Minutes of the Health Commission Meeting
Tuesday, September 12, 2006*
101 GROVE STREET, ROOM 300
San Francisco, CA 94102
1) CALL TO ORDER
Commissioner Monfredini called the meeting to order at 3:10 p.m.
- Lee Ann Monfredini, President
- James M. Illig, Vice President
- Roma P. Guy, M.S.W.
- David J. Sanchez, Jr., Ph.D.
- Donald E. Tarver, II, M.D.
- John I. Umekubo, M.D. (arrived at 3:30 p.m.)
President Monfredini announced that the September 19th Health Commission
meeting will be held at the Southeast Community Facility Alex Pitcher
Jr. Community Room, 1800 Oakdale Avenue, San Francisco, CA 94124. The
meeting will begin at 3:00 p.m. The Budget Committee meeting will be
held at 101 Grove, Room 300, beginning at 1:00 p.m.
President Monfredini welcomed former Commissioner Harrison Parker to the
Health Commission meeting.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF AUGUST
Action Taken: The Health Commission (Guy, Illig, Monfredini, Sanchez,
Tarver) approved the minutes of the August 15, 2006 Health Commission
meeting. There was one correction to Commissioner Tarver’s comments on
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Sanchez chaired and Commissioner Tarver attended the Budget
Committee meeting. The Budget Committee requested that the following
items be moved from the Approval calendar to the Discussion and Approval
calendar: 3.4 and 3.6.
Items for Approval
(3.1) DPH-Finance – Request for approval of a resolution authorizing the
Department of Public Health, Laguna Honda Hospital & Rehabilitation
Center, to accept a gift of funds, in the amount of $50,000, to provide
supplementary assistance for the support of the Hospice Unit, which
provides healthcare services to adult disabled or chronically ill
citizens of San Francisco.
(3.2) AIDS OFFICE-HIV Health Services – Request for approval of a
retroactive renewal contract with Baker Places Inc., in the amount of
$157,521, which includes a 12% contingency, to provide HIV substance
abuse detoxification services for individuals diagnosed with AIDS or
disabling HIV disease, for the period of March 1, 2006 through August
Secretary’s Note – Commissioner Tarver abstained from voting on this
(3.3) AIDS OFFICE-HIV Health Services – Request for approval of a
retroactive renewal contract with Native American Health Center, in the
amount of $184,800, which includes a 12% contingency, to provide Centers
of Excellence services for Native American individuals diagnosed with
HIV or AIDS, for the period of July 1, 2006 through December 31, 2007.
Commissioners’ Comments (at the Health Commission meeting)
- Commissioner Illig said his understanding was that the Centers of
Excellence were funded with CARE funds. Michelle Long from the AIDS
Office said there are two Centers of Excellence that are funded by the
general fund: The Native American Health Center and the Forensic AIDS
(3.5) BHS – Request for approval of a retroactive contract renewal with
Lincoln Child Center, in the amount of $234,748, with an annual contract
amount of $156,499, which includes a 12% contingency, to provide
children’s mental health services, for the period of July 1, 2006
through December 31, 2007.
Items for Discussion and Approval
(3.4) PHP-CHPP – Request for approval of a retroactive renewal contract
with Black Coalition on AIDS, in the amount of $365,117, which includes
a 12% contingency, to provide fiscal agent and support services to the
African American Coalition for Health Improvement and Empowerment, as
the community partner for the DPH African American Health Initiative,
serving African Americans city-wide, for the period of July 1, 2006
through June 30, 2007.
- Commissioner Tarver asked what the violence prevention modality
entails. Ms. Smyly said that BCA said the contract includes pilot
projects funded by mini-grants of no more than $5,000. There is no
longer a violence prevention modality included in this contract. Last
year’s contract included a violence prevention component. She provided
the Budget Committee members with the correct budget summary.
(3.6) BHS – Request for approval of a retroactive contract renewal with
the Regents of the University of California, in the amount of $345,610,
which includes a 12% contingency, to provide program evaluation services
for the Children’s System of Care, for the period of September 30, 2006
through September 29, 2007.
- Commissioner Sanchez said the Budget Committee is looking for
assurances that the original charge of the grant can be completed within
the fiscal year or the time that has been allotted.
- Commissioner Tarver said he was at the MST celebration, and it is a
wonderful program that has achieved much success. He was surprised,
therefore, that the contract monitoring report indicates poor
performance. The Department must have the data to show that this model
program is in compliance and is successful. He is looking for assurances
that these problems will be rectified in the future. Dr. Abram
Rosenblatt, program director, said they had a number of challenges this
past year, including two key staff people leaving and one staff going
out on disability. This year, they are recruiting for the project
director and they are confident they will be able to accomplish all the
required tasks. Ms. Chan-Sew said DPH is very proud of what has been
accomplished through the SAMHSA grant, and she wants this success to be
documented, evaluated, and the information disseminated. The project did
take on a new evidence-based project, which required some ramping up.
This contract includes a very detailed workplan, and she will work very
closely with the contractor to fulfill the workplan.
(3.7) PHP-Housing & Urban Health – Request for approval of a new
contract with Lutheran Social Services, in the amount of $226,505, which
includes a 12% contingency, to provide supportive housing services and
rental subsidies at the Folsom-Dore Apartments, targeting homeless
adults, for the period of October 1, 2006 through June 30, 2007.
(3.8) PHP-Housing & Urban Health – Request for approval of a retroactive
new contract with Mission Creek Senior Community, in the amount of
$603,120, which includes a 12% contingency, to provide rental subsidies
to 51 Direct Access to Housing residents who are frail, formerly
homeless seniors, for the period of July 1, 2006 through December 31,
(3.9) BHS – Request for approval of a retroactive contract renewal with
Community Awareness and Treatment Services, in the amount of $7,203,526,
which includes a 12% contingency, to provide substance abuse treatment
services, for the period of July 1, 2006 through December 31, 2007.
- Commissioner Tarver asked how agencies that have used the McMillan
Sobering Center in the past were notified of the change. Mr. Stillwell
said notices were sent out to all non-profits CBHS does business with.
In addition, the Mobile Assistance Project will continue to operate 24
hours a day, and CBHS will work closely with them to make sure there are
adequate overnight resources available.
- Commissioner Sanchez commended the agency on its outstanding
(3.10) BHS – Request for approval of a retroactive contract renewal with
Jelani, Inc. in the amount of $3,222,099, which includes a 12%
contingency, with an annual contract amount of $1,986,916, to provide
residential substance abuse services for women and families, for the
period of July 1, 2006 through December 31, 2007.
(3.11) BHS – Request for approval of retroactive renewal contract with
the Bayview Hunter's Point Foundation for Community Improvement in the
amount of $6,776,264 per year, which includes a 12% contingency, to
provide mental health and substance abuse services for the period of
July 1, 2006 through September 30, 2007, for a total contract value of
- Commissioner Sanchez is pleased with the collaborative between BVHPF,
Potrero Hill Neighborhood Center and Morrisania West. He commended the
agency’s monitoring report scores.
- Commissioner Tarver asked if the agency is still faced with space
issues. Jacob Moody, BVHPF executive director, said one of the
properties that they lease for their mental health program is for sale,
at a price that the agency cannot afford. They have begun to look for
property in the neighborhood. They are also moving forward with
integration of programs, but there is still the need for administrative
space. Commissioner Tarver asked if the agency is considering housing
clinicians offsite at other locations. Mr. Moody said the agency is very
open to being completely integrated into the neighborhood and taking
advantage of places where there is space. He has been in discussion with
the director of the Southeast Health Center about placing clinicians
(3.12) Central Administration – Request for approval of a revenue
supplemental appropriation of $950,000 to provide clinical services to
youth receiving services as a result of the SB 163 State initiative.
Action Taken: The Commission (Guy, Illig, Monfredini, Sanchez, Tarver)
approved the Budget Committee Consent Calendar. Commissioner Tarver
abstained from voting on Item 3.2.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
DPH Response to Multi-Casualty Incident
The City’s Emergency Medical Services System and Hospital Emergency
Departments responded to a multi-casualty incident on the afternoon of
August 29 when a driver struck and injured 19 pedestrians. The EMS
System activated a Red Alert and the Multi-Casualty Incident Plan.
Ambulances from the Fire Department and private providers transported 14
patients to local hospitals. Of these, eight patients--including three
triaged as having potentially life-threatening injuries--were
transported to San Francisco General Hospital’s Trauma Center.
The SFGH Emergency Department and Trauma Physicians, nurses and support
staff quickly mobilized to prepare for incoming casualties when the
first reports of this incident were communicated to the hospitals via
the EMResource system Red Alert at 1:08 p.m. The first patient was
received at the Trauma Center at 1:15, followed in rapid succession by
six more patients. Due to the complexity of this multiple-location
event, the last patient arrived at SFGH at 2:20. All patients were
thoroughly evaluated and stabilized, and a total of five patients were
admitted for further treatment and observation, including one patient
with spinal injuries admitted to the ICU. As of today, two of these
patients remain at San Francisco General.
Mayor Newsom visited the ED and spoke to the treating clinicians as well
as a number of family members of those injured. We were able to provide
media updates throughout the afternoon of the incident, followed by a
formal press event later in the week when media interest was still high
and the outcome of most of the patients was evident. While this tragic
event underscores the need for ongoing preparedness efforts, Dr. Katz is
pleased to report that the City’s Hospital and Trauma Center and overall
EMS system responded in a well-coordinated and practiced manner to
ensure the best possible outcome for those injured.
SFGH Medicare 2567 Report
On September 6, SFGH received the Medicare 2567 Report summarizing the
findings of the Center for Medicare and Medicaid Services (CMS)
Validation Survey that was conducted June 26-29.
The cover letter confirms that SFGH made significant strides complying
with the Plan of Correction (POC) that was submitted in response to the
December 2005 survey. There were four Conditions of Participation that
were not met:
- Governing Body
- Quality Assessment and Performance Improvement
- Nursing Services
- Pharmaceutical Services
SFGH is now in compliance with three of the above-mentioned conditions.
Only Pharmaceutical Services remains out of compliance.
The POC for this Medicare 2567 Report is due in the CMS San Francisco
Regional Office by this weekend, Saturday, September 16. SFGH
leadership, medical and hospital staff have been developing plans of
correction using our internal preliminary list of deficiencies.
Fortunately, all of the items identified on the Medicare 2567 Report
were already identified on our preliminary list. If the POC is accepted
by CMS, there will be a third, and hopefully final, unannounced survey.
New Health Access Program Administrator
Dr. Katz announced that Tangerine Brigham will be rejoining the
Department on October 23rd as the Health Access Program (HAP)
Administrator to lead us in the planning, design, and implementation of
HAP. In this position, she will be chairing the two HAP Departmental
committees, Program/Operations and Fiscal/IT, and will ensure that all
of the Department’s preparation for HAP is coordinated.
Many of you will recall Tangerine as the former Director of Policy and
Planning. She left the Department in May 2001 after 10 years of service
in the City, including eight years in DPH. Most recently, Tangerine was
the Program Officer for Community Health at the San Francisco
Foundation. She holds a masters degree in Public Policy from the
University of California, Berkeley, and a Bachelor of Arts degree in
economics from UCLA.
Health at Home
Health at Home received an unannounced survey from the Department of
Health Services, Licensing and Certification Division on August 21st. An
RN surveyor spent 3 ½ days interviewing managers, staff, and patients,
making home visits with nurses and therapists, and reviewing medical
records, employee personnel files, and selected agency policies and
procedures. There were no “condition-level” citations. However, she
cited some instances of errors in documentation of the reasons for
missed patient visits and the accompanying physician notification, and
on the need for more thorough documentation on home health aide
supervision. At the exit summation, the Surveyor indicated that the
overall quality of care provided by Health at Home is very good. Once
the Surveyor’s written report is received and the agency’s plan of
correction is submitted and accepted, re-certification of the agency
will be completed.
Medi-Cal Reimbursement for Mobile Methadone Clinics:
AB 631 (Leno) passed the Legislature on August 31st. Senator Kuehl
presented the bill in the Senate without using the word “methadone” –
she used mobile narcotic treatment units instead. The Governor has until
September 30th to sign it. Our lobbyists have been working with the
Governor's staff to explain that this bill is not about driving drugs
around to addicts -- it's about reimbursing the City for a successful
program we're already doing, which provides identical treatment to
addicts who refuse to come into the clinics. Dr. Katz will keep the
DPH PrEP Survey
Pre-exposure prophylaxis (PrEP), or the use of antiretroviral drugs by
HIV-negative people prior to HIV exposure in an attempt to prevent HIV
infection, is currently being tested in clinical trials in San Francisco
(www.projectt-sf.org) and around the world. To evaluate anecdotal
reports and a previous survey suggesting substantial PrEP use in the
community, the DPH HIV Research Section conducted surveys of 851 gay and
bisexual men recruited at various venues in SF, at the SF City Clinic,
and at the Palm Springs White Party (an annual circuit party). About
one-fifth of the men had heard of PrEP, with the most common sources of
information being the media and friends. Men who reported unprotected
anal sex in the past 6 months were more likely to have heard of PrEP.
Only one respondent said he had used PrEP (although his responses
suggest he may have meant post-exposure prophylaxis (PEP), or one month
of antiretroviral therapy started shortly after a high-risk exposure). A
substantial majority (68 percent) said they would use PrEP in the future
if proven to be safe and effective.
Contrary to prior reports, this study found that community PrEP use
appears to be rare. Research efforts should focus on determining whether
PrEP is safe and effective for HIV prevention. Meanwhile, given
potential harms associated with unmonitored use, PrEP is not currently
recommended outside clinical trials.
Sign the Steel Beam Party at Laguna Honda Hospital Replacement Project
Dr. Katz hopes the Commissioners will join the Laguna Honda Hospital
staff and hundreds of residents, neighbors and volunteers this Friday,
Sept 15th, from 1-4 p.m., when we celebrate a construction milestone at
a “Sign the Steel Beam” party. Everyone who attends will have the
opportunity to sign their name on a large steel beam before it gets
installed in the new East Building. The event comes with live music,
celebration and a number of surprises.
San Francisco is well on its way to becoming the first city in the
nation that will have all of its hospital healthcare systems achieve the
status of designated “Stroke Centers.” Stroke is the second leading
cause of death to San Franciscans. As a designated Stroke Center,
hospitals will have the ability to rapidly prioritize potential stroke
victims, perform blood tests and CT scans to identify reversible causes
of stroke, provide expert neurological consultation quickly and provide
treatment and rehabilitation for stroke victims. Stroke centers must
meet rigorous criteria established by the Joint Commission on the
Accreditation of Hospitals and Health Care Facilities.
The Department hosted a press conference last week at SFGH to highlight
the training currently being given to the City’s paramedics, emergency
personnel and dispatchers that will support stroke patients during their
transport to the receiving hospitals. Gene O’Connell, Dr. John Brown,
Medical Director of EMS and Dr. J. Claude Hemphill, Director of SFGH’s
Stroke Program, were joined by representatives from the American Stroke
Association, SFFD Paramedics, other hospitals and a young stroke patient
who talked about her treatment at an accredited Stroke Center. Speakers
emphasized the importance of recognizing the symptoms of a stroke,
stroke prevention and improved stroke care once a patient arrives at the
hospital. Within the next several months, SFGH, St. Mary’s, St. Francis,
Sutter at Davies, and Chinese Hospital will become designed Stroke
Centers. UCSF has already achieved this designation.
Tobacco Free Project
The Tobacco Free Project staff contributed a chapter on "The Community
Action Model in a Public Health Department Setting Case Study: Tobacco
Divestment on College Campuses," which was recently published in
Tackling Health Inequities Through Public Health Practice: A Handbook
for Action, a publication of The National Association of County & City
Chris Murphy, Director of the California Office of Traffic Safety, (OTS)
has officially congratulated the San Francisco Department of Public
Health for successfully completing the objectives of the DUI Enforcement
and Education Program grant, which ended in February 2006. His letter of
August 25, 2006 states, "The Department's traffic safety contribution
increases the relevance and impact of our California Traffic Safety
Program to the overall national program." OTS credits the grant efforts
for a substantial decrease in the number of San Francisco's young
adults, ages 21 – 34, involved in fatal and injury collisions when they
had been drinking. This project was part of the Traffic and Pedestrian
Safety Program in Community Health Promotion and Prevention.
September is “5-A-Day” month. On September 20th, nutritionists and staff
from the Feeling Good Project, the Chinese 5-A-Day Project and the WIC
program will be promoting good nutrition by reminding shoppers at the
Civic Center Farmer’s Market to eat at least five servings of fruits and
vegetables every day to maintain good health. From 10 a.m.- 1 p.m.,
staff will also be giving out cookbooks, answering nutrition questions
and distributing gifts to the farmers. The Civic Center Farmer’s market
supports family farms and brings fresh, seasonal produce, fish, olive
oil, nuts, honey, flowers and baked goods to the middle of San
New Medical Director at TWHC
Dr. Katz welcomed Deb Borne, MD, as the new Medical Director for Tom
Waddell HC Homeless Programs and Community Sites. Dr. Borne comes to DPH
from Brooklyn, NY where she spent the past five years working in the
Bronx serving a high-risk population as part of her National Health
Service Corps assignment. She has much experience with HIV,
multi-diagnosis, and impoverished patients. Dr. Borne previously
completed her Family Practice Residency Program training at SFGH, so
this is a welcome return for this excellent new COPC Medical Director.
Community Health Network, San Francisco General Hospital, September 2006
07/06 to 09/06
Changes in Privileges
Current Statistics – as of 09/1/06
Affiliate Professionals (non-physicians)
Applications In Process
Applications Withdrawn Month of September 2006
4 (07/06 to 09/06)
SFGH Reappointments in Process Oct. 2006 to Jan. 2007
- Commissioner Guy is delighted that Ms. Brigham is back to help DPH meet the
challenge we have embarked upon.
- Commissioner Sanchez noted the outstanding protocols that were followed during
the multi-casualty tragedy. The Mayor mentioned at a seminar at USF the San
Francisco is funding programs in the schools, and Commissioner Sanchez asked if
any of this funding would be used for wellness centers, school nurses and other
health resources. Dr. Katz said his understanding is that the funding is for the
wellness centers through the Department of Children, Youth and their Families.
The intention is to use this money until every school has a wellness center.
- Commissioner Tarver asked Dr. Katz if he has any initial thoughts about what
the expectations are for the meeting in the Bayview next week. Dr. Katz said the
idea behind the report is to take the somewhat separate conversations and
activities that have been happening, combine them, and take a broad, geographic
look at the major issues. The Department examined what services were provided,
where the programs were located, where the gaps are and what the next steps are.
Based on this report, the Commission would support policy directions based on
- Commissioner Illig commended the Department on its response to the hit-and-run
tragedy. The fact that our response worked so well shows that DPH is ready. He
wants to acknowledge Health at Home for passing the licensing survey with flying
colors. This is a very complex service, and HAH should be commended.
- Commissioner Monfredini said the response to the hit-and-run tragedy was
wonderful. Everyone worked together in wonderful form. She knows that San
Francisco General Hospital will respond to the CMS survey in a timely manner.
She welcomes Ms. Brigham back to the Department.
5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS FOR SEPTEMBER
Commissioner Guy presented the Employee Recognition Awards for September.
Tom Waddell Health Center
Patient Visit Redesign Team
Barbara Wismer, M.D.
· Sandra Aseltine
· Amy Bolanos
· Cynthia Collins
· Angela Davidson
· Paul Hathaway
· Chris Nguyen
· Rosario Noble
· Julie Brown-Modenos
- Commissioner Tarver applauded the redesign effort and asked if it
could be replicated at other clinics. Dr. Drennan, Director of Primary
Care, said the consultants focused on a large clinic redesign. Also, Tom
Waddell has very specific logistics. However, what they learned at Tom
Waddell will be transferable to other sites.
6) PRIMARY CARE UPDATE
Michael Drennan, M.D., Director, Community Oriented Primary Care (COPC),
presented COPC’s annual report. The report charts the progress over the
past year in COPC and outlines the key components of the administrative,
clinical and quality of care infrastructures that support COPC. Dr.
Drennan said that COPC developed a number of utilization reports over
the past year and a half that help COPC understand what they do now and
plan for the future when capacity will be expanded. Dr. Drennan
described a number of the reports that are prepared and distributed to
clinics to track patient utilization and productivity. The reports
provided various patient demographic information including gender, age,
ethnicity, neighborhood, primary language and payor source and other
Dr. Drennan gave an overview of the Primary Care quality improvement
infrastructure. Quality Improvement (QI) Committee remains the main
vehicle for monitoring quality improvement activities in the COPC
clinical sites. The CPC Clinical Service is part of SFGH Medical Staff,
and quality improvement activities are funneled through SFGH’s QI
structure and ultimately reported to the San Francisco General Hospital
Joint Conference Committee.
Quality Improvement Goals:
Goal 1: Develop more effective and more standardized Quality Improvement
Committees at each COPC clinical site.
Goal 2: Integrate CPC QI activities into SFGH Medical Staff and SFGH
Quality Management Office.
Goal 3: Integrate CPC QI activities with QI activities of SFGH based
Primary Care clinics and the Ambulatory Care Committee (ACC) of the SFGH
Goal 4: Improve procedures for responding to external audits at CPC
Community Primary Care conducts annual Client Satisfaction surveys of
patients/clients system-wide, results of which may guide quality
improvement efforts in the individual clinics and COPC overall.
Dr. Drennan gave an overview of COPC’s finances. Primary care has a very
large self-pay category, which leads to a heavy reliance on the general
fund. In FY 2005-2006, general fund accounted for 67 percent of
revenues. The revenue mix may change as a result of the HAP program.
Dr. Drennan said COPC has a variety of innovative chronic care programs,
and highlighted the diabetic collaborative efforts and other chronic
Dr. Drennan updated the Committee on behavioral health integration with
Primary Care. Lack of psychosocial resources continues to plague Primary
Care. The Department did not receive the as much money as was
anticipated from the Mental Health Services Act. Dr. Drennan described
some of the primary care services provided at behavioral health sites.
Community projects include Community Health Programs for Youth,
Southeast Health Center initiatives and Project Homeless Connect.
- Access to care needs highlighted by SFHAP
- Need 10-15,000 new patients into DPH primary care clinics, similar
numbers for SFCCC and others
- Complex patients, aging population
- Much from data projects useful in assessing capacity, monitoring
patient utilization, provider productivity and quality measures
- Clinic Productivity
- Monthly reports track visits per clinic hour
- Clinical time at 75% of total provider time
- Adequate support staff needed to improve provider efficiency
- Chronic Disease Management Challenges
- Sustaining gains made through innovative pilots
- Spreading beyond initial pilot sites
- Spreading to other chronic conditions
- Produce and maintain information infrastructure
- Expansion of quality indicator projects
- Primary Care capacity to handle SFHAP
- Additional staff needs: provider, support staff
- Capital improvements: expanded exam room and group meeting/counseling
- IT and other infrastructure improvements
- Staffing mix and role redefinitions
- Planning efforts with SFHAP partners
- COPC internal planning
- SFHP, COPC, SFCCC early planning efforts
- DPH Implementation work group
Dr. Katz said that primary care is an area of tremendous growth and
change, and it is the area that most needs to be nourished and flourish.
DPH is incredibly lucky to have a tremendous primary care leadership
team. He is optimistic about primary care’s future. San Francisco has an
advantage of being a leader in the primary care movement and has the
benefit of primary care experts. DPH also has, for the first time, some
money to for dedicated consultant resources with individual projects.
This has been a major boon. A huge amount of progress has been made
addressing the capital needs of the clinics. So DPH has the right
people, the right ideas, money and adequate physical space. The HAP
brings in a sizeable amount of new money, and offers the opportunity for
everyone to win. There are a lot of reasons to be excited, and there is
a lot of room for Health Commission suggestions about how to bring
primary care to the next level.
- Commissioner Umekubo thanked staff for the report. With regard to
capacity, we are looking at potentially 2,000 patients added to a system
that already serves 62,000 unduplicated patients. Workflow is key for a
primary care clinic to run efficiently, and inefficient systems lead to
bottlenecks. Every day is a challenge in primary care, and he
appreciates what DPH staff does day in and day out. He is seeing a
change in patients’ healthcare, in terms of outcomes, new medications,
etc. COPC’s diabetes numbers are excellent. The challenge is to try to
streamline processes as much as possible. He is aware that there is a
movement away from new medical school graduates to go into primary care.
This is a scary challenge. Dr. Drennan said that 15 years ago, the
number of doctors going into primary care was increasing, but now it is
decreasing. He encourages all the clinics to be involved in training
programs, and place resident trainees in the clinics. The medical school
just went through a large change that attaches first-year residents to
high-need urban environments.
- Commissioner Sanchez noted that the medical staff at Laguna Honda
Hospital has established a community medicine training program, which is
so important to the continuity of care and emphasizing Laguna Honda’s
value to the education community. Primary care, including family
practitioners, schools, wellness centers, refugee clinics, and everyone
involved in caring for working families, is well-suited to provide
leadership in this area. It is great to have institutions that have a
unified mission, offer the highest level of quality care, create bridges
to the community and provide quality services.
- Commissioner Guy said the Health Department and Health Commission have
the responsibility to bring primary care in San Francisco into the 21st
century. She agrees with the future challenges that have been brought to
the Commission’s attention. Other issues she wants COPC and the new HAP
administrator to address: DPH’s relationship to the San Francisco
Community Clinic Consortium; the acknowledgement that staff is going to
be asked to embark upon a new initiative and do new things that will
entail a lot of hard work; problem solve about how mental health is
going to be integrated into this venture. She also wants to discuss when
it is appropriate to have another discussion about this at the CHN JCC.
- Commissioner Illig asked if COPC would be implementing Dr.
Bodenheimer’s primary care model. Dr. Drennan said this model provides a
jumpstart and COPC is looking at opportunities for Dr. Bodenheimer to
get involved in DPH efforts. Commissioner Illig applauded the new data
collection and analysis tools, and asked if the data would be used to
develop new outcomes. For example, if primary care patients are high
utilizers of SFGH’s emergency department, we have the data to identify
those patients and identify ways to treat these patients differently.
Roland Pickens, San Francisco General Hospital, said the Medical High
Utilizer Program is very active at San Francisco General, and he would
be happy to update the Community Health Network Joint Conference
Committee. Commissioner Illig asked if there is a way for DPH to reduce
wait times for new appointments, using Community Clinic Consortium
clinics and St. Mary’s Clinic. This should be an outcome. Dr. Drennan
said that there are opportunities to create new appointment space for
new appointments and returning patients. In addition, each health center
needs to dedicate some of its time to urgent care. Commissioner Illig
was under the impression that FQHC accounted for a larger portion of
COPC’s revenues. He would also like to explore the unique model of the
Curry Senior Center, and asked if the Department is looking at similar
- Commissioner Tarver is concerned about where CBHS sits within the
Community Health Network. It is not fully incorporated into the CHN. One
major challenge to integration is cultural, rather than financial. The
primary care clinics are really not designed as multi-care sites, and
both the mental health needs and medical needs of mental health patients
are underserved. It is a culture change, and the Health Commission
should provide policy direction on where it wants the integration
efforts to go. With regard to recruitment, Commissioner Tarver wants to
ensure that people being recruited reflect the language and cultural
diversity of our patients. Medically trained personnel at all levels
will be returning from military service abroad, and DPH should make
connections with this community as part of its recruitment efforts. He
would like to see the Commission foster the shared mission of mental
health and primary care, and the overlap of patients. He would like to
see more joint positions, joint funding, and other efforts. Sheila Kerr
said that one effort to integrate mental health into primary care is
through the diabetes initiative.
- Commissioner Monfredini asked what the next steps are, in terms of an
update to the CHN JCC, given that Tangerine Brigham starts her new job
in October. Commissioner Illig said that there should be a report to the
CHN JCC prior to Dr. Katz reporting to the Board of Supervisors in
January. The consensus is to schedule a report to the CHN JCC in
7) PRESENTATION OF THE NEW EMPLOYEE ORIENTATION VIDEO
Frances Culp, Senior Health Program Planner, presented the new employee
orientation video that was created at the request of the Integration
Steering Committee. While employees receive a formal orientation through
Laguna Honda Hospital and San Francisco General Hospital, other
employees do not receive anything beyond informal orientations through
their supervisor and/or employee handbooks and materials. The video is
designed to contain specific, important information that is useful to
new employees, but general enough to apply to all employees regardless
of their positions. DPH will begin airing the video at existing
orientations at SFGH and LHH, and include it in the Human Resources
processing procedures at 101 Grove.
- Commissioner Tarver said this department-wide video is greatly needed.
It gives employees a sense of the scope of DPH activities as well as a
sense of connection to these activities. It was a welcome addition to
inform staff about their opportunities to participate in public forums.
Commissioner Tarver said the video is also relevant to current
employees, and he looks forward to it being available on the
Department’s Intranet. The other potential audience is DPH contractors.
- Commissioner Guy asked at what point during an employee’s orientation
would the video fit in. Ms. Culp said to start with, it will play as
part of the orientations at San Francisco General Hospital and Laguna
Honda Hospital, right at the beginning of orientation. Other employees
will see the video when they come to 101 Grove to be processed by Human
- Commissioner Umekubo congratulated staff on the video. It flowed very
well, was engaging and contained a lot of information.
- Commissioner Illig asked how the video was paid for. Ms. Culp said
that the video was produced by SFGTV, who did it at a reasonable price.
DPH paid for it out of facilities funds.
8) PUBLIC COMMENT/OTHER BUSINESS
- Michael Petrelis said the Health Commission meetings need to be
broadcast on Channel 26. This provides great transparency for
commissions, and it one more way to involve everyone in San Francisco
government. The Health Department takes up the biggest chunk of the
city’s budget, and the Health Commission has a lot of influence.
Citizens should be able to know what is going on.
The meeting was adjourned at 5:40 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