole
source contract renewal with Positive Resource Center, in the amount of
$105,700, to provide employment development services targeting people
with HIV/AIDS who are seeking to enter/re-enter the workforce, for the
period of July 1, 2002 through June 30, 2003. This contract is
retroactive due to contract negotiations and the late award of some
General Fund programs following the budget process. The contractor has
continued to provide services and receive payments under an interim
agreement as approved by the Health Commission on April 16, 2002.
- Commissioner Monfredini asked if people are still fearful of
returning back to work. Mr. Lipp, executive director, said that this
is still a barrier and part of their program is to provide
counseling and services to assist individuals in overcoming these
- Commissioner Penn asked how people find out about these services.
Mark Misrok, program manager, said there is constant interaction
throughout the AIDS services community and the employment services
committee. In addition they have significant interaction with the
mental health and substance abuse services communities. Most of the
referrals come through other agencies. Collaborations have been a
very effective way of doing outreach.
- Commissioner Umekubo asked what their success rate is. Mr. Misrok
said that there is a complex definition of success, but last year
they achieved just fewer than 500 job placements, 150 of which were
considered long-term placement. They hope to develop and track
successes moving people into training programs and career
(3.7) PHP-AIDS Office - Request for approval of a retroactive new
sole source contract with the Regents of the University of California
San Francisco-AIDS Health Project, in the amount of $98,734 for year one
and $170,000 for year two, for a two-year total of $268,734, to provide
HIV Cognitive Impairment Program and Standards of Care Training for
CARE-funded service providers, for the period of September 1, 2002
through February 29, 2004. This contract is retroactive due to the time
required to finalize the service specifications and prepare the required
- Commissioner Monfredini asked staff to clarify if St. Mary’s
AIDS Dementia Unit is closed. Ms. Long Dixon said that the unit is
closed but there is a skilled nursing facility, which was the step
down for the locked AIDS dementia unit. However DPH does not have a
contract for patients at the SNF. The purpose of this contract is to
ascertain where these patients previously served by the Dementia
Unit are. Commissioner Monfredini asked when outcomes would be
available. Ms. Long Dixon said preliminary data would be available
at the end of February. Joanna Rinaldi from the UCSF AIDS Health
Project said they are looking at patients across the entire system
to determine how many individuals have HIV-related cognitive
impairments. They are also trying to understand how people with
cognitive impairments who are not in LHH or SFGH dedicated
residential settings are being managed.
Public Comment (at Health Commission)
- Abdul, volunteer at AACHIE, regarding Item 3.3. The program is
really doing well. The staff and volunteers do a lot of outreach and
are helpful to the community.
Action Taken: The Commission (Chow, Guy, Monfredini, Parker, Penn,
Umekubo) approved the Consent Calendar of the Budget Committee. The
Commission requested a 60-day written report to Budget Committee for Item
3.3, with a more detailed report to the April PHP JCC. The Commission also
requested a report in 90 days to the CHN JCC for Item 3.4.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
Star Hotel Housing Program
The Department of Public Health welcomed the first residents to the
Star Hotel Housing Program on January 6th. The newly
rehabilitated Star Hotel, a single room occupancy hotel in the Mission
District, is the latest addition to DPH’s Direct Access to Housing
Program. The Star Hotel Housing Program is designed to serve homeless
single adults with recent histories of being institutionalized,
hospitalized, treated in residential programs, or housed in shelters.
Homeless individuals with a history of rotating through various systems of
care are also eligible. Sixteen units have been allocated for people with
HIV/AIDS. The program provides on-site support services through Baker
Places, Lutheran Social Services, and Tenderloin AIDS Resource Center. By
March of this year, the Star will be home to 54 residents.
Jo Ruffin Retires
After 36 years of service with Community Mental Health Services, Laura
Jo Ruffin retires from the Department this month. Jo’s long career with
the Department has demonstrated her unwavering commitment to ensuring and
improving mental health care and services for all San Franciscans. The
Commission is looking forward to the opportunity to honor Jo at the
January 21st Commission meeting. In further tribute to Jo’s dedication
to the City, the Independent published a front-page article on Jo’s
history with the Department, the Board of Supervisors will declare January
16, 2003 Laura Jo Ruffin Day in the City and County of San Francisco, and
a reception will be held in her honor on the evening of January 16th. For
more information on the reception, contact Richard Snowdon at 255-3474.
Behavioral Health Community Forum
On Wednesday, January 30th, the Community Behavioral Health Services
Planning Committee will present their work to date on a plan to integrate
mental health and substance abuse services. The Community Forum will be an
opportunity to learn and give input about the integration process. It will
take place at 101 Grove, in Room 300 from 3:00 to 5:00 p.m.
