Minutes of the Health Commission Meeting

Tuesday, July 7, 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 Debra A. Barnes
  • Commissioner Edward A. Chow, M.D.
  • Commissioner Lee Ann Monfredini
  • Commissioner Harrison Parker, Sr., D.D.S.
  • Commissioner David J. Sanchez, Jr., Ph.D.


  • Commissioner Roma P. Guy, M.S.W.
  • Commissioner Ron Hill

Action Taken: The Commission unanimously adopted the minutes of June 16, 1998.


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

Status report on UCSF Stanford Health Care's Compliance Plan for Board and staff diversity

Commissioners expressed appreciation to the four representatives of UCSF Stanford Health Care for the compliance plan and for their presence today.

President Monfredini offered UCSF Stanford Health Care to look at the Health Commission as a partner and a resource in identifying qualified candidates for the Nominating Committee.

Status report on SAGE's compliance for Board diversity

Commissioner Barnes acknowledged the excellent progress towards compliance by the contractor.

Request to authorize the renewal of San Francisco's participation in the California Health Cities Project.

Commissioner Barnes requested a copy of the CHIPPS report.

Commissioners recommended support for Resolution # 26-98, "Supporting the San Francisco Healthy Cities:  CHIPPS Senior Injury Prevention Collaborative Project."

(3.4) DPH – Request to approve a resolution authorizing San Francisco General Hospital to accept and expend a gift currently valued at $1.27 million bequeathed to the hospital by the estate of Kathleen Mason.

(3.5) DPH-Administration-CSAS – Request to enter into a FY 1998-99 Combined Net Negotiated Amount and Drug Medi-Cal Hold Harmless Agreement with the State Department of Alcohol and Drug Programs in the amount of $15,986,354.

Commissioner Barnes requested staff at the appropriate time to present substance abuse State funding issues to the Commission.

(3.6) CHN-SFGH – Request to approve continuation of a Proposition J contract for the provision of laundry processing services at SFGH for the period of July 1, 1998 through June 30, 2000.

(3.7) PH&P- AIDS Office - Request for approval of 1998-99 Ryan White Comprehensive AIDS Resource Emergency Act of 1990 (CARE) Title I awards in the category of Mental Health and new service awards from RFP 018-97 Integrated HIV Services and Other HIV/AIDS Health Services in the amount of $8,204,914 and new General Fund service awards from RFP 018-97 in the amount of $686,156.  The contract period for the Mental Health CARE Title I contracts will be March 1, 1998 through February 28, 1999, and July 1, 1998 through June 30, 1999 for the new CARE Title I and General Fund contracts with the following contractors:

Note: Not including Dental Services, which will be calendared at a future Budget Committee meeting

PH&P-CSAS – Request for approval of retroactive first modification to the contract with San Francisco State University (SFSU) in the amount of $100,000 to augment a new 14 month Community Health Training and Development Center program to provide training in drug addiction treatment for the period of May 1, 1998 through June 30, 1999.  The total contract amount including this modification is $177,394.  (DPH contracted with SFSU for services totaling $77,394 during FY 1996-97).

Commissioner Sanchez requested the President of the Commission to send a letter to the new Chancellor of the California State University system regarding compliance to Health Commission Policy #24.  Another alternative is to have City College of San Francisco, whose Board of Trustees is reflective of diversity, be the lead agency for this contract.

Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with the specific requests.

Commissioner Chow expressed concern for a uniform position on how the Commission looks at Policy #24 and the need for clarity on the diversity of Board and staff.  He requested the Department to re-look at Policy #24 and come back to the Commission with any potential amendments to the policy.


(Provides information on activities and operations of the Department).

