Minutes of the Health Commission Meeting
Tuesday, December 2, 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
Commissioner Edward A. Chow, M.D., President
Commissioner Roma P. Guy, M.S.W., Vice
Commissioner Lee Ann Monfredini
Commissioner Harrison Parker, Sr., D.D.S.
Commissioner John I. Umekubo, M.D.
Commissioner Michael Penn, M.D., Ph.D.
Commissioner David J. Sanchez, Ph.D.
Commissioner Umekubo left at 6:00 p.m.
2) APPROVAL OF THE MINUTES OF THE MEETING OF NOVEMBER
Action Taken: The Commission (Chow, Guy, Monfredini,
Parker, Umekubo) approved the minutes of the November 18, 2003 Health
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET
Commissioner Monfredini and Commissioner Umekubo
attended the Budget Committee meeting. Commissioner Penn was absent.
(3.1) PHP-HUH - Request for approval to accept
retroactively and expend a grant from the Substance Abuse and Mental
Health Services Administration, in the amount of $1,658,874, for the
period of September 30, 2003 to September 29, 2006 and approval of a
contract with Baker Places, Inc., totaling $832,466, for the same time
(3.2) PHP-HUH - Request for approval to accept
retroactively and expend a grant from the Health Resources Services
Administration through the San Francisco Community Clinic Consortium, in
the amount of $808,269, for the period of September 1, 2003 to August 31,
(3.3) PHP-CHPP - Request for approval of a retroactive
contract renewal with San Francisco Study Center, in the amount of
$218,669, to provide program support services to the DPH African American
Health Initiative, for the period of July 1, 2003 through June 30, 2004.
Commissioner Monfredini commended the San Francisco
Study Center and the Black Coalition on AIDS. The Black Coalition on AIDS
had experience some problems, but is back on track. Perry Lang, Executive
Director of Black Coalition on AIDS, and Aimee Zenzele Barnes, Board
President, attended the meeting.
(3.4) BHS-Mental Health - Request for approval of a
retroactive contract renewal with the Regents of the University of
California in the amount of $3,948,013 per year, for a total contract
value of $7,896,027, to provide citywide case management mental health
services targeting Psychiatric Emergency Services clients and county jail
inmates with mental illness, for the two-year period of July 1, 2003
through June 30, 3005.
(3.5) BHS-Mental Health - Request for approval of a
retroactive contract renewal with the Regents of the University of
California, on behalf of the UCSF Clinical Practice Group, in the amount
of $3,645,744 per year, for a total contract value of $7,291,488, to renew
the Single Point of Responsibility Program serving severely mentally ill
adults, for the period of July 1, 2003 through June 30, 2005.
(3.6) BHS-Mental Health - Request for approval of a
retroactive contract renewal with Jewish Family and Children’s Services,
in the amount of $815,345 per year for a total contract value of
$3,261,377, to provide mental health services, for the period of July 1,
2003 through June 30, 2007.
(3.7) BHS-Mental Health - Request for approval of a
retroactive new contract with Boys and Girls Club of San Francisco, in the
amount of $103,040, to provide mental health services for youth ages 7
through 18, for the period of July 1, 2003 through June 30, 2004.
(3.8) BHS-Mental Health/Substance Abuse - Request for
approval of a retroactive contract renewal with the Regents of the
University of California, Center on Deafness, in the amount of $475,553,
to provide mental health/substance abuse residential/outpatient services,
for the period of July 1, 2003 through June 30, 2004.
(3.9) BHS-Mental Health/Substance Abuse - Request for
approval of a retroactive contract renewal with Walden House, Inc., in the
amount of $9,135,851, to provide residential mental health and substance
abuse treatment services for the period of July 1, 2003 through June 20,
Barbara Garcia, DPH Deputy Director, provided an
update on the agency’s management issues. There are six new board
members. Staff anticipates that the Attorney General’s investigation
will be closed by June 2004. There has been a fairly extensive program
review as part of the Cal Mortgage application process. The agency has
continued to bring in more than $1 million in grants.
Gregg Sass, DPH Chief Financial Officer, gave a
financial update. Because of a variety of fiscal problems, Mr. Sass
has closely monitored Walden House’s financial situation. The agency
has made a lot of progress. Their cash is forecasted to be positive
through year-end. They agency still has the challenge of getting
expenses in line with receipts. Mr. Sass will continue to closely
monitor actual expenses. Receivables are lower than they were a year
ago. A continued concern is the fact that the agency does not have an
auditor on board, so the FY 2003 audit is not done. Mr. Sass continues
to ask for a number of monthly reports, which are due on the 15th of
each month: financial statement, cash forecasts, update on status of
Attorney General investigation, status of Cal Mortgage application,
status of the audit and updates on personnel and governance issues.