Vickie Wells Appointed to National OSHA Advisory Committee
On December 31st, U.S. Secretary of Labor Elaine L. Chao announced the
appointment of Vickie Wells, DPH’s Occupational Safety and Health
Director, to the National Advisory Committee on Occupational Safety and
Health (NACOSH). The committee, established
under the Occupational Safety and Health Act of 1970, advises the
Secretaries of Labor and Health and Human Services on occupational safety
and health programs. Members of the 12-person advisory committee are
chosen on the basis of their knowledge and experience in occupational
safety and health. Congratulations to Vickie for her well-deserved
recognition as a national occupational health leader.
Herminia Palacio, MD, MPH, Appointed Health Director for Harris
County Public Health and Environmental Services
Dr. Katz announced that Herminia Palacio, MD, was appointed Health
Director for Harris County Public Health and Environmental Services.
Harris County includes Houston and its surrounding areas. It has a
population of three million people and is the third largest county in the
United States. Prior to her move, Dr. Palacio, was a primary care resident
at SFGH, an attending physician at Ward 86, the Acting Medical Director of
Maxine Hall Health Center, and a Special Policy Advisor to the Director of
Health. During her tenure at DPH, Herminia was responsible for the
initiation of office based opiate addiction treatment (OBOAT) and the
creation of a medicinal marijuana identification card. Dr. Palacio sent
her best regards to the Commission and Department staff and credits her
time at DPH as giving her the experience to take on this challenging job.
- Commissioner Umekubo said that many of his colleagues received a
letter from Dr. Klausner about the syphilis epidemic that was very
informative and well written. He commended Dr. Klausner for this
5) PRESENTATION OF THE EEO/CULTURAL COMPETENCY ANNUAL REPORT
Norm Nickens, Deputy Director of EEO Affirmative Action and Cultural
Competence, presented the EEO/Cultural Competency Annual Report. Mr.
Nickens described the general responsibilities of the EEO Office. The
presentation focused on cultural and linguistic competency.
Mr. Nickens summarized the CLAS standards, which were developed by the
Office of Minority Health and adopted by the Health Commission. Standards
1-3 relate to culturally competent care. Standards 4-7 relate to language
access and include legal mandates. Standards 8-14 are about organizational
2002 Implementation Activities
- Distribution of CLAS Standards and Commission Policy to contractors
- Formation of Cultural Competency Task Force
- Development of Cultural Competency Web Page
- Coordination of training activities with Community Mental Health
Services, Department of Human Services and Mayor’s Office of
- Training of EEO Office staff
- Technical assistance to contractors
- Training for contractors and DPH staff, including Cultural
Competency in Working with the Arab and Muslim Communities, Mental
Health Needs of the African American Community, Introduction to
Cultural Competency and Introduction to Linguistic Competency, among
2003 Implementation Activities
- Various training activities are planned, including Implementation of
the CLAS Standards, Working with the Disabled Community and Working
with the L/G/B/T Communities, among others.
- Ongoing meetings with DPH Program Managers
- By March 2003, development of DPH Cultural Competency monitoring
protocol and reporting format
- Ongoing technical assistance to DPH Program Managers/Analysts
- Ongoing development of model policies and procedures
- Ongoing development of a “train the trainer” and technical
assistance program for contractors
- Ongoing review of DPH compliance with ADA and Equal Access to
- Coordination with Behavioral Health integration committees.
- Commissioner Monfredini appreciates the work in implementing Policy
24. While the policy was straightforward, the implementation of the
policy is quite complex. Mr. Nickens said that the Department now has
a strong framework to build upon.
- Commissioner Parker congratulated staff for developing the
framework. He was a little apprehensive at the beginning of this
process and is now more reassured. He asked if community input is
being incorporated into the CLAS standards, or do professionals drive
them. Mr. Nickens said that one funnel for community input is the
Cultural Competency Task Force. In addition, they try to incorporate
providers in all of the trainings. Finally, through the annual
reporting process they have identified agencies that have great
cultural competency programs and are using these programs as models.
Commissioner Parker asked if the seminar for African American Issues
in Mental Health seminar is targeted toward community providers. Mr.
Nickens said it is targeted toward staff as well. He added that as a
rule they try not to charge for the training, unless continuing
education credits are given for the training. Commissioner Parker is
concerned that cost might be a barrier for some community-based
- Commissioner Penn commended Mr. Nickens for taking a systematic
approach to implementing complex issues. He asked if the reporting
structure would apply to DPH programs as well as contractors. Mr.
Nickens said the current program applies to contractors, with a future
goal of applying it to Department programs. Commissioner Penn asked
what happens if there are deficiencies in the reports submitted to EEO.
Mr. Nickens said this information is brought back to the program
managers. His office is in the process of ranking the reports on a
scale of one to four. The ultimate goal is to have more information
reported as part of the contract renewal process. Commissioner Penn
said that this is a very important component of contract evaluation.