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


FY 98-99 Budget

The Finance Committee of the Board of Supervisors completed FY 98-99 budget hearings June 25th and made final recommendations on the budget to be forwarded to the full Board for consideration.   A summary of the additional funding and cuts recommended by the Finance Committee include:
FY 98-99


Mental Health - Pharmaceuticals

$ 267,000

Parent Talk Line


Juvenile Action Plan – 5 FTE's


Walden House


Gambling Prevention


RAMS Vocational Training


Latino AIDS Prevention


Mission Community Family Net


Shanti HIV/AIDS Services


HIV City College Testing


COLA - Mental Health/Sub Abuse




Community Health Network

$  (133,603)

Population Health & Prevention





$  2,374,624


I am pleased to announce that the Finance Committee recommended additional funding of $2.69 million for the Department of Public Health.  The Finance Committee recommended cuts of only $315,376 for the Department.  These recommendations included reductions to personnel expense and computer equipment.

State Budget

Although the State 1998-99 fiscal year began July 1,1998, a budget has not yet been passed. 

As you undoubtedly have heard from the media, Democrats and Republicans in the Legislature and the Governor's Office are at odds over how the State's $4.2 billion surplus should be used.  The major issues involve possible tax and Vehicle License Fee (VLF) reductions, education spending, and to some extent, local government relief.  On July 2,1998 the Democrats announced a counter-proposal to the Governor's VLF proposal, which includes a cent reduction in the state sales tax, a partial restoration of the renter's tax credit, and a variety of business tax cuts.  It is felt that a sales tax reduction would be more evenly distributed across income levels than would a reduction in VLF.

The Legislature created a special Conference Committee on Potential Tax Relief, which has been meeting over the last two weeks to discuss three Vehicle License Fee reduction proposals and nearly ninety different tax cut proposals.  To date, the Committee has not taken formal action or made final recommendations.

The Legislature's Budget Conference Committee had made most of the less controversial decisions on budget items by mid-June.  However, last week the Committee revised those figures by cutting approximately $700 million to allow for major tax cuts.  The Committee originally budgeted several Medi-Cal reimbursement rate increases, most of which have now scaled back to 50% of the proposed increase. Other health-related decisions made by the Committee include:

  • Reduction of Disproportionate Share Hospital (DSH) State administrative fee by $40 million (the funds will be distributed to public hospitals pursuant to AB 2087, signed into law June 25, 1998 as Chapter 71);
  • Allocation of $7.7 million for local public health/communicable disease control services;
  • Allocation of $5 million and authorizing language for the California Statewide Supportive Housing Initiative;
  • Allocation of $36.8 million and authorizing language to continue State funding of prenatal care for undocumented residents; and
  • Authorizing language to continue long-term care for undocumented residents.

The entire budget, including the above items, is subject to the Governor's approval or line item veto, which will not occur until the other major issues are resolved and the Legislature passes the final budget.

Republican Patient Protection Proposal

Last month, the House Working Group on Health Care Quality issued a plan to protect patients "without big government."  This Republican proposal is based on an incremental approach to health care reform.

The plan is designed to improve accessibility, affordability and accountability.  Many of the accessibility initiatives relate to ensuring that an individual has appropriate and direct access to specialty services and point of service plans.  The affordability measures are based on market reforms such as expanding medical savings accounts and creating "HealthMarts."  Reforming medical malpractice is also proposed.  In the area of accountability, consumers would have increased access to health plan information and medical review panels, and "gag rules" that interfere with provider and patient communication would be lifted. 

As you are aware, earlier this year the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry released its report.  This Republic Health Care Proposal could be seen as an alternative to the Advisory Commission's recommendations.  However, many of the House Working Group's recommendations were proposed by the Presidential Advisory Commission.  

Appointment of Special Policy Advisor to the Director of Health

I am very excited to report that Herminia Palacio, M.D., MPH, began as Special Policy Advisor to the Director of Health on July 6, 1998.  Her major responsibilities will be to develop an evaluation and research agenda for the Mayor's Blue Ribbon Committee Recommendations on Universal Health Care.  She will also serve as an AIDS Policy and Medical Advisor and be the Department's liaison to the Mission Peace Initiative, a community based effort to improve the quality of life for Mission District residents.

Dr. Palacio is a graduate of Barnard College and Mt. Sinai School of Medicine.  She received her MPH degree at the University of California, Berkeley.  She trained as a Primary Care resident at San Francisco General Hospital and was a primary care physician and Acting Medical Director at Maxine Hall Health Center, between 1991 and 1993.  Since 1993 she has been an attending physician at the AIDS Program at San Francisco General Hospital and has been a leading investigator on the effect of HIV/AIDS on women.  She has served on the Mayor's Blue Ribbon Committee on Universal Healthcare coverage and on the Mayor's HIV Summit Insurance Subcommittee.

We are fortunate to have recruited Dr. Palacio back to the Department of Public Health and I'm sure the Commissioners will enjoy getting to know her better in the coming months.

Appointment of Director of Business Office

I am happy to announce the appointment of Diane Keefer as the new Director of the Community Health Network's Business Office.  Prior to her appointment to the CHN, Diane was the Project Manager with Health Management Systems, which provides billing and cost recovery services to the CHN.

Since 1993, Diane has proven herself to be very effective manager of the automated billing system used throughout San Francisco General Hospital and our primary care clinics.  She was responsible for assisting us in the integration of our Community Oriented Primary Care Clinics into the existing San Francisco General Hospital patient billing system.  She has monitored all billings and collection efforts and has enhanced revenues at the Community Health Network through the HMS Comprehensive Account Management Services and the Retroactive Claims Re-processing project.  Prior to her work with Health Management Systems, Diane was the manager of the Business Support Bureau of St. Luke's Hospital.  At St. Luke's she was responsible for the management of the hospital billing, cash posting and customer service.

Diane began her appointment as Director of Business Office on June 15th.  Please help me welcome her into this new role.

1998 Managerial Excellence Awards

I am pleased to announce the Department's nominees for the 1998 Managerial Excellence Awards.  These managers excel leading the Department of Public Health through a time of great change in the health care field:

  • Tangerine BrighamDirector, Policy and Planning
  • Barbara GarciaDirector, Community Substance Abuse
  • Monique Zmuda, Chief Financial Officer
  • Yuki Kubo-Hendricks, Supervising Pharmacist, Jail Health Services
  • Nancy Presson, Associate Director/Managed Care, Mental Health Services
  • Health at Home Mgt. Team
    • Kathy Eng, MPH
    • Pam Bohman, RN
    • M.K. McKown, RN, NP
    • Lisa Johnson, M.D.
    • April Lax, MSW
    • Mary McCutcheon, RN

Blood Donor Program

The Department of Public Health was honored by the Blood Centers of the Pacific at its annual recognition event with a Gold Award for participation in the blood donor program.  Accepting the award were Department coordinators Judy Schutzman of CMHS and Rose Fuapopo of Facilities Management.


Mission District Fire. 

The Department of Public Health was asked to assist in the relief efforts for approximately 100 people who were left homeless as the result of a three-alarm fire in a Mission District apartment building on Friday, July 3.  Luckily no one was injured in the blaze.   Many of the primarily Spanish-speaking residents had nowhere to go as they tried to come to terms with the loss of their homes and many of their possessions.  Within hours a temporary shelter was established at Mission High School.

Bi-lingual staff from Mission Mental Health was on the scene shortly after the fire to provide emotional support and counseling.  Staff members also visited nearby restaurants to get the owners to agree to provide meals to displaced residents.  Three bi-lingual public health nurses from the Castro-Mission Health Center were also on site to conduct assessments of need in the aftermath of the fire in order to provide immediate assistance when needed and to brief the Red Cross nurse, who was scheduled to arrive in the early evening.  The public health nurses also brought formula for three infants who were among the many children displaced by the fire.  Laguna Honda Hospital agreed to provide fresh towel service to the approximately 75 people who were sheltered by the Red Cross at Mission High School.  In addition, staff from the Environmental Health Section provided weekend consultation to San Francisco Unified School District staff who were asked to get steam tables operating in the school cafeteria to facilitate serving of meals.  We expect that families will be successfully placed in alternate housing early this week, which will enable the closing of the temporary shelter.  I want to thank all Department of Public Health staff, including our contract employees, who provided assistance to the homeless families, especially on the long holiday weekend.

Health Clinic for Lesbian Gay Bisexual Transgender Youth Follow-up Report

As we reported at last Health Commission hearing, "Dimensions" the new clinic at the Castro Mission Health Center serving LGBT queer and questioning youth opened July 2nd.  A few specifics that make this particular clinic unique:

  • Target Population: 12 to 25 years old queer or questioning youth.
  • Parental Consent: Parental Consent is not necessary.
  • Confidentiality: AnonymityPseudonyms (fake names) are acceptable.
  • Cost: No one will be turned away for lack of funds. The Clinic is sensitive to the fact that using parents' insurance would jeopardize confidentiality and so won't use it if that is an issue. 
  • Services Provided: Comprehensive Primary Care, Mental Health, Substance Abuse, Health Education, Referrals, Peer Support/Counseling.
  • Pregnancy Abortion: This Clinic will not perform abortions but will appropriately  assess, counsel, and refer pregnant clients.
  • Low Cost Therapy: Anti-retrovirals and Protease Inhibitors for HIV infected orexposed youth are provided.

Consolidation of Records and Statistics within Community Health Services Research and Immunization Section

The Records and Statistics section of the Department of Public Health has become increasingly involved in helping with the development and planning of an Immunization Registry.  The Immunization Section and Records and Statistics have begun to coordinate various activities, including sending out vaccine reminders to all children, and developing a consent process for the immunization registry as part of the Birth Certificate process.  Logically, the Records and Statistics section will be involved in maintaining the Immunization Registry along with the Birth and Death Registries.  Therefore, I have chosen to streamline their reporting lines by having the Records and Statistics section, run by Ed Hernandez, report to Dr. Jan Gurley in the Community Health Services Research and Immunization section.  I think this move will further the productive collaborations between the sections that have already been established.

Masters in Public Health Program at SF State University

I am pleased to inform you that the first class of students has been selected for the new Masters in Public Health program at San Francisco State University, which is a joint project with the Department of Public Health.  Of the 20 students selected, 70% are ethnic minority (30% Latino, 20% African American, 20% Asian).  I am especially pleased that four of the incoming students—Viva Delgado (AIDS), Maria Tuthill (Breast and Cervical Cancer Services), Chiung-Yueh Francis Chang (Chinatown Public Health Center) and Juliet Valeiro (Mental Health)—are employees of the Department of Public Health.  It is a confirmation of our understanding that the new program will not only include people from the communities we serve, but will also offer an avenue of professional advancement for our current employees.  I am heartened by the results of the selection process and look forward to a long and mutually rewarding association with San Francisco State University.

Violent Injury Prevention Award

The Health Promotion Section has been awarded an 11-month continuation grant of $25,000 from the California Department of Health Services, Epidemiology and Prevention for Injury Control Branch to enhance multi-sectorial violent injury data collection, analysis and reporting.  The funding will be used to plan, develop and field test a prototype of a multi-source data collection and reporting system for firearm injury.


Update on Laguna Honda Hospital

On July 1, 1998, Departmental representatives met with representatives from the Regional Health Care Financing Administration (HCFA) Office for 2-1/2 hours.  The meeting was productive and a number of important issues were clarified.  We were able to reach an agreement on an approach that Laguna Honda Hospital could use in its next Plan of Corrections submittal.  The Plan of Correction will include addressing in greater detail decreases in the census, privacy and dignity in the open wards, individual closet space for residents, resident dining spaces, and therapeutic activity programs.  With regard to the census we've committed to decreasing each open ward by 4 beds to allow the installation of individual closet spaces for the residents.  These closets will be installed in the open wards to provide additional privacy for residents.

We intend to submit this addendum to our Plan of Correction on July 8, 1998.  If the Plan of Correction is accepted, we would expect a follow-up very soon thereafter to assess whether we have met those early deadlines contained in our Plan of Correction.  We also expect a repeat full survey no later than March of 1999.  I will continue to keep the Commission informed about updates concerning Laguna Honda Hospital.

LHH's Hospice Unit Recognized

In the June 1998 edition of AARP's "Bulletin" Laguna Honda Hospital's Hospice Unit was recognized in an article describing hospice care programs.  A color photograph appears of LHH Hospice patient Leon Medina, recently deceased father of Supervisor Jose Medina, surrounded by the LHH caregiving team.  LHH's Hospice program has been featured twice and lauded for the quality of their program in AARP's Bulletin this year.

Completion of Radiology Department Renovation

The SFGH Radiology Department undertook a major renovation project last August, with the main objectives of updating the Fluoroscopy suite, Angiography suite, and one Computerized Tomography (CT) scanner, and adding a second CT scanner.  Additionally, a new Magnetic Resonance Imaging (MRI) unit opened in July 1997.  This reconstruction effort was done with multiple phases of inspections and approvals, in order to insure on-going operations of the Department.  The final phase of renovation has been completed, with State Licensing granting approval for this last phase on June 25, 1998.  All areas in the Radiology Department are now approved for patient care.

The impact on speed, efficiency and quality of patient care has been significant.  MRI, CT and fluoroscopy imaging now take about half the time to perform with imaging quality greatly enhanced.  The Fluoroscopy and Angiography suites have upgraded to digital imaging systems that have networking capability.  Digitalization is a technology that computerizes radiologic images, speeds up the exam, causes less radiation exposure, and achieves superior imaging results.  Finally, each of the Department's reconstructed areas has been made to be more appealing to the eye and include many upgrades such as ADA-compliant bathrooms and dressing rooms.  

Mary Anne Johnson, M.D. Resigns

It is with sadness that I announce the resignation of Dr. Mary Anne Johnson from her duties as Medical Director of Laguna Honda Hospital effective September 30, 1998.  Dr. Johnson has served in this capacity for 11 years.  Prior to her appointment at Laguna Honda, Dr. Johnson was a UC employee at San Francisco General Hospital for seven years.   She has been one of those rare individuals who possess both excellent clinical and administrative skills.  Her contributions to the Department have been numerous.  Dr. Johnson is leaving to become the Vice Chair of the UCSF Department of Geriatrics at the Veteran's Hospital Fort Miley Campus.

Dr. Maria Rivero will serve as acting Medical Director until such time as a permanent Medical Director is appointed.

CHN Quality Management Resignation

It is also with regret that I announce the resignation of Sue Currin, effective July 17, 1998.    As the Director of the CHN Quality Management Program Ms. Currin has been instrumental in improving the quality of care at San Francisco General Hospital and throughout the Community Health Network.  After 20 years of exemplary service to the Department of Public Health, and a time consuming commute from the East Bay, Sue has decided to accept a position with Kaiser in the East Bay.  A farewell reception is planned for Ms. Currin on July 13th, 3:00 – 5:00 at the SFGH Cafeteria.  We would be delighted if members of the Health Commission attended.

CHN Management Intern

On July 1, Connie Young began serving as the first Management Intern for the CHN.  The one-year program is designed to develop a bridge from academia to practice, renew our commitment to minority recruitment and provide executive mentorship.  Ms. Young holds a Master of Science from the Harvard School of Public Health with a concentration on Maternal and Child Health.

Habitat for Humanity Project

The Rehabilitation Department of SFGH is volunteering with the Habitat for Humanity project in the Mission District July 11, from 8:00-4:30.  For more information, please contact Katie Thompson, or Lisa Bell, PT, 206-5776.

New STD Controller Hired

I am delighted to announce that Jeffrey Klausner, M.D., MPH began as the San Francisco STD Controller on June 15, 1998.  As the Commission is aware our former STD Controller, Dr. Gail Bolan left the Health Department in April of 1997, after ten years of distinguished service to the Department of Public Health.  We had to wait a long time to find someone of Dr. Bolan's capability and I am happy that after a very long search we were able to find such a person in Dr. Klausner.

Dr. Klausner is a graduate of Cornell University, received his M.D. degree at Cornell University Medical College and his MPH at Harvard School of Public Health.  He was an Epidemic Intelligence Service Officer at the CDC between 1995 and 1997.  During that time he was assigned to our Division of STD Control, which is how we came to know him and to recruit him for this position.  During the last year he has been a senior fellow at the University of Washington Center for AIDS and STD.  I believe Dr. Klausner will continue the tradition of excellence of our STD Division.

It is equally important to recognize the outstanding efforts of Wendy Wolf, MPA, who shepherded the STD Program for the last 16 months.  Wendy has been with the Health Department STD Program for more than 15 years.  She is one of its staunchest advocates and has been the glue that has kept this program together and made it the recognized national leader in STD control.  As Interim Director, Wendy forged forward with important initiatives for the program, maintained staff morale, and contributed tremendously to the excellence of the program.  She and Dr. Klausner will make a very strong team for the STD Program and I am very grateful to her for the support she has provided in this past year.

President Monfredini presented Wendy Wolf with a special Certificate of Appreciation from the Commission.


Nancy Presson, Associate Director/Managed Care for Mental Health Services, and Louise Rodgers, Assistant Director of Managed Care, presented an update for the SF Mental Health Plan since it began on April 1, 1998.

Public Speakers:  in support of a supplemental request in order to provide a single standard of access for mental health services.

  • Bill Hirsh, Mental Health Association
  • Fancher Larson
  • Estela Reyes Garcia, Instituto Familiar de la Raza
  • Jane Kahan, Mental Health Association
  • Steve Fields, Progress Foundation
  • Marykate Connor, Caduceus Outreach Services
  • Chance Martin, Coalition on Homelessness
  • Johnnie Dorden, Coalition on Homelessness
  • Jennifer Freidenbach, Coalition on Homelessness
  • Steve Leoni, Coalition on Homelessness/Mental Health Association

Dr. Katz stated that any consumers served in the pilot phase will continue to be served.  The Department would focus on consumers with the greatest need based on severity of the illness and economic circumstances.

Commissioners' comments:

  • The Commission, from a fiscal and moral basis, strongly endorsed the original Commission Resolution #28-97.
  • The question of gathering more data and information on the pilot project was raised.  The 2-month data presented is not enough data.
  • The Commission made an original commitment to a certain level of care.
  • Need to validate data over a 4-month period (April through July).
  • Need to have more detailed demographics of consumers using the services.
  • The Commission should continue this item and extend the Pilot Phase for 60 more days.
  • Need to evaluate systems for efficiency and the impact on finances.

By consensus, the Commission requested the Department to continue this item and also requested the Department to bring back the 4-month data (April through July) to the Commission in September.


Tangerine Brigham, Director of Policy and Planning, presented an update on the California Healthy Families Program, which officially began on July 1, 1998.

Commissioners thanked Ms. Brigham for comprehensive and clear report.

Commissioner Chow asked the Department to look at the role of other entities (i.e., SFCCC) in this plan.  If the Department is in a partnership, then all of the partners would be on an even playing field and that the partnership would be in all activities, not just selected ones.

Commissioner Parker commented that, the plan is good, but the application (35 pages) is too long.  Ms. Brigham stated that the application could be shortened and streamlined.







Action Taken: The Commission voted to hold a Closed Session for this item.






    Action Taken: The Commission unanimously voted to approve the $25,632.65 settlement for the unlitigated claim against CCSF filed by the Business Software Alliance for Software Infringement by the SFGH Radiology Department.


    Action Taken: The Commission unanimously voted not to disclose any discussions held in closed session.

The meeting was adjourned at 5:50 p.m.

Sandy Ouye Mori, Executive Secretary to The Health Commission