Minutes of the Health Commission Meeting
Tuesday, September 16, 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 Commissioner Chow at 3:10 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, M.D., Ph.D.
- Commissioner David J. Sanchez, Ph.D.
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE MEETING OF SEPTEMBER 2, 2003
Action Taken: The Commission approved the minutes of the September 16,
2003 Health Commission.
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) AIDS Office-HIV Prevention - Request for approval of a
retroactive sole source contract renewal with Centerforce, Inc., in the
amount of $709,863, to provide HIV prevention services targeting
incarcerated and post-release inmates of San Quentin State Prison,
Central California Women’s Facility and Fresno County Jail, for the
period of July 1, 2003 through June 30, 2004.
(3.2) AIDS Office-HIV Prevention - Request for approval of a
retroactive sole source contract renewal with Continuum HIV Day
Services, in the amount of $614,874, to provide HIV support services
targeting incarcerated men, women and transgendered individuals and a
research project to assess the effectiveness of the program, for the
period of July 1, 2003 through June 30, 2004.
(3.3) BHS-Mental Health - Request for approval of a retroactive
contract renewal with Conard House, in the amount of $5,202,299, to
provide residential, outpatient, supportive housing and vocational
training mental health services, for the period of July 1, 2003 through
June 30, 2004.
(3.4) BHS-Mental Health - Request for approval of a retroactive
contract renewal with Family Service Agency, in the amount of $6,075,757
to provide mental health case management and medication support services
for children and adults, for the period of July 1, 2003 through June 30,
- Commissioner Penn asked when evaluation data would be available.
Charles Collins from FSA replied that they expect data in the Fall
of 2004, and also will be presenting findings to the State
(3.5) BHS-Substance Abuse - Request for approval of a retroactive
contract renewal with Addiction Research and Treatment (dba BAART), in
the amount of $5,519,938, to provide substance abuse services, for the
period of July 1, 2003 through June 30, 2007.
Jim Stillwell, DPH staff, noted that the contract term is through
June 30, 2004, not June 30, 2007 as stated on the agenda.
(3.6) CHN-Nursing Operations - Request for approval of contract
renewals with the following firms for a combined total of $1,350,000:
HRN Services, Inc., Medical Staffing Network, Inc., Medstaff, Inc.,
Nurse Providers, Inc. and United Nursing International to provide
supplemental, temporary per diem and traveling nursing personnel for San
Francisco General Hospital (SFGH), Community Health Network, for the
period of September 1, 2003 through June 30, 2004.
Commissioner Monfredini noted that there is a mistake on the contract
summary form (page 3.6). The “Annualized Difference” column has
($64,167) and the correct amount should be ($770,004).
(3.7) Central Administration-Policy and Planning - Request for
approval of a new contract with P.B. Strategies, in the amount of
$323,676, to provide strategic planning and project management services
for ongoing primary care capital improvement projects, for the period of
October 1, 2003 through June 30, 2005.
(3.8) Central Administration - Annual Report of Gifts Received in FY
Commissioners’ Comments (at the full Commission)
- Commissioner Parker asked staff to clarify demographic information
for Item 3.1. Steven Tierney stated that the 14,475 adults represent
the total number of prisoners who go through orientation. The health
curriculum and the HIV curriculum are part of the orientation. For
3.2 Commissioner Parker asked when the research data would be
reported. Mr. Tierney said they would report to the Commission,
through the PHP JCC, in December. For Item 3.3, staff clarified the
per unit cost.
Action Taken: The Commission approved Items 3.4 through 3.8 of the
Consent Calendar of the Budget Committee. After separate discussion, the
Health Commission approved Items 3.1, 3.2 and 3.3 of the Budget Committee
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
Legislature Adjourns After Passing Major Health Care and Workers’
The Legislature adjourned for the first year of its 2003-04 session in
the early hours of Saturday, September 13th. Among the many measures they
passed and on its way to the Governor is a
SB 2 (Burton/Speier) the “Pay or Play” employer health insurance
mandate. If signed, the bill would require that employers either provide
health insurance coverage for their employees or pay into a State pool
that would purchase coverage for those employees. The “Pay or Play”
mandate would be effective on January 1, 2006 for large employers (200 or
more employees), who must offer coverage to employees and their
dependents. Medium-sized employers (50 to 199 employees) would be required
to comply by January 1, 2007 and would have to offer coverage to employees
only. Employers with between 20 and 49 employees would be exempt unless a
subsequent tax credit is enacted, and those with fewer than 20 employees
are completely exempt. Coverage would have to comply with Knox-Keene HMO
standards, plus prescription drugs. Employers would have to cover at least
80% of the premium costs, or pay into the State pool. Health benefits
determined through Taft-Hartley or any other collective bargaining
agreement would be exempt. If enacted, it is expected that significant
litigation will follow, including issues around ERISA. The reform package
is expected to extend health insurance coverage to approximately one
million of the seven million currently uninsured Californians.
In addition to health care reform, a seven-bill Workers’ Compensation
reform package has also been sent to the Governor and he has already
declared he will sign it into law. Proponents claim the measures will
reduce costs by over $5 billion, largely as the result of medical reforms,
to the $29 billion workers’ compensation system.
Supervisor Ammiano’s Homeless and Housing Press Conference
Supervisor Ammiano sponsored Resolution 252-03 early last summer
requesting a report from DPH on “Strategies for Homeless Individuals
with Mental Health Diagnoses, Substance Abuse Diagnoses and Chronic
Medical Conditions”. The information requested was similar to that
provided in the Homeless and Housing Report September 2nd to the Health
Commission. Yesterday, Supervisor Ammiano held a press conference to
release the report and called for an expansion of the DAH program,
highlighting the lack of permanent housing as a key obstacle to achieving
lasting health improvements. Dr. Katz spoke at the conference and
concurred that housing is a health issue.
Childhood Lead Prevention Program
The Department’s Childhood Lead Prevention Program is revising its
case management protocol in response to recent and compelling research
that indicates adverse health effects from relatively low exposures to
lead. Families of children with blood lead levels of 5 - 9 mcg/dL will
routinely be sent an information packet containing health education
material on lead hazards and lead poisoning. These families may also
request an environmental investigation, which may require property owners
to remediate identified lead hazards. Families of children with blood lead
levels of 10 - 14 mcg/dL will receive an environmental investigation to
assess potential environmental lead exposures to children. DPH staff
conducting environmental investigations will have enforcement authority to
require property owners to correct problems contributing to lead hazards.
Prior to this revision, this level of service was provided in accordance
with the State Childhood Lead Poisoning Prevention Branch case management
protocol, which required an environmental investigation for blood lead
levels of 15 mcg/dL and above.
AB 2034 Homeless Outreach Program Update
The AB 2034 Homeless Outreach Program served 163 clients in FY 2002-03.
For these clients, there has been a documented reduction of 40% in annual
average number of psychiatric hospitalization days, a 75% reduction in
annual average number of days incarcerated, an 84% reduction in annual
average number of days homeless on the streets or in shelters, and a 49 %
increase in annual average number of days employed. The program has served
a total of 205 clients since its inception.
APHA Art Contest for SFUSD Students
The American Public Health Association (APHA), DPH’s Occupational and
Environmental Health Section and the San Francisco Food Systems Council
are co-sponsoring an art contest for San Francisco Unified School District
students as part of the annual APHA Conference that will be held in San
Francisco this November The "Harvesting Health: Food, Health, and the
Environment" art contest is requesting submissions by SFUSD students
illustrating how growing, sharing and eating good, nutritious food
contributes to the health and well being of our communities. This contest
is aimed at increasing awareness of and respect for how good food is grown
and processed, how it is eaten and recycled. Additional information on
this project may be found online at www.sffoodsystems.org, by clicking on
Open House at LHH Rehab Services Department
In honor of a National Rehabilitation Awareness Week, the
Rehabilitation Services Department at Laguna Honda Hospital and
Rehabilitation Center (LHH) is hosting an Open House for staff and other
Bay Area health care providers on September 25th, from 2 p.m. to 4 p.m. in
the Physical Therapy and Occupational Therapy/Speech Pathology
Departments. It has been an exciting and rewarding year for LHH’s Rehab
Services staff. They continue to develop and refine programming in many
areas, including community re-entry, restorative care, restraint
reduction, and fall prevention. They have also been distinguished with
Best Practice awards and recognitions. The event is an opportunity to
learn more about the Community Reintegration Program, Restorative Care
Program, and other rehabilitation services at LHH.
Intimate Partner Violence Strategic Plan
The Intimate Partner Violence project is celebrating the completion of
its Strategic Plan on Wednesday, September 24th, from 3 p.m. to 5 p.m. at
the GLBT Center. The Plan is the result of a yearlong planning process and
focuses on primary prevention of intimate partner violence. It takes a
public health perspective and describes the root causes and risk factors
associated with intimate partner violence. The plan outlines 15 primary
prevention objectives and potential strategies to reach them.
Proyecto ContraSIDA Por Vida honors Barbara Garcia, Deputy Director
Proyecto ContraSIDA Por Vida (PCPV) celebrated 10 years of serving the
Latina/bisexual, lesbian, transgender, and gay communities in
resisting/responding to HIV and other diseases. This year, PCPV’s Por
Vida Awards honored Deputy Director of Health Barbara Garcia for her
dedication to improving the quality of health and health care in the
Latino community and for her leadership in the adoption of a harm
reduction mandate in San Francisco.
- Commissioner Parker asked what impact the workers compensation
reform would have on the Department. Dr. Katz said it is not yet
known. San Francisco is self-insured, which is different from how
other employers operate.
- Commissioner Chow asked how DPH identifies children with high lead
levels. Dr. Katz said there is mandatory reporting of lead levels from
other laboratories to DPH.
- Commissioner Guy said that the State legislature should be applauded
for AB 2034 Homeless Outreach Program. DPH can demonstrate the
positive impact of this program on so many levels. The Department can
continue to learn about what really solves homelessness from this
- Commissioner Penn asked why SB 2 would not be effective until 2007.
Dr. Katz said the delay is partly political and partly to provide
businesses time to prepare for implementation. Commissioner Penn asked
how many children would be impacted by the revised protocol for lead
exposure. Dr. Katz said that it is not a large number of children, but
the research demonstrated that the lower levels did result in
detriments to intelligence where previously it was not thought so. Dr.
Katz will provide the Commission with the New England Journal of
- Commissioner Umekubo is pleased that the legislature is paying
attention to the plight of the uninsured. With regard to workers
compensation, he asked if there would be more changes to workers
compensation. Dr. Katz replied that he does not know, and this is a
balancing act between businesses and patient advocates.
- Commissioner Parker asked if the SFUSD Art Contest would include a
focus on youth obesity. Dr. Katz said the emphasis would be on healthy
food, rather than a negative message about obesity.
- Commissioner Sanchez added that a key part of children’s health is
physical activity, not just healthy eating. There has been a
tremendous decrease in play areas over the years.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE
RECOGNITION AWARDS FOR THE MONTH OF SEPTEMBER
Commissioner Monfredini presented the Department of Public Health
Employee Recognition Awards for September.
Team #1 Awardees
CHN - Planning
Susan Fernyak, M.D., Director, Community Health Epidemiology and
Amy Pine, Immunization Programs Manager
PHP - Community Health Epidemiology and
Ann Stangby, EMS Specialist
SFGH - Disaster Planning
Team #2 Awardees
Frances Culp, Health Program Planner
DPH - Policy and Planning
Anne Kronenberg, Deputy Director, DPH
Jim Soos, Sr. Health Program Planner
6) PRESENTATION OF A REPORT ON THE McMILLAN STABILIZATION CENTER
Barbara A. Garcia, Deputy Director of Health, Community Health
Services, presented an update on the McMillan Stabilization Center. The
Board of Supervisors appointed the Hospital Diversion Task Force to
address hospital diversion and the medical burden of chronic public
inebriates. One of the recommendations was to develop a pilot sobering
unit project that includes medically safe triage protocols for inebriate
transport to a sobering center and on-site case management and linkage.