Commissioner Penn emphasized the importance of bilingual services, and
agreed with Mr. Nickens that just because a person speaks another
language does not mean they are competent to provide medical
- Commissioner Umekubo commended staff for evolving this issue over
the past four years. How is DPH doing in this area compared with other
California counties? Mr. Nickens attended a national conference and
was struck by how much more complex these issues are in San Francisco
than other areas. For example other areas deliberate over
English/Spanish bilingual signage, yet in San Francisco DPH has
signage in so many other languages. Also, the main theme of the
training in other counties was how to convince the governing body of
the need for culturally competent services, which is definitely not an
- Commissioner Guy appreciates the progress that has been made. The
goals for 2003 are appropriate and reflect where DPH wants to go.
While the information that is presented with the Budget Committee
reports will still not be at the level the Health Commission
ultimately wants, this will eventually happen. She thanked the
contractors who, with their exemplary reports, provide models of
culturally competent services. Mr. Nickens said that they are
beginning the effort to incorporate lesbian/gay/bisexual/transgendered
standards of care. Commissioner Guy wants to begin the process of
applying these protocols to internal programs next year.
- Commissioner Chow said that the groundwork would carry DPH into the
future. Now, this needs to be put into a usable format and tested. The
hope is to have more than two lines about cultural competency in the
contract reports. Mr. Nickens said that the first iteration, to begin
in July 2003, would probably be a one to two page checklist for each
agency. Commissioner Chow clarified that the intent is to use the new
monitoring protocols without negative consequences for the first year.
Mr. Nickens said that this is correct. Commissioner Chow recommended
that both of the topics of the new contract monitoring protocols and
how DPH begins to extend these efforts to internal programs be
referred to all of the Joint Conference Committees. He also wants
reports on the progress of improving language competency within the
6) PRESENTATION OF THE STATE LEGISLATIVE ANNUAL REPORT
Colleen Johnson, Assistant Director, Office of Policy and Planning,
presented the State Legislative Report.
Ms. Johnson gave an overview of the legislative year, which was marked
by tremendous fiscal uncertainties. In May 2002 the Governor anticipated a
deficit of $23.6 billion, which was $11 billion greater than he had
anticipated in January 2002. Although significant cuts in health services
were made, many of the Department’s highest legislative priorities were
successful. Another highlight of the legislative year was in hospital
outpatient care. AB 915 (Frommer) established a program to allow public
hospitals to match their local general fund contribution for outpatient
services with federal Medicaid dollars. For San Francisco General Hospital
(SFGH), this could mean an additional $5 million in Medicaid revenue in
2002-03. Trauma Services received a second year of one-time funding of $25
million to be allocated to trauma centers like SFGH’s. The Governor
reduced this allocation to $20 million but this funding is still seen as a
victory. In the area of HIV/AIDS, the Governor signed AB 2197 (Koretz),
which provided Medi-Cal benefits to Californians with HIV who meet the
financial requirements but who are not considered disabled.
Ms. Johnson described the City’s legislative process. Individual
Departments do not take positions on State legislation. DPH makes
recommendations to the Mayor’s Office of Legislative Affairs and the
Mayor’s State Legislative Committee for City positions on health-related
legislation. At the beginning of each legislative session the Mayor’s
Office approves DPH’s State Legislative Plan that outlines the
Department’s recommendations on issues likely to arise. In addition,
positions are taken on a bill-by-bill basis for those issues that are not
addressed in the plan.
Ms. Johnson summarized the 2002 legislative highlights (Attachment A).
Ms. Johnson said the 2003 State Legislative Plan is comprehensive and
addresses anticipated health-related issues to be debated in the
Legislature. Significant issues are anticipated to be bioterrorism, Medi-Cal/Healthy
Families, Realignment and the State Budget. (The Governor will release his
proposed budget on January 10.)
- Commissioner Chow noted that DPH was opposed AB 1833, an emergency
medical services bill that passed, and asked if we are still opposed.
Ms. Johnson said the Department is still opposed to the mandated
change in billing structure for Maddy EMS Funds. Although the bill
passed, regulations still have to be developed and the Department will
be commenting on these regulations. Commissioner Chow requested a
federal legislative update in the fall.
- Commissioner Penn asked how the Department voices opposition to cuts
to programs such as Medi-Cal. Ms. Johnson said that San Francisco has
a very strong delegation in Sacramento, led by Senator Burton, so it
is relatively easy to get our voices heard.
- Commissioner Guy would like continued updates on the State budget
through the Director’s Report, since this is such a difficult
legislative and budget year. The Commission can add to the advocacy
efforts. She asked if there could be a future report on the
implementation of AB 1421, Court-ordered assisted outpatient mental
health treatment program. Dr. Katz said that the Department has done a
very preliminary analysis and it is unlikely that the Department would
recommend implementing the program.
7) PRESENTATION OF THE COMPLIANCE UPDATE
Dennis Scott, Chief Compliance Officer, presented at Compliance status
- CY 2002 Compliance Focus
- HIPAA Administrative Simplification and Privacy
- Compliance Briefing and Training
- Compliance Intervention
Announcements and Updates
- Compliance Council Meeting Schedule
- To insure that meetings are conducted every three months,
Compliance Council meetings will have a specific date, which is
the second Wednesday of every month
- HIPAA Budget Process
- Objective is to identify FY 2003 and FY 2004 implementation
costs, and include in DPH budget priority discussions. Costs are
- UCSF Data Security Agreement
- Transmitting clinical data outside of the DPH secured network to
unsecured UCSF sites creates exposure for DPH
- Gene O’Connell and Dr. Phil Hopewell have begun preliminary
discussions on conditions of transmission and possible UCSF
indemnification of DPH
- Dennis Scott, Chief Compliance Officer, and Dave Counter, Chief
Information Officer, will assume responsibility
- Compliance Division Mission
- Division has expanded dramatically in the last year, and needed
a focus for how to conduct business
- The mission is to encourage an atmosphere of integrity in DPH
clinical and business operations, and promote understanding and
compliance with federal, State and local privacy and other health
- FY 2003 Objectives
- Effectively manage HIPAA implementation to insure that
regulations are implemented and deadlines are met
- Analyze OIG’s 2003 Compliance Work Program and work with DPH
operating departments to minimize exposure
- Promote cooperative working relationships with DPH operating
Mr. Scott gave a project status summary for HIPAA implementation and
status on coordination with other City Departments. Mr. Scott discussed
significant developments, status of implementation efforts and compliance
risk factors for both HIPAA privacy implementation and HIPAA business
Mr. Scott updated the Commission on the Department’s Compliance
Activities. The focuses of the OIG FY 2003 Compliance Plan are:
consecutive inpatient stays, medical necessity of Inpatient Psychiatric
stays; uncollected beneficiary deductibles/coinsurance; procedure coding
of Outpatient Physician Services; hospital specific Disproportionate Share
payment limits; Medicaid diagnosis-related group payment window; Nursing
Home Quality Assessment and Assurance Committees; nursing home survey and
certification; Medicaid payments to SNF for Medicare-covered services;
immunization and Ryan White Grants. Mr. Scott also discussed other
significant activities including MD profiles, UPIN numbers and coding and
documentation training for providers.
- Commissioner Monfredini commented that one of the areas she believes
DPH is still vulnerable on confidentiality is providers and staff
talking about clients inappropriately. Mr. Scott said that this is
addressed through training. This is a big area of exposure because the
Office of Civil Rights is going to respond to complaints, rather than
- Commissioner Chow asked if the Department is going to have a single
privacy notice to be distributed to patients, and will this be
bilingual. Mr. Scott said there is a model policy that applies across
DPH but developed to allow modification for more appropriate versions
for different programs. The notices will be in the target languages.
Commissioner Chow asked for a six-month update to the Commission, and
also recommended that the SFGH JCC and LHH JCC stay apprised as
compliance deadlines approach.
- Commissioner Umekubo said one vulnerability is that the education is
very hit or miss. Different clinicians get different levels of
information. He asked if the implementation is proving to be as costly
as anticipated. Mr. Scott said it depends on what decisions are made.
In DPH budget priorities, patient care is clearly the highest
priority. DPH is seeking reasonable accommodation given its budget
priorities, and will not be developing a Cadillac HIPAA program. DPH
has to focus on areas that might generate complaints.
- Commissioner Penn asked what the estimated implementation costs will
be. Dr. Katz said that personnel costs are the major expense and there
are five staff people in Mr. Scott’s office. There is not an added
cost for computer systems because the equipment is HIPAA compliant.
Commissioner Penn asked how big of a problem transfer of data between
UCSF will present. Mr. Scott said it is not a huge problem but there
is a lot of research that goes back and forth between the two
institutions and need to ensure that there are appropriate protections
in place. He feels confident that this will happen.
- Commissioner Parker said that HIPAA is an additional cost of doing
business, and also requires an annual cost to maintain the program. He
asked if DPH is liable if DPH contractors and other agencies the
Department does business with do not comply. Mr. Scott said that there
is contractual language that requires entities DPH does business with
to be HIPAA compliant. Due diligence will be required in following up
on complaints, but DPH is not required to audit these agencies.
8) PUBLIC COMMENTS
The meeting was adjourned at 6:10 p.m.
Michele M. Olson, Executive Secretary to the Health Commission