Minutes of the Health Commission Meeting
Tuesday, October 17, 2006
101 GROVE STREET
San Francisco, CA 94102
1) CALL TO ORDER
President Monfredini called the meeting to order at 3:15 p.m.
- Lee Ann Monfredini, President
- James M. Illig, Vice President
- Edward A. Chow, M.D.
- Roma P. Guy, M.S.W.
- David J. Sanchez, Jr., Ph.D.
- Donald E. Tarver, II, M.D.
- John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF OCTOBER
Action Taken: The Commission approved the minutes of the October 3, 2006
Health Commission meeting with the following changes. On Page 2,
comments under Item 3.5 were amended to read “UOP” rather than “UCSF.”
On page 11, the following was added to Commissioner Tarver’s comments:
“Commissioner Tarver said it might behoove staff to re-examine the
potential for moving the outside stairs on Building 30 to support
aesthetic appeal and to increase available horizontal space.”
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Sanchez chaired and Commissioner Tarver attended the Budget
Committee meeting. Commissioner Chow joined the meeting for the
discussion of Item 3.11. The Budget Committee requested that the
following items be moved from the “Approval” section of the agenda to
the “Discussion and Approval” section: 3.1, 3.2, 3.3 and 3.6.
Items for Approval
(3.4) CHPP-Health Promotion – Request for approval of a sole source
contract renewal with the Regents of the University of California-Family
Health Outcomes Project, in the amount of $225,120, which includes a 12%
contingency, to provide evaluation services to the DPH Seven Principles
Project, for the period of September 30, 2006 through September 29,
(3.5) CHPP – Request for approval of sole source contract renewal with
Booker T. Washington Community Services Center, in the amount of
$348,553, which includes a 12% contingency, to provide logistical and
administrative support services for the SevenPrinciples Project,
targeting African Americans, for the period of September 30, 2006
through September 29, 2007.
Items for Discussion and Approval
(3.1) PHP-AIDS Office – Request for approval accept and expend
retroactively a new grant from the Centers of Disease Control and
Prevention, in the total amount of $456,829, for the period of September
30, 2006 to September 29, 2008 and approve a contract with Public Health
Foundation Enterprises Management Solutions, in the amount of $192,711
for year one and $175,027 for year two, for the period of September 30,
2006 to September 29, 2008.
(3.2) CBHS – Request for approval of a retroactive contract renewal with
Catholic Healthcare west dba Saint Francis Memorial Hospital, in the
amount of $504,000, which includes a 12% contingency, to provide 24-hour
adult acute psychiatric inpatient hospital services, for the period of
July 1, 2006 through December 31, 2010.
(3.3) CBHS – Request for approval of a retroactive contract renewal with
Catholic Healthcare West dba St. Mary’s Medical Center, in the amount of
$856,800, which includes a 12% contingency, to provide adolescent acute
psychiatric inpatient hospital services, for the period of July 1, 2006
through December 31, 2010.
Secretary’s Note – Commissioner Illig and Commissioner Umekubo abstained
from voting on this item.
- Commissioner Tarver asked why there is such a large difference in the
rates for adolescent beds and the rates for adult beds. Ms. Chan-Sew
said that they have been doing business with St. Mary’s Hospital for
many years. Katrina Bennett, Executive Director, said the cost for
adolescents is approximately $1,300 per day, which is more than what
they receive from the DPH contract. There are different requirements for
this unit. Abby Yant, St. Francis Hospital said that St. Francis, in the
spirit of cooperation with the memorandum of understanding between CHW
and DPH, and the fact that there is a crisis in San Francisco regarding
inpatient psychiatric facilities, agreed to the rates, although they do
not cover the costs for this year. They are hoping that in the next
fiscal year the rates could be increased. 27 different individuals were
served through this contract. The contract was increased the contract
from $50,000 to $100,000. Commissioner Tarver said more resources are
needed to place people in the appropriate level of care and he
appreciates St. Mary’s and St. Francis cooperating and negotiating to
allow for expanded access.
(3.6) PHP-Policy & Planning – Request for approval of a modification to
increase the contract with Anita Ruiz Contreras, by $60,450, for the new
total amount of $109,200, which includes a 12% contingency, to provide
Trauma Nurse Core Course training services for San Francisco Hospital
Nurses, for the period of April 7, 2006 through November 30, 2006.
- Commissioner Sanchez said this is a very important training protocol,
and he asked for more detail about the evaluation and review that will
be undertaken at the end of the training sessions. Ms. Ruiz Contreras
said there is an evaluation component, both in terms of evaluating the
course and evaluating the instructors. If performance falls below a
certain level, the instructors must be counseled and subsequent courses
that they teach are monitored. Mary Ellen Carroll said that at the end
of the training program, 300 nurses would have been trained. Staff is
currently evaluating whether to continue this training under a different
source of funding.
- Commissioner Tarver is interested in hearing the final report once it
is completed. Ms. Carroll said she would incorporate this into the
November disaster preparedness report that will be presented to the
(3.7) CBHS – Request for approval of a contract modification with
Central City Hospitality House, in the amount of $439,303 for a total
amount of $1,584,391, which includes a 12% contingency, to provide
mental health socialization and wellness services and pursuant to the
Mental Health Services Act Supportive Services for Housing and a Peer
Based Center, for the period of July 1, 2006 through December 31, 2007.
- Commissioner Tarver asked if satisfaction surveys were done last year.
Dr. Cabaj said that this is the first full year of the contract, and as
such the official satisfaction survey has not been done yet. Dr. Cabaj
added that the contract funding includes funding for additional staff.
(Secretary’s Note – the information regarding FTEs was submitted by the
Contracts Office after the meeting.) Commissioner Tarver said that the
Budget Committee has requested that the contract monitoring reports that
come before the Commission also be reviewed by program managers who are
presenting the contract and agency representatives to ensure that the
reports are accurate.
(3.8) CBHS – Request for approval of a retroactive contract renewal with
Conard House, in the amount of $8,488,789, with an annual amount of
$5,659,193 which includes a 12% contingency, to provide residential,
outpatient, supportive housing and vocational training mental health
services, for the period of July 1, 2006 through December 31, 2007.
- Commissioner Sanchez commended the agency for its high performance
- Commissioner Tarver is aware that there is a really tight pool of
public payees, and he has had clients who have a great deal of
difficulty getting appropriate rep payees. Stephen Banuelos, CBHS, said
the CBHS rep payee program is relatively new, and operationally just
started this year. They are looking to expand by 100 clients. This is
something CBHS is working with the agency on. Conard House has a long
history of rep payee services through HSA. The contract is designed to
incrementally increase the number of clients that are served.
Commissioner Tarver asked if there is a wait list of people waiting for
a rep payee, and are there services available for people who are not in
IMDs. Richard Heasley, Executive Director of Conard House, said they
open wait lists when they know there are going to be open slots. Mr.
Heasley said 30 of the 100 from the new group are going to be non-IMD
clients. In total, Conard House serves approximately 1,000 clients
through its rep payee program. Their system has unlimited capacity to
expand on demand so as the need is expressed, the agency can respond.
(3.9) CBHS – Request for approval of a retroactive contract renewal with
Family Service Agency of San Francisco, in the amount of $7,459,730,
which includes a 12% contingency, to provide mental health services, for
the period of July 1, 2006 through June 30, 2007.
- Commissioner Tarver asked for a clarification about the unit of
service cost for Children’s Tenderloin case management services. Tom
Mesa, CBHS, said that the contract summary page shows the minute rate
rather than the hourly rate, which is the unit of service. The hourly
rate is $112.80 per unit.
(3.10) CHPP-AAHI – Request for retroactive approval of renewal contract
with Bayview Hunters Point Health and Environmental Resource Center, in
the amount of $529,734, which includes a 12% contingency, to provide
health and well services, for the period of July 1, 2006 through
June 30, 2007.
- Commissioner Sanchez said that he could see the level of frustration
in the documents that were presented to the Health Commission. He
appreciates the challenges that contractors and the Department go
through to make things work. Ms. Smyly said that programmatically the
agency does really well and continues to meet its units of services. The
Department has also challenged Bayview HERC to provide services a
different way, with an emphasis on advocacy, and this will be a
- Commissioner Tarver asked Betty McGee, Bayview HERC Executive
Director, if she was able to resolve her problems with the Department.
Ms. McGee said that she feels they are on the right track, and that with
continued cooperation with DPH staff they can continue to do good work.
She added that the environmental advocacy is a new challenge and, given
time, they will do this well. Commissioner Tarver asked if HERC has a
relationship with Southeast Health Center. Ms. McGee said yes.
(3.11) Central Administration – Consideration of a Board of Supervisors
resolution retroactively approving listed contract modifications.
Gregg Sass, DPH Chief Financial Officer, presented Item 3.11 at the
Health Commission meeting as well as the Budget Committee meeting. Mr.
Sass said the City Attorney has recently ruled that the Health
Department contract approval process does not meet the requirements of
the City Charter. The new interpretation means that many more contracts
would need Board of Supervisors approval than has been the case in the
past. Mr. Sass said the Health Department has always been respectful of
the public nature of its contract approval process. Contracts are
brought before the Health Commission with contract monitoring
information and opportunities for public input and scrutiny by
Commissioners. Mr. Sass said the Health Department is working with the
City Attorney to prepare a Board of Supervisors resolution to approve
contract modifications that have already been approved by the Health
Commission. The Health Department is working with the City Attorney,
Controller, Purchaser and other parties to prepare an amendment to the
Administrative Code as a long-term solution.
Commissioners’ Comments (at Health Commission meeting)
- Commissioner Illig is very distressed by this issue. In the past, the
City Attorney’s Office has told contractors that San Francisco cannot do
master contracts. Yet now the City Attorney is saying that contracts
that span more than one year are really one contract, which is
contradictory to previous statements. He applauds staff for coming up
with a quick and efficient solution.
- Commissioner Guy asked if this new way of doing business changes
anything. Mr. Sass said that the change to the Administrative Code would
allow the Department to do things as they are done currently.
- Commissioner Chow said it seems as if using the sole source avenue as
a legislative fix is a little oblique. Dr. Katz replied that this has
been a very frustrating issue. The only way to change the Charter is to
go to the voters. The Administrative Code can be changed legislatively
to reflect that, for non-profit contractors, it is not sensible to rebid
services every year. Short of changing the Charter, this is the best
solution. Dr. Katz added that when the amendment to the Administrative
Code is prepared, it would be submitted to the Health Commission.
Action Taken: The Commission approved the Budget Committee Consent
Calendar. Commissioner Illig and Commissioner Umekubo abstained from
voting on Item 3.3.
4) DIRECTOR’S REPORT
Anne Kronenberg, Deputy Director of Health, presented the Director’s
Pertussis Vaccine for New Moms at SFGH
The Communicable Disease Prevention Unit has established a pilot project
with the State Immunization Branch enabling Labor and Delivery at SFGH
to vaccinate new moms with Tdap (tetanus, diphtheria, pertussis) prior
to discharge from the hospital. Until now, L&D was only able to access
20 doses a month for their 100+ deliveries. CDC recommends administering
this new vaccine to adults in order to protect babies from pertussis
(whooping cough), a disease prevalent in the adult population and deadly
to young infants who cannot begin the vaccination series against the
disease until they are two months of age.
IDSA 44th Annual Meeting
On Saturday, October 14, 2006 Dr. Katz delivered an invited talk on
Emergency Preparedness for Epidemics at the Infectious Diseases Society
of America (IDSA) 44th Annual Meeting.
District 10 Town Hall Meeting
Mayor Newsom and Supervisor Maxwell are holding a Town Hall meeting at
noon Saturday, October 28 at the Southeast Community Facility, located
at 1800 Oakdale Avenue. Department representatives have been invited to
participate and to listen to community priorities. Jimmy Loyce will be
representing DPH at the forum. A resource fair will be held before the
Town Hall meeting at 11:00 am. All Commissioners are invited to attend
Health Fair on Treasure Island
Treasure Island Homeless Development Initiative (TIHDI) and DPH are
co-sponsoring the first annual Treasure Island Health Fair on October 28
from 11:00 a.m. - 3:00 p.m. DPH will have representation from Primary
Care, Nutrition, Dental, STDs, Child Passenger Safety, and Family
Mosaic. Other participating agencies will offer information on HIV
Education and Support Services, Substance Abuse, and screenings for
Asthma, Blood Pressure and Diabetes.
Curry Senior Center Open House
The Commissioners will be receiving an invitation to attend the Curry
Senior Center Open House on November 8, from 4-6 p.m. Formerly known as
the North of Market Senior Center, the Curry Senior Center has undergone
a major seismic upgrade resulting in four new exam rooms, a new
laboratory, registration area, two counseling/interview rooms, ADA
improvements and a new ventilation system. The $2.5 million construction
budget was a combination of seismic bond funds and financing from the
Mayor’s Office of Community Development, (MOCD) Community Development
Block Grant (CDBG) funding.
Methamphetamine Study Launched
The National Institute of Health has funded three studies by the San
Francisco Department of Public Health AIDS Office to determine whether
medications have potential to both treat methamphetamine addiction and
to reduce HIV risk behavior associated with methamphetamine use. In San
Francisco, the rates of methamphetamine use are ten to twenty times
higher than in the general population. Historically, pharmacological
interventions have been shown to be effective in treating heroin,
alcohol, and nicotine dependence. Three medications are planned for
testing: bupropion (Wellbutrin), which is also used to treat depression
and nicotine dependence; mirtazapine (Remeron), another antidepressant;
and aripiprazole (Abilify), a mood stabilizer. While all the drugs are
FDA-approved, none is approved for the treatment of methamphetamine
Participants will be randomized to receive one of the drugs or placebo.
All participants will receive substance use counseling and HIV
risk-reduction counseling. Researchers are hopeful that in combination
with counseling, pharmacological interventions will reduce
methamphetamine craving and withdrawal. Individuals interested in
enrolling in the studies should call 415/554-9013 or visit
www.sfbump.com. Grant Colfax, MD, is principal investigator for this
Chinese Gold Chef Competition
Staff from the Chinatown Public Health Center participated in a
semi-finalist cook-off competition this afternoon for healthy, low-fat
Chinese cooking at the Lady Shaw Center. The competition, entitled
“Chinese Healthy Gold Chef Cooking Contest,” also featured keynote
speaker Dr. Desiree Backman, Manager of the California 5-a-Day Campaign.
Today’s winning semifinalists will advance to the finals scheduled for
October 21 at the San Mateo Fair Grounds. The event sponsors include
Sing Tao Daily, Self Health for the Elderly, Chinatown Public Health
Center and Lifemark Group.
Tobacco Free Panelist
Tobacco Free Project staff member Mele Lau-Smith was a participant for
the plenary panel at the 5th Annual Conference of APPEAL (Asian Pacific
Partners for Empowerment, Advocacy and Leadership), October 12-13. The
theme of the conference was, "Towards Justice for AAPIs: Applying
Lessons from Tobacco Control to Obesity". The plenary panel was an
interactive session to discuss how the lessons learned in tobacco
control could be applied to the obesity epidemic.
Community Health Network, San Francisco General Hospital, October 2006
Credentials Report (From 10/02/06 MEC)
07/06 to 10/06
Changes in Privileges
Current Statistics – as of 10/1/06
Affiliate Professionals (non-physicians)
Applications In Process
Applications Withdrawn Month of October 2006
4 (07/06 to 10/06)
SFGH Reappointments in Process Nov. 2006 to Feb. 2007
- Commissioner Chow asked if the pilot project allows for 100 vaccines
per month. Ms. Kronenberg said that the pilot program allows SFGH to
have as many doses per month as it needs. Commissioner Chow asked staff
to get him additional information about why the State is calling this a
pilot program, as opposed to just increasing access to the vaccine.
- Commissioner Guy asked if there is another purpose for the District 10
hearing, or is it an open forum to provide testimony to the District 10
Supervisor. Ms. Kronenberg said that it is an open forum, and every
department in the city that deals with constituents has been invited to
attend the meeting.
5) EMPLOYEE RECOGNITION FOR THE MONTH OF OCTOBER
Commissioner Illig presented the Employee Recognition Awards for the
month of October.
Individual Award Division, Nominated By Janet
Individual Award Division Nominated By
Individual Award Division Nominated By Jo Ellen
Vormohr, M.D. Mary Ann Angel and Shotsy Faust
DPH, San Francisco
Behavioral Health Center
6) CONSIDERATION OF A RESOLUTION ENDORSING THE SAN
FRANCISCO TOBACCO FREE COALITION PROPOSED SECOND HAND SMOKE POLICIES
Alyonik Hrushow, San Francisco Tobacco Free Project and Nancy Abdul-Shakur,
co-chair of the Tobacco Free Coalition, presented the Coalition’s second
hand smoke policy campaign. The focus of the campaign is to close
loopholes in smoking laws passed 11 years ago and to expand protection
from second hand smoke to outdoor areas and multi-unit housing
complexes. In 2006, the Air Resources Board (ARB) declared second hand
smoke a toxic air contaminant. The ARB’s decision to do so was based on
a rigorous four-year review of epidemiological and toxicological
literature on second and smoke and its impacts. ARB found that there is
no safe level of exposure.
The Tobacco Free Coalition is advocating for a comprehensive policy to
provide protection from second hand smoke. The coalition plans to work
with members of the Board of Supervisors in the next few months to put
forth this proposal. The Coalition is asking the Health Commission to
endorse the policy by adopting a resolution. Second hand smoke policy
- Enclosed Areas
- 100% of lobbies of hotels, motels
- Designate 75% of guest rooms smoke free in hotels, motels
- All bars including hookah bars
- Tobacco shops
- Outdoor Areas
- Outdoor dining areas of restaurants, cafes, coffee shops
- Service areas, waiting lines
- Within 20 feet of entrances, exits, operable windows, intake vents of
private, non-residential buildings
- Recreation areas, including street fairs, commercial piers, 100% of
- Multi-Unit Residences
- Prohibit smoking in indoor common areas
- Designate at least 75% of existing units as smoke free. Phase in smoke
free units as existing tenants vacate units
- Designate at least 90% of new units as smoke free
- Second Hand Smoke Defined as a Nuisance
Ms. Abdul-Shakur concluded the presentation by requesting that the
Health Commission endorse the Tobacco Free Coalition’s proposed policies
to expand protections from second had smoke.
- Commissioner Monfredini is concerned about people not being able to
smoke in their own residences. Ms. Alyonik said existing tenants would
not be affected by this provision. As units become vacant, units would
have to be designated non-smoking. Commissioner Monfredini said that
Trinity Housing is building a rather large residential building on
Market Street, providing much needed housing to low-income people. She
is concerned that people will have to choose between being housed and
being able to smoke, and perhaps 90% is too ambitious. Commissioner
Monfredini agrees that second hand smoke is toxic, yet housing is a
health issue. She is grappling with this issue of 90% of new units.
- Commissioner Guy said that second-hand smoke is toxic. It does not
mean that we do not have to make difficult choices. Commissioner Guy
said as an example her sister cannot smoke in her San Francisco
apartment because the property owner’s rules do not allow smoking.
Commissioner Guy said the Department could concretely identify if it is
a problem that people are choosing not to go into HUH housing programs
because they cannot smoke. Smoking kills and second hand smoke is
- Commissioner Tarver was working at SFGH when they banned smoking in
the psychiatric unit. There was a lot of opposition due to the
perspective that psychiatric patients need to smoke. Behavior can
change, and this has been successful.
- Commissioner Monfredini asked if smoking is allowed at DPH supportive
housing facilities. Richard Heasley, Executive Director at Conard House,
said that there is no prohibition against smoking at the Plaza. In the
rest of the supportive housing run by Conard House, smoking is allowed
in the rooms and there is an issue of second hand smoke traveling
through the hallways, the ventilation systems, etc. Mr. Heasley added
that there would be nothing to prohibit Conard House with complying with
this policy, given a reasonable amount of time to grandfather in current
- Commissioner Tarver asked if people could smoke medical cannabis. He
also noted the fact that many SROs have had fires due to smoking
factors. He also noted that the supportive housing units take a harm
reduction approach to other substance use, and there seems to be some
inconsistency. Ms. Hrushow said they view second hand smoke differently
than other substances, in that it impacts other people. Furthermore,
second hand smoke has no therapeutic value like medicinal marijuana.
- Commissioner Umekubo supports the resolution and thanked the coalition
for continuing to come up with creative ideas to eliminate this problem.
He feels very strongly about this since his father died from lung
- Commissioner Illig said that this policy is based on sound science,
and the Health Commission should endorse a change in society’s attitude
- Commissioner Chow said that second hand smoke has become such a
problem that even large hotel chains are moving toward complete
non-smoking facilities. It is critical that we stamp out this habit that
has no value, and the Health Commission should do everything to
discourage its use.
- Commissioner Sanchez said that this policy is a reaffirmation of the
Health Commission’s desire to protect people from the impact of second
- Commissioner Monfredini supports the resolution, but wants to state
her concern about rental units, particularly for low-income residents.
Ms. Hrushow assured Commissioner Monfredini that people who smoke would
not be prohibited from living in supportive housing or any other
Action Taken: The Commission approved Resolution 14-06, “Endorsing the
San Francisco Tobacco Free Coalition Proposed Policies to Expand
Protections from Second Hand Smoke,” (Attachment A).
7) NON-PROFIT CONTRACTING TASK FORCE UPDATE
Anne Okubo, Deputy Finance Director, presented an update on the
implementation of Non-Profit Contracting Task Force recommendations. The
Board of Supervisors is holding a hearing on the implementation of
recommendations on November 13th. Milestones include:
- Best Practices – an interdepartmental work group composed of
representatives of DPH, Human Services Agency, Department of Children,
Youth and Families and Mayor’s Office of Community Development met to
discuss best practices around contract consolidation, timely payments,
standardized and simplified contract forms and eliminating unnecessary
- Dispute Resolution Procedure – the Task Force adopted a procedure to
address contract disputes.
- Electronic Invoicing – in an effort to streamline processes and assure
timely payment, DPH issued a policy to accept electronic invoices from
- Survey of Non-Profit Contracting – In June the Office on Contract
Administration surveyed non-profit contractors to illicit feedback on
Task Force recommendations. Thirty-two DPH contractors responded. Ms.
Okubo gave a brief summary of survey findings for DPH contractors.
Ms. Okubo said the Human Services Network has expressed concerns about a
number of issues including timeliness of reports, late certification,
unnecessary requirements, lack of standardization, submission of
multiple documents and concerns about COOL. DPH staff will be meeting
with representatives of the mental health contractors association for
- Judith Stevenson, Human Service Network, chair of Contract Reform
Committee, said HSN has filed a report with the Health Commission (on
file in the Health Commission Office), which they also plan to present
to the Board of Supervisors, that presents significant disagreement on
the perception of the Department. The survey that was done is incomplete
in that many agencies do not feel comfortable giving true feedback about
DPH practices. If the Health Commission wants to know how contractors
feel, it needs to get input from contracts. There is an enormous amount
of process in DPH, but very little outcome in terms of streamlined,
effective contracting processes.
- Kavoos Bassiri, Chair of San Francisco Mental Health Contractors
Association and Executive Director of RAMS, spoke in support of the
problems that were raised in HSN’s memo to the Health Commission.
Overall what they are asking for is a partnership when it comes to
contracting, and problem solving with each program. For example,
outcomes should be more meaningful.
- Sherilyn Adams, Larkin Street Youth Services, echoed the words in the
HSN report. The thing that they find most alarming is that they have not
been able to move toward a systemic solution. Instead problems are
addressed on an individual basis. Streamlined processes, timely payments
and joint solutions mean that agencies can go about the business of
taking care of clients.
- Debbie Lerman, Human Services Network Administrator, said they got
input from 50-60 contractors. Issues that seem dry on the service really
go to the heart of the City-non-profit contractor relationship. DPH
practices seem to be getting worse, particularly around late
certifications, while other departments have improved. DPH leadership
has worked with the contractors and is in support of the recommendations
but this has not been incorporated into the DPH culture and embraced by
middle management. There are specific requests outlined in the memo,
such as concrete performance measures and written policies and
procedures. They would also like more regular reports to the Health
- Eve Meyer, San Francisco Suicide Prevention, said every year CBHS
contractors are required to fill out a checklist of documents they have
in their offices and where they are displayed. One year she was given a
failing grade because she did not initial in each of the blanks, but
rather signed at the end of the page. She was enraged because she could
not figure out what this had to do with anything.
- Commissioner Sanchez said that the issues raised today provide an
opportunity to open up our process, listen to our contract partners and
find ways to improve how we do business. There are many factors in
creating and sustaining a level of partnership, including a level of
trust. Ms. Okubo said that the Health Department is very complex, with
more than 300 contracts. That said, she appreciates the written input
from the Human Services Network, as she appreciates specific
recommendations. The HSN report was distributed to program staff
throughout the Department. She offered to meet, along with Michelle
Long, with the Human Services Network to review and address the
- Commissioner Illig said there are 176 agencies that contract with DPH.
Almost $400 million of DPH’s budget goes to contractors. It is clear
that the agencies that do business with DPH are our partners, but they
are not being treated that way. It is telling that the Human Services
Network is willing to stand up, file its own report to the Board of
Supervisors, and say the Health Department is not improving. This
demonstrates the challenges of running a large, bureaucratic department.
Many lower level employees have too tight a control over contracts. The
Health Commission should ask for specific performance outcomes, one of
which should be an anonymous vendor satisfaction survey. Also, the
Health Commission needs to receive reports more frequently than every
six months. The Commission needs an ongoing way of staying on top of
these issues and ensuring progress.
- Commissioner Guy said the Health Commission needs to take if very
seriously if there is an issue of leadership directives around
contracting not funneling down to middle management.
- Commissioner Chow appreciates the Human Services Network being so
frank. He is disappointed that such a large number of contractors feel
as though progress has not been made in DPH. He suggested that the
Budget Committee monitor this issue.
- Commissioner Umekubo is surprised at the information he received. The
contracting process has been in evolution since he began on the Health
Commission. He supports looking at all avenues to streamline the
contract process. That said, contract monitoring is a pivotal Health
Commission role, and this needs to be continued.
- Commissioner Tarver said the Department’s efforts to extend contracts
for a longer period of time would continue to pay off in terms of the
flow of funds to contractors. There was also the allocation of funds for
cost of doing business. These efforts and others are an indication of
DPH’s partnership with contractors. The Health Department and Health
Commission want to be responsive to contractor concerns. The criticism
that the Department operates in silos is valid and has been noted by
others, including the HMA report. The Health Commission’s contract
review process should be expanded so that program managers as well as
fiscal staff are involved in presentations. It seems that a contractor
needs to be able to access multiple staff within DPH so that contractors
never feel beholden to one contract staff. He will continue to lend his
voice to trying to be responsive and supportive of efforts to improve
- Commissioner Illig suggested that the Commission ask that the monthly
meetings between Human Services Network and the Purchasers Office focus
on the Health Department for the next six months.
- Commissioner Monfredini appreciates the HSN memo, and is very
concerned about two specific issues. The first is the feeling by
contractors that they cannot raise issues without fear of retribution.
She is also concerned that an individual staff person could cause so
many contract delays. Commissioner Monfredini asked that a meeting be
set up with she and Dr. Sanchez, representatives from the Human Services
Network, and DPH staff including Barbara Garcia, Finance and the AIDS
Office. She agrees with the vendor survey and asked who could develop
this. Ms. Okubo said that the Contracts Office would put together a
draft survey in a couple weeks. Gregg Sass added that the contractors
have to be involved in developing the survey. Commissioner Monfredini
asked Commissioner Illig to work with staff in the development of the
vendor survey. Gregg Sass added that DPH has some excellent program
managers who do excellent work, so a report card on program management
by division will be helpful.
- Commissioner Guy said that the survey must be credible, involve
contractors, and be well thought out. So take the necessary time to
develop the survey.
- Commissioner Monfredini asked when the next report should be
presented. Dr. Katz said people have been trying to implement
recommendations, but clearly these efforts are not meeting the goals.
Mr. Sass, Ms. Garcia and Dr. Katz will know what they are doing
differently in the next month or so, so he can report back at the second
meeting in November.
8) DEPARTMENT OF PUBLIC HEALTH ANNUAL REPORT
Anne Kronenberg, Deputy Health Director, Director, Office of Policy and
Planning, presented the Department of Public Health’s Annual Report. Ms.
Kronenberg gave an overview of the inside of the Department, including
the number of DPH employees, community advisory groups and DPH contract
partners. She gave an overview of DPH clients, including demographics
and the number of people who receive DPH services. Ms. Kronenberg then
described selected DPH initiatives in the context of the DPH Strategic
- Goal 1 – San Franciscans Have Access to Health Services
- Avon Breast Cancer Center
- LHH Opens Specialty Care Unit – Care for cerebral palsy, epilepsy,
autism and mental retardation
- Let’s Be Healthy
- Goal 2 – Disease and Injury are Prevented
- 3 for Life
- Safe Device Committee
- Direct Access to Housing Program
- Goal 3 – Services, programs and facilities cost-effective and resources
- Expanded Nurse Training, Recruitment and Retention
- SFGH Rebuild – Blue Ribbon Committee
- LHH Replacement Project – Phase one will add 780 beds ready by 2008
- Primary Care Center Retrofits – Curry Center complete, Silver under
construction, Tom Waddell to begin in January
- Public Health Laboratory PCR Equipment
- Goal 4 – Partnerships with communities sustained
- Advancing Cultural Competency – grant funded reference manual and five
- San Francisco Food, Nutrition and Agriculture Directory - 3rd Edition
released in September 2005, available on line.
- Environmental Health issued regulations for effective bedbug
prevention and control – training owners and operators
- Pandemic Influenza planning for the business community – working on a
concept of operations plan in the event of a pandemic
- Commissioner Illig commended the annual report. The breadth of
services that the Department provides always astounds him. He asked that
AIDS Office data be included in the “Who We Serve” section of the
report. His vision is that in the future, every program will have
identified outcomes, which will be reported in the Annual Report. Ms.
Kronenberg said that, with the establishment of the SF Stat System, more
and more of this data will be able to be presented over the next few
- Commissioner Guy commended Ms. Kronenberg and staff for the Annual
Report. As an annual report, it serves to inform the public about what
the Department does. However it is not that effective with respect to
informing the Health Commission about how the Department has advanced
Strategic Plan objectives. The purpose of the Strategic Plan cannot be
completely incorporated into an annual report. So the Health Commission
and Department need to re-examine how the Health Commission review the
value of the Strategic Plan and use health assessment tools to evaluate
the health status of San Franciscans.
- Commissioner Chow commended the report, and offered suggestions.
Commissioner Chow echoed Commissioner Guy’s desire to have a
comprehensive review of the Strategic Plan. Commissioners should think
about how they want this review to come forward. Commissioner Chow added
that an appendix of reports that the Health Department has published
throughout the year would enhance the report.
9) PUBLIC COMMENT/OTHER BUSINESS
- Daisy Anarchy, Sex Workers Organized for Labor, Human and Civil
Rights, presented documents to the Health Commission, including a draft
resolution that has been submitted to the Commission on the Status of
Women regarding labor conditions of exotic dancers (on file in the
Health Commission). Exotic dancers have given written statements to the
Commission on the Status of Women about the labor conditions. DPH should
not be funding a “community needs assessment” with St. James Infirmary.
Her organization believes in the complete legalization of consensual
adult prostitution, but does not believe that private booths and rooms
should be allowed in exotic dance venues because this leads to coercion,
sexual assault and rape in these establishments.
- Yvonne Martinez, SEIU 790, shared her frustration about how difficult
it is to get things done in DPH. It has been three months since 50
employees at Southeast Geriatric Clinic had advocated for more staff.
She is pleased to report that while the clinic has received some staff,
there is still no one at the clinic to answer the phone and clinical
staff still must do this.
10) CLOSED SESSION
A) Public comments on all matters pertaining to the closed session
B) Vote on whether to hold a closed session
Action Taken: The Commission voted to hold a closed session.
The Commission went into closed session at 6:20. Present in closed
session were Commissioner Monfredini, Commissioner Illig, Commissioner
Chow, Commissioner Guy, Commissioner Sanchez, Commissioner Tarver and
C) Closed session pursuant to Government Code Section 54957 and San
Francisco Administrative Code Section 67.10(b)
PUBLIC EMPLOYEES PERFORMANCE EVALUATIONS:
- MITCHELL H. KATZ, M.D, DIRECTOR OF HEALTH
- EXECUTIVE SECRETARY TO THE HEALTH COMMISSION, MICHELE M. SEATON
D) Reconvene in Open Session
The Commission reconvened in open session at 7:30 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 Session (San Francisco Administrative Code Section 67.12(a).)
Action Taken: The Commission voted not to disclose any discussions held
in closed session.
The meeting was adjourned at 7:30 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