Minutes of the Health Commission Meeting

Tuesday, June 16, 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 3:05 p.m.


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


Action Taken: The Commission unanimously adopted the minutes of June 2, 1998.


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

(3.1) DPH  Request for approval of Department's Annual Report of Memberships in professional organizations for FY 1997-98, and approval of a resolution to the Board of Supervisors amending the Administrative Code to add organizations to the Department's FY 1998-99 list.

PH-CH&S-IMMUNIZATION  Request for approval to accept and expend a new grant in the amount of $523,318 from the California Department of Health Services to provide immunization-related services for the period of July 1, 1998 to June 30, 1999, and sole source

approval for six new contracts:  Northeast Medical Services in the amount of $39,916; Mission Neighborhood Health Center in the amount of $51,932; San Francisco Health Plan in the amount of $18,327; San Francisco Medical Society in the amount of $31,791; St. Luke's Health Care Center in the amount of $ 21,000; and San Francisco Community Clinic Consortium in the amount of $53,849, for the same time period.

PH-MIS  Request for approval of combined retroactive sole source in the amount of $483,435 for custom programming services for MIS' INSYST and SMS/EAD systems for the period of January 1, 1998 through June 30, 1999, and retroactive contract renewal with United Behavioral Health Services (UBH) in the total amount of $1,731,331 to continue maintenance of the Department's INSYST system, to procure system/licensing for the Department's new cCura3 Managed Care System and to procure custom programming services to interface the Public Health Division's INSYST and SMS/EAD systems with all department (PHD/CHN) systems for client/services tracking for the period of July 1, 1997 through June 30, 2000.

(3.4) PH-BEHM - Request for approval of contract modification with the Industrial Emergency Council in the amount of $72,550, for the provision of hazardous materials and confined space rescue training for the period of July 1, 1998 through December 31, 1998.  Total amount of contract, including this modification, is $164,550 for the period of January 1, 1998 through December 31, 1998.

(3.5) PH-CHP&P-AIDS Office  Request for retroactive renewal contract with the University of California San Francisco Urban Health Study (UCSF), in the amount of $538,970, to provide community-based HIV prevention, counseling and testing services to injection drug users, 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) CHN-SFGH  Request for contract renewal with Richmond Area Multi-Services, Inc. (RAMS), in the amount of $2,039,150 per year to provide partial hospitalization services for the period of July 1, 1998 through June 30, 2001.  (DPH contracts with RAMS for services totaling $4,013,809 during FY 1996-97).

(3.7) CHN-SFGH  Request for approval of new contract with Agostini Nurse Staffing, Groves Nurses Registry, HRN Services, Net Healthcare, Nurse Providers, The Registry Network, Sunrise Nurses, Professional Recruiters, TherAmerica and United Nursing International, for the provision of supplemental nurse staffing for a combined amount not to exceed $1,600,000 per year for the period of July 1, 1998 through June 30, 2000, and a sole source and new contract with The Registry Network for the provision of supplemental radiology personnel for $100,000 for the period of July 1, 1998 through June 30, 1999.

Public Speaker: Dale Butler, SEIU Local 790

CHN  Request for retroactive contract renewal with Bayview Hunter's Point Foundation (BVHP) in the amount of $421,587 for the provision of mental health case management and outreach services to homeless persons for the period of July 1, 1997 through June 30, 1998. 

(DPH contracted with BVHP for services totaling $6,861,177 during FY 1996-97).

Commissioner Sanchez expressed his concern on the low scores in the monitoring report and the retroactivity of this contract.

President Monfredini expressed her concern on any multiyear renewal of this contract.  She requested the Department to extend this contract on a month-to-month basis through September.  She also requested the Department to come back in 90 days (September 15, 1998) with a list of community-based organizations eligible to compete for this contract if the present contractor continues to be out of compliance.

Commissioner Hill requested the Department to bring back an alternative plan if the present contractor continues to be out of compliance.

Commissioners recommended to approve the retroactive contract for FY 1997-98.

(3.9) CHN  Request for approval of new contract with The Lewin Group in the amount of $160,000, to provide Strategic Planning Services for the Community Health Network for the period of July 1, 1998 through June 30, 1999.

Commissioner Sanchez referred to Health Commission Policy #24 on the Board and staff diversity.  He posed the question to the contractor on what would be their plan to comply with the policy.

Dr. Molly Coye, Project Director, stated that the Chairman and CEO of Quintiles Transnational Corporation feels this is a legitimate issue and indicated his support in a letter.

Commissioner Hill commented that specific policies need to be followed if contractors want to do business in San Francisco.  He also noted that the demographics on the Contract Providers Summary Form for gays and lesbians were not included.

Commissioner Sanchez requested to continue this item for 30 days (July 21, 1998).  A letter will be sent to the CEO of Quintiles, with a copy of the Health Commission Policy #24, and a request for a plan for compliance to the policy.  If a response is received prior to the 30 days, this item will be recalendared prior to July 21, 1998.

Commissioner Sanchez commented that the Commission could also consider a waiver policy with specific criteria.

(3.10) CHN  Request for approval of new performance agreement with Foundation Health Systems (FHS), to provide hospital services to members of FHS Affiliates, specifically HealthNet, for the period of July 1, 1998 through June 30, 1998.

(3.11) CHN  Request for approval of new performance agreement with the San Francisco Health Plan for services provided under the California Managed Risk Medical Insurance Board, Healthy Families Program of the State of California for the period of July 1, 1998 through June 30, 1999.

Action Taken: The Commission (Monfredini, Sanchez, Guy, Hill and Parker) approved #3.1, 3.2, 3.3, 3.4, 3.5 (Commissioner Sanchez abstaining), 3.6, 3.7, 3.8, 3.10 and 3.11.  Item #3.9 was continued for 30 days.  Refer to #3.9.

(Provides information on activities and operations of the Department). 
(Mitchell H. Katz, M.D., Director of Health)


Prenatal Care to Undocumented Women

On June 10, 1998, the State Supreme Court unanimously and without comment denied the State's request for a review.  The State had appealed to the Supreme Court to ask for reconsideration on a lower court's decision to prevent the State from funding prenatal care to undocumented women.  In addition to this appeal, the State is also appealing an order in the Los Angeles Appellate Court.  That trial is scheduled for November 1998.  Therefore, at this time the State is still required to fund necessary prenatal care services to undocumented women.


Suicide Prevention

An innovative wire fence designed to prevent people from jumping off the Golden Gate Bridge was unveiled at a press conference June 9th convened by the Golden Gate Bridge District.  Completion of the prototype is a milestone in the decades long attempt to end the string of suicides that have characterized this remarkable structure.  Records indicate that more people have committed suicide by jumping off the Golden Gate Bridge than from any other site in the world.

Also presenting at the press conference were members of the Golden Gate Bridge Barrier Coalition whose advocacy efforts over the years have pressed the Bridge District to develop a technological solution to counter the attractiveness of the bridge to suicide.  The Coalition noted the fact that suicide is frequently a tragic and permanent end to a temporary problem, and that research demonstrates that over 90% of those prevented from committing suicide on the Golden Gate Bridge do not attempt suicide again.  Although there has been much attention recently to the proposed median barrier to reduce traffic accidents, there were more deaths from suicides on the bridge last year (40 known suicides) than there were from motor vehicle fatalities over the last quarter century (34 deaths).

It should be noted that consensus on the proposed design has not yet been reached.  Some factions have expressed their concern that this particular design would ruin the aesthetic lines of the bridge and needs reengineering. 

The prototype fence will remain on display by the administrative building at the southwest entrance to the bridge for public viewing and comments over the next few months.  Comments can be sent to:   Golden Gate Bridge District, P.O. Box 9000, Presidio Station, San Francisco, CA  94129-0601

Currently the newly designed Bay Bridge has no plans for a safety barrier to prevent suicide attempts even though pedestrian and bicycle access will be available.  The department will be forcefully advocating for safety features to be incorporated into the structure during the design phase of the project.

Immunization Registry Grant

We have received written notification of a $232,000 grant award for the Immunization Registry Grant.   This is a substantial increase over the previous award of $90,000.   Grant funds will pay for two technical positions with approximately $80,000 extra for development and equipment.  I would like to acknowledge the good work of Jan Gurley, M.D., Iker Navarro and Diane Portnoy in putting this grant package together.

Illegal Disposal Site - Yosemite Avenue Follow-Up

You may recall in last months Director's Report I announced that the Superior Court awarded the City a default judgment of $3.6 million against the property owner of 1301 Yosemite Avenue.

This judgment affirmed the City's findings that the property owner was operating an illegal dump site and that the accumulated solid waste on his property was creating a public health and environmental hazard.  It appears that the property owner will not comply with the clean up demand.  Consequently, Environmental Health staff has set up a mid-June meeting and a site visit with California Integrated Waste Management Board staff.  This meeting will set forth a schedule and a plan of action to remediate the hazard.

In addition, the City is pursuing several businesses that had operated an illegal solid waste facility and an illegal asbestos disposal waste site at the same location.   The City is seeking recovery of costs associated with enforcement efforts, attorney's fees and civil penalties for the operators of the solid waste facility.  A trial is set for late August.  The court will hear the City's request for a temporary restraining order and a preliminary injunction for the asbestos disposal operators in late June. 

New Food Package for Homeless Prenatal Participants

Over the past few months, WIC Program staff has been working with the State WIC Branch to determine the appropriate food supply for homeless women. Currently, the standard WIC food package provides milk, cheese, dried beans or peanut butter, eggs and juice.   Homeless families have difficulty using these foods because of lack of cooking and storage facilities.

The researchers organized focus groups and interviews at homeless shelters and soup kitchens.  As a result of the study, a new variation on the standard prenatal food package was developed.  Prenatal women will now be able to receive their milk in half-gallon containers and will be offered canned beans instead of eggs.  WIC program managers estimate the new food package will be available to approximately 100 homeless prenatal women in San Francisco.  California has approximately 4,400 homeless prenatal women.

Health Clinic for Lesbian, Gay, Bisexual and Transgender Youth

Castro Mission Health Center will be home to a new clinic serving LGBT queer and questioning youth starting July 2.  The clinic, called Dimensions, will be held every Thursday night from 5 to 8 p.m. as a 6-month pilot program.  It will house comprehensive primary care, mental health, substance abuse, and health education and promotion activities. 

Dimensions was created as a result of research showing that LGBT youth were unlikely to seek medical care out of the belief that providers are insensitive to their needs, and that confidentiality regarding sexual orientation may be breached to parents and others.  Dimensions is the result of a strong collaboration between Castro Mission, SPY, the Office of Lesbian and Gay Health Services and community-based agencies, including Health Initiatives for Youth, LYRIC, and New Leaf.

Mental Health Association Jubilee

Jo Ruffin, LCSW, Director of Community Mental Health Services, was honored at the 50th Jubilee Anniversary Celebration of the Mental Health Association of San Francisco on May 19, 1998 for her leadership in community mental health services and her years of distinguished service.  She was also honored on June 2, 1998 at the 36th Annual Suicide Prevention Banquet.


State Licensing Survey Team Visit

Members of the State Licensing Survey Team made an unannounced visit to SFGH last week.  The four-member team spent four days reviewing charts, interviewing patients and staff, and observing the care process on Ward 4A and in the Mental Health Rehab Unit.  This type of examination is used to determine our ability to maintain our license and to treat Medicare and Medi-Cal patients at the Skilled Nursing level of care.  After such intense scrutiny, no significant findings were made.  Only minor deficiencies were found such as soap scum in a single shower.  These are excellent results and every staff member involved with these units is to be congratulated. 

Status of Annual Licensing on Certification

On June 8th the State Licensing and Certification Division (L&C) notified Laguna Honda that its Plan of Correction for deficiencies identified in the annual survey was unacceptable.  The L&C also reported that it was recommending imposition of monetary penalties to HCFA.  Disappointingly, the L&C provided no information regarding why the Department's Plan of Correction was unacceptable.  On June 11th, I convened a press briefing to discuss the L&C survey in a public forum.  At the briefing, I released a copy of my June 11th letter to HCFA, where I requested:

  • A 60-day extension on all penalties,
  • A commitment from the State and HCFA to work collaboratively to determine whether we could decrease the census by discharging residents home or to other appropriate settings, and
  • A written response to our Plan of Correction.

Laguna Honda staff has begun implementation of the Plan of Correction, which includes a 90-day moratorium on new admissions with the exception of patients from SFGH who have been denied admission to all other San Francisco facilities.   We have also committed to the creation of separate dining spaces and activity areas.  We have told the State and HCFA that we believe in creating new dining and activity areas and will certainly include them in the plans for the new facility.  However, we believe the need for these areas must be weighed against the needs for caring for people who have no alternatives.  I will keep you apprised of our progress on this important issue.

AHA Volunteer of the Year Award

Anthony Wagner was honored June 5th at the American Heart Association's  (AHA) Western States Affiliate (California, Nevada and Utah) annual dinner in Irvine, California.  Tony was presented with the AHA's highest award of the year -- Non-Physician Volunteer of the Year.

Congratulations to Tony for more than 23 years of volunteer service to the AHA where his contributions have been substantial, serving at the national level on numerous committees and on the board.

Celebration of Philippine Independence Day

Laguna Honda Hospital staff have coordinated the production of a special variety show of singers, dancers and guest speakers to celebrate Philippine Independence Day in Gerald Simon Theater and Clarendon Hall on June 19th.  The residents focused event will serve as a major activity for residents of Filipino descent and all other cultures who would like to partake in the show and festivities.  Staff members are producing the event on their own time and are to be commended for their efforts to contribute to the cultural enrichment and entertainment activities for our residents.

LHH Senior Pharmacist Retires

On behalf of the Executive Committee and management staff, I would like to acknowledge and commend Wiley Chan, Senior Pharmacist, for his 37 years of dedicated service to the residents of Laguna Honda Hospital.  Mr. Chan is retiring at the end of June.

May 1998 CHN Statistics

The Community Health Network computer used to track CHN statistics became infected with a virus (transferred from an in-house diskette) last week.  The virus wiped out most of the data files.  Information Systems is attempting to restore the files.  If unsuccessful, they will send the computer out to a data recovery specialist.  As a result, last months utilization statistics are unavailable. Hopefully, the problem will be fixed by next month.

May statistics for other areas are available in the Commission Office.

Commissioners Monfredini, Sanchez and Guy commended Dr. Katz for his proactive strategy in the press conference on Laguna Honda Hospital.  The full Commission is in support of Dr. Katz's public position in opposing any inappropriate discharging of patients from Laguna Honda Hospital.

President Monfredini acknowledged Larry Funk, Executive Administrator of Laguna Honda Hospital, for his leadership and commitment to the patients.

Commissioner Guy emphasized the need for public education on Laguna Honda Hospital and its role in housing for the frail elderly and disabled.



John Williams, CEO and President of Catholic Healthcare West Bay Area Region; Rosemary Fox, Vice President/COO of St. Mary's Medical Center; and Daniel Ostrow, Administrator of St. Mary's Medical Center, were present for this item.

Action Taken: The Commission unanimously adopted Resolution #23-98, "Determining Whether the Closure of the Obstetrics Inpatient Service at St. Mary's Medical Center Will or Will Not Have a Detrimental Impact on Health Care Service of the Community".


Dr. Mitch Katz, Director of Health, submitted his response to the Commission's request for additional information on the governance issue.

Public Speakers:

  • Dale Butler, SEIU Local 790
  • Frederick Hobson, S.F. Tomorrow

Commissioner Guy, from a public health point of view, supported the concepts of consumer participation, public accountability, and cultural competency for any governance structure.  She would like to have implementation protocols developed for the governance aspect of the Universal Health Care Plan.

Action Taken: The Commission unanimously adopted Resolution #24-98, "Supporting the Recommendations of the Mayor's Blue Ribbon Committee on Universal Health Care".


Bob Prentice, Ph.D., Director of the Public Health Division, submitted a Memorandum of Understanding (MOU) executed between the Public Health Division of the Department of Public Health and the School Health Programs Office of the San Francisco Unified School District, as well as a copy of a letter jointly signed by Mitch Katz, M.D., Director of Health; and Waldemar Rojas, Superintendent of Schools, inviting people to participate in a new School Health Planning Committee.  Together they represent important strides forward in the development of a collaboration between the Health Department and the School District.

The letter signed jointly by Mitch Katz, M.D. and Waldemar Rojas, establishes the forum in which planning for school health services will occur.  It is intended to encourage the thoughtful development of school health in initiatives, collaborative models and financing strategies to improve the health and well being of children and youth in school.  Although there had previously been a School Health Planning Committee, it was not as broadly constituted, nor did it have a formal charge from the Director of Health and the Superintendent of Schools.  Its deliberations seldom were translated into policy.  The new School Health Planning Committee not only has the endorsements of the Director of Health and the Superintendent of School, it incorporates representatives of private sector health care providers and private schools to broaden the base of school health planning.  It also has a more comprehensive charge to look not only at clinical programs in schools, but at physical and social environmental factors that affect the health of students and staff in the schools.  From a public health perspective, it is a welcome forum to incorporate hitherto separate interactions related to student nutrition, environmental health issues (food safety, lead, asbestos, air quality, pesticide use, etc.) and social environment, into a more broadly conceived understanding of healthy children, healthy schools and healthy communities.

Trish Bascom, Director of School Health Programs in the San Francisco Unified School District, supports and emphasized the importance of collaborative efforts with the goal of benefiting the children and youth in the City and County of San Francisco.

Public Speaker: Nathan Nayman, Hospital Council

Commissioner Sanchez expressed his support for collaborative efforts with good communication among all of the partners.

Commissioner Guy encouraged the participation of students and families in any planning process.

Commissioner Parker is impressed with the emphasis on prevention and education.


Monique Zmuda, CFO, presented the following:

The existing maternity package offered at the Community Health Network, which applies to San Francisco residents and tourists, has been in place since 1991 and is offered to approximately 25 women per month (300 per year).  The Department proposes to amend the package to differentiate the cost to San Francisco residents from the cost to tourists and non San Francisco residents.  It will also provide an alternative to Medi-Cal coverage for women who are ineligible for Medi-Cal.  The amendment also updates the fees to reflect cost increases over the past seven years.

The following proposal recommends two policies for the Commission's consideration:

  • Development of an OB package which is reasonably priced (recovering Medi-Cal rates of reimbursement), which can be offered to low income women and those who opt to pay for services rather than apply for Medi-Cal.
  • Development of an OB package rate, which differentiates between San Francisco residents and non-residents.

The proposal is priced competitively at the Medi-Cal reimbursement rates which will offset potential revenue losses which might occur in the event that women opt to pay for the maternity services in lieu of applying for Medi-Cal coverage.  In addition, the new package is priced consistent with San Francisco market for non-residents.

Highlights of the maternity package revisions are:

  • Provides a payment alternative for women who are ineligible for Medi-Cal because of excess financial resources, or women who are eligible for Medi-Cal but decline to apply.
  • Package has not been revised since 1991.  Current prices are well below other hospitals' payment plans and less than Medi-Cal reimbursement rates for prenatal care and normal delivery.
  • Package currently used by an average of 25 women a month  about 20% of SFGH deliveries.
  • Proposed package prices are set at Medi-Cal reimbursement rates and competitive with other San Francisco hospitals.
  • Prenatal and delivery package rates will be used at SFGH and Health Centers, which are now on the same billing system.
  • Proposed package has two payment options to accommodate different patient circumstances:
    • Prenatal care and labor and delivery
    • Labor and delivery only

Action Taken: The Commission unanimously adopted Resolution #24-98, "Approving a Revised Maternity Fee Package for the Community Health Network,".


Frederick Hobson, S.F. Tomorrow

The meeting was adjourned at 4:40 p.m.


Sandy Ouye Mori, Executive Secretary to the Health Commission