Minutes of the Health Commission Meeting
Tuesday, April 20, 2004
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The meeting was called to order by Commissioner Monfredini at 3:05 p.m.
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. – arrived at 4:15 p.m.
Absent: Commissioner Edward A. Chow, M.D., President
2) APPROVAL OF THE MINUTES OF THE MEETING OF APRIL 6, 2004
Action Taken: The Commission (Guy, Illig, Monfredini, Penn, Sanchez)
approved the minutes of the April 6, 2004 Health Commission meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Sanchez chaired, and Commissioner Guy and Commissioner Penn
attended, the Budget Committee meeting.
(3.1) PHP-Environmental Health Management – Request for approval of a
new contract with La Raza Centro Legal, in the amount of $311,760, to
develop and establish a structure and the resources to improve the health
and safety of day laborers’ and to begin implementation of interventions
that would improve their working conditions, for the period of May 1, 2004
through April 30, 2008.
- Commissioner Penn asked how many day laborers are in San Francisco, and
how many are served by this program. Anamaria Loya, Executive Director of
La Raza Centro Legal, said that the exact number of day laborers in San
Francisco is unknown. On any given day, approximately 220 day laborers go
to the Day Laborer Program. Twice that number is estimated to be on the
- Commissioner Guy asked if this grant is one-time or on-going. Ms. Yu of
DPH said the grant has been approved for four years, but must request
annual renewals. Commissioner Guy requested an update to the Population
Health and Prevention Joint Conference Committee midway through the grant
period. This is a very exciting program.
(3.2) PHP-CHPP – Request for approval of a contract modification with
O’Rorke, Inc., in the amount of $25,000 for one year (2003-04) for a
total contract value of $72, 800, for the provision of public relations
services for the Pedestrian Safety Campaign, for the period of July 1,
2003 through June 30, 2005.
- Commissioner Guy asked if there is an evaluation component to this
campaign. Mr. Radetsky said there is a feedback component in that they
look at how many people are getting the information. However there is not
a formal evaluation component.
(3.3) PHP-CHSS-TB Control – Request for approval of a sole source
contract renewal with the Regents of the University of California, in the
amount of $228,000, to provide physician and radiologist services to
patients referred to the SFGH Tuberculosis Clinic, for the period of July
1, 2004 through June 30, 2005.
- Commissioner Sanchez abstained from voting on this item.
(3.4) AIDS Office-HIV Prevention Services – Request for approval of a
retroactive new contract with CompassPoint Nonprofit Services, in the
amount of $105,000, to provide Organizational Development and Technical
Assistance services targeting SFDPH HIV prevention service providers and
SFDPH HIV prevention programs, for the period of January 1, 2004 through
December 31, 2004.
- Secretary’s Note – Jimmy Loyce noted that the source of funds for
this contract is CDC and State Prevention dollars, not CARE I as indicated
on the contract summary.
- Commissioner Penn asked for further details on the types of technical
assistance that is being provided. Cristina Chan from Compass Point said
they offer management consulting, assistance meeting ELI data entry
requirements, assistance developing evaluation tools and other services.
- Commissioner Guy asked if the budget cuts are impacting this program.
Ms. Chan replied that Compass Point regularly discuss with the AIDS Office
the priority services and the funds available to provide these services.
For the last few years the priority has been the ELI system. They then
meet with program managers to determine which other services to provide,
be it organizational management, board development, evaluation, etc.
Commissioners’ Comments (at Health Commission)
- Commissioner Illig, regarding item 3.4, asked for clarification of the
Health Commission’s policy on retroactive contract approval.
Commissioner Monfredini said that the Commission’s policy is to not
approve contracts when the retroactivity is the fault of DPH.
Action Taken: The Commission (Guy, Illig, Monfredini, Penn, Sanchez)
approved the Budget Committee Consent Calendar. Commissioner Sanchez
abstained from voting on Item 3.3.
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
TV Turn Off Week
The Maternal Child Health program is promoting April 19th through the 25th
as "TV Turn Off Week," an event celebrating its 10th year of
bringing public attention to the serious unintended consequences of
excessive television watching by young children and their families. This
year, organizers are putting a special focus on learning about healthy and
active lifestyle alternatives to TV viewing. A website, www.tvturnoff.org,
offers lots of family fun alternatives to TV watching.
WIC Working on Obesity Prevention
The San Francisco Women, Infants and Children Supplemental Nutrition
Program (WIC) was chosen by the California State WIC program to
participate in a special nutrition education project: Finding the Teacher
Within. The two-day training focused on improving nutrition education by
using “learner-centered” approaches that encourage active
participation by the WIC clients. WIC continues to draw from a variety of
innovative and dynamic methods of nutrition education to promote obesity
HIV Prevention Campaign Targets Day Laborers
A new HIV prevention media campaign targeting monolingual Spanish-speaking
day laborers has begun with a billboard at the interaction of Cesar Chavez
and Mission Streets. The effort will continue throughout the summer with
messages in bus shelters, bus interiors, and neighborhood billboards
depicting maps showing where men can find health and other supportive
services. Latinos comprise 14 percent of the City’s population but
nearly 20 percent of new HIV cases. The $250,000 campaign is the result of
a joint funding initiative between DPH and Bristol-Myers Squibb Virology,
and is being managed by UCSF Center for AIDS Prevention Studies. The San
Francisco-based firm, Cabra Diseno, developed the campaign messages
through extensive interviews and focus groups with the day laborers
Castro-Mission Health Center, News Update
Castro-Mission Health Center (CMHC) in collaboration with the DPH AIDS
Office will launch the Routine HIV Testing Pilot project to integrate into
primary care routine HIV testing of patients who wish to be tested with
the HIV rapid test. Providers will ask all primary care and women’s
clinic patients if they would like a HIV test and obtain their written
consent to participate in the pilot project. The medical assistant will
perform the HIV rapid test and the results will be processed while the
patient waits. The provider will meet with the patient once again to give
the result. CMHC nursing staff trained as HIV test counselors will follow
up immediately if the test is “preliminary HIV+”. For these patients,
a confirmatory test specimen will be taken and a return appointment
Access at Castro Mission Health Center
In July 2003, CMHC converted 50 percent of its primary care providers’
appointments to Open Access, which schedules same-day and next-day
appointments, and eliminated add-on double and triple booking
appointments. In the two years prior to implementation of Open Access, the
no-show rate hovered around 25 percent. Between October 2003 and January
2004, the no-show rate for Open Access appointments averaged just 7.2
percent. The success of Open Access at CMHC has required close team
collaboration across disciplines involving daily problem solving between
operations, medical records, nursing, and medical staff and an active
support of the CHN Information Systems.
The MIS Office has issued new information on the number of visits to the
website last month, along with some key data on what information visitors
accessed. Nearly 7,300 individuals visited the website each day –for a
total of 225,840 visits during March – and stayed an average of nine
minutes. Seventy-one percent of the hits are from within the U.S. and 11
percent are from international addresses. Of no surprise, the Employment
Opportunity page is the most frequently visited. Other topics that have a
popular appeal are the variety of pages focusing on STDs, information
about pelvic exams and pap smears, ordering birth and death records and
the SFGH/CHN site. Dr. Katz is pleased with the growing popularity of the
website and congratulated all the staff who continue to update its content
and keep the information current and meaningful.
National Infant Immunization Week
The San Francisco Immunization Coalition is hosting a special presentation
on Wednesday, April 28th, from 11 a.m. to 2 p.m. at Mission Neighborhood
Health Center. San Francisco Giants Third Baseman Edgardo Alfonzo and
Senator Jackie Speier will be featured speakers at this special community
event that includes activities for children, healthy snacks and toy
Workshop on Land Use and Public Health in Washington, D.C.
The National Association of County and City Health Officials and the
American Planning Association have asked the DPH Occupational and
Environmental Health Section and the SF Department of Planning Citywide
Policy Division to participate in a national workshop on land use and
public health in Washington DC. In the U.S., DPH is one of a handful of
local health agencies that is actively working on land use issues.
Residential Care Conference
A “Residential Care Conference,” is scheduled for Friday, April 23rd,
from 8:30 a.m. to 4:30 p.m. at St. Mary’s Conference Center, 1111 Gough
Street at Geary. Barbara Garcia, Bob Cabaj, MD and Marc Trotz will serve
as speakers and panelists. The conference will address the complex mental
health needs of adult and geriatric residents and their families. The
event is co-sponsored by Family Service Agency, Community Behavioral
Health Services and a number of other related agencies. For more
information call 474-7310.
2004 Consumer and Family Mental Health Fair
Community Behavioral Health Services (CBHS) salutes May as Mental Health
Month with the 3rd Annual Consumer and Family Mental Health Fair, Monday,
May 24th, 12 p.m. to 4 p.m. at the San Francisco Main Library, lower
level. There will be videos on various mental health topics,
entertainment, refreshments, and a number of information booths with
representation from the City’s various consumer and family self-help
organizations, and mental health and substance abuse programs. For
information, please contact Wanda Deams at 255-3694.
Chinese Community Health Summit
CBHS is pleased to be a co-sponsor of the upcoming Chinese Community
Health Summit, which will be held Wednesday, May 26th, from 8:00 a.m. to
4:30 p.m. at the Holiday Inn Golden Gateway at 1500 Van Ness Avenue. The
Summit is being organized by NICOS Chinese Health Coalition and will focus
on developing strategies to address health care access and prevention
needs of San Francisco’s Chinese community. CBHS staff will present on
various panels at the Summit. For pre-registration please contact Jeanne
Kwong at (415) 255-3427.
- Commissioner Penn asked for the background on the HIV Prevention
Campaign. Mr. Loyce said that this was a partnership with Bristol Myers
Squibb, the Office of Mayor Brown and the Department of Public Health,
with BMS giving money and the City providing matching funds. Commissioner
Penn asked how easy it would be to implement Open Access throughout the
DPH system. Dr. Katz said Open Access is a national movement. It has been
implemented in most of Mental Health. Castro Mission was the first Primary
- Commissioner Guy asked if the HIV Prevention Campaign is coordinated
with the grant for the Day Laborer Program that was approved by the Budget
Committee. Mr. Loyce said that the AIDS Office was involved in the
application process for that grant.
- Commissioner Monfredini read in the paper that an executive director
was chosen for the Laguna Honda Hospital Foundation. The woman seems like
a wonderful candidate. Commissioner Monfredini supports the Foundation’s
independence, and wants to ensure that the Foundation and the Health
Commission have good communication.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION
AWARDS FOR THE MONTH OF APRIL
Commissioner Guy presented the April Employee Recognition Awards.
Individual Awardee Division Nominated by
Sharon McCole Wicher, RN, MS SFGH - Behavioral Kathy Ballou and
Director of Nursing for Health Division/Admin. Alex Anagnos
Psychiatry at SFGHMC
Team Awardees Division Nominated by
Community Health Education Team Community Programs Ginger Smyly
Christina Goette Carpenter, MPH
Alyonik Hrushow, MPH
Susanna Hennessey-Lavery, MPH
Michael Radetsky, MPH
Mele Smith, MPH
6) THIRD QUARTER FINANCIAL UPDATE
Gregg Sass, DPH Chief Finance Officer, presented that Third Quarter
Financial Report. The report presents the third quarterly financial
projection of revenues and expenditures for the Department of Public
Health for fiscal year 2003-04. These projections are based on revenue
collected and billed, and expenses incurred for the first eight months of
the fiscal year ending February 29, 2004. DPH is currently projecting a
net surplus of $6.522 million. Projections include a revenue surplus of
$13.605 million and over expenditures of $7.083 million.
The Department will seek a supplemental appropriation to address the
structural issues at San Francisco General Hospital and Laguna Honda
Hospital. These appropriations will not require additional General Fund
and will be entirely covered with surplus revenues. The supplemental
appropriation request is for $12.3 million, with $11.115 million for San
Francisco General Hospital and $1.152 million for Laguna Honda Hospital.
Projection of Year End Results
Eight months ended 02-29-03
(For use for Controller’s Nine Month Report)
- Commissioner Illig asked if the proposed supplemental is what is being
considered by the Board of Supervisors to backfill CARE cuts. Mr. Sass
said no, that is a different supplemental. The proposal for the backfill
is to use unexpended or carryover funds. Dr. Katz added that there was
discussion about using DPH’s surplus to backfill CARE cuts. If this had
occurred, the surplus would have been unavailable to offset cuts in the
contingency budget, and neither the Health Commission nor the Board of
Supervisors would have the ability to look at priorities across the
Department. Instead, Dr. Katz suggested an alternative to use the $500,000
specifically allocated by Supervisor Daly, as well as rollover dollars to
backfill the contracts. Commissioner Illig asked if this proposal would
fund all of the cuts for the 12 months of the grant. Dr. Katz said the
contracts are funded for two months at the reduced level.