Commissioner Monfredini expressed disappointment with
Deloitte and Touche for walking away from Walden House. They overlooked
inappropriate expenditures in the past, and to walk away when the agency
is trying to get its house in order is reprehensible. She offered to meet
with the firm if it would help. Commissioner Monfredini thanked Ms. Garcia
and Mr. Sass for taking on the task of working with this agency. She
congratulated Board President Chris Cunnie and Executive Director Chuck
Deutschman for starting the process of turning the agency around. Chris
Cunnie thanked DPH staff for working so closely with Walden House staff
and board members. The job is not done, and the Board is committed to
continuing the work. Mr. Deutschman said Walden House has so many
wonderful staff, appreciates support from DPH staff and the Commission.
Commissioner Umekubo asked about the prospects for
retaining an auditor. Mr. Deutschman said the four firms Walden House met
with are not willing to go forward until Deloitte and Touche provides
completed information from the previous audit.
Commissioner Monfredini asked Walden to commit to
continuing to provide DPH staff with monthly information. She asked the
status of the Cal Mortgage application. Mr. Cunnie said they still
pursuing this, but until the Attorney General’s investigation ends, this
will not move forward. The board and staff are working closely with the
Attorney Genera’s Office and Bank of America. Commissioner Monfredini
commended Mr. Cunnie for continuing as board president during these very
(3.10) BHS-Substance Abuse - Request for approval of a
retroactive contract renewal with Center for Juvenile and Criminal
Justice, Inc. (CJCJ), in the amount of $249,250, to provide substance
abuse recovery services targeting San Francisco male parolees over 18
years old, for the period of July 1, 2003 through June 30, 2004.
Commissioner Monfredini expressed concern about the
lateness of FY 01-02 audit, which was due in December 2002. Dan Macallair,
CJCJ Executive Director, said that it took the agency some time to catch
up on its audits. The FY 02 audit is almost complete. From this point
forward, the agency will meet all fiscal and administrative requirements
on time. Commissioner Monfredini asked for a report to the Community
Health Network Joint Conference Committee when the audit is complete.
Action Taken: The Commission (Chow, Guy, Monfredini,
Parker, Umekubo) approved the Budget Committee Consent Calendar.
Walden House (Item 3.9) will continue to
provide monthly reports to DPH staff.
Item 3.7 was referred to the Population
Health and Prevention Joint Conference Committee for a
follow up report.
Item 3.10 was referred to the Community
Health Network Joint Conference Committee for a report once
the audit is complete.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented
the Director’s Report.
McMillan Sobering Center
The McMillan Sobering Center has generated a great deal
of attention since its opening earlier this year. The staff has been very
generous with their time, allowing reporters occasional access and sharing
what has been learned about opening the Center with professionals from
across the country. Tonight at 11 p.m. and repeating Wednesday night at 5
p.m., Mike Sugarman from KPIX TV, Channel 5, will be showcasing the Center
during those news hours. While the specifics are not certain or what the
final story will have to say about the efforts being made through the
McMillan Sobering Center, DPH is confident that the program and services
will reflect a positive image.
DPH’s Charity Care Report in the Media
Several local media outlets covered the Department’s
charity care report and the hearing on the subject at the last meeting.
The San Francisco Business Times wrote the most extensive article. A small
article also appeared in the San Francisco Chronicle, which was picked up
by California Healthline, the daily health update sponsored by the
California Healthcare Foundation, and DPH was contacted by The Examiner
for a future article. Additionally, KTSF, Channel 26, taped part of the
hearing for their Chinese-language programming. The Board of Supervisor’s
has expressed an interest in holding a follow up hearing early next year.
