Minutes of the Health Commission Meeting
Tuesday, March 21, 2006
101 GROVE STREET, ROOM 300
San Francisco, CA 94102
1) CALL TO ORDER
President Monfredini called the meeting to order at 3:10 p.m.
- Commissioner Lee Ann Monfredini, President
- Commissioner James M. Illig, Vice President
- Commissioner Edward A. Chow, M.D.
- Commissioner Roma P. Guy, M.S.W.,
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner Donald E. Tarver, II, M.D.
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MARCH 7,
Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez,
Tarver) approved the minutes of the March 7, 2006 Health Commission
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Sanchez chaired, and Commissioner Tarver and Commissioner
Chow attended, the Budget Committee meeting
Items for Approval
(3.1) CHN-SFGH – Request for approval of a contract modification to add
SFG Imaging Consultants, Inc. to the previously approved contract shared
by three contractors to provide intermittent, as-needed, professional
services of per diem and traveling radiology technologists with on-call
availability 7 days a week, for San Francisco General Hospital and to
increase the contract by $509,000, from $1,200,000 to $1,709,000, for
the period of July 1, 2005 through June 30, 2006.
Items for Discussion and Approval
(3.2) CHN-Patient Financial Services – Request for approval to submit a
resolution to the Board of Supervisors to accept revenues estimated to
exceed $1,000,000 under a contract with Health Advocates, LLP.
(3.3) CHN-Patient Financial Services – Request for approval of a renewal
contract with Health Advocates, LLP to enhance Medi-Cal and other
third-party reimbursements through uncompensated care reimbursement
recovery services at San Francisco General Hospital, with compensation
based on contingency fees to be paid out of recoveries obtained by the
contractor, for the period of
April 1, 2006 through December 31, 2009.
(3.4) CHN-Administration – Request for approval to submit a resolution
to the Board of Supervisors to accept revenues estimated to exceed
$1,000,000 under a contract with Toyon Associates, Inc.
(3.5) CHN-SFGH, LHH & HAH – Request for approval of a renewal contract
with Toyon Associates, Inc., in the amount of $1,754,056, to provide
regulatory reporting and reimbursement and revenue optimization services
to San Francisco General Hospital, Laguna Honda Hospital and Health at
Home, for the period of April 1, 2006 through March 31, 2010.
(3.6) CHN-SFGH – Request for approval of a retroactive new contract with
Tsang Architecture, in the amount of $160,000, to provide master
planning services for the development of a new acute care hospital
building for San Francisco General Hospital, for the period of March 1,
December 31, 2006.
(3.7) DPH-Community Programs Prevention Services – Request for approval
of a resolution approving the use of interim agreements to extend the
terms and conditions of FY 2005-06 contracts into the first six months
of FY 2006-07.
Secretary’s Note – Commissioner Tarver abstained from voting on this
item as it relates to the contracts with Baker Places and Westside
Community Health Center. Commissioner Chow abstained from voting on this
item as it relates to the contract with NICOS. Commissioner Illig
abstained as it relates to the contracts with St. Mary’s Medical Center
and Project Open Hand.
(3.8) PHP-CHSS-TB Control – Request for approval of a retroactive sole
source contract renewal with the Regents of the University of
California, in the amount of $1,488,000, to provide operational services
of the Francis J. Curry Regional Training and Medical Consultation
Center, targeting health care providers, allied health professionals,
social service providers, TB and other related training providers,
funders interested in TB, and related health concerns throughout the
United States, for the period of January 1, 2006 through December 31,
Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Sanchez,
Tarver) approved the Budget Committee Consent Calendar, including
Resolution 05-06, “Approving Use of Interim Agreements to Extend the
Terms of Fiscal Year 2005/06 Contracts into the First Six Months of
Fiscal Year 2006/07 for the Department of Public Health,” (Attachment
A). Commissioner Tarver abstained from voting on Item 3.8 as it relates
to Baker Places and Westside Community Mental Health, Commissioner Chow
abstained as it relates to NICOS and Commissioner Illig abstained as it
relates to Project Open Hand and St. Mary’s Medical Center.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., presented the Director’s Report.
World TB Day
The Department will be co-hosting its annual World TB event with the
Chinese Newcomer’s Service Center March 23, 10 a.m., at Chinatown Public
Health Center. The good news this year is that San Francisco’s TB cases
for 2005 are the lowest in the City’s history. Between 2002 and 2005, TB
cases in the City dropped to a record low of 132 from a recent high of
296 in 1993 when TB cases began to spike during a brief resurgence among
people infected with HIV/AIDS. However, the City’s TB case rates remain
the highest in the nation. The TB Control Section points to a number of
strategies that have proven effective in producing better TB outcomes.
Last year, San Francisco was the first county in the nation to adopt a
breakthrough technology—Quantiferon-TB Gold® (QFT), a new, blood
assay-based TB diagnostic—to replace the less accurate, subjective,
100-year-old skin test for TB. The new TB test does not require patients
to return to a clinic to have their tests read by a nurse, resulting in
greater accuracy and more immediate results.
Currently data shows that Asian newcomers bear a disproportionate burden
of TB in the City, which is where the Department will focus its efforts
on World TB Day and throughout the coming year. A patient from the Asian
community who has undergone treatment for TB will be speaking at the
press conference. Dr. Katz encouraged Commissioners to join staff for
this press event on Thursday.
Cultural Competence Training Courses Nearly Complete
The Department’s Cultural Competence unit is completing a series of
trainings and workshops that were designed to instill in DPH staff and
community partners a deeper understanding of the critical role that
cultural competency plays in the delivery of public health services. The
series of five workshops began in November and will conclude on May 12th
with “Best Practices in Cultural Competence.” Past topics addressed
awareness, assessment, setting goals and objectives and the differences
in communicating with diverse populations.
The final workshop will provide a forum for recognizing a program or
components of programs that have made exemplary efforts to advance
cultural competence. The organizers of the May 12th workshop have asked
DPH staff to identify programs that reflect a Best Practices approach to
delivering health care within a cultural competency framework. Dr. Katz
believes this Department has a wealth of such programs that will be
St. Luke’s Community Forums
As the Commission is aware, St. Luke’s Board of Director’s has voted to
merge with CPMC, a Sutter Health affiliate. As a result of this pending
merger, St. Luke’s is hosting two community forums to help determine
what services are important to their patients and local residents who
rely upon St. Luke’s as a facility for their health care needs.
At the first forum last week, St. Luke’s informed those in attendance
that they have no plans to close down St. Luke's, the emergency room or
the inpatient hospital. Additionally, they will continue to provide
charity care and maintain their mission of not turning people away based
on inability to pay. St. Luke’s intends to continue taking uninsured and
Medi-Cal patients and, at the same time, will also pursue privately
insured patients to decrease their losses. They also talked about the
rebuild and said that they are hoping that St. Luke's will not be under
the 2008 deadline, but the 2013 deadline because they will now fall
under the CMPC umbrella, and CPMC is planning to rebuild their hospital.
The final community meeting is this afternoon.
Hearing on Massage Parlor Rules and Regulations
The Environmental Health Section is hosting a public hearing March 23rd
at 9:30 a.m., on the proposed modifications and additions to the rules
and regulations for massage establishments and practitioners. The
hearing will provide the opportunity for staff to review the new
proposed rules and regulations with owners and practitioners and answer
questions. Some of the new regulations include:
- Facilities must be equipped with massage tables. No beds permitted.
- Outside doors may be locked for security purposes. Inside doors cannot
- A massage trainee practitioner’s permit will be issued for 90 days,
with only one 90-day renewal allowed.
- Chair massage therapists, previously not mentioned in the original
ordinance, will come under the new regulations.
The Department of Public Health has been regulating massage facilities
and therapists since July 2004. This is the first set of changes to the
original regulations. The new ordinance is posted on the Department’s
As a result of increased reports of bedbug infestations, the
Environmental Health Section has scheduled a symposium entitled “How to
Control Bedbugs in San Francisco” March 30, from 3 – 6 p.m. here at 101
Grove St. The Department has sent letters of invitation to all licensed
pest control companies and hotel owners and operators in the City. The
workshop will cover the biology of bedbugs, scientifically proven
control methods, legal responsibilities and the Department of Public
Health’s expectations of pest control operators and those who own and
manage hotels. Organizers of the event have lined up speakers from the
California Department of Health, Vector Borne Disease Section;
Entomologists from the industry; Biologists from the Department of
Agriculture on Pesticides Use/Control; and a Deputy City Attorney.
Nutrition Services, whose programs served more than 84,000 San Francisco
residents last year, is holding a Community Partners Open House March
29th 3:30 - 5:30 p.m. 30 Van Ness, Suite 3500 (3rd floor). The afternoon
gathering will provide staff from Nutrition Services an opportunity for
community partners to network and to update them on all of the programs
that are available to their clients. Refreshments from the Heart of the
City Farmers' Market and La Cocina Community Kitchen will be served.
Each of the Commissioner’s has been sent an invitation to this event. We
hope you can join Nutrition Services next Wednesday to learn about this
important nutrition program for many of the City’s youngest and most
ABC News 20/20 at Laguna Honda Hospital
An ABC 20/20 news team spent last Friday at Laguna Honda Hospital
videotaping Dr. Ian Zlotolow, a dentist at Laguna Honda Hospital. Prior
to coming to San Francisco, Dr. Zlotolow’s had spent some time in Africa
making prosthetic ears for people mutilated by war in Sierra Leone. His
work there and his subsequent adoption of his son, Lansana, was brought
to the attention of ABC news from a number of sources, including a
special feature on his work in the New York Times. This remarkable man
and his story will be featured on ABC News 20/20, Channel 7, March 24th.
LHH Replacement Structure to Appear on News Hour With Jim Lehrer
Reporter Spencer Michaels and the crew from the Jim Lehrer News Hour
spent some time videotaping the steel frame of the Laguna Honda Hospital
Replacement Program new Link Building last week as part of their special
report on the 100th Anniversary of the 1906 Earthquake. The Laguna Honda
Replacement piece was chosen to illustrate the requirements for
California hospitals to meet seismic standards. The program will air on
Community Health Network, San Francisco General Hospital, March 2006
07/05 to 03/06
Changes in Privileges
Current Statistics – as of 03/1/06
Affiliate Professionals (non-physicians)
Current Statistics – as of 03/1/06
Affiliate Professionals (non-physicians)
Applications In Process
Applications Withdrawn Month of March 2006
2 (07/05 to 03/06)
SFGH Reappointments in Process Apr. 2006 to Jul. 2006
- Commissioner Monfredini said it is exciting to see the steel go up at
Laguna Honda Hospital.
- Commissioner Chow thanked Dr. Katz for highlighting the World TB
efforts in Chinatown. He asked if there was any mention at the St.
Luke’s community forums of closing St. Luke’s OB services. Dr. Katz said
St. Luke’s has not said they are closing any services.
- Commissioner Illig asked that once DPH staff identifies cultural
competency best practices, these be brought to the Community Health
Network Joint Conference Committee. Commissioner Illig encouraged his
colleagues to attend one of the tours that are being organized by the
Long Term Care Coordinating Council.
- Commissioner Chow said that he and Commissioner Guy attended the tour
of the Mercy Housing Mission Creek development. It is a wonderful
- Commissioner Monfredini said she and Commissioner Tarver were at the
opening of the Plaza housing development, and were very impressed.
Commissioner Guy said this is a wonderful standard to have reached.
- Commissioner Illig said there was much support for the $25 million
supplemental for the SFGH rebuild and he commended Gene O’Connell and
the doctors from San Francisco General for speaking so passionately in
support of the rebuild.
5) PRESENTATION OF THE MARCH EMPLOYEE RECOGNITION AWARDS
Commissioner Monfredini presented the Employee Recognition Awards for
the month of March.
Psychiatric Consultation Liaison Nursing Service Team
Alicia Boccellari and Sharon Wicher
6) UPDATE ON NON-PROFIT CONTRACTOR TASK FORCE
Anne Okubo, Deputy Finance Director, gave a status report on the
implementation of recommendations of the Non-Profit Contracting Task
Force. Ms. Okubo reminded the Commission that the Board of Supervisors
created the Non-Profit Contracting Task Force to review city contracting
and make recommendations to improve and streamline contracting processes
for non-profit health and human service contractors. There were 13
Ms. Okubo updated the Commission about what has transpired since the
last report to the Health Commission in October 2005. Progress has been
made in the areas of joint monitoring, revised milestones and 18-month
contracts. 67 non-profit agencies have contracts with two or more city
departments. Fiscal, compliance and program reviews have been completed
for more than half of the agencies. DPH is the lead department for
approximately one-third of the agencies. DPH also participates in
monthly meetings with the Controller’s Office, HSA and DCYF to
coordinate and review the implementation of joint monitoring. Recently,
a Steering Committee was established by the Controller’s Office to
review joint monitoring protocols and procedures. DPH is a member of the
Steering Committee. New milestones for achieving Task Force
recommendations will be presented to the Board of Supervisors at a
hearing on April 24. A few highlights of revised milestones are:
Contracts to include clear service definitions and monitoring
protocols. In future contract renewals, these service definitions and
monitoring protocols will be used to develop outcome driven services.
Departments will adopt the Controller’s Office risk assessment
protocols to determine which agencies will be monitored. Agencies that
are low risk may require a site visit once every three years. New
agencies or programs at higher risk may be monitored annually. The
Controller’s protocols also establish the criteria to determine if a
review requires a site visit or if it can be done as an agency
The Office of Contract Administration will survey contractors on
implementation of Task Force recommendations to get feedback on
unnecessary requirements; systemic causes of contract certification
delays or payments; and preferences for consolidated contracts.
DPH piloted a new contract model that combines the 12-month annual
contract and the 6-month interim contract. Community Behavioral Health
Services will begin to see the benefits of the 18-month contract in the
new fiscal year. The 18-month contract model will be implemented DPH-wide
as contracts are renewed.
Ms. Okubo said that contractors have been critical of DPH implementation
of the task force recommendations, and specifically concerned with late
contract certifications, minimal consolidation of DPH contracts and that
the contracted scope of services is too broad and does not clearly
identify service definitions, monitoring requirements and outcome
objectives. Dr. Katz convened a meeting yesterday with DPH staff and
contractor representatives from Task Force. Four outcomes were agreed
upon as a result of that meeting:
- DPH will review the proposed milestones to ensure that timelines are
- DPH will participate in an interdepartmental work group to review the
best practices of other city departments;
- DPH will review statistics on late contract certifications to provide
quantitative data to assess delays; and
- A representative of DPH programs will join the Non-Profit Task Force
to ensure both administrative and program representation by DPH.
- Judith Stevenson, representative of the Human Services Network, said
it is exciting to see the progress being made around contract reform and
the support of the Health Commission and the Board of Supervisors. This
has been a five-year process. She thanked Dr. Katz, Anne Okubo, Jimmy Loyce, Michelle Long, Barbara Garcia and others for their efforts. Ms.
Stevenson urged the Commissioners to talk to their colleagues on other
commissions to be clear that contract reform does not negatively impact
- Commissioner Tarver asked if the task force is looking at clinical,
programmatic treatment outcomes as well as fiscal and compliance
objectives. Ms. Okubo said that is beyond the scope of this group. The
focus of this group is to examine how to best do joint contract
monitoring. Ms. Okubo said there is a lot of interest in the Department
to monitor outcome objectives. Commissioner Tarver asked Ms. Okubo to
comment on the impact of staff reductions on this effort. Ms. Okubo said
there are opportunities to streamline processes to make them more
efficient, but it is also an issue of reduced administrative staff.
Commissioner Tarver asked if there has been any consideration of cross
training across departments. Ms. Okubo replied that she recently had
discussions about cross training within DPH, and she will pursue this
further with the consultants
- Commissioner Illig thanked Dr. Katz for convening the meeting with the
non-profits. Commissioner Illig is pleased that DPH has very specific
milestones, which will be presented to the Board of Supervisors. He is
particularly pleased to see that OCA is going to survey contractors. He
looks forward to future updates.
7) PROGRESS REPORT ON INITIATIVES TO INCREASE HEALTH INSURANCE COVERAGE
AND ACCESS IN SAN FRANCISCO
Mitchell H. Katz, M.D., Health Director, presented an overview of two
new initiatives to expand health care coverage in San Francisco. The
Department has taken an incremental approach to achieving universal
health care. Since 1991 DPH has developed four significant programs to
expand coverage and access for the uninsured: Healthy Workers, the
Health Care Accountability Ordinance, Healthy Kids, and the Healthy Kids
Young Adult expansion. The two new initiatives are the Taxi Driver
Initiative and the Universal Health Care Council. Jean Fraser, Director
of the San Francisco Health Plan, described the Taxi Driver Initiative.
Taxi Driver Health Coverage Plan – Overview
- 7,000 taxi drivers in San Francisco, most are independent contractors
- Approximately half of all taxi drivers in SF lack health insurance,
and taxi drivers are very low income
- Proposal to fund health coverage through the San Francisco Health Plan
(SFHP), with funding to be obtained from four possible industry revenue
sources: drivers, medallion holders, cab companies, and the riding
Mayor Newsom’s Universal Health Care Access Council
In 2005, Supervisor Ammiano introduced legislation that would require
all San Francisco employers with 20 or more employees to either provide
health insurance to workers or pay into a fund to cover the cost of the
City of uncompensated care provided to uninsured workers. At the same
time, Mayor Newsom developed a Universal Health Care Council charged
with developing strategies for providing health access to all uninsured
persons. In particular, he asked that the Council develop a defined
benefit plan. Under such a plan there would be a list of services with a
corresponding list of co-pays that people would be entitled to.
Employers would pay for some of the cost of the program.
The Universal Healthcare Council’s agenda is to clarify the scope of
benefits to be provided, specify the model of service delivery and the
provider network, specify eligibility requirements, determine program
administration and organization, avoid “crowd out,” recommend financing
and determine regulation. Dr. Katz described the many benefits of a
defined benefits plan, including 24-hour customer service, set charges
so people know in advance how much they will be charged for their care
and the fact that people will have a medical “home” with an emphasis on
prevention and primary care service.
- San Francisco is one of the most generous municipalities in the US in
providing health care benefits
- No one is turned away from San Francisco General Hospital, the primary
care centers or emergency departments
- With coverage, people are more likely to receive needed medical care
and have better health status
- San Franciscans have repeatedly demonstrated their strong commitment
to universal health care coverage for all residents
- Commissioner Chow asked if the Taxi Commission is going to in fact
select one of these options. Ms. Frasier said that the Taxi Commission
has asked that this proposal be presented to the Commission at its next
meeting. It is up to them to decide if they want to take action.
- Commissioner Sanchez asked if the health insurance would be available
for dependents of taxi drivers, as well as the driver. Ms. Fraser said
that including dependent care rendered an already complex issue
prohibitively complex, so the decision was made not to include
dependents. Commissioner Sanchez asked if commercial health care is
available for this population. Ms. Fraser said that this population
would not be considered a group, so the only commercial product
available would be individual plans, which are costly.
- Commissioner Tarver noted that there is a capacity problem in CBHS and
CHN, so this has to be taken into consideration when assumptions are
made about where people can access care. Ms. Fraser noted that it was
never assumed that the CHN network would be the delivery system for the
taxi cab drivers, but rather the entire SFHP delivery system.
- Commissioner Guy said this proposal is another attempt to increase
health insurance and access to that large population of uninsured
adults, and she applauds and supports these policy discussions. It might
be the case that other SFHP programs would cover the child dependents of
- Commissioner Chow asked how offering services through a defined
benefits plan differs from telling people that they can come to the
public hospital. Dr. Katz said that through this initiative and
Supervisor Ammiano’s legislation, there is the potential for a revenue
source that could be used to expand services. In addition, channeling
people through the benefits plan allows for a level of customer service
that does not currently exist. Thirdly, this would allow the Department
to tell people what each service costs before he or she receives
services. They will know what to expect in terms of their financial
obligation. This certainty does not exist in the current system. Related
to that, there are large numbers of low-income people who would benefit
from our system but do not use it, for a variety of reasons. By
enrolling people in this plan, people are more likely to use the
service. If this initiative gets off the ground, the Department and the
Health Commission may want to reconsider replacing part of its sliding
fee scale with this program. Commissioner Chow asked if there are models
for this program. Dr. Katz said San Mateo County moved from its existing
sliding scale to this model, but for a limited population. They found
that satisfaction improved and they collected more money.
- Commissioner Guy supports this effort. It is a breakthrough for the
community. San Francisco has a rich public health system to build on.
She asked if the San Francisco Health Plan has the capacity to
administer this program. Ms. Fraser said the SFHP governing board has
begun this discussion. The board has directed the health plan to pursue
expanding capacity. Commissioner Guy said there is going to be a public
forum on April 5th.
- Commissioner Tarver supports the expansion of health care. He is
concerned that attention be paid to the culturally competency and
cultural match of providers. Ms. Fraser replied that the main way the
health plan addresses this is to provide a provider directory that lists
provider details, and allowing enrollees to choose. The health plan has
a fairly large network, which allows for diversity. Commissioner Tarver
said there are people who want to see someone of a specific ethnicity,
race, gender, etc., and should be given the means to easily find someone
they are comfortable with. Ms. Fraser said she is willing to look at
this issue further.
- Commissioner Illig noted that the point was made at the CHN Joint
Conference Committee meeting that many of the people who would be part
of the defined benefit plan are already part of the DPH system.
Commissioner Illig said another reason for the increase cost of health
care is the profit margin. Commissioner Illig asked when the Universal
Health Care Access Council would complete its work. Dr. Katz said it
would be finished in May.
- Commissioner Chow is confident that these reasonable, effective and
efficient initiatives could only happen with the leadership of people
like Jean Fraser and Mitch Katz.
- Ed Warshauer, SEIU 790, said the union is very proud to be associated
with the Taxi Driver and Universal Healthcare initiatives. He thinks it
would be a problem if the employee is required to pay a share of
insurance costs. A small portion of even a discounted rate may be too
much for people to afford.
8) PUBLIC COMMENT/OTHER BUSINESS
The meeting was adjourned at 5:30 p.m.
Michele M. Seaton,
Executive Secretary to the Health Commission
Health Commission meeting minutes are approved by the Commission at the
next regularly scheduled Health Commission meeting. Any changes or
corrections to these minutes will be noted in the minutes of the next
Any written summaries of 150 words or less that are provided by persons
who spoke at public comment are attached. The written summaries are
prepared by members of the public, the opinions and representations are
those of the author, and the City does not represent or warrant the
correctness of any factual representations and is not responsible for