Project funders included DPH, the Hospital Council and other private
sources. It was a truly collaborative effort with many DPH programs, the
Fire and Emergency Communications Departments, the Hospital Council, CATS
and Baker Places.
Dr. Barry Zevin continued the presentation with a description of the
McMillan Stabilization Project:
- McMillan Drop-in Center (MDIC) - located at 39 Fell Street, provides
drop in support for unsheltered homeless people. MDIC is operated by
- Sobering Unit - 20 stabilization beds at MDIC and staff assigned to
ensure that intoxicated clients will safely sober up.
- McMillan Stabilization Pilot Project - Sobering Unit and associated
primary care and behavioral health providers collaborating to
facilitate long term stability for clients.
- When fully staffed, the project will operate 24/7, 365 days per
year. Paramedics will triage inebriates on the street. MDIC nursing
staff will be guided by protocol with specific inclusion and exclusion
criteria. The project has a robust case management model. And
throughout the entire department, services will be prioritized for
McMillan Stabilization Project Goals
- To provide better care for chronic public inebriates and improve
their health outcomes. This goal will be measured through discharge
status and utilization of the treatment system.
- To decrease the number of inappropriate ambulance trips that are
transporting chronic public inebriates to the Emergency Department.
This goal will be measured by seeing if there has been appropriate
triage and transportation of destination for the client on the street
and if there has been a decrease in the total number of hours of ED
- To decrease the number of inappropriate chronic public inebriates
seen in the emergency room. This goal will be measured by determining
if there has been a decrease in inappropriate ED use and the number of
pick ups by the MAP VAN after clearance at participating hospitals.
It is anticipated that the program will serve 500 unduplicated clients
per years and will have 5,000 to 10,000 encounters per year with these
clients. The project had an ambitious timeline and Dr. Zevin said they
planning committees (Project Oversight Committee and Medical Advisory
Committee) have met the timeline goals.
Dr. Katz said one expected outcome is an improvement in the payor mix
at the SFGH emergency department, which is important because these savings
have already been allocated to fund the program.
- Scott Campbell, M.D., Chairman of the San Francisco Ambulance
Diversion Task Force and emergency room physician at Kaiser San
Francisco, said that this pilot project is a new model of
public/private partnership for alternative transportation for a very
complex group of patients. This has not been done before in
California. The data shows that the number of ambulance transports a
city generates directly correlates with how busy emergency departments
are, so anything that can be done to decrease the number of transports
will be beneficial.
- Abbie Yant, St. Francis Memorial Hospital and member of the
Ambulance Diversion Task Force, said a number of decisions, including
the Police Department decision to not transport inebriates to jails,
culminated in the crisis of emergency room overcrowding. This project
addresses a disenfranchised population in a way that meets their
needs. They do not need to be in an emergency room, but instead in an
environment like the stabilization center.
- Ron Smith, Hospital Council, said this was a wonderful
public/private partnership that can be used as a model. The program
has already had successful results.
- Glenn Ortiz-Schuldt, Emergency Communications Department, said ECD
is excited about this new partnership. Currently ECD fields 6-8 calls
per day from emergency rooms that are referred to the MAP van for
patients to be transported to the stabilization center. On October 1,
paramedics will for the first time transport from the scene directly
to the sobering center. ECD will be tracking this data and can provide
various reports to DPH upon request.
- Commissioner Monfredini asked about the staffing pattern. Dr. Zevin
said the center has LVNs, medical assistants, nurse practitioners,
caseworkers, social workers and sometimes physicians. Commissioner
Monfredini asked if IVs could be used at the center. Dr. Zevin replied
that if a patient requires an IV, he would be transported to a
hospital. Commissioner Monfredini asked if the MAP van has the
capacity to accommodate increased numbers. Barbara Garcia replied that
the MAP van staffing has been reworked to now provide more than just
transportation. There will be gaps, and the pilot project evaluation
will identify these gaps. Dr. Campbell added that Seattle and Portland
have been using MAP vans very safely and effectively.
- Commissioner Chow asked how the Department assures that the right
mix of staff will be at the center. Dr. Zevin said that he visited
both Seattle and Portland, talking to medical directors and reviewing
their protocols. This information, was discussed through the Medical
Advisory Committee, which developed the specific protocols for
McMillan. Quality assurance will be performed throughout. The
protocols are available on the DPH Intranet site.
- Commissioner Penn asked if the MAP van staff is trained on the same
protocols. Dr. Zevin said MAP staff is not trained medical personnel,
but trained on working with this population. They use their own
protocol to determine where the person should be transported. Once a
person is taken to McMillan, McMillan staff will reevaluate the
patient and may determine that the person does need to go to a
hospital. This is the same evaluation as that done by trained
paramedics on the street. This will be fully analyzed as part of the
pilot project evaluation. Commissioner Penn asked if the pilot project
evaluation would allow the Department to see if it is impacting the
20% of the patients who use 80% of the ambulances services. Barbara
Garcia said they already have a cohort of 140 and can immediately look
at their utilization. Furthermore, the new computer systems will allow
the Department to look at service usage throughout the Department. Dr.
Campbell added that many physicians are awaiting the data that will
come out of McMillan and will provide another level of review.
- Commissioner Umekubo commended everyone for developing the
public/private solution for this complex problem. With regard to
funding, will the Hospital Council continue to fund a portion of the
project, and how will funding be sustained. Ms. Garcia said the hope
is that the private partners will continue to fund the project, there
is funding from San Francisco General Hospital and funding will
continue to be a high priority for DPH. Mr. Smith stated that the
Hospital Council will evaluate the data and if the program is
successful would look favorably at providing additional funding.
- Commissioner Chow asked when staff would be ready to report
evaluation findings. Ms. Garcia said they could provide updates every
six months. She noted, however, that there is no money attached to the
evaluation piece but a number of people are interested in undertaking
the evaluation. Commissioner Chow asked for an update on the October
1st implementation in November, in terms of volume of people being
served. Project evaluation updates should go through the Community
Health Network Joint Conference Committee.
- Commissioner Monfredini asked for the San Francisco General Hospital
Joint Conference Committee to be kept apprised as well, specifically
regarding the impact on SFGH ED diversion.
- Commissioner Guy asked how DPH would use the evaluation to identify
both successes and areas that need modification. Funding for the
evaluation is critical and needs to be identified. Ms. Garcia said
that evaluation is a priority and there is a commitment from staff to
undertake the evaluation.
- Commissioner Sanchez said there might be some evaluation funding
available through state sources.
- Commissioner Parker is excited about the McMillan center, which has
been badly needed for a long time. Crisis often leads to creativity,
and this is one example. The money DPH will save in the emergency
department will outweigh what is spent on this program, so DPH should
continue to fight to maintain this service. This program will have a
positive impact across the board, from diversion rates to homeless
deaths, to quality of life.
- Commissioner Chow commented that the real message is that this
program focuses the problems of public inebriates. This emphasis got
lost in discussions about revenue losses at private hospitals and SFGH.
This program emphasizes addressing the needs of this complex
7) PRESENTATION OF A REPORT ON THE SAN FRANCISCO FOOD SYSTEMS
Rajiv Bhatia, MD, MPH, Director of Environmental and Occupational
Safety, said the focus on food consumption and sustainability came out of
the environmental justice movement in Bayview Hunters Point. DPH initiated
the San Francisco Food Systems Council as a partnership with the San
Francisco Foundation Community Opportunities Fund in 2002. The Council’s
mission is to build bridges between urban food consumers and regional
sustainable agriculture in order to support accessible and affordable
nutritious food for all San Franciscans.
Fernando F. Ona, PhD., MPH, Occupational and Environmental Health,
continued the presentation. A youth led survey of food needs along the
third street corridor resulted in four priorities: a grocery store,
farmers markets, better food choices at corner markets and better fast
One of the initiatives is the Farm-to-School project. Staff did a
school food environment survey at SFUSD schools, and has started a pilot
project with SFUSD School Nutrition Services. Another big issue is to have
local farmers’ markets accept food stamps/electronic benefit transfers.
This is a complex, controversial and somewhat political issue. But if
Subway can accept EBTs, then farmers’ markets should be able to.
- Coalition, Partnership and Collaboration Building
- Food Alliance
- Technical Advisory Board and Strategic Planning
- Working with SFUSD, CBOs and other entities
- Community Food Assessments and Community Action Research
- The San Francisco Food Systems Guidebook
- Childcare provider Food Assessment - they received a grant from
the USDA to provide healthy food to providers in Visitation Valley
- West Point Hunters’ View Food Assessment
- Visitation Valley Food Ethnography
- Alemany Mini-Community Food Assessment
- Food Assistance at Farmers’ Markets
- Technical Support and Assistance
- Integrating Food Systems Activities
- Supporting CBOs in food work
- Connecting state, regional and local food systems’ work
- Building capacity of communities
- Bridging academic, government and community
Mr. Ona stated the six strategic plan goals:
- To increase awareness of food as a systems issue within San
Francisco and the importance of a sustainable and equitable food
system for San Franciscans.
- To support local and regional sustainable food production.
- To maximize opportunities for the sale and distribution of local and
regional sustainable agriculture in San Francisco’s urban markets.
- To ensure access by all people at all times to enough nutritious,
affordable, safe and culturally diverse food for an active, healthy
- To encourage recycling of all organic residuals, reinforce the
elimination of chemical use in agriculture and landscaping and promote
the use of sustainable practices that enhance natural regional
biological systems upon which the City and County of San Francisco
- To establish and coordinate mechanisms for community participation
in the development of relevant policies to achieve a sustainable and
equitable food system.
- Implementation of the Strategic Plan
- Continued development of the website (www.sffoodsystems.org
- Building the Food Alliance
- Strengthening food systems’ work
- Supporting community capacity building
- Publication and dissemination of work
- Commissioner Monfredini is frustrated that the farmers markets do
not accept food stamps. This needs to be rectified. Commissioner
Monfredini also noted that many urban neighborhood markets carry fresh
fruit and produce, and this should be replicated at all of San
- Commissioner Umekubo said that food is such a fundamental issue but
is also very complex. How can the Health Commission support the
initiative? Dr. Bhatia said that they have been able to leverage funds
for this effort, so funding is not the primary issue. The Food
Alliance will be developing policy solutions and the Health Commission
can advance these policies through resolutions and other actions. The
Health Commission can also help break down the silos in the City by
working with other Commissions, through panels, meetings, etc.
Commissioner Umekubo asked if the Farm to School program was at
private schools. Mr. Ona said not at this time, but hope to expand to
all schools in the future.
- Commissioner Chow asked why a simple issue of creating a salad bar
at a school is so difficult. Mr. Ona said there are many impediments,
including lack of food preparation facilities at schools, the labor
required to prepare food, and the lack of will by SFUSD to engage in
Farm to School. They are working to overcome these obstacles.
- Commissioner Guy thanked the Commission and the Department for being
open to looking at health and nutrition from a broader perspective. It
took a long time for the problem of unhealthy food choices and food
systems to develop, and the solutions will not happen over night. The
Commission will continue to support the good work of this initiative.
8) PUBLIC COMMENTS
The meeting was adjourned at 6:10 p.m.
Michele M. Olson, Executive Secretary to the Health Commission