Dr. Katz will keep the Commission informed as more information becomes
Maxine Hall Grand Re-Opening
The Commissioners will be receiving an invitation to a
grand re-opening of the newly renovated Maxine Hall Heath Center and
Westside Methadone Maintenance and Detox Center scheduled for December
10th from 1pm to 4pm. Thanks go to Marcellina Ogbu, Center Director, her
staff and Mark Primeau, Project Manager, for seeing the project through to
The San Francisco Health Plan's 2nd Annual Healthy Kids Appreciation
Night was held on Tuesday, October 28th. A number of CHN Primary Care
staff and programs were given special awards for their role in creating
access to care for our patients:
- 2003 Healthy Kids Crystal Heart Award:
Hospital Eligibility Workers (2908s)
Lola Escobar, SFGH
Sharon Kong, Noreen Lum and Maria Quevedo of Community Primary Care
- 2003 Healthy Kids Clinic Certificate of Excellence:
Chinatown Public Health Center
San Francisco General Hospital
Silver Avenue Family Health Center
- 2003 Healthy Kids Health Hero Award
Patricia Pérez-Arce, Ph.D., past Primary Care Administrator, Director
Sharon Thyne, M.D., Medical Director of Children's Health Center, SFGH
Assembly Bill (AB) 846 - New Smoking Law
On January 1¸2004, a new law affecting public buildings goes into
effect. The new law prohibits smoking within 20 feet of main entrances,
exits, and operable windows of any building owned, leased, and occupied by
the s tate, county, or city, and buildings of the University of
California, California State University, and California community
colleges. The previous law prohibits smoking within five feet of the
doorways of these buildings.
Commissioner Parker is pleased that the Board of
Supervisors is interested in holding a hearing on the Charity Care
report. This report should be used to demonstrate that the Department
needs more resources.
Commissioner Chow expressed appreciation that the
San Francisco Health Plan held an appreciation night.
5) FIRST QUARTER FINANCE REPORT
Gregg Sass, DPH Chief Finance Officer, presented the
first quarter financial report (Attachment A). The report projects
revenues and expenditures for fiscal year 2004, based on revenue collected
and billed, and expenses incurred for the first three months of the fiscal
year. Unless the Department institutes a decrease in spending rate, it
will end the year with a deficit of $5.11 million. Projections include
revenue surplus of $3.432 million in over expenditures of $8.533 million.
Mr. Sass presented financial information by division, and presented a
deficit reduction plan to enable the Department to balance its budget by
year-end. The plan consists of:
$2.3 million in projected additional cost report
settlements anticipated at SFGH and Primary Care
$2.325 in other expenditure savings including
anticipated contractual savings due to underutilization of services
and deferral of certain new initiatives.
Close unexpended balances in two capital projects:
$261,000 for the Laguna Honda Roof Replacement and $215,000 for the
SFGH lobby restroom.
Commissioner Chow asked why workers’ compensation
expenses are such a large part of the projected deficit, and why are
the expenses largely in Primary Care. Dr. Katz said that the City’s
Human Resources Department, not DPH, does the projections. They are
actuarial estimates that can be skewed by buyouts of certain claims.
DPH has made a number of suggestions to the City Attorney about how to
control costs. Dr. Katz pointed out that the $5 million projected
deficit is a relatively small variance for this early in the year. His
concern is what is going to happen in January and February.
6) AIDS OFFICE UPDATE
Jimmy Loyce, Deputy Director of Health, AIDS Programs,
presented the 2003 AIDS Office Report. The AIDS Office has four sections:
Prevention; Health Services, Research; and Statistics and Epidemiology.
The focus of this year’s report is epidemiology and research, to provide
a context for the myriad HIV/AIDS prevention programs and direct services.
HIV Prevention Challenges
New funding guidance from CDC and the State of
California will require new RPF for all prevention contracts in 2004.
New data suggested more targeted prevention efforts
and provides a challenge for long time community agency-partners, the
AIDS Office will provide training and technical assistance to help
these partner agencies remain relevant and competitive.
Increased HIV infection among African American MSM
is significantly among those not identified as gay. Men who do not
identify are hard to reach.
CDC and federal guidelines that limit the scope
language used in health promotion and risk reduction messages will
require San Francisco to maintain our commitment to culturally and
linguistically appropriate education and information.
HIV Health Services 2003 Accomplishments
The Title I Award
Standards of Care were developed for the major
The HIV Planning Council has allocated funds to
support a community planning process aimed at enhancing primary care
services for African Americans in the San Francisco Hunter’s Point
Bay View district
Prevention for Positives
Funding for Office of Minority Health
Title III capacity building grant from HRSA
Dr. Sandy Schwarcz presented the 2003HIV/AIDS
Epidemiology Report. Dr. Schwarcz presented data on cumulative AIDS cases
in San Francisco, annual AIDS incidence rates since 1993, for both males
and females, survival curves and HAART use by neighborhood. The survival
rate for African Americas with AIDS is worse than for other groups. Dr.
Schwarcz said HAART use predicts better survival and African Americans
initiate HAART later in the course of the disease. HAART use is lower
among residents of low-income neighborhoods, and African Americans tend to
reside in low-income neighborhoods. Dr. Schwarcz discussed the history of
HIV transmission in San Francisco and the HIV incidence among MSM seeking
Conclusions and Challenges
New AIDS cases and deaths declining
Number of persons living with HIV/AIDS increasing
Increased demands for prevention, health and social
Need to address disparities in HAART use to improve
survival for all
HIV risk behaviors and incidence may be stabilizing
but need to expand efforts to monitor the leading edge of the epidemic
Dr. Susan Buchbinder, AIDS Research Section, discussed
what staff is learning about HIV risks and strategies to reducing HIV
infection rates. Research moved from observation studies in the early
1980s to mid-1990s to testing interventions. The main target population is
MSM but also testing interventions that may work across populations and in
sister sites in Zimbabwe and Puerto Rico. The research focuses on
interventions with the greatest likelihood of reducing HIV infection
rates. Dr. Buchbinder presented the HIV prevention approaches: behaviors,
focused on sexual practices and reducing substance abuse; vaccines; STDs;
microbicides; and antiretrovirals.
Finding ways to help people make and sustain
Involving at-risk communities in research studies
Speed in testing new strategies; speed in
implementing old strategies
Possibility that political concerns will limit
Mr. Loyce concluded by summarizing AIDS Office
Hank Wilson said that poppers were promoted at the
Folsom Street Fair, and asked the Department to inquire of the
organization that sponsors the fair about this practice. He also asked
the Department to inquire of the Federal Trade Commission about
allowing the widespread advertising of poppers. He also asked that the
annual report include a statistic about the number of homeless
individuals who have AIDS.
Commissioner Guy applauded the approach of
providing the epidemiology and research context. However, there is
clearly the challenge of diminishing resources and even though this
was not an emphasis of the report, it should not be forgotten.
Commissioner Chow said there has been much
discussion about infection rates in and services to the youth
population, but did not see it in this report. Dr. Schwarcz said that
AIDS cases occur a long time after HIV infections, so they expect AIDS
cases to be in older individuals. They see new HIV acquisition in gay
men in their mid 20s to mid 30s. The Annual Epidemiology Report does
document homeless individuals with HIV/AIDS.
Commissioner Umekubo asked the amount of the
funding decrease over the last year. Mr. Loyce said that grant funding
fluctuates from year to year. The CDC is beginning to cuts its
research dollars. Commissioner Umekubo asked how the CDC approaches
primary prevention. Mr. Loyce said that the CDC is becoming less
inclined to fund primary prevention and moving toward funding more
medicalized prevention. Mr. Loyce said there has never been a
longitudinal study on the effectiveness of primary prevention
approaches. Commissioner Umekubo asked if AIDS dementia has decreased.
Dr. Schwarcz said cases still occur. Dr. Katz said that
antiretrovirals have greatly decreased the number of individuals with
AIDS dementia. Ms. Long said that the Health Service Section is
examining the issue of clients who have dementia, but not AIDS-related
Commissioner Parker said the report is encouraging
in that San Francisco’s rates are declining and people are living
longer compared to the rest of the country. He asked if there is any
data that indicates that infected individuals are coming from other
cities. Mr. Loyce said that there is anecdotal data that the African
Americans go to San Francisco, Oakland, San Mateo and other cities to
socialize. So there needs to be a regional approach. Commissioner
Parker asked how inmates receive education, information and services
about AIDS. Mr. Loyce said the AIDS Office works with Centerforce to
provide all new inmates with AIDS information.
7) FEDERAL AND STATE LEGISLATIVE UPDATE
This report was continued to the December 16, 2003
Health Commission meeting.
8) APPROVAL OF SAN FRANCISCO GENERAL HOSPITAL
ADMINISTRATIVE POLICIES AND PROCEDURES, (HOSPITAL PLAN FOR THE PROVISION
OF PATIENT CARE, IN-PATIENT UTILIZATION REVIEW PROGRAM, PERFORMANCE
IMPROVEMENT AND PATIENT SAFETY), AND PRESENTATION OF EMPLOYEE PERFORMANCE
AND COMPETENCY REPORT AND ENVIRONMENT OF CARE SAFETY ANNUAL REPORT
Gene O’Connell, Executive Administrator, SFGHMC,
provided the introduction to the various reports. John Luce, M.D.,
summarized the changes to the Administrative Policies and Procedures. The
major changes to the Hospitals Plan for the Provision of Care is that the
information in the plan was reorganized per 2004 JCAHO standards, updated
statistics on the communities served by the hospital is included and there
are added sections on education of patients and family, medication
management, management of environment of care and information systems,
competency assessment for non-medical staff and infection control
surveillance. The major changes to the Performance Improvement and Patient
Safety Program is that a reference to HIPAA has been added and it now
includes PIPS, Executive Committee and Medical Director of Quality
Management roles in review and oversight of the Tertiary Care Contract and
managed care programs. These two changes were also made to the Inpatient
Utilization Review Program. In addition, the additional responsibilities
to the Supervising Nurse Manager were added, as well as a Bridge to
Wellness to the Psychiatry Utilization Review Plan.
Rod Auyang presented the Employee Competency Report. As
of October 31, 2003, 97 percent of performance appraisals for CCSF SFGH
employees had been completed. Employees exceeded or met standards at least
98.2% of the time in all areas. The performance evaluations with “unmet
expectations” ratings showed three primary reasons for the need for
improvement: time management, communication and quality of work. Human
Resources works with managers to ensure that developmental plans and
monitoring are in place, particularly for direct patient care staff.
Mr. Auyang also discussed recruitment and retention
measures. Future challenges include State-mandated nurse-patient staffing
ratios in inpatient settings effective January 1, 2004 and analysis of the
correlation between vacancies/attrition and clinical and service
indicators, which is now required by JCAHO.
Linda Henson presented the Environment of Care Report.
FY 02-03 focused on security management. Accomplishments include:
Implemented main lobby security system - 94 percent
of staff found wearing badges during EOC safety rounds.
Developed one-day badge system
Secured access to the main hospital and outer
buildings via tunnels
Secured access to hazardous waste shed
Implementing card key system
Other issues include:
Continue to address and review smoking policy
Citywide master contract prepared for disposal of
Need to replenish shortage of N95 respirators
Need funds for nurse call system repair and
Approved loan for power plant upgrades
The transfer of DPH Institutional Police to Sheriff’s
Department is completed
Action Taken: The Commission (Chow, Guy, Monfredini,
Parker, Umekubo) approved amendments to the SFGH Administrative Policies
and Procedures, specifically the Hospital Plan for the Provision of
Patient Care, Inpatient Utilization Review Program and Performance
Improvement and Patient Safety Program, and accepted the Employee
Performance and Competency Report and the Environment of Care Safety
9) APPROVAL OF A SUPPLEMENTAL APPROPRIATION FOR THE
LAGUNA HONDA HOSPITAL REPLACEMENT PROJECT
Gregg Sass, DPH Chief Financial Officer, presented a
request for approval of a $211.5 million supplemental appropriation for
Laguna Honda Replacement Program construction expenditures. The source of
funds for this supplemental appropriation is General Obligation Bonds. No
General Funds are requested. The requested supplemental appropriation will
allow the encumbering of capital expenditures for the Replacement Program
through December 2005. The LHRP project team has projected that the
project will have to encumber $295 million through December 2005. The
Health Commission and the Board of Supervisors previously approved an
$82.7 million appropriation. The Mayor’s Office of Public Finance
anticipates introducing a bond sale resolution to the Board of Supervisors
on December 9th.
Action Taken: The Commission (Chow, Guy, Monfredini,
Parker) approved the supplemental appropriation for the Laguna Honda
Hospital Replacement Project.
Patrick Monette Shaw (given verbally then submitted
electronically) - A $14 million discrepancy exists between the $211
million in General Obligation Bonds Mr. Saas’ memo states the LHH
Project Team estimates needs to be issued and the $225 million the
Department of Public Finance and Business Affairs will propose to the
Board of Supervisors seeking another Supplemental Appropriation
Ordinance. Commissioner Monfredini’s excuse the $14 million is
required to prevent “cash flow” problems is ludicrous; when bond
instruments are signed, money becomes available instantly, so claiming
“cash flow” is unbelievable. Surely you know the proposed
settlement of Louise Renee’s lawsuit regarding $25 million raided
from the tobacco settlement fund to balance Mayor Brown’s budget
involves a $5 million gap; the tentative settlement allocates $20
million to the furniture, fixture and equipment project. Where is the
missing $5 million, and why the $14 million discrepancy? Taxpayers
hadn’t voted to pass Prop A, as I did, permitting misspending this
combined $19 million.
10) PUBLIC COMMENTS
The meeting was adjourned at 6:10 p.m.
Michele M. Olson, Executive Secretary to the Health