Minutes of the Health Commission Meeting
Tuesday, April 4, 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. – left at 5:30 p.m.
- Commissioner Donald E. Tarver, II, M.D. – left at 5:30 p.m.
- Commissioner John I. Umekubo, M.D.<
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MARCH 21,
Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver)
approved the minutes of the March 21, 2006 Health Commission meeting.
3) DIRECTOR’S REPORT
Anne Kronenberg, Deputy Director of Health, presented the Director’s
On Wednesday, March 22nd, the Budget and Finance Committee recommended
approval of $1,127,000 in project funding to begin planning for the
rebuild of San Francisco General Hospital. The total projected cost of
planning, which will include design work and completion of the
environmental impact report, is projected to cost $25,000,000 and will
span two years. Additional funding for the 2006/07 fiscal year, which
will enable the project to continue, will be considered as part of the
2006/07-budget process. This will enable the Department to complete
detailed planning and provide accurate cost estimates to the voters when
a General Obligation Bond is placed on the ballot. General fund
appropriations for this project will be repaid from the proceeds of
General Obligation Bonds when those bonds are approved by the voters and
On March 29th, the Committee also recommended approval of $1,755,000 for
three projects at our neighborhood clinics. $450,000 will fund a
workflow process improvement review at 12 clinics. $405,000 will fund
wiring and data systems upgrades and exam room equipment at 6 clinics,
and $900,000 will fund additional wiring at 9 clinics. The Board of
Supervisor’s takes final action on these appropriations today.
Mental Health Services Approves Community Services and Supports Plan
Dr. Katz is happy to report that the California Department of Mental
Health (DMH) has approved the Community Services Supports (CSS)
three-year program and expenditure plan. This approval brings DPH the
opportunity to begin spending funds from the November, 2004
voter-approved Prop 63, now known as the Mental Health Services Act (MHSA),
which provides increased funding, personnel and other resources to
support mental health programs for children, transition age youth,
adults, older adults and families. The first round of approved funding
covers the remaining three months of the current fiscal year. DPH has
been authorized to expend $1.3 million for CSS programs and
administrative costs, plus $1 million in one-time funding for items such
as rent subsidies for transitional age youth, community violence and
trauma recovery services and equipment to support two Access Team sites.
On March 30th, the Department’s Community Behavioral Health Services (CBHS)
division held a community forum to receive input from the public on how
to use MHSA funds for peer-related services for adults. CBHS is holding
an additional forum on April 7, 3-5 p.m. here at 101 Grove St., Room
300, to hear from the community on how to use peer-related funds for
Children and Transitional Age Youth.
DPH Response Team
In an effort to provide counseling and assistance to families whose
young members become involved in a violent incident, DPH has established
a Response Team as a component of the Comprehensive Child Crisis
Services. DPH has also obtained a dedicated blackberry for SFPD to
notify DPH of woundings/homicides incidents and for SFGH to notify the
Response Team when there are fatalities.
Medical Director at Southeast Health Center
Dr. Katz announced that Mark Ghaly, MD, has started as the Medical and
Center Director at Southeast Health Center in the Bayview Hunters Point
Community. Mark is a pediatrician with expertise in program development
and providing care to low-income children. He is one of the founders of
the Healing Arts Center in Bayview Hunters Point that serves teens and
provides medical care as well as an array of other services and
opportunities. The center is a collaboration of community groups, UCSF,
and SFDPH. We welcome Mark to the Department and know he will make
important contributions to our programs and patients.
Journal Article Published
Christina Goette Carpenter, Ginger Smyly, Iman Nazeeri-Simmons and Ana
Validzic published an article in the Fall 2005 issue of the Journal of
Community Youth Development describing the Youth Development Policy
adopted by the Health Commission in 2004. The article, "Using Policy to
Promote Youth Development" describes the background and rationale for
the policy. It also provides an overview of the policy components. The
article can be viewed on line at: http://www.cydjournal.org/2005Fall/carpenter.html.
Chronicle Editorial Attached
Dr. Katz attached to his report a March 23rd editorial from the San
Francisco Chronicle that supports Assembly Bill 2560, which would
require the state to establish a “Public School Health Center Program”
to promote the concept of teen health centers in public schools. The
Bill is being considered by the Assembly Health Committee today. Dr.
Katz will inform the Commissioners of the outcome of the vote on AB2560
at the next Health Commission meeting.
- Commissioner Illig requested that the Department’s response to the
proposal to establish a Community Living Trust Fund be presented at the
next Health Commission meeting, either as part of the Director’s Report
or as an agenda item. Commissioner Illig also requested an update on
changes at Southeast Health Center at the next CHN JCC meeting.
4) PUBLIC HEALTH WEEK- 100th ANNIVERSARY OF THE 1906 EARTHQUAKE AND
CONSIDERATION OF A RESOLUTION RECOGNIZING PUBLIC HEALTH WEEK
Brian Katcher, Pharm. D., Public Health Pharmacist, CHPP, Community
Programs, presented an overview of the DPH website that looks at the
1906 earthquake and fire and draws from it three public health stories,
all of which underline the theme of what public health is. The three
stories that emerged are care of the injured, sanitation and plague. The
presentation included many pictures of the city after the earthquake,
including the military hospitals that were set up at Golden Gate Park
and camps set up all over town. Sanitation was a major problem, and
there was a public health response, including the construction of
emergency latrines. Everything was done to prevent a cholera outbreak,
and efforts were largely successful. There was, however, a small typhoid
outbreak. After the earthquake and fire there was a dramatic increase in
the rat population, which led to 160cases of plague in 1907. There was a
concerted effort to rid the city of rats, with the involvement of health
officials, businesses, labor and ordinary citizens. Garbage ordinances
were established and miles of concrete poured.
The lessons learned were that, in each case, the local health
authorities were able to promptly assess the nature of the problem, and
the policies needed to address them and assure the right outcome
required a broad collaboration with all sectors of society.
- Commissioner Monfredini commented on role of the military in 1906,
noting both the Army and Navy were located here and could deploy
quickly. This was an excellent report with wonderful pictures and
- Commissioner Guy appreciates the report because it is important to
look at our history, and appreciate how the definition of public health
has changed. For people who are in the middle of struggles such as
disaster preparation, health access, fitness, etc., it is not always
easy to see the long-term outcomes. There were a lot of lessons learned
from the 1906 earthquake and fire, which resulted in a number of
- Commissioner Sanchez reaffirmed the commitment of those who responded
to the 1906 emergency. This report highlights many of the interventions
and collaborations that happened around the earthquake and fire. Many
resources that were in place, such as military bases and VA hospitals,
are no longer here. Building a helipad for medical airvac services is
critical. He also noted that the report illustrates that San Francisco
was and is a city of immigrants. San Francisco has always been about
living and sharing and facing challenges together.
- Commissioner Illig said many healthcare institutions are looking back
and celebrating their history. He commented on the importance of making
decisions based on science instead of fear. It bothers him that public
health is getting hijacked by fear—bioterrorism, avian flu terrorism,
- Commissioner Tarver commented on how disaster response varies when
underrepresented communities are impacted, specifically Chinatown in
1900 and New Orleans in 2005, as compared with how disaster affected the
mainstream in 1906. We always must be mindful that different communities
are impacted by disaster differently and the Department should work
proactively to prevent this from happening.
Action Taken: The Commission approved Resolution #06-06, “Resolution
Honoring Public Health Week, April 3-9, 2006,” (Attachment A).
5) DISASTER PREPAREDNESS/HOMELAND SECURITY UPDATE
Anne Kronenberg, Deputy Health Director, Director, Office of Policy and
Planning, Mary Ellen Carroll, Senior Health Planner and Susan Fernyak,
M.D., Director, Communicable Disease Prevention and Control, presented
an update on the work the Department has done around disaster
preparedness and homeland security. Ms. Kronenberg said DPH has made
every effort to do planning that is logical and addresses issues San
Francisco is likely to face, rather than planning from fear.
DPH is responsible for the medical response of a mass casualty incident,
whether the result of human action or a natural event. DPH’s
responsibilities fall into the following areas: emergency medical
services; infectious disease emergency response; environmental hazard
identification, assessment and response; community health services; and
response to Chemical, Biological, Radiological, Nuclear and Explosive (CBRNE)
events. Grant funding has allowed the Department to dedicate staffing to
disaster preparedness activities and has driven the increase in
planning, training and equipment related to disaster preparedness and
response. The main sources of funding for these activities are Federal
UASI, State Homeland Security, Centers for Disease Control, Cities
Readiness Initiative and the HRSA National Bioterrorism Hospital
Preparedness Program. DPH has been allocated more than $18 million from
2001 to 2005. Grant funding has allowed the Department to increase its
staffing levels over the last two years by approximately 20 personnel
funded by Homeland Security/CDC grants.
Ms. Kronenberg’s presentation highlighted the three areas where DPH,
through the Office of Policy and Planning, is doing its planning. This
encompasses the work of Communicable Disease Prevention and Control,
Emergency Medical Services and Environmental Health. In addition, she
noted that SFGH has an emergency plan and is part of the Hospital
Council’s planning efforts.
The Department has made great strides in disaster preparedness.
- Updated and expanded the Department’s Emergency Operations Plan
- Unified and standardized training for the National Incident Management
- New and improved Department Operations Center with a training program
and frequent drills
- EMResource, a new and improved hospital resource tool, and EMTrack, a
new and improved electronic patient tracking system
- Protecting Employees through efforts like the Avian/Pandemic Flu Task
Force, respiratory protection program and determining potential roles of
employees in different disaster scenarios
- Expanding surge capacity and capability
- Environmental Health Emergency Response – on call 24 hours, seven days
- Pandemic Influenza and other infectious disease emergency responses,
including mass prophylaxis, clinical outreach, lab response, EPI Go
kits, disease control and Biowatch/BDS.
This year’s focus is to ensure that all of the planning that needs to
get done is completed. Funding for all 19 UASI funded planning positions
expires in December 2006. The BT/CDC grant has decreased significantly
over the past five years, and positions funded through this grant are at
risk. The efforts cannot be successful DPH figures out how to sustain
the programs. One way to do this is to have more existing Department
staff to take on emergency preparedness planning and response roles.
Second, Ms. Kronenberg is hopeful that there will be other sources of
funding to allow the Department to keep some of the wonderful
Ms. Kronenberg said DPH is going to play a large role in any disaster
scenario in San Francisco, and the Office of Emergency Services (OES)
understands this. Director Conroy has quarterly meeting with heads of
Police, Fire, Sheriff and DPH. Ann Stangby, Chief of Disaster
Preparedness Division at OES, said up until the past 18 months there was
no partnership between the Health Department, the health community and
OES, and there is one now. This is really important.
- Commissioner Guy inquired about role of ABAG, and stressed the
importance of transportation systems and regional planning.
- Commissioner Chow asked about the future of Federal funding. Ms.
Stangby discussed Super UASI and regional funding versus local
allocations that will change how funds are designated. The range of
funding may vary and competing interests in the region will lobby for
- Commissioner Sanchez said some grant-funded positions were added when
other Health Department activities were being cut. Others positions
existed and were moved to grants. The Department should look to other
foundations to assist with financial support and co-funding to assure
sustainability. This is an excellent report.
- Commissioner Illig noted that 29 positions were added for this effort,
in addition to some moved from other jobs in DPH. Ms. Kronenberg said
there was a prohibition on using this funding to supplant current staff
and activities, which meant that the staff took on new roles.
Commissioner Illig said that communication is a critical part of
disaster response, and asked how DPH trains workers to report in
emergencies. Further, how do we communicate when the phones are down?
Ms. Kronenberg said response training would occur. Commissioner Illig
expressed concern that if 101 Grove collapses, the Public Health
laboratory would be out of commission. Finally, he urged the Department
to share the after action reports on the tabletops and other exercises.
- Commissioner Monfredini said in the past the City has dealt with
emergencies, such as Jonestown, the 1989 Loma Prieta earthquake and the
Dan White verdict, that have tested its ability to respond and has
generally done well
- Commissioner Tarver commended the presentation and accomplishments and
use of funds, and he had a number of comments. First, there are silos in
DPH that are disorganized and it is not clear how employees are reached
during an emergency. Are there up to date contact information and lists?
Second, not all DPH sites have a clinical database of who is expected to
respond in an emergency. Third, how could non civil service staff
(contractors) be provided with emergency credentials to prevent
charlatans from misrepresenting DPH? Fourth, he emphasized the
importance of the helipad. Fifth, he would like the role of the
commissioners during an emergency to be clearly defined. Lastly he asked
if San Francisco has a plan to deal with pets during a disaster.
- Commissioner Monfredini said that during an emergency, commissioners
should stay out of the way unless they are MDs or have specific roles to
fill in an emergency.
- Commissioner Chow said local preparedness requires neighborhood plans
with tabletop and planned exercises. County support is needed to address
unique needs of individual communities.
6) PUBLIC COMMENT/OTHER BUSINESS
The meeting was adjourned at 6:00 p.m.
Michele M. Seaton,
Executive Secretary to the Health Commission