Minutes of the Health Commission Meeting

Tuesday, April 21, 1998, 3:00 p.m.
at 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 3:00 p.m.


  • Commissioner Debra A. Barnes
  • 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 Edward A. Chow, M.D.
  • Commissioner Ron Hill

Action Taken: The Commission unanimously adopted the minutes of April 7, 1998.


(Commissioner David J. Sanchez, Jr., Ph.D.)

(3.1) DPH-CMHS - Request to approve a resolution authorizing the extension of Mental Health, Substance Abuse, Public Health and AIDS-related contracts expiring on June 30, 1998 for six months until the renewal contracts, effective July 1, 1998, can be negotiated, developed, processed and certified.

Commissioner Barnes encouraged contractors who are out of compliance on the Board diversity policy to address this issue prior to the Commission's consideration of their contracts.

Commissioner Sanchez abstained on the UCSF contracts due to conflict of interest.

(3.2) PH-CHS-CMHS - Request for retroactive approval of new contract with the Regents of the University of California San Francisco (UCSF) Langley Porter Hospital and Clinics for mental health outpatient services in the amount of $20,000 for the period of April 1, 1998 through June 30, 1998; and $100,000 for the period of July 1, 1998 through June 30, 1999 to provide outpatient services to San Francisco Mental Health Plan enrollees under a managed care program. (DPH contracted with UCSF for services totaling $13,848,952 during FY 1996-97).

(3.3) PH-CHS-CMHS - Request of approval of new contract with Westside Community Mental Health Center, Inc. for the provision of Mental Health and Substance Abuse Services for the CalWorks Program in the amount of $362,833 for the period of May 1, 1998 through June 30, 1999.

Commissioner Barnes requested the outcomes for this contract.

(3.4) PH-CHS-AIDS Office - Request for approval of retroactive renewal contract with the Regents of the University of California at San Francisco (UCSF) - AIDS Health Project, in the amount of $62,620, for the provision of the Repeat Anonymous Testers HIV Seroincidence Study, for the period of January 1, 1998 through December 31, 1998. (DPH contracted with UCSF for services totaling $13,848,952 during FY 1996-97).

Commissioner Sanchez abstained on this item due to conflict of interest.

(3.5) PH-CHS-AIDS Office - Request for approval of retroactive renewal contract with the Regents of the University of California at San Francisco (UCSF) - AIDS Health Project, in the amount of $93,692, for the provision of HIV counseling, testing, referral and partner notification (CTRPN) provider training, for the period of January 1, 1998 through December 31, 1998. (DPH contracted with UCSF for services totaling $13,848,952 during FY 1996-97).

Commissioner Sanchez abstained on this item due to conflict of interest.

(3.6) PH-CHS-AIDS Office - Request for approval of retroactive renewal contract with GAPA Community HIV Project, in the amount of $450,511, for the provision of HIV prevention services targeting behavioral risk populations, for the period of January 1, 1998 through December 31, 1998. (DPH contracted with GAPA for services totaling $425,744 in FY 1996-97).

(3.7) CHN-Primary Care - Request for retroactive approval of sole source and renewal contract with North of Market Senior Services (NOMSS), in the amount of $188,378, for the provision of primary care, outreach, drop-in and outpatient substance abuse services to seniors in the Tenderloin, South of Market and Potrero Hill areas, for the period of July 1, 1997 through June 30, 1998. (DPH contracted with NOMSS for services totaling $419,145 during FY 1996-97).

The Department will expedite the processing for the retroactive payments to the contractor.

(3.8) CHN-Planning & Marketing - Request for approval of renewal contract with Barnes Clarke Inc., in the amount of $300,000, to provide CHN strategic marketing services, for the period of May 1, 1998 through April 30, 1999. (DPH contracted with Barnes Clarke for services totaling $496,900 during FY 1996-97).

(3.9) CHN-Information Systems - Request for approval of new contract and sole source with

Peter B. Harrison, M.D., in the amount of $90,000, for medical information system consulting services for the Community Health Network for the period of May 1, 1998 through June 30, 1999.

Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on #3.4, 3.5 and the UCSF contracts of #3.1.

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


Healthy Families

I am very pleased to report that the San Francisco Health Plan (SFHP) has been selected as the Community Provider Plan in San Francisco. As such, they will be able to offer discounted premiums to families who enroll their children in their health plan. The Community Health Network has a contract with the SFHP to provide services to Healthy Families enrollees.

 The other health plans that will be available to families in San Francisco are Blue Cross, Blue Shield, Health Net and Kaiser. Under Healthy Families, parents/guardians will choose from combinations of health, dental and vision plans. The two dental plans offered in San Francisco will be Denticare and Delta Dental. The vision plan is Vision Services Plan (VSP); this is the only vision plan available in Healthy Families statewide. The San Francisco Health Plan is paired with both dental plans. The member premium for enrolling with the San Francisco Health Plan will be:

100 - 150% FPL

One Child

Two or More

SFHP, Denticare, VSP



SFHP, Delta Dental, VSP



150 - 200% FPL

One Child

Two Children

Three or More

SFHP, Denticare, VSP




SFHP, Delta Dental, VSP





For all other combinations of health, dental and vision plans, monthly premiums start at $7 and go to $27, depending upon household income and the number of children enrolled.

 I would like to acknowledge the tremendous work of the San Francisco Health Plan in securing the Community Provider Plan designation.

 Kellogg Grant

I am sorry to report that the Health Department received word on April 17 that we were not chosen to submit a proposal for the final round of the Kellogg Foundation Grant. In making it to the second stage of site visit, the Health Department had successfully made the first cut. The site visit went well and I am grateful to all those, including the President and Vice President of the Commission, who made themselves available for the site visit.


Needle Exchange

 On April 20, Health and Human Services Secretary, Donna E. Shalala, announced that based on her review of extensive scientific research, needle exchange programs are an effective form of HIV prevention and do not encourage the use of illegal drugs. While we were very happy that the Secretary concurs with the determination that was made by our Health Commission, Board of Supervisors and Mayor almost five years ago, we were dismayed that she did not lift the federal funding ban on needle exchange. Her statement thus provides a mixed message to local communities. On one hand the Secretary is saying needle exchange works. On the other hand, she's saying that federal dollars cannot be used to support this highly effective form of HIV prevention. As the Commission is aware, our San Francisco program exchanges two million needles a year, as well as providing condom distribution and referral to substance treatment and other treatments. Perhaps the Secretary's statement does represent progress on future fundingor needle exchange, but it is unfortunate that many people will die needlessly of HIV because of communities that do not have resources to establish needle exchange programs.

Adverse Drug Effect Article

A recent San Francisco Chronicle article (April 15), "Warning on Deadly Drug Side Effects: Study Says Medications Kill Over 100,000 a Year," reported on an analysis in the current issue of the Journal of the American Medical Association (JAMA) of studies about adverse drug reactions among hospitalized patients. The JAMA article excluded studies of adverse drug reactions due to medication errors; i.e., the study focused only on drugs that were intentionally prescribed and administered. Nonetheless, the number of resulting deaths ranked among the top ten causes of mortality in the nation.

It is important to keep in mind, however, that the analysis included many studies of patients in university teaching hospitals, who might have been sicker than average and, therefore, not necessarily representative of the more than 33 million patients who are admitted to hospitals in the United States each year. The actual burden of mortality ascribable to adverse drug reactions might, therefore, be somewhat less than the estimated 100,000 per year.

An accompanying editorial called for the implementation of better computer-based surveillance systems to assist in preventing such adverse drug reactions. The author of the editorial, David Bates, MD, MSci, of the Harvard Medial School, published his own study of adverse drug reactions in JAMA last year. His study estimated that the cost of preventable adverse drug reactions at Massachusetts General Hospital and Brigham and Women's Hospital in Boston (700 beds) is $2.8 million per year.

Although the benefits of drug therapy clearly outweigh the risks, as demonstrated by randomized controlled studies, more attention needs to be paid to the risk side of the equation. Risk reduction strategies also need to look beyond hospital care.

TB Control Program Featured in National Magazine

Congratulations are in order to L. Masae Kawamura, MD, Director of TB Control Program and her staff for the excellent article appearing in the April issue of Hippocrates magazine. "Stopping Tuberculosis" highlights the City's aggressive approach to fighting the spread of TB. The author noted the special challenges that San Francisco faces as a port city with 30,000 immigrants coming though the TB Control clinic each year. Additionally, the article details several case studies showing the extraordinary success of outreach workers administering Direct Observed Therapy (DOT) to patients in the Tenderloin, where TB transmission rates are more than 30 times higher than the national average. In the face of such overwhelming obstacles, San Francisco's TB cases have declined for four years in a row bringing rates to the lowest in history. I hope you will join me in commending Dr. Kawamura and her staff for their notable efforts.

Warning Signs – Bay Fishing

As you may recall, last year DPH Environmental Health staff posted temporary signs along the bay waters warning people of the potential health issues related to Bay fish consumption. The Department had permanent metal signs made, but jurisdiction for posting belongs to the Port and Golden Gate National Recreation Area (GGNRA). Staff have been working in cooperation with GGNRA, State Parks, San Francisco Port Authority, and the City's Recreation and Parks Department, to get the multilingual signs (Spanish, Tagalog, Cantonese, Vietnamese, Thai, and English) installed. Last week the permanent signs were posted along the Bay, at identified sports fishing locations. They are the first signs installed by any jurisdiction in the Bay Area. This signals the ongoing commitment of the Department to promoting good public health and informed consumers. A total of 21 signs have been installed at 11 various locations along the Bay from Fort Point to Candlestick Point. All four (4) of the property owners have been cmitted to maintaining the existing signs and have been supplied additional copies should replacements or additional postings become necessary.


Regulatory IssuesLaguna Honda Hospital has submitted plans of correction to the State Fire Marshall's Annual Survey and the Acute portion of the annual Licensing and Certification Survey. Findings from both of these surveys were routine with the exception that the State Fire Marshall invoked a life safety code prohibiting more than 30 patients in an open ward. LHH's plans of correction necessitated reducing census on two wards by one bed each.

 On April 14, the Hospital received the SNF survey results from Licensing and Certification. This voluminous document is under review by the CHN Executive Committee. The Executive Committee will begin developing short-term correction plans and developing a permanent long-term plan of correction to be submitted to Licensing and Certification. This plan will include consideration of a revised General Obligation Bond Program to fund a new facility for LHH.

Volunteers Annual Luncheon

Over 200 Laguna Honda Hospital volunteers have been invited to attend the Annual Volunteers luncheon to be held in Simon Auditorium tomorrow. Volunteers, Inc., President Jean McClatchy Bricker and the Volunteers, Inc. Board acknowledge the invaluable contribution volunteers make to LHH residents throughout the year during this annual celebration.

 The SFGH Volunteers will hold their annual Volunteer Recognition Luncheon on Saturday,

 April 25, 1998, the last day of National Volunteer Week. The luncheon is the way we thank our more than 800 volunteers who generously donate their time and talents to projects and programs at the SFGH.

The March statistics and Utilization Report are available in the Commission Office.


Monique Zmuda, Chief Finance Officer, reported the following:

A surplus of $16.2 million is projected for FY 19977-98 based on actual expenditures and estimated revenues for the first eight months of the fiscal year ending February 28, 1998. This projected surplus includes $8.8 million in one-time FQHC revenue that is anticipated this fiscal year and will be carried forward to FY 1998-99 to fund one-time equipment and facilities maintenance expense. One-time equipment and facilities maintenance expense funded by FQHC revenues was included in the FY 1998-99 budget that was approved by the Health Commission. This projected surplus also includes $6.8 million in Medi-Cal SB 855 Disproportionate Share revenue that will be accrued this fiscal year but received next fiscal year.

Excluding the FQHC revenue of $8.8 million and the SB 855 revenue of $6.8 million, the net surplus is $0.6 million. This projected net surplus of $0.6 million is a $8.6 million decrease from the second quarter projection of $9.2 million. This decrease is primarily due to: 1) revised estimates of State Realignment revenue provided by the City's Controller that indicate a $4.4 million reduction to projected realignment revenue this fiscal year; and 2) revised revenue estimates for Mental Health the Community Health Network.

The table shows projected fiscal year revenues and expenditures by Division.

Commissioner Sanchez thanked Ms. Zmuda for a comprehensive report. He reminded the Commission to revisit the revenues and expenditures from a budget perspective and service (quality assurance) perspective.

Commissioner Guy pointed out that we are starting to see how the safety net changes affect the Department's budget. She emphasized the need for policy to be reflected in the budget. She encouraged discussion and dialogue.

Commissioner Barnes noted the challenges for next year's budget.


Dr. Mitch Katz, Director of Health, provided statistical analysis and data at the Mission Rock Shelter. He gave the following update on the Mission Rock Shelter:

The Mission Rock Shelter contains separate areas for men, women and transgenders. Chemical Awareness and Treatment Services (CATS) was awarded the contract to operate the shelter and serve three meals a day to clients. CATS is providing case management of clients, benefits assistance, substance abuse counseling and information and referrals. The Health Department is furnishing medical support, mental health counseling and janitorial services. DPH provided security services until CATS was able to complete their own contract with TURF to provide 24-hour a day coverage.

Since opening its doors Mission Rock Shelter has averaged a census of 563 people, with a high of 687 and a low of 281. Approximately 16% of the population are women, and 1% transgender.

CATS provides daily and weekly updates to the Department. Included in these updates are a client count, case management referrals, transports, meals served, pet count, staffing, and financing. A Health Status Assessment meeting is held every other Thursday with CATS and all the Departmental staff involved with the project, including Community Substance Abuse Services, Mental Health, TB Control, Environmental Health, and Tom Waddell Clinic.

The Mayor has been very pleased with the success of Mission Rock Shelter and has instructed h is Budget and Homeless Offices to support financing the program as an ongoing shelter. Mayor Brown instructed Bill Lee to locate alternative sites in anticipation of the Mission Rock Shelter demolition in April 1999 when the Giants Ball Park is built. Ongoing conversations have ensured between the Mayor's Office, Department of Human Services, the Homeless Coalition advocates, and the Health Department to develop a forward looking homeless shelter plan encompassing the goals set forth by the Mayor.

DPH believes a very real need exists for these 600 plus shelter beds. At the same time we realize that shelter alone is not the answer to the problems that are encountered by the homeless population. It is the philosophy of the Department and of the City to provide as many opportunities as possible for exits to homelessness. Given this philosophy, staff has been working with CATS in the development of a number of innovative programs to use this shelter as a stepping stone to permanent housing.

CATS has developed a work training program for clients under Case Management (currently 110 individuals) that begins April 23. The program is designed to teach clients work skills, including janitorial, housekeeping and kitchen/culinary duties. The 3-month program will include weekly seminars. At the end of the 3-month course, clients will receive graduation certificates and job referrals. This program will help those clients trying to re-enter the work force. In addition, an MOU between Glide and CATS to provide vocational training is close to being finalized. Needs assessments were conducted for all clients. CATS is evaluating the assessments to determine educational and literacy needs.

In the fiscal year 1998-99 budget that the Commission approved, we included as a high priority a program to provide direct access to housing. We believe that having an emergency shelter will enable the Department to stabilize individuals and help them make the transition to more permanent types of housing.

Based on this information, the Department makes the following recommendations for the Commission's consideration:

  • DPH continue to build and refine its internal shelter team using an integrated service delivery approach as the model;
  • Enumerate the type of services that DPH will provide through its own and or/contract employees to the shelter population; and
  • Work with the Mayor's Office, Department of Human Services, other relevant City Departments and homeless advocates to craft expansion of the shelter program beyond April 1999 using the Continuum of Care Plan as a model.
Commissioners' Comments:
  • The shelter program is a shared responsibility with the Department of Human Services, and, therefore, financial commitments should reflect this.
  • TB prevention approach is good.
  • This is a first step in a major dialogue and action towards a coordinated approach to homelessness.
  • Dialogue should include the Departments, the Commissions, the Local Homeless Program Board, businesses, corporations, and the comment.
  • There are many more homeless persons not being served.
  • The data shows more men are in need. There needs to be a revitalization of services for men.
Action Taken: The Commission unanimously adopted Resolution #19-98, "Supporting Continuing Shelter Operations at Mission Rock and Further Working on the Development of a Shelter Policy Extending Beyond Operation of this Facility to Emphasize Exits from Homelessness, Rather than Warehousing of Individuals."


Barbara Garcia, Director of Community Substance Abuse Services, provided a summary of the process and progress of Treatment on Demand for the past two years. For a copy of the report, contact the Commission Office at 554-2666.

Ms. Garcia reported the following:

The goal of Treatment on Demand is to reduce delays in gaining access to substance abuse care by providing appropriate treatment services to those in need in a prompt manner.

The design of the services represents some of the most innovative approaches in the country. Programs were designed, enhanced or expanded during the first two years with an emphasis on adults, families and underserved populations. There were seven new Request for Proposals (RFP) completed during FY 1997-98, and one (MSM/Methanphetamine Users) that is anticipated for release by May 26, 1998. The RFP work groups was a new process for Community Substance Abuse Services and were reflective of the cultural, gender, orientation and ethnic diversity of San Francisco. The prioritization and enhancement of new Treatment on Demand services was based on available substance abuse data, results from public hearings, and Council members expertise in the field.

Looking towards FY 1998-99 we have several challenges, the standardization of services including waiting list management, the integration of services with Mental Health and Primary Care, and to continue to increase access of substance abuse services to underserved populations.

Ms. Garcia acknowledged the CSAS staff and the 23 members of the Treatment on Demand Planning Council. The Council includes service providers, consumers, community leaders, and representatives of appropriate City Departments. She reported that for FY 1997-98, there are over 2600 service slots funded with $7-1/2 million from CSAS.

The Council believed that all system enhancements should become part of the new Treatment on Demand system. A number of the system enhancements will require the development of new linkages between programs and systems, such as better linkages between treatment and vocational and educational resources. Others will require training, such as alternative to booking on the police officer level for parolees, ex-offenders, youth, and multiple diagnosed people; this enhancement will also require enhanced linkages among services and systems. Others are a matter of adding services or approaches to current programs and system orientation, such as smoking cessation and needs assessment and strategic plan development for youth.

  • Community partnerships
  • Systemwide linkage with Mental Health
  • Hospital medical discharge linkages to substance use services
  • Housing support for homeless substance users
  • Faith and spiritually-based interventions
  • Environmental strategies for all users
  • Smoking cessation in all treatment programs
  • Medical detoxification non-residential treatment in the Tenderloin and Mission
  • Family focused integration into programs for Neighborhood African-American Treatment Programs
  • Long-term medical detoxification for lesbians, gays, bisexuals, and transgender
  • More accessible and increased availability of needle exchange for lesbians, gays, bisexuals and transgender
  • Outpatient treatment for Latino youth
  • Better linkages between treatment vocational and educational resources
  • Multidisciplinary teams in treatment settings for multiple diagnosed people
  • Diversion to treatment and home detention treatment services for parolees/Ex-offenders
  • Needs assessment services for hearing and visually impaired people
  • Developing collaborative efforts with disability, advocacy and services organizations
  • Treatment sites meeting the Americans with Disabilities Act
  • Formalized discharge planning from jails and prisons for the incarcerated
  • Better links to veterans' system for veterans
  • Needs assessment and strategic plan for youth
  • Training and education mobile team and programs for sexually traumatized people
Michael Siever, Ph.D., Co-Chair of the Council, gave an overview of the structure and themes of the Council. The Committees include: 1) response teams, 2) membership, 3) accountability, and 4) evaluation of needs. The themes of the Council include cultural competency, a holistic approach to integrating services, development of strategies to engage people into treatment, harm reduction, standards of accountability, training of staff, and the concept of wrap-around services.

President Monfredini thanked Ms. Garcia for a comprehensive report and stated that all of our citizens in the City need to be truly informed about Treatment on Demand.

Commissioner Sanchez supported the direction of the Treatment on Demand concepts being discussed in the wider circle at the Federal level, private foundations, and other cities.

Commissioner Guy stated the community partnership and integration piece are all valuable.

Commissioner Barnes expressed concern about having adequate administrative staffing for the large number of contracts and development of the RFP's.


Anthony Wagner, Interim Executive Administrator of the Community Health Network, reported the following:

As a result of the increased pressures to provide medical care in modern, efficient settings, and coupled with the obsolescence of several buildings at San Francisco General Hospital, it has become necessary to develop new clinical facilities on the Campus. The construction of a new 120,000 square foot structure, housing ambulatory clinics and medical research labs is essential to the continued success of the Community Health Network, and its development will create many long-lasting benefits for health care delivery to the residents of San Francisco.

A version of this project came before the Health Commission in 1993 as the RFD Building, which at the time was intended to respond to a request by the University of California at San Francisco for a research facility in the City. Numerous studies, estimates, and schematic plans were developed in connection with that proposal, and although the University ultimately withdrew the request, the investigations created the foundation for the current proposal.

The present day proposal for the Ambulatory Care and Research Center blends clinical and medical research activities in a four-story structure which will allow relocation and consolidation of various clinics from obsolete quarters to modern, attractive, efficient clinic space. At the same time, the availability of new space will set the stage for renovation or replacement of older facilities at the SFGH Campus.

The investigation and planning to date by the Community Health Network indicates that excellent circumstance exist now for the development of this project, and it is an opportunity that will serve the residents of San Francisco well for years to come.

Commissioner Guy requested the Department to bring back to the Commission the plan for financing this project. She expressed her concern about the role of private financing for a public project and any public policy implications.

Action Taken: The Commission unanimously adopted Resolution #20-98, "Directing the Community Health Network to Develop a New Ambulatory Care and Research Center at San Francisco General Hospital,".


President Monfredini acknowledged the National Nurses' Week activities during the week of May 6-12, 1998.

President Monfredini adjourned the meeting at 5:10 p.m. in memory of Pamela Melillo, R.N., B.S.N., a Health Educator at San Francisco General Hospital for 13 years. Ms. Melillo died of breast cancer yesterday.

Sandy Ouye Mori, Executive Secretary to the Health Commission