Minutes of the Health Commission Meeting
Tuesday, April 6, 2004
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 3:05 p.m.
- Commissioner Edward A. Chow, M.D., President
- Commissioner Lee Ann Monfredini, Vice President
- Commissioner Roma P. Guy, M.S.W.
- Commissioner James M. Illig
- 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 MARCH 23, 2004
Action Taken: The Commission approved the minutes of the March 23, 2004
Health Commission meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Sánchez chaired, and Commissioner Guy and Commissioner
Penn attended, the Budget Committee meeting.
(3.1) AIDS Office-Research - Request for approval of a new contract
with Public Health Foundation Enterprises, Inc., in the amount of
$63,445, to provide fiscal administrative services for the “HIV/AIDS
Surveillance Activities” project, targeting newly diagnosed or
reported cases of HIV infection or AIDS in San Francisco, for the period
of April 1, 2004 through December 31, 2004.
- Secretary’s Note: this contract was presented by the HIV/AIDS
Statistics and Epidemiology Section, not the AIDS Office of
Research, as noted on the Contract Request Summary.
(3.2) AIDS Office-Prevention - Request for approval of a new
retroactive contract with UCSF AIDS Health Project, in the amount of
$100,000, to provide integrated STD/AIDS testing services targeting
defined high-risk populations, for the period of January 1, 2004 through
June 30, 2004.
(3.3) PHP-Community Health Services - Request for approval of a
retroactive contract modification with AmeriChoice, in the amount of
$100,000, to provide additional fiscal intermediary services to the
Personal Assisted Employment Services (PAES) for dental services, for
the total contract amount of $328,657, for the period of July 1, 2003
through June 30, 2004.
- Commissioner Sanchez asked staff to evaluate the feasibility of
having some of the patients served through this program seen at the
SFGH Dental Clinic, and report back to the Community Health Network
Joint Conference Committee.
- Commissioner Guy asked Ms. Martinez to explain why the model of
having these patients served at Tom Waddell was unsuccessful. Ms.
Martinez said the primary factors were facility limitations and the
inability to get positions released.
- Commissioner Penn asked if the average cost per patient for this
program is accurate. Po Yee Lindahl said the amount is an average
and is for reference only. Some patients use more of the dollars
(3.4) BHS-Mental Health - Request for approval of new retroactive
contracts totaling $270,000 with the following out-of-county hospitals
to provide inpatient mental services for San Francisco child and
adolescent clients, for the period of July 1, 2003 through June 30,
2004: Adventist Health-California Specialty Hospital; Alta Bates
Hospital, Herrick Campus; Fremont Hospital; John Muir/Mt. Diablo Health
System; Mills-Peninsula Hospital; Stanislaus Behavioral Health Center
and Sutter Health.
Commissioners’ Comments (at full Commission meeting)
- Commissioner Illig asked why the Department is seeking waivers
from the Equal Benefits Ordinance for these contracts. Mr. Sass said
that these are sole source contracts for children who need these
services. The placement of these children is often out of the
Department’s control, and each institution might only have one
placement in a year. But the Department needs a mechanism to pay for
the services. Commissioner Illig would like all contractors to
comply with the Equal Benefits Ordinance and will work with staff on
- BHS-Mental Health - Request for approval of a retroactive contract
modification with Positive Resource Center, in the amount of $50,798
per year for a total contract value of $250,798, to provide SSI
advocacy and training services for disabled, uninsured clients, for
the period of April 1, 2003 through June 30, 2004.
- Commissioner Guy asked how long it has taken to get people
approved for SSI. Jane Gelfand from Positive Resources Center
replied that they have been able to get 28 patients on SSI in less
than one year. This is tremendously exciting, since the perception
is that it can take a very long time to become eligible for SSI.
- Commissioner Sanchez asked staff to clarify whether the
modification is for start-up costs or a supplementation to the
services. Ms. Martinez said the initial contract was April 2003
through April 2004 in the AIDS Office. Staff wants to renew it in
Mental Health, with a contract ending July 2004. So this
modification bridges the three months. Also, initially PRC was only
going do benefits counseling. Staff immediately saw the need for
additional services, and needed the modification to pay for these
Action Taken: The Commission approved the Budget Committee Consent
Calendar. Commissioner Sanchez abstained from voting on Item 3.2.
The Community Health Network Joint Conference Committee will receive an
update on Item 3.3 within 90 days.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
San Francisco Farm-to-School Report
The Occupational and Environmental Health Section would like to
announce the release of The San Francisco Farm-to-School Report. In 2002,
San Francisco Food Systems in partnership with the San Francisco Unified
School District (SFUSD) and the Occupational and Environmental Health
Section began assessing the feasibility of incorporating fresher, locally
grown fruits and vegetables into the meal programs within SFUSD in order
to support students’ health and the surrounding farm economy. The
purpose of this project was to understand the local school food
environment in relationship to sustaining a farm-to-school project. The
final report is available to download from the San Francisco Food Systems
By advancing our project plan in the years ahead, San Francisco Food
Systems hopes to ensure that our local community, including the San
Francisco Unified School District, is vested in food systems activities
that support sustainable environments and healthy, sustainable
Ten Year Homeless Council
Mayor Newsom’s Ten Year Homeless Council, chaired by former
Supervisor Angela Alioto, began meeting in late March and is expected to
deliver a 10-year plan aimed at reducing chronic homelessness by the end
of June. The 30-member council is comprised of a diversified group of
leaders from various sectors of the community. Dr. Robert Okin, Chair of
SFGH Psychiatry and Anne Kronenberg in her capacity as co-chair of the
Local Homeless Coordinating Board are members of the council. Marc Trotz,
Director of HUH, is providing technical assistance for the council along
with Dariush Kayhan from Department of Human Services. The federal
government has made the creation of these ten-year plans integral to
securing resources for homeless programs.
HIV Vaccination Trials
Dr. Katz shared the good news with the Commission that in this year's
annual evaluation of the 17 HIV Vaccine Trial Units in the United States,
Caribbean, South America, Africa and Asia, San Francisco was the #1
performing site. Dr. Katz congratulated the Vaccine Team and the many
others in the AIDS Office that support their work.
Lesbian Mental Health Conference
Community Behavioral Health Services (CBHS) is sponsoring a conference
entitled, “SF LGBT Pride Celebration: Current Challenges in Lesbian
Mental Health,” on Friday June 25th. This conference will be of
particular interest to Primary Care providers as well as other DPH staff
working in the field of mental health. For registration and more
information, please call 502-5209 or access the information online at:
- Commissioner Penn commended the Vaccine Team on their recognition.
It is a great accomplishment.
5) ACCEPTANCE OF THE LAGUNA HONDA HOSPITAL FOUNDATION ARTICLES OF
Larry Funk presented the Laguna Honda Hospital Foundation Articles of
Incorporation. Mr. Funk introduced Louise Renne, the chair of the Laguna
Honda Hospital Foundation. Ms. Renne told the Commission that a number of
people have agreed to be on the Foundation Board, and the membership will
be announced shortly. The Foundation is dedicated to raising the
additional funds needed to make the new Laguna Honda Hospital a resource
for centuries to come. The Foundation will provide the Commission with
Commissioner Chow expressed the Commission’s gratitude to Ms. Renne
for all her work in making the new facility a reality.
- Commissioner Monfredini is pleased that the bylaws are structured so
- Commissioner Sanchez, as former chair of the Laguna Honda Hospital
Joint Conference Committee, said he is pleased at the work that was
done to build consensus around both the hospital and the Foundation.
- Commissioner Illig asked why, upon dissolution, the resources do not
revert to the institution, but instead to a generic non-profit. Ms.
Renne said the bylaws give the flexibility to give money, upon
dissolution, to the LHH Volunteers or the hospital or another entity.
Under any circumstances, the first purpose is to give money to Laguna
Honda. She will get additional information to the Commission.
- Commissioner Umekubo said the Foundation could not come at a better
time, as there are a number of needs for the new facility, including
- Commissioner Guy commended Ms. Renne and Mr. Paley for committing
their time to this cause. Due to their efforts, there is broad
consensus in the community that the hospital will be modernized and
will have a role in the 21st century.
Action Taken: The Commission approved the acceptance of the Articles of
6) PRESENTATION OF A RESOLUTION HONORING PUBLIC HEALTH WEEK
Ginger Smyly, Director, Community Health Promotion and Prevention,
informed the Health Commission about Public Health Week activities. The
theme of this year’s Public Health Week is eliminating health
disparities, particularly racial and ethnic health disparities. The
celebration includes the resolution, local and federal observances, and
sample DPH programs.
Ms. Smyly noted a seminal report, San Francisco Burden of Disease and
Injury: Mortality Analysis, 1990-1995.
Ms. Smyly highlighted sample DPH programs addressing health disparity,
including Breast and Cervical Cancer Services, the Immunization Coalition,
health services for LGBTQQ youth and the Seven Principles Project.
- Commissioner Guy said given these budget times, it is very important
to recognize the benefits of projects such as Seven Principles and
other public health projects.
- Commissioner Umekubo noted that the fact that only 21 states
recognize Public Health Week underscores the lack of attention to
- Commissioner Chow said it is so important to highlight the
elimination of racial and ethnic health disparities, and the
resolution underscores that fact that the Health Department works
toward this every day.
Action Taken: The Commission approved Resolution #05-04, “Honoring
Public Health Week, April 5-11, 2004,” (Attachment A).
7) PRESENTATION OF SAN FRANCISCO GENERAL HOSPITAL REBUILD
Gene Marie O’Connell, Executive Administrator, SFGHMC, and John
Kanaley, Senior Associate Administrator, Support Services, presented a San
Francisco General Hospital Rebuild update.
The Rebuild Steering Committee was reconvened to focus on the immediate
mandate that SFGH be compliant with SB 1953. The focused work did not seek
to develop an entire Facility Master Plan, but strictly focused on seismic
compliance. The Rebuild Steering Committee began its work under two
assumptions: SFGH will be rebuilt by 2013; and there would be a November
2004 General Obligation Bond. The plan was to cost no more that $550
million for a General Obligation Bond. The Steering Committee reviewed
many threshold issues, including location of the hospital, location of
psychiatric beds, number of acute care beds, status of SNF beds at Potrero,
additional sources of funds and location of research facilities. The
Steering Committee reached consensus that the replacement hospital should
be 267 acute care beds. The Steering Committee also reached consensus
regarding psychiatric beds remaining at the Potrero Campus even if the
acute care hospital is built at Mission Bay. The process included various
Mr. Kanaley reviewed the concepts that were developed, reviewed and
debated by the Steering Committee:
A-1 - Rebuild a new acute care hospital on the north side of the
A-3 - Retrofit the existing Potrero hospital building for continued
acute care use, and build a new critical care tower
B-2 - Rebuild a new acute care hospital collocated with UCSF at
Mission Bay, with ambulatory services at Potrero.
Steering Committee Recommendation
Many on the Steering Committee felt that more time was needed to fully
explore the Mission Bay collocation option. Dean David Kessler of the UCSF
School of Medicine re-opened the door to discuss collocation, and many of
the SFGH medical staff support the dialogue. The SFGH Steering Committee
voted to continue exploration of all options, including collocation with
UCSF, before choosing an option. The recommendation does not rule out
proceeding with a Potrero rebuild concept in the future.
Dean Kessler of UCSF has made arrangements for Bruce Vladik, former
HCFA administrator, to participate in discussions on collocation. The goal
is to reach agreement that collocation is, or is not, a viable option.
Staff will provide regular updates to the SFGH JCC and will give a formal
presentation to the Health Commission in six months.
Dr. Katz said that although the recommendation is for further study, a
lot has been achieved already. He was pleased with the process, and that
the Steering Committee was able to make a decision on bed size. What
remains as the major question is the new openness on the part of UCSF to
collocate at Mission Bay. Dean Kessler has a broad vision about what
hospital care could look like in a collocated environment. There are still
a number of issues that would have to be resolved if Mission Bay is to be
a reality. But it is important that all options be fully examined and
pursued before a bond is put before the voters.
- Lucy Johns, a member of the Steering Committee since its inception,
spoke in support of the proposed resolution. The Steering Committee
did the best it could to propose a solution, within financial
constraints, that resulted in the best hospital for the public, the
medical students and the employees. In the end, they chose to explore
fully every opportunity they were presented with before making a final
- Larry Bevan, Shop Steward, Local 250, spoke against the resolution.
His concern is that the November 2004 election is the best opportunity
to pass a bond for the hospital. Also, the Commission should look at
UC’s history of taking over Mt. Zion. They only keep services that
- Sue Carlisle, M.D., Associate Dean at SFGH, encouraged the
Commission to support the resolution to further study the future site
of the hospital. SFGH is the safety net hospital and the city’s
trauma center. SFGH is one of the best public hospitals in the world
due to the partnership between the hospital and the UCSF physicians.
The physicians feel that the two Potrero options would not provide the
opportunity to recruit the highest quality doctors.
- Valerie Ng, M.D., Chief of the Medical Staff, said the Medical
Executive Committee fully supports the resolution and pursuing further
study about collocation. The best opportunity to provide quality care
is at Mission Bay.
- David Grace said that global warming will have tremendous impacts
and there will be a need for more than 267 beds at SFGH. The Mission
Bay campus is on landfill, which would be dangerous during an
- Commissioner Penn is much more comfortable with the present options,
and that there are good options even if Mission Bay is not the final
site. He asked the timeline for the collocation discussions. Dr. Katz
said UC must make a decision on collocation by June or July.