- Commissioner Monfredini noted that the supplemental would be forwarded
to the Board of Supervisors.
7) CONSIDERATION OF A RESOLUTION AUTHORIZING THE DEPARTMENT OF PUBLIC
HEALTH TO JOIN THE STATE DEPARTMENT OF GENERAL SERVICES PHARMACEUTICAL
PURCHASING PROGRAM TO EXPLORE THE COST BENEFITS OF PARTICIPATION, AND
APPROVING PARTICIPATION IN STATE DEPARTMENT OF GENERAL SERVICES
PHARMACEUTICAL PURCHASING CONTRACTS THAT PROVIDE FAVORABLE COST BENEFITS
FOR THE DEPARTMENT OF PUBLIC HEALTH
Sharon Kotabe, Pharm.D., Associate Administrator, Pharmaceutical Services,
Community Health Network, presented a proposal to participate in the State
Department of General Services (DGS) Pharmaceutical Purchasing Program. At
this time DPH does not know whether the DGS program would result in lower
pharmaceutical pricing than it receives through the current vendor,
Novation. DGS will disclose their contract pricing formularies and other
program details to those local government agencies that agree to join the
program. The Department wants to explore the cost benefits of
- Commissioner Penn asked if participation requires DPH to purchase
through the program. Dr. Kotabe said that agreement to participate in the
DGS program does not obligate the City to purchase through this program
Action Taken: The Commission (Guy, Illig, Monfredini, Penn, Sanchez)
approved Resolution #8-04, “Urging the San Francisco Board of
Supervisors to Authorize the Department of Public Health to Explore
Joining the State Department of General Services Pharmaceutical Purchasing
Program to Ascertain the Potential Cost Benefits of Participation,”
8) BEHAVIORAL HEALTH INTEGRATION UPDATE
Bob P. Cabaj, M.D., Director, Community Behavioral Health Services, gave
an update on the integration of Community Behavioral Health Services. Dr.
Cabaj highlighted accomplishments and challenges for the Executive Team,
Clinical Services, Client Relations, Cultural Competency, Provider
Relations, Quality Management, Placement, Evaluation, Information Systems,
Research and Grant Development. Accomplishments include:
- Developed a five-year integration plan
- Designed and instituted new organizational structure
- Developed cross-training model for line staff
- Co-located referral and assessment services and integrated Mental Health
and Substance Abuse assessment team functions
- Creating an integrated Mental Health and Substance Abuse Client Council
- Conducted survey to broaden use of peers for peer/case management
- Establishing integrated CBHS Cultural Competence Advisory Committee
- Integrating the provider complaints/grievance process
- Creating uniformity in contracts between Mental Health and Substance
Abuse; the blended contract document is being developed by the Citywide
- Instituted CBHS Compliance Committee and developed uniform incident
reporting, follow-up and evaluation structure, to be implemented by June
- Centralized Mental Health and Substance Abuse assessments and placement
- Working to address issues related to the large number of organizations
providing placements and operating independently.
- Improving ability to evaluate effectiveness of programs; identified
activities to develop core client outcomes.
- Developed plan to provide information on best practices in clinics
Examples of integration in action are the TAP and Access Team, the
McMillan Stabilization Center, Advanced Access, Administrative
cross-training and the Behavioral Health Court.
Next Steps - Challenges
- Truly integrating two separate entities
- Adjusting resistance to changing clinical approaches
- Addressing different levels of licensure and credentialing
- Maximizing revenues within resource constraints
- Keeping systems consumer friendly and welcoming in the face of resource
Commissioner Sanchez left at 4:30 p.m.
- Commissioner Monfredini commended Dr. Cabaj for condensing a complex
process into a clear, comprehensive report.
- Commissioner Illig is amazed at the progress that has been made.
Non-profit services providers deliver the vast majority of services. How
much are providers involved in preparations and planning groups? Dr. Cabaj
said community organizations were fully involved in the process, with the
head of every major CBO as part of the planning group. This last phase was
more internally focused. The clinical integration will not happen without
the CBOs full involvement. Dr. Cabaj noted that many CBOs have already
been providing integrated services, but the funding streams can still be
- Commissioner Guy asked if there has been resistance as a result of
licensure issues. Dr. Cabaj said everyone must be credentialed. Staff held
a community presentation that began to address the credentialing issues
substance abuse providers might face. One of his fears was the different
backgrounds of mental health providers and substance abuse providers. But
this has not been as much of a problem as he expected. Commissioner Guy
said that it has been a challenge to get the patient voice in the
evaluation tool, and she looks forward to seeing how this can be
incorporated into the integrated Behavioral Health system. She asked how
this initiative is affected by the budget crisis. Dr. Cabaj said that
whether the City is in a budget crisis or not, integration is the correct
approach. It is a better system for the client. This process will help the
Department know what community services will need to be strengthened even
during budget cuts.
- Commissioner Umekubo said that Commission is very quality driven, and
asked how the evaluation component is progressing and when can the
Commission could expect to see the final product. Dr. Cabaj is hoping to
have evaluation reports in Fall 2004. One challenge is the shortage of
technology and hardware. This will be reported through the Community
Health Network Joint Conference Committee.
- Commissioner Penn commended Dr. Cabaj for his leadership in this
effort. It is incredibly challenging to bring together two independent
systems that serve the same client population. He asked how outcome
evaluation for the integration would be funded. Dr. Cabaj said he is using
grant monies to do evaluation. He views this as part of clinical
reporting, and is using data he already has to see where the differences
are. Commissioner Penn asked if this approach could be used for other DPH
programs. Dr. Katz said the Department is moving toward this. Commissioner
Penn asked if this integration is resulting in job losses. Dr. Cabaj said
no one officially lost his or her job. A few people retired, and some
vacant positions are proposed to be eliminated. Commissioner Penn asked if
there are budget savings opportunities. Dr. Cabaj said there would be
savings opportunities, for example in contract monitoring. Also, the goal
is to have only one community advisory board.
- Commissioner Illig asked which other counties have moved in this
direction. Dr. Cabaj said San Diego has been a model of full integration,
and other counties, such as Alameda, have done administrative integration.
San Francisco is not using the Alameda model because in that case Mental
Health virtually subsumed substance abuse services. Dr. Katz told the
Commission that DPH had a failed attempt at integration when it was done
only on the administrative level.
9) PUBLIC COMMENT
10) CLOSED SESSION:
A) Public comments on all matters pertaining to the closed session
B) Vote on whether to hold a closed session (San Francisco Administrative
Code Section 67.11)
Action Taken: The Commission (Guy, Illig, Monfredini, Penn, Umekubo) voted
to hold a closed session. The Commission went into closed session at 5:00
p.m. Present in closed session were Commissioner Guy, Commissioner
Monfredini, Commissioner Penn, Commissioner Umekubo, Mitch Katz, M.D.,
Director of Health, Deputy City Attorney Sallie Gibson, Larry Funk,
Executive Administrator of Laguna Honda Hospital, Norm Nickens, Deputy
Director, EEO and Cultural Competency Programs and Michele Olson, Health
Commission Executive Secretary.
C) Closed session pursuant to Government Code Section 54956.9 and San
Francisco Administrative Code Section 67.10(d)
Approval of a settlement in the amount of $175,000 in the Joyce Vanman vs.
City and County of San Francisco, Superior Court File Case #318-756, City
Attorney File #011206
Action Taken: The Commission (Guy, Illig, Monfredini, Penn, Umekubo)
approved the settlement of $175,000 in the Joyce Vanman vs. City and
County of San Francisco, Superior Court File Case #318-756, City Attorney
D) Reconvene in Open Session
The Commission reconvened in open session at 6:05 p.m.
- Possible report on action taken in closed session (Government Code
Section 54957.1(a)2 and San Francisco Administrative Code Section
- Vote to elect whether to disclose any or all discussions held in closed
(San Francisco Administrative Code Section 67.12(a).
Action Taken: The Commission (Guy, Illig, Monfredini, Penn, Umekubo) voted
not to disclose discussions held in closed session.
The meeting was adjourned at 6:05 p.m.
Michele M. Olson, Executive Secretary to the Health Commission
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.