Minutes of the Health Commission Meeting

Tuesday, July 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 3:05 p.m.


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



Action Taken: The Commission unanimously adopted the minutes of July 7, 1998, with the addition of the following names to #3.1:

  • Haile Debas, UCSF Vice Chancellor, Medical Affairs; and Dean of the U.C. Medical School
  • William Kerr, Executive Vice President and Operating Officer for UCSF Stanford Health Care
  • Patricia Perry, Senior Vice President for Strategic Development
  • Reece Fawley, Vice President for Health Plan Services


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

(3.1) Reconsideration of a request for approval of a 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 Barnes commented that the July 20, 1998 letter submitted from Quintiles Transnational Corp. is a good start.  She supports moving forward with this contract and requested a report from the Nominating Committee be submitted to the Commission in September.  She raised questions regarding the total number of Board slots, if there are term limits, and when will be the next opening on the Board.  Additionally, Commissioner Barnes, underscoring Commissioner Chow's recent request to the Department to re-look at Policy #24, requested the Department to see if the criteria of direct services vs. consultant services and local vs. national companies be taken into consideration.

Commissioner Hill supported the approval of this contract.

Commissioner Sanchez stated that concerns raised regarding compliance to Policy #24 do not reflect on the competency of the project staff but rather to the spirit of compliance with the diversity policy.  Recently, he was in North Carolina and noticed the diversity of the population in Research Triangle Park.  The Board's compliance to Board diversity is a good opportunity to reflect the diversity of the population.

(3.2) Status report for the California AIDS Intervention Training Center:  Women and Families Community Health Project.

A positive progress report was submitted to the Commission.

DPH – Report of Annual Gifts received in FY 1997-98.

Commissioner Barnes requested information about the administration of the Public Health Foundation.

(3.4) CHN-SFGH – Request to approve an amendment to the Performance Agreement between the San Francisco Health Plan and the Community Health Network to include the In-Home Supportive Services line of business.

Resolution #27-98, "Approving a Proposal to Provide Health Insurance to In-Home Supportive Services Workers Providing Care to Medi-Cal Recipients who Reside in San Francisco", was recommended for approval.

CH&SS-Community Health Epidemiology – Request for approval to accept and expend a grant in the amount of $85,012 from Public Health Foundation Enterprises, Inc., to provide acute hepatitis surveillance for the period of July 1, 1998 through December 31, 1998.

PH&P-CHS-SAS – Request for retroactive approval of first modification to the contract with Haight Ashbury Free Clinics, Inc. (HAFC), in the amount of $801,623, to provide new Oshun Program Start-up, Outpatient, Day Treatment and Prevention Services for women and their families in the Tenderloin, for the period of January 1, 1998 through June 30, 1999; and Research/

Conference, Administrative Support, Mentoring, Acupuncture and Emergency Shelter staffing for the San Francisco Target Cities Project, for the period of October 1, 1997 through June 30, 1998.  (DPH contracted with HAFC for services totaling $10,606,732 during FY 1996-1997).

This item was divided into two sections, the first section (i.e., new  Oshun Program) being continued to a future meeting due to the implementation of Proposition I, which was approved by the voters this past June; and the second section (i.e., Target Cities Project) being considered today.

(3.7) PH&P-CHS-HIV Services - Request for approval of 1998-99 Ryan White Comprehensive AIDS Resource Emergency Act of 1990 (CARE) Title I, new service awards for dental services from RFP 018-97 Integrated HIV Services and Other HIV/AIDS Health Services, in the amount of $649,600, for the period of August 1, 1998 through February 28, 1999.

For this item, the Community Dental Services Decentralized Dental Services at $332,500 is being continued to a future meeting due to Proposition I.

Commissioner Sanchez abstained on the UCSF Center on Deafness item due to conflict of interest.

(3.8) CHN-Primary Care-Homeless Services – Request for retroactive approval of contract with Central City Hospitality House (CCHH), in the amount of $520,579, to provide drop-in center for peer counseling, self-help groups, training advocacy and case management services in the Tenderloin for the period of July 1, 1998 through June 30, 1999.  (DPH contracted with CCHH for services totaling $520,579 during FY 1997-98).

In 60 days, the Department will provide a status report on compliance to Policy #24.

Commissioner Barnes requested the Department to look at outcome measures.

Commissioner Sanchez commented that this is a good monitoring report.

Consideration of the FY 1998-99 Patient Rates for the Department of Public Health Services.

Action Taken: The Commission approved the Consent Calendar of the Budget Committee, except the items continued in #3.6 and #3.7, and with specific follow-up for #3.1 and 3.8.

4) DIRECTOR'S REPORT  (Mitchell H. Katz, M.D., Director of Health)

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


Fire-Based EMS Services

The merger of the Paramedic function into the Fire Department continues to make progress towards our goal of optimizing Emergency Medical Services for San Francisco residents.  The Criteria Based Dispatching System has been fully implemented at the Fire/EMS Dispatch Center, which has resulted in improved call taking (pre-arrival instructions to callers) and increased the level of response.  This has resulted in no call queuing (calls for assistance awaiting assignment of a response) and decreased numbers of unanticipated red-lights-and-sirens transports of patients (an indicator of mismatching patient need to EMS response).  The EMS Section will be making a preplanned site visit in August to evaluate the implementation process.

Ambulance call volume remains higher than projected, based on historical parameters, with 200 to 250 dispatches per day (an increase of 20-30%).  The Fire Department was approved for funding for an additional ambulance in the 1998-1999 budget process.  In addition, the Fire Department continues to work hard to develop other options, including capping the number of calls to a particular unit with a mandatory rest period after the cap is reached, redistribution of lower-acuity calls, and system status management when staffing levels fluctuate.  The contract for the new EMS positions with Local 798 has been approved, and recruitment for these positions will continue as the workload solutions are implemented.  The Fire Department will make a presentation to the Health Commission in September, which will include further information on the site visit and workload improvement issues.

Food Handling Class

Every summer the California Department of Education, United States Department of Agriculture (USDA), and the Mayor's Office of Children and Youth and their Families (MOCYF), contract with the San Francisco Unified School District (SFUSD) to provide meals to school children during the summer vacation.  Approximately 100 sites are being used this year for food service.  These sites include community centers, some public schools, and Recreation and Park facilities.

To ensure safe food handling and the highest levels of sanitation these various sites are inspected by staff from Environmental Health.

In preparation for the program, Environmental Health staff provided a comprehensive food handling class, based on Hazard Analysis Critical Control Point (HACCP) Principles, to 115+ site Supervisors.  The classes emphasized basic food microbiology and the cause of food borne illnesses; proper food storage/temperatures and how to log food temperatures; proper hand washing; how to inspect the integrity of all foods and the criteria for rejecting unwholesome products.  Environmental Health staff are making an extra effort to prevent problems that occurred last year with the Summer Food Program.

June statistics are available in the Commission Office.


On behalf of the Commission and Department, President Monfredini presented the Employee Recognition Awards to the following Department of Public Health employees:

President Monfredini described each employee's achievements and accomplishments in their jobs.  The Commissioners and Dr. Katz congratulated each employee.


Dr. Mitch Katz, Director of Health, provided the following update:

On July 10 we learned that HCFA had accepted our most recent Plan of Correction.  Among many changes, the Plan of Correction includes an action to reduce the census in the open wards at Laguna Honda Hospital.   We will accomplish a reduction of census with a moratorium on new admissions, except patients coming from San Francisco General Hospital, who have no suitable alternative placement, and by relocating existing doctors' and nurses' offices to increase our number of semi-private rooms for residents.  We have also established a Level of Care Task Force whose membership includes participants from various community agencies.  The charge of the Task Force is to identify residents who may be cared for in a less restrictive and more appropriate environment outside of Laguna Honda Hospital.  The recommendations of the Task Force will include a safe discharge plan for those identified residents.

While I am pleased with our present agreement with HCFA, Laguna Honda Hospital continues to face serious challenges to its future.  We are negotiating with the Department of Justice over a variety of other issues identified in their findings letter.  We have asked the Department of Justice (DOJ) to consider our Plan of Correction to HCFA as evidence of our commitment to make substantial changes to improve the quality of life for residents at Laguna Honda Hospital.  Through negotiations, I remain hopeful that the DOJ will find that their further intervention is unnecessary.

Yesterday, (July 20, 1998), the Mayor met with Dr. Katz and other City officials, including labor, to discuss a direction for Laguna Honda Hospital.  With the recent groundswell of public support and the City leadership's support for Laguna Honda Hospital, the Mayor would like to go forward with a bond measure for the November 1998 election.  The Mayor is recommending to the Board of Supervisors to build a new Laguna Honda Hospital with 1200 beds at the existing site, retrofitting Clarendon Hall for seismic requirements, and no relocating of existing residents. 

At the July 20, 1998 Board of Supervisors' meeting, the Board passed a series of resolutions waiving the usual 30-day waiting period for all new legislation and keeping the City's debt ratio low through creative financing.  The Board will schedule two special public hearings for Thursday, July 23, 1998 at 1:30 p.m.; and Tuesday, July 28, 1998 at 2:00 p.m.

Dr. Katz stated the Department will continue to push for non-institutional care; but the projections show that the need for skilled nursing facility beds will increase.

Commissioner Barnes thanked the Mayor for his leadership role to address the vital needs of the present and future elderly of the City and County.

Commissioner Sanchez commended the Department and President Monfredini for promoting the quality of care and the needs of our patients at Laguna Honda Hospital.

Commissioner Parker commended the Department for the progress being made at Laguna Honda Hospital.  He stated that our humanity is based on how we treat our elderly.

Public Speakers: Naomi Gray, former Health Commissioner of the original Health Commission

With these latest developments, President Monfredini requested the Commission to consider adding an item (Consideration of a Resolution Supporting a Bond Measure for Laguna Honda Hospital) because the issue arose after the agenda out to the public; and because the need to take immediate action on the item is so imperative as to threaten serious injury to the public interest if action were deferred to a subsequent special or regular meeting.

Action Taken: The Commission unanimously voted to add this item to the agenda for the reasons cited.

Action Taken: The Commission unanimously adopted Resolution #28-98, "Supporting a General Obligation Bond to Rebuilt and Retrofit Laguna Honda Hospital."


Rod Auyang, Human Resources Manager, presented the 1996-97 performance appraisals at SFGH as follows:

                                                                                  % Completion

  • SFGH Clinical Employees                         (1,013)     90
  • SFG Administrative/Support Employees    (933)        77
  • UCSF                                                       (all)          96

Later this year, Mr. Auyang will bring back to the Commission the 1997-98 performance appraisals reports.

Mr. Auyang described the process used to achieve 100% completion of the performance appraisal reports in order to ensure safe and competent care and services.

President Monfredini encouraged the Department to achieve the 100% completion of the performance appraisal reports as part of all managers' responsibilities.

Commissioner Barnes raised the issue of having incentives for managers.  Ed Gazzano, Human Resources Director, explained that only the Municipal Executives Association (MEA) has a Pay-for-Performance requirement.  Other bargaining unit employees receive raises regardless of performance appraisals.  The Department goal is to conduct performance appraisals for all employees.

Action Taken: The Commission unanimously approved the 1996-97 San Francisco General Hospital Competency Compliance Report.



The meeting was adjourned at 4:10 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission