Minutes of the Health Commission Meeting

Tuesday, February 17, 1998 3:00 p.m.
101 Grove Street, Room #300 San Francisco, CA 94102


The regular meeting of the Health Commission was called to order by President Lee Ann Monfredini,

 at 3:05 p.m.


  • Commissioner Debra A. Barnes
  • Commissioner Edward A. Chow, M.D.
  • Commissioner Roma P. Guy, M.S.W.
  • Commissioner Lee Ann Monfredini
  • Commissioner Harrison Parker, Sr., D.D.S.
  • Commissioner David J. Sanchez, Jr., Ph.D.


  • Commissioner Ron Hill  

1) CALL TO ORDERThe regular meeting of the Health Commission was called to order by President Lee Ann Monfredini,

 at 3:05 p.m.

2) APPROVAL OF MINUTES OF THE MEETING OF FEBRUARY 3, 1998Action Taken: The Commission unanimously adopted the minutes of February 3, 1998.

3) CONSENT CALENDAR OF THE BUDGET COMMITTEE(Commissioner David J. Sanchez, Jr., Ph.D.)

 (3.1) Consideration of a request to substitute the "Grant Application Information Form" for the "Health Commission Summary of Grant Request" for Health Commission review of requests for grant approvals.

Monique Zmuda, CFO, welcomed suggestions from Commissioners on information to be included in the new Grant Application Information Form.

Commissioner Sanchez commented that the Budget Committee will periodically review grant and contract policies.

 (3.2) PH-CHS-HIV Postexposure Prophylaxis Project - Request to retroactively accept and expend new funding in the amount of $140,156 from the University of California, San Francisco, Center for AIDS Prevention Studies, to provide counseling and medical services for HIV postexposure prophylaxis services for the period of December 1, 1997 through November 30, 1998.

 (3.3) PH-CHS-Mental Health Services - Request to retroactively accept and expend a renewal grant in the amount of $60,000 from the Miriam and Peter Haas Fund to support a consultant planner to develop policies and programs for the mental health managed care plan for the period of

 December 15, 1997 through December 14, 1998.

 Anita Fong is the consultant planner who will continue under this grant renewal.

 (3.4) PH-CHP&P-Dental Health Services - Request to accept and expend retroactively new funding in the amount of $63,295 from the Dental Health Foundation to provide preventive dental health services to low-income and immigrant children for the period of January 1, 1998 through February 29, 2000.

 (3.5) Central Administration-Finance - Request to increase the revolving fund for the Public Health division by $8,000 to $33,000.

 (3.6) PH-CHS - Request to approve the extension of 54 CARE-funded AIDS health services contracts from March 1, 1998 through June 30, 1998.

 (3.7) PH-CHS-MH - Request to exercise fourth year option of a 4-year contract with Crestwood Hospitals, Inc./Crestwood Behavioral Health, Inc. (Crestwood), in the amount of $4,341,508 to provide 24-hour services and subacute locked skilled nursing services for the period of July 1, 1997 through June 30, 1998. (DPH contracted with Crestwood for services totaling $6,222,892 during

 FY 1996-97).

Commissioner Monfredini expressed to the contractor that the Commission views the Board and staff compliance policy seriously. She stated that Advisory Boards are not acceptable for compliance. She suggested to the contractor to consider adding two more Board members who will be non-shareholders with voting privileges.

Commissioner Barnes advised the contractor to relook at its bylaws and increase the number of Board members. She requested the Department have an alternative plan in place if the present contractor continues to remain non-compliant. She also noted that this renewal is retroactive.

Commissioner Sanchez suggested this contractor's Board reassess the importance of continuing to do business with the Department and then look for models to adhere to compliance. He requested a report back to the Budget Committee prior to renewal of this contract.

The Commissioners approved the retroactive contract for the current fiscal year but will review the contractor's plan for compliance prior to any future renewals.

Action Taken: The Commission approved the Consent Calendar of the Budget Committee.

4) DIRECTOR'S REPORT (Provides information on activities and operations of the Dept.).

(Mitchell H. Katz, M.D., Director of Health)

ADMINISTRATIONEmergency Shelters Opened

The recent onslaught of storms resulting from El Niņo caused the Mayor to declare a State of Emergency in San Francisco on February 5. The declaration put emergency operations into place and the Red Cross opened three emergency shelters in Recreation and Parks facilities at:

  • 6th and Folsom, in the SOMA area;
  • the Joe Lee Recreation Center, in Bayview Hunters Point; and
  • Kezar Auditorium in the Haight.

Since the emergency shelters opened February 6, DPH has provided medical, mental health and substance abuse services to those housed at the shelters. The Department has also provided oversight of environmental health issues. This experience granted an excellent opportunity for DPH to test its own emergency response program. In addition, the experience has been an invaluable learning tool for piloting the integrated delivery system model proposed in the Department's recent reorganization.

I am pleased with the performance and commitment of DPH staff, who have worked long hours to assure that all who sought shelter had access to medical and mental health services.

 PUBLIC HEALTH Chlorinated Drinking Water

This past week there was considerable coverage of an article that will appear in the next issue of Epidemiology which suggests a relationship between some drinking water and miscarriages. Specifically, the study suggests that women who drink more than five glasses per day of drinking water which contains more than 75 parts per billion of Total Trihalomethanes (TThm) during their first trimester of pregnancy may be at greater risk for miscarriages. San Francisco's drinking water often exceeds this level.

While the results of the study are of great concern to us, the study has a number of limitations. Our staff are working closely with the staff of the Public Utilities Commission to get more information and to generate a coordinated response.

In the meantime citizens who are concerned should call the PUC's Water Quality Bureau at (650) 872-5942. We are currently advising people who are concerned to speak with their physician. We are also telling people who want to remove TThm's from their tap water that they can use activated charcoal filters or they can boil their water.

COMMUNITY HEALTH NETWORK Community Health Network Resignation

It is with regret that I announce the resignation of Richard Cordova, who served as the Executive Administrator of the Community Health Network. Rich left DPH last Friday to accept a position as Vice President of the East Bay region of Kaiser Permanente. I am sure you join me in thanking Rich Cordova for the fine leadership he provided over the last six years as Administrator of SFGH/CHN. Rich leaves behind a leadership team that is capable of taking the Community Health Network to the next step.

I asked Anthony Wagner to act as Interim Executive Administrator of the Community Health Network. I look forward to working with Tony in his new role, and am confident in his ability to lead and direct the CHN through this transition period.

SFGH CREDENTIALING 4th Quarter 1997 Board Report

4th Quarter 1997 Board Report

New Appointments
Reappointment Denials
Disciplinary Actions
Restrictions/Limitation of Privileges
Changes in Privileges (additions/deletions) 30

President Monfredini acknowledged Anne Kronenberg, Eileen Shields, Barbara Garcia, and all Department of Public Health staff who have worked on the operations of the emergency shelters. Commissioner Guy has been receiving positive responses to the shelters. Commissioner Chow complimented the Department staff for responding to the needs of the public.

5) CONSIDERATION OF A RESOLUTION CREATING A RESERVE FOR THE DEPARTMENT OF PUBLIC HEALTHMonique Zmuda, Chief Finance Officer, reported that this reserve will be a Departmentwide reserve that will be used to replace revenues that have been volatile due to uncertainties of State and Federal government programs and their rules for claiming and eligibility. Surplus revenues in the current fiscal year will be used to establish a reserve fund. The reserve will be replenished to a minimum amount and when surplus funds are available.

Action Taken: The Commission unanimously adopted Resolution #8-98,

 "Creating a Department of Public Health Reserve to Guard Against

 Future Funding Uncertainties", (Attachment A).

6) CONSIDERATION OF THE PROPOSED DEPARTMENT OF PUBLIC HEALTH BUDGET FOR FY 1998-99, AND CONSIDERATION OF A RESOLUTION FOR A POLICY TO EXPAND HOUSING SERVICES, PREVENTION SERVICES, AND SPECIFIC INFRASTRUCTURE PRIORITIESMonique Zmuda, Chief Finance Officer, reported that the fiscal year 1998-99 annual Department of Public Health budget will be transmitted to the Mayor and the Controller on February 20, 1998. In May, the Controller certifies the revenues. In June, the Mayor transmits the City Budget to the Board of Supervisors. The Finance Committee of the Board holds hearings on the budget and makes recommendations to the full Board. The Board of Supervisors votes on the budget in early July.

Ms. Zmuda presented additional information requested by members of the Commission regarding the Department's budget request for FY 1998-99:

  • Cost information on population-based prevention programs;
  • Estimated cost and timeline to implement Treatment on Demand for multiyear periods;
  • Information on the Target Cities grant funded programs which will be phased out in FY 1998-99; and
  • Details on capital projects to comply with Joint Commission on Accreditation of Hospitals.

Additionally, the following new initiatives were proposed for inclusion in the budget:

(Attachment B).

  • Risk Management Plan for businesses storing regulated substances which is supported entirely by fees;
  • Further augmentation of rodent control program;
  • Action Point Centers for HIV infected persons; and
  • An employment reentry program for HIV-infected persons.

The Department will work with the Mayor's Office to develop further details and specific dollar amounts for the last two new initiatives. These new initiatives, the Action Point Center and Employment Reentry Program, were recommended at the Mayor's AIDS/HIV Summit. The Department will present details of these two new programs at a future Commission meeting.

Commissioners' Comments:

Commissioners expressed appreciation for the clear, organized, and informative budget document.

Commissioner Guy encouraged the Department to work with the community-based organizations who already anticipated what is needed and what the numbers are for an employment program. There should be a determination about what the Department could do and what should be contracted out.

Commissioner Chow expressed support for the enhancement of rodent control. He also supported population-based prevention programs and the Department's process in determining a population-based need (i.e., study by NICOS).

Commissioner Sanchez pointed out that the proposed budget calls for major funding and emphasized the opportunity to seek more grants. He also reported that the Budget Committee will be reviewing the Department's capital budget.

Commissioner Monfredini expressed her high priority for roof repairs at Laguna Honda Hospital.

Commissioner Guy expressed her appreciation for a report that addresses the high-volume census at San Francisco General Hospital. A copy of this report was requested for each Commissioner.

President Monfredini acknowledged two letters submitted to the Commission in support of prevention programs:

Gary Rayan, D.D.S., S.F. Dental Society

Neil Gendel, Healthy Children Organizing Project

Public Speakers:

Paul Causey, AIDS Benefits Counselors

Karen Greener, LIFE Program

Gary Virginia, PWA and AIDS Benefits Counselors

Stephen J. LeBlanc, San Francisco Citizen with HIV

Dan Merer, staff nurse, SFGH, Emergency Department, Local 790, Shop Steward

Dale M. Butler, SEIU Local 790

Hank Wilson

Action Taken: The Commission unanimously adopted Resolution #9-98, "Expanding Services for Housing for the Homeless, for Prevention of Illness, and for Maintaining and Expanding Existing MIS and Other Infrastructure Within the Department," (Attachment C).

Action Taken: The Commission unanimously adopted the proposed Department of Public Health Budget for fiscal year 1998-99; and that this budget be transmitted to the Mayor.


The meeting was adjourned at 4:45 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission