Minutes of the Health Commission Meeting
March 17, 1998 3:00 p.m.
101 Grove Street, Room #300 San Francisco, CA 94102
1) CALL TO ORDER
The regular meeting of the Health Commission was called to order by President Lee Ann
at 3:05 p.m.
1) CALL TO ORDER
- Commissioner Debra A. Barnes
- Commissioner Edward A. Chow, M.D.
- Commissioner Roma P. Guy, M.S.W.
- Commissioner Ron Hill
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Jr., Ph.D.
2) APPROVAL OF MINUTES OF THE
MEETING OF MARCH 3, 1998
Action Taken: The Commission unanimously adopted the minutes of March 3, 1998.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner David J. Sanchez, Jr., Ph.D.)
(3.1)PH-CHS-CSAS - Status report on Bay Area Addiction Research and
Treatment, Inc.'s compliance to the Health Commission's Policy on Board Composition.
Commissioner Barnes expressed that she was pleased with the progress of the
(3.2) DPH - Presentation and consideration of the Department-wide
Capital Projects for
FY 1998-99 in the amount of $19 million.
(3.3) CHN - SFGH - Consideration of a proposed lease amendment for
the General Clinical Research Center (GCRC) at San Francisco General Hospital.
Commissioner Sanchez abstained on this item due to conflict of interest.
(3.4) CHN-LHH - Approval of acceptance of a gift of stocks, valued
at $178,000, to Laguna Honda Hospital from the Barbara Wylie Trust.
(3.5) Central Administration - Policy & Planning - Approval of
a new contract with The Pacific Health Policy Group, in the amount of $119,695, to provide
consultant services for the 1115 Waiver Development Project, for the period of April 1,
1998 through March 31, 1999.
(3.6) PH-CHS-CMHS - Retroactive approval of a new contract with
Davis Y. Ja and Associates, Inc. (D.Y. Ja), in the amount of $173,320, for a research
project for the period of January 1, 1998 through June 30, 2000. (DPH contracted with D.Y.
Ja for services totaling $53,000 during
(3.7) PH-CHS-CSAS - Retroactive emergency contract and sole source
approval with Chemical Awareness and Treatment Services, Inc. (CATS), up to the amount of
$749,279, to provide overnight shelter and support services to homeless residents of San
Francisco for the period of March 1, 1998 through May 31, 1998. (DPH contracted with CATS
for services totaling $2,566,823 during FY 1996-97).
This item was deferred to Item #9 on the agenda.
Action Taken: The Commission unanimously approved the
Consent Calendar of the Budget Committee, except for #3.7, which was deferred to Item #9
on the agenda. Commissioner Sanchez abstained on #3.3.
President Monfredini acknowledged
today's swearing-in by the Mayor of Commissioner Chow's reappointment to the Commission.
W. K. Kellogg Foundation
The W. K. Kellogg Foundation announced that it was launching a major new initiative
with the goal to develop improved models for safety net providers. The San Francisco
Department of Public Health and the University of California at San Francisco were sent a
request for qualification to apply for the initiative. The Foundation anticipates awarding
10 five-year project grants, ranging in value from $2.5 to $5 million.
DPH, working in collaboration with the UCSF and the San Francisco Community Clinic
Consortium (SFCCC), submitted a proposal in response to the request for qualifications.
Dr. Andrew Bindman, head of the San Francisco General Hospital Primary Care Research
Group, took the lead on preparing the proposal. DPH and the SFCCC wrote sections of the
proposal. We highlighted five areas where we thought San Francisco safety net providers
could improve services to vulnerable population groups. The areas were:
The Kellogg Foundation required a three week turn-around for
response to the request for qualification.
- Improvement in the medical information systems . In particular, given the large
investment that DPH has made in its MIS system, for a relatively small additional
allocation we could create links between the CHN and the SFCCC. Also by improving our
capacity to perform population-based analysis, we can learn more about the cost and
outcomes of the care we provide.
- Focus on primary and preventive care strategies . The Department's proposal highlighted
two current projects that are working to increase the use of primary and preventive care:
the APPROACH project and the Emergency Department case management program. In our response
we said we would look at additional ways that we could improve our application of primary
care and case management throughout the CHN and the SFCCC.
- Community outreach . Here we proposed expanding models of community mobilization and
community empowerment to address important health care issues in San Francisco. We cited
the example of our work with the Bayview Hunter's Point Task Force and the Bridges Project
as two examples of the importance of these community safety net collaborations.