Commissioner Penn asked if research would be a topic in the
discussions with UCSF. Dr. Katz said that the Dean sent out a letter
that said it is UCSF’s responsibility to provide research space. It
is the first time that UC recognized that the SFGH medical staff was
as much a part of the research staff as those who are on the Parnassus
- Commissioner Guy supports the proposed direction, even though it
means giving up the November 2004 election. The new dean at UCSF has
reinvigorated the collocation option. But if further study is going to
be done, every stakeholder has to be open to all alternatives,
including Potrero. She is concerned that the medical staff believes
that quality care is not possible at Potrero. Dr. Ng clarified that
the medical staff is committed to serving the patients, and they will
do so regardless of where the hospital is rebuilt. But there are
concerns. Dr. Ng said the medical staff fully recognizes that the
decision about where to rebuild is much larger than their views. Dr.
Katz added that his priority is that San Francisco has a public
hospital-this should be everyone’s number one goal. With that as the
context, the Department needs to identify the most viable option for
having a public hospital. SFGH closes in 2008 if there is no viable
- Commissioner Sanchez said there is a new spirit at UCSF. There is a
valid concern about whether the SFGH model will continue to work. But
we will not know what the new pathway will be until the State budget
is approved. UC’s research budget has been cut 20%. Yet the new Dean
has still said he is committed to and responsible for research. This
is an amazing commitment. In all this turmoil, the Steering Committee
has stayed its course. All options need to be explored to see if we
can give generations of San Franciscans the services of SFGH.
- Commissioner Monfredini said she had been opposed to further study
of collocation because she did not think it was a realistic option.
However, the new Dean has really breathed new life into this option
and it is important that the Commission do its due diligence to pursue
- Commissioner Chow said the Steering Committee has worked very
diligently. The goal is to find the very best solution for this county
and he believes this can be done and still meet the 2013 timeline.
Action Taken: The Commission approved Resolution #06-04, “Accepting
the San Francisco General Hospital (SFGH) Rebuild Steering Committee
Recommendations With Regard to Bed Count and Maintenance of Psychiatry
Wards in Current Building, and Directing the Department to Further Study
the Hospital Rebuild Options, Including Collocation with the University of
California at San Francisco (UCSF),” (Attachment B), and directed staff
to provide a report to the Commission in six months, and update the San
Francisco General Hospital Joint Conference Committee on a regular basis.
8) APPROVAL OF DIVERSION PROGRAMS TO IMPLEMENT PROPOSITION M
Mitchell H. Katz, M.D., Director of Health, presented the Health
Department’s plan to implement requirements proscribed by Proposition M.
Proposition M was passed by the voters in November 2003 and bans all
aggressive solicitation in public places, replacing the police-based
approach to panhandling with a public health-based approach. Specifically,
Proposition M requires the Health Department to establish, administer
- Guidelines for diversion program eligibility,
- Services to screen and assess violators for substance abuse and/or
mental health treatment and services appropriate for treatment of
- Guidelines for determining whether the conditions were met
- Establish Guidelines - DPH recommends that all individuals convicted
for Prop M violations be able to participate in all established DPH
- Develop Screening, Assessment and Referral - DPH Treatment Access
Program (TAP) will provide screening and assessment services to
determine the level of behavioral health care needed for each client
using the TAP initial screening instrument and/or the Addiction
Severity Index Form. Following the assessment, DPH/TAP will arrange
placement into an appropriate program.
- Develop Guidelines for Determining Whether the Conditions of
Diversion Have Been Satisfied - TAP will report routinely to the
Courts regarding status of client’s compliance and/or completion of
Dr. Katz said that because the DPH Proposition M Diversion Program
would only be invoked if the individual does not cease aggressive
solicitation after being warned and given a chance to comply with the
ordinance, is convicted of a misdemeanor or infraction and agrees to enter
the DPH Proposition M Diversion Program, it is assumed that the number of
persons who go through all three steps will be relatively small. DPH, in
collaboration with the Department of Human Services (DHS), sees
Proposition M as one small part of the overall response to homelessness
and panhandling. By June 2004, DPH and DHS will be implementing a citywide
street outreach program that will focus on several homeless populations,
- Andre Rucker said that if there are not treatment spaces now, there
certainly will not be spaces in the next month. And this proposal will
bring two very stressed individuals together-stressed police and
hungry people. People will be locked up because there will be no room
in diversion programs.
- Michael Lyon said the plan is predicated on the services existing,
and they do not exist now, let alone after $37 million worth of cuts.
Worse, it adds the patina of public health to a system that punishes
people for being poor. This is below the Health Department’s
- David Grace, the Health Commission should not enforce
- Philip McDonald, Coalition on Homelessness, said thousands of
dollars will be wasted on going after poor people.
- L.S. Wilson, Coalition on Homelessness, fears that this is a
smokescreen for the police to be able to crack down on people for
being poor. In order to make the legislation look good, the Health
Department is going to have to displace people who have been waiting
for services for months.
- John Melone, Homeless Senior Task Force, the task force worked
diligently to get money for 100 units of housing, which was deposited
in the Health Department’s budget. They are requesting an additional
$2 million to provide housing and services to help solve the homeless
- Diana Valentine, Coalition on Homelessness, said the Health
Commission could prevent this program from being implemented by not
approving this plan. Services do not exist, so the Health Commission
has the responsibility and the ability to say no to this program.
- Karl Start, Citation Defense Program, asked how the police are
supposed to know which panhandlers have been contacted by an outreach
worker and offered real treatment, and who is going to pay for this?
- Larry Bevan is concerned that the engagement and outreach process is
very time consuming. There are so few services available, and
resources are becoming even more limited. The Health Commission needs
to really look at how services are going to be allocated.
- Commissioner Illig asked if DPH is guaranteeing that anyone who gets
cited and gets diverted through this program will be placed in a
treatment slot. Dr. Katz, yes, they would be provided with treatment.
- Commissioner Guy said there are only so many treatment slots
available. Will these individuals displace others, because this is now
a priority? Where is the capacity, and who is being displaced? Dr.
Katz replied that there is no question that under this plan, the
Health Department would be prioritizing people who were found guilty
under Proposition M, so it is possible people could be displaced.
Proposition M did not come with any additional funding.
- Commissioner Monfredini clarified to the public that Dr. Katz
developed this plan because he was mandated to. Commissioner
Monfredini is not very concerned that people under Proposition M will
displace current clients, because so few will get referred to the
Health Department through this program.
- Commissioner Penn asked for clarification that there will be no
directive to our outreach workers to refocus what they do to
prioritize panhandlers over any other person they are outreaching to.
- Commissioner Guy said even if five people are diverted through this
program, the questions are appropriate because there are not enough
services. The Health Commission needs to carefully monitor this plan
to see if it is successful. How will this plan be evaluated? Dr. Katz
said the evaluation parameters are fairly clear-how many people, where
were they placed, what was the outcome. He will provide a report
through the Community Health Network Joint Conference Committee.
- Commissioner Illig is reassured that people will get treatment as
part of this plan, not just assessed and given a referral.
- Commissioner Penn said DPH has no control over what the police do
under Proposition M, so while we can hope for the best, we do not know
that there will be a low number of participants. He is not sure that
as a Health Department the first priority for services should be for
this program. The resolution should reflect that there could be a
reshifting of resources. What happens if through monitoring we find
that this is deleterious? Dr. Katz said we would have to make hard
choices to provide additional residential mental health and substance
abuse treatment. Commissioner Penn does not want to put the Department
in the position it is in with Jail Health in that the Commission has
communicated that it is okay with a plan, does not communicate its
concern, and will be stuck with it.
- Commissioner Chow said the monitoring process would allow the
Commission to assess the impact and possibly suggest other priorities.
- Commissioner Guy said there is nothing in the resolution that
assures the public that diversion means treatment. And she wants the
resolution to address the capacity issue.
Action Taken: The Commission approved amending the resolution to add:
“Further resolved that the Health Commission will review on a quarterly
basis the number of individuals assessed, treated and diverted under Prop
M and the impact of more diversion on system resource capacity.
Action Taken: The Commission approved amending the resolution to add
“eligible” before the word “panhandler” in the third whereas.
Action Taken: The Commission unanimously approved Resolution #07-04,
“Approving the Guidelines and Identifying the Diversion Programs
Mandated by ‘Proposition M - Aggressive Solicitation Ban’ Passed by
Voters in November 2003,” as amended (Attachment C).
9) PUBLIC COMMENT
- Andre Rucker, the Health Commission just voted on something when the
public is screaming that it will cause harm. When the program is
reviewed, the information should be in writing.
- David Grace said the homeless population is expected to increase to
20 million people worldwide by 2010. This is an ugly scenario, and the
Health Commission should be preparing for it.
- Karl Start, Citation Defense Program, the Police Department has
already begun to issue citations under Prop M.
The meeting was adjourned at 6:25 p.m.
Michele M. Olson, Executive Secretary to the Health Commission
Note: These Minutes will be adopted at the next Health Commission
meeting. Any amendments to these Minutes made by the Health Commission
will be recorded in the Minutes for the next Health Commission meeting.