- Training . Use of the Kellogg Foundation resources would allow providers throughout the
CHN and the SFCCC to participate in a broader training mission.
- Improved Planning . We proposed further planning to make the safety net sites more
accessible to clients.
I am happy to report that, based on our
submission, the Kellogg Foundation has said they would make a formal site visit to San
Francisco the first week of April. If, based on the site visit, they are interested in
funding us we will bring a formal request to apply for and accept funds to the Health
Commission for approval. This initiative is very exciting in that it offers potential
financial support for strengthening our safety net providers in San Francisco.
Contractor Merit Awards
In July 1997, the Board of Supervisors appropriated $1 million to the Department of
Public Health budget to provide one-time, merit-based incentive grants to DPH contractors.
These awards were designed to acknowledge excellence and to provide incentives for
continued high performance and compliance with Health Commission and City and County of
San Francisco policies.
I am pleased to inform the Commission that the performance-based merit awards
were sent out early this month. Performance was measured by the organization's past
accomplishments of objectives, client satisfaction, quality and quantity of work
performed, timeliness of reports, quality assurance, and staff and board demographics.
Public Health Division-wide Meeting
The Public Health Division held its first annual staff meeting at Civic Auditorium
March 2nd. Offices remained open and programs continued operation with a skeletal staff.
Over 600 Public Health staff attended the forum which focused on an overview of the
organization of the Public Health Division and an update on the programs within its
The session opened with a slide show featuring Public Health Division staff
accompanied by a Charlie Parker soundtrack. The goal of the two-hour meeting was to foster
communication and discussion of public health issues within the Division. The new Public
Health Division has also produced a newsletter, News & Views, and has created the
Urban Health Seminar series. A dedicated group of staff, led by Jessica Wolin, are to be
congratulated for organizing this successful event.
1998 Women Making History
I am pleased to announce that Barbara Garcia, Director, Community Substance Abuse
Services, and Cynthia Selmar, Director, Southeast Health Center, are recipients of the
"1998 Women Making History , Women's Health Award." The reception on March 24
will be held at California Historical Society.
COMMUNITY HEALTH NETWORK
Black History Month
On February 26, Maxine Hall Health Center commemorated Black History Month with an Open
House. The event was attended by more than 100 community residents and health center
clients. Highlights of the program included: two African American vocalists who live in
the community; poetry recitations by two poets who are health center clients; a poetry
recitation by a nine year old African American community resident; a quilting display by a
health center client; and, a display of handmade ethnic jewelry by another health center
client. All who attended were inspired by this celebration of health and art in the
African American community.
It is with regret that I announce the resignation of Kate Favetti, Senior Personnel
Officer at San Francisco General Hospital. Kate accepted the position of Executive Officer
of the Civil Service Commission. She began her new job yesterday, I am sure you join me in
wishing her well.
SFGH Trauma Center Pediatric Resuscitation Room Opens
The Trauma Center at SFGH is pleased to announce the grand opening of the new
Pediatric Trauma Resuscitation Room on March 12, 1998. The new Trauma Room was made
possible by a generous gift of the Rhoda Goldman Foundation and becomes the fourth trauma
resuscitation room located in the SFGH Emergency Department. The design and development of
the room was a collaborative effort involving the SFGH Foundation, Drs. Margaret Knudson
and Ron Dieckmann, and ED Chief Nurse John Fazio. An opening celebration was attended by
members of the SFGH Foundation, Dr. Douglas Goldman, Trauma Center Physicians and staff,
Emergency Department physicians and staff, and an eleven year old former trauma center
patient and her mother.
Over 200 children a year who require the specialized care available at a Level 1
Trauma Center are admitted to the SFGH Trauma Service. While the focus of the Pediatric
Trauma room is on care and treatment of children with life-threatening injuries, the
Center was designed as a multipurpose area. The room is also used to care for adult trauma
victims and for children requiring conscious sedation during extended emergency
Metropolitan Medical Strike Team [MMST]
SFGH will be hosting the United States Department of Defense biochemical and
hazardous materials exposure training for health care workers March 30 to April 2. Ann
Stangby, RN, SFGH Base Hospital Coordinator, is directing SFGH's participation in this
program and is co-chairing the MMST Hospital Task Force.
This training is part of the nationwide effort to provide specialized training to
EMS and acute care hospital personnel in 27 cities throughout the U.S. The course content
will include rapid response, decontamination and emergency treatment for victims of
weapons of mass destruction. The program is specifically designed as a
"train-the-trainers" model. Program participants from SFGH, SFFD EMS, community
hospitals within San Francisco, San Francisco International Airport Medical Clinic, and
the EMSA will then be expected to return to their home department to provide education and
training to colleagues. This training is part of a larger weapons of mass destruction
readiness program being funded by a grant awarded to Dr. John Brown, EMSA Medical
President Monfredini and Commissioner Barnes indicated their willingness to participate
in the site visit from the Kellogg Foundation.
February statistics are available in the Commission Office.
Jessica Wolin, Senior Health Planner, reported the following:
this week, the Department of Public Health will build upon the National Public Health Week
theme of "Healthy People in Healthy Communities." We plan to release two
reports: the executive Summary of the "San Francisco Mortality Report", and a
brief paper entitled "How Healthy is San Francisco?: The Department of Public Health
Gives San Francisco A Checkup.'
In the early fall, a synopsis of the Mortality Report was presented to the Health
Commission and a review of the final report will be possible in the future. The report
will be an analysis of all deaths in San Francisco from 1990 to 1995 broken down by age,
sex, race and zip code. In addition, this report links causes of death with their
underlying risk factors or determinants. The Mortality Report is the most comprehensive
report of the City's health that has ever been undertaken. The Executive Summary will
provide the most important information in a format that is easily understood.
In addition, the Department will release "How Healthy is San Francisco?: The
Department of Public Health Gives San Francisco A Check-Up. In this user-friendly paper,
the Department will highlight key statistics and information that indicate the public
health status of our city. We will take a broad view as we define "public health
status." What determines if we are a healthy community are many factors not
traditionally thought of as health indicators, such as social issues, economics and the
environment. It is our hope that by drawing together information about the City and County
of San Francisco that illustrates our public health status in a manner that is accessible
to the public and the media, we can bring attention to the myriad of issues that affect
our community's well being.
In honor of Public Health Week, the Department will distribute these reports to
community members, other organizations, and City Department, to raise awareness about
public health. Furthermore, we will do extensive outreach to the media to encourage them
to focus on public health issues during the week of April 6, 1998.
Commissioner Barnes encouraged a photo opportunity with the Mayor to publicize Public
Commissioner Guy suggested having an editorial in the S.F. Chronicle or S.F. Examiner.
Action Taken: The Commission unanimously adopted Resolution #11-98,
"Requesting the Mayor and the Board of Supervisors to Proclaim April 6-12, 1998,
Public Health Week, in the City and County of San Francisco," (Attachment A).
6) CONSIDERATION OF A RESOLUTION SUPPORTING THE CONCEPT OF A CITY AND COUNTY
OMBUDSPROGRAM TO ADVOCATE FOR HEALTH CARE CONSUMERS
Dr. Mitch Katz, Director of Health, reported that the Board of Supervisors,
under the leadership of Supervisor Amos Brown, is drafting legislation that would create a
countywide ombudsprogram. The program would provide consumer education, outreach, advocacy
and direct assistance to Medi-Cal recipients in San Francisco.
The Health Department maintains ombudsprograms at San Francisco General Hospital and at
Laguna Honda Hospital. This new program would, however, serve all medical recipients,
regardless of where they are currently receiving services.
The establishment of an ombudsprogram is consistent with the Consumer Bill of Rights
and Responsibilities established by the Presidential Advisory Commission on Consumer
Protection and Quality in the Health Care Industry.
A letter of support for a countywide ombudsprogram was submitted to the Commission by
Supervisor Amos Brown.
Mr. Hobson clarified that this program will start with Medi-Cal recipients and then expand to all consumers.
- Frederick Hobson, Consumer Board member, S.F. Health Authority
- Howard Wallace, Health Care worker, Local 250
- Maria Luz Torre, Parent Voices
- Patricia Bruno, Medi-Cal Community Assistance Project
- Shirley A. Bierly, President, California Legislative Council for
- Older Americans
- Michael Lighty, California Nurses Association
The Commission encouraged the
Department to have its staff liaison with this program.
Action Taken: The Commission unanimously adopted Resolution #12-98,
"Supporting the Concept of a City and County Ombudsprogram to Advocate for
Health Care Consumers," (Attachment B).
7) PRESENTATION AND CONSIDERATION OF A RESOLUTION
ENDORSING A RESPONSE TO THE BOARD OF SUPERVISORS HEALTH, FAMILY, AND THE ENVIRONMENT
COMMITTEE'S REQUEST TO SUBMIT A PROPOSAL TO ADDRESS ASTHMA, BREAST AND CERVICAL CANCER,
AND PROSTATE CANCER IN BAYVIEW HUNTERS POINT
Dr. Bob Prentice, Director of
Public Health Division, as background information, reported that a town hall meeting
organized under the auspices of the Bayview Hunters Point Health and Environmental
Assessment Project (BVHP-HEAP) resulted in hearings before the Health Commission and the
Board of Supervisors to review findings related to health problems in Bayview Hunters
Point. The Health, Family and the Environment Committee of the Board of Supervisors asked
the members of BVHP-HEAP and other community groups and individuals to return with
specific proposals to address the identified problems of asthma and breast, cervical and
prostate cancer, with the understanding that these are only initial programmatic responses
that will serve as a foundation to build from over time.
The attached budget and narrative are the result of a collaborative community process
that reflects hours of discussion and review among community representatives, members of a
variety of public and nonprofit organizations and Health Department staff. The process not
only brought together groups that had not worked together before, but even encouraged some
to set aside historical tensions in order to achieve a higher goal.
Dr. Prentice introduced Karen Pierce, the new Project Coordinator of the Bayview
Hunters Point Health and Environmental Assessment Project, who presented a proposal
(Attachment C), which is a multiyear program that the community feels it needs. Other
members of the Project presented. Marie Hoemke, member of the Asthma Task Force, presented
the asthma portion of the proposal. Kathy Sommers presented the breast and cervical cancer
portion of the proposal.
Cynthia Selmar, Director of Southeast Health Center and member of the Project, reported
that a detailed workplan is underway.
Commissioner Parker, as a provider in the Bayview Hunters Point community and
acknowledging the historical neglect in the community, stated that this is an opportunity
to welcome this challenge and move forward to address these health issues. Commissioner
Parker commended the Board of Supervisors in designating this project as a priority.
President Monfredini announced that even though Commissioner
Barnes had to leave, Commissioner Barnes is in support of the proposal.
- Dee Epps-Miller, BVHP Healthy Start Collaborative
- Gloria Thornton, S.F. Health Plan
- Ena Aguirre, resident of BVHP
- Nathan Nayman, Hospital Council
- Ray Thompkins, BVHP Task Force
- Francine Carter, resident, BVHP Task Force
Monfredini thanked everyone who testified. She noted that the Task Force has completed
this phase and encouraged the members to step back, look at the larger goal, and look to
your professionals. She commended the Task Force for its commitment and hard work to come
to this point.
Action Taken: The Commission unanimously adopted Resolution #13-98,
"Endorsing a Response to a Request from the Health, Family and the
Environment Committee of the Board of Supervisors to Submit a Proposal to Address the
Problems of Asthma and Breast, Cervical and Prostate Cancer in the Bayview Hunters Point
Community," (Attachment D).
Dr. Katz reported that Supervisor Bierman will hold another hearing in April at the
Health, Family, and Environment Committee. She is working on a resolution upon
recommendations from the Commission.
8)STATUS REPORT ON THE EMERGENCY MEDICAL SERVICES (EMS) RECONFIGURATION PLAN
Dr. John Brown, Medical Director for EMS Agency, introduced the second
quarterly report (October-December 1997) of the San Francisco Fire Department, EMS
Division, with the following:
The Fire Department has accomplished several important milestones in the merger
process, including the deployment of the paramedic ambulances to fire stations and the
electronic linkage of the Fire and EMS Dispatch functions. While response times have not
yet decreased, the changes in staffing and deployment strategies occurred late in the
quarter and it is too early to see the benefit of these changes. Moreover, call volume has
been affected by various factors, including a high hospital diversion rate, which results
in longer transport times.
I believe we are on tract with the implementation of the Phase II EMS Plan as amended.
We anticipate that Local 798 labor negotiations will conclude soon and we will have full
implementation of the new ambulance deployment strategy.
Rich Shortall, EMP-P, EMS Chief of the Fire Department, and Dr. S. Marshal Isaacs, EMS
Medical Director, provided an update on the status of changes in the delivery of emergency
medical services. For a copy of the full report, contact the Commission Office (554-2666).
The following areas were covered:
Additionally, they presented the following addendum:
- Station Deployment/Paramedic Captains
- Combined Communication Center
- Medical Direction
- Quality/Risk Management
- Multicasualty Incidents/Special Events
- Response Times
February 21, 154 paramedics officially became H-1 Fire-Rescue Paramedics and began 24-hour
shift assignments at 16 strategic Fire Stations throughout the City. The Department's
ability to staff 16 paramedic ambulances 24-hours each day is the first significant step
towards the goal of improving ambulance response times and the overall delivery of
emergency medical care to San Francisco residents and visitors.
We have begun to monitor the number of emergency calls that each ambulance is
dispatched to during a given 24-hour period. We specifically review the number of times an
ambulance is dispatched during the final 7 hours of the shift. It is our ultimate goal to
distribute the EMS workload as evenly as possible given our EMS resources, in order to
meet response time standards without creating an unreasonable workload for our EMS
providers. Toward this end, the first meeting of a joint Labor/Management Committee to
review workload and its potential impact on the quality of care delivered has been held.
This committee will meet on a regular basis.
Consistent with the trends noted during the second quarter, we continue to note
an increase in requests for emergency medical service. The dispatch center reports an
average of 210 ambulance dispatches per day. This is a significant increase over the 160
EMS dispatches that had been historically reported. In addition to factors already
discussed, the heaviest rains ever reported in the Bay Area certainly contributed to the
increase in EMS call volume. We are currently analyzing response time data for this period
in preparation for the next quarterly report.
President Monfredini thanked the Fire Department staff for the
quarterly report and will look forward to the next report.
- There needs to be careful analysis of data to determine the cause of the increased EMS
- Demographic data of the population is needed.
- The time of day and specific neighborhoods could be factors.
- The merger process on the whole has been positive, with the present problems being
minor. Personnel issues were the most important and were the biggest hurdles.
- Staff was encouraged to approach major foundations to do a comprehensive study for
- The integration process has been successful. Concern was expressed for Local 790.
9) PRESENTATION AND
DISCUSSION ON THE EMERGENCY SHELTER PROGRAM AND POTENTIAL POLICY IMPLICATIONS
Note: This item was presented prior to the Director's Report. (Agenda
Dr. Mitch Katz, Director of Health, gave a report of the 1998 Emergency Shelter Program
(Attachment E), with an overview of the potential policy implications raised by the
Dr. Katz raised issues of the impact on warehousing of the homeless, security concerns,
public health issues (i.e., TB, lice, scabies, gastrointestinal problems), and the site
not being available for long-term use. He emphasized that up to now there has been minimal
negative impact from these factors. Dr. Katz reported that after taking into consideration
the Commissioners' concerns and after gathering data, the Department will come back to the
Commission with a proposed policy regarding the emergency shelter. He emphasized that the
emergency shelter should be seen as a first step towards permanent housing.
President Monfredini stated the Department would target April 21, 1998 to bring any
policy issues to the Commission.
(3.7) PH-CHS-CSAS - Retroactive emergency
contract and sole source approval with Chemical Awareness and Treatment Services, Inc.
(CATS), up to the amount of $749,279, to provide overnight shelter and support services to
homeless residents of San Francisco for the period of March 1, 1998 through May 31, 1998.
(DPH contracted with CATS for services totaling $2,566,823 during FY 1996-97).
- Although the emergency shelter is not a permanent solution, keep the shelter open as
long as monies are available.
- The shelter should be a year-round commitment with a plan to have permanent housing for
- Homelessness should be looked at by other Departments; not sure this Commission is the
body to make the decision on the emergency shelter.
- Permanent housing, not just warehousing of the homeless, should be developed.
- Dialogue on the issues is welcomed.
- Data collection is needed for analysis.
- Dialogue with the community and staff prior to any decision is needed.
- Homeless crisis is on-going and is separate from a natural (El Niņo) crisis.
- There is a need to study the constituency.
- The emergency shelter is a half solution; and yet, the City cannot wait for permanent
Guy raised the concern about the impact of this emergency contract on the contractor's
existing programs and its Board of Directors.
Action Taken:The Commission unanimously approved the emergency contract.
The meeting was adjourned at 6:00 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission