4, 1998, 3:00 p.m.
The regular meeting of the Health Commission was called to order by President Lee
Ann Monfredini, at 3:05 p.m.
meeting dates for the Commission will be:
Tuesday, September 1, 1998, 3:00 p.m.
Tuesday, September 15, 1998, 3:00 p.m.
Tuesday, September 29, 1998, 3:00 p.m.
There will not be a Commission meeting on Tuesday, October 6, 1998. There will be
a meeting on Tuesday, October 20, 1998, 3:00 p.m.
2) APPROVAL OF MINUTES OF THE MEETING OF JULY 21, 1998
Action Taken: The Commission adopted the minutes of July 21, 1998.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner David J. Sanchez, Jr. Ph.D.)
DPH-Administration Request to approve a resolution authorizing the Department of
Public Health to accept and expend 37 recurring grants from the State of California.
CHN-Homeless Services Request for approval to enter retroactively into a
performance agreement in the amount of $90,994 with Lutheran Social Services for the Tom
Waddell Health Center, to provide preventative and primary health care services to
multiple-diagnosed persons with HIV/AIDS at the Gough-Hayes, Ambassador, Vincent and
Hillsdale Hotels for the period of
October 1, 1997 to September 30, 1998.
(3.3) CHN-SFGH Request for approval of an amendment to the Administrative
Services Agreement between the Department of Public Health and the Physician-Hospital
Organization at St. Luke's Hospital (SLPHO). (The underlying Administrative Services
Agreement was approved by the Health Commission on March 4, 1997.)
(3.4) CHN-SFGH Request for approval of an amendment to the Administrative
Services Agreement between the Department of Public Health and the Chinese Community
Health Plan (CCHP). (The underlying Administrative Services Agreement was approved
by the Health Commission on March 4, 1997.)
(3.5) CHN-PCS-Primary Care Request for retroactive sole source approval
and multiyear contract with Haight Ashbury Free Clinics, Inc. (HAFC), in the amount of
$50,261 per year, for the provision of primary medical care and HIV screening, for the
period of July 1, 1998 through
June 30, 2002. (DPH contracted with HAFC for services totaling $10,606,732 during
(3.6) CHN-PCS-Primary Care Request for retroactive sole source approval
and multiyear renewal contract with Bayview Hunter's Point Adult Day Health
the amount of $50,858 per year, for the provision of therapeutic recreation, personal care
and exercise assistance to frail elders and disabled persons, for the period of July 1,
1998 through June 30, 2002.
(DPH contracted with BVHPADH for services totaling $50,858 during FY 1996-97).
(3.7) PH&P-CHS-AIDS Office - Request for approval of 1998-99 Ryan White Comprehensive
AIDS Resources Emergency Act of 1990 (CARE) Title I, new dental service awards from
for the period of August 1, 1998 through
February 28, 1999.
Commissioner Sanchez requested an update on the site selection be calendared in 30 days
(September 15, 1998) for the Budget Committee. He also requested a comprehensive
overview of the new contractor.
(3.8) PH&PAB 75 Project Request for approval to apply for, accept and expend
retroactively a grant allocation in the amount of up to $9,150,401 from the State
Department of Health Services, through its California Healthcare for Indigents Program
(CHIP), to provide reimbursement for health services delivered to indigent persons for the
term FY 1998-99.
(3.9) PH&P-Mental Health Services Request for retroactive renewal contract with
California Pacific Medical Center (CPMC), Department of Psychiatry for
psychiatric inpatient hospital services for the period of July 1, 1998 through June 30,
1999. The total dollar amount for psychiatric inpatient hospital services for
Medi-Cal beneficiaries for all six (6) hospitals is $5,000,000. (DPH contracted with
CPMC for services totaling $7,279,550 during FY 1996-97).
Commissioner Sanchez commended CPMC for its progress towards compliance for Board
(3.10) PH&P-Mental Health Services Request for retroactive renewal
contract with Ross Hospital to provide: 1) Acute psychiatric inpatient hospital
services for children and adolescents in the amount of $110,000, and 2)
funded psychiatric inpatient hospital services for adults for the period of July 1, 1998
through June 30, 1999. The total dollar amount for adult psychiatric inpatient
hospital services for Medi-Cal beneficiaries for all six (6) hospital providers is
$5,000,000. (DPH contracted with Ross for services totaling $80,000 during FY 1996-97).
Commissioner Barnes requested a written update in February 1999 to the Commission on
the progress towards compliance for Board diversity.
Commissioner Barnes inquired about the status of retroactive contracts. Galen
Leung, Director of the Office for Contract Management and Compliance, reported that the
Department's goal is to have 90% of the contracts for FY 1998-99 reviewed by the
Commission by the middle of October. Mr. Leung also reported that more contract
staff have been hired.
Action Taken: The Commission approved the Consent Calendar of the Budget Committee,
with President Monfredini abstaining on #3.9
4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).
Governor Wilson and legislative leaders have reached an agreement on the 1998-99
State budget, however, the budget still needs to be approved officially. The State
has been without an approved budget for 35 days.
Budget negotiations have focused on spending the State's estimated $4 billion
surplus. Current reports indicate that the 1998-99 budget will include a $1.4
billion tax cut and a $800 million increase in education spending. It is unclear
whether the budget agreement includes financial relief for counties and any increases in
benefits to CalWORKS recipients.
Last month the Governor signed SB 267 -- urgency legislation, which allowed the State
to continue paying current expenses from July 1, 1998 to August 5, 1998. The State
was required to do the Los Angeles Superior Court rule that the State could not pay
expenses without an approved State budget. If a State budget is not approved by
tomorrow, then urgency legislation will again be required to pay State expenditures.
The Department is concerned that the budget negotiations have resulted in continued
funding of the State Department of Health Services' Port of Entry Detection Program and
California Airport Residency Program. These programs allow DHS to place armed
personnel at the California-Mexico border and at airports. The DHS staff shares
information with the Immigration and Naturalization Service (INS) and asks some immigrants
to repay medical benefits that they have received lawfully. As part of the
budget negotiations, an independent review of both programs would be performed by the
Bureau of State Audits. In addition, an ombudsperson program or a toll free number
would also be created however, it is our understanding that no funding was
allocated to either of these. Continuing these programs will discourage some
immigrants (both legal and undocumented) from receiving necessary health care. In
addition, the Department believes that this program will discourage some immigrant parents
from enrolling their eligible children in Healthy Families.
The Department will closely follow the State 1998-99 budget negotiation and keep the
Health Commission apprised of any new developments.
I am pleased to report that, as of yesterday, the Community Health Network had 148
Healthy Families enrollees. As yet, we do not have the enrollment figures for all
five participating health plans in San Francisco. Countywide enrollment figures for
the program will be released later this week from the Managed Risk Medical Insurance
Board. Once the statewide reports become available, the Department will be able to
provide the Health Commission with comparative enrollment statistics.
I would like to acknowledge the tremendous work done by the Community Health Network,
in particular clinic staff and enrollment specialists who have taken the time to assist
families in completing applications. The Network has undertaken an extensive
education and outreach plan to inform staff, parents and the overall community about this
new children's insurance program.
Patient Protection Legislation
Last month I reported that the Republican Working Group on Health Care Quality had
released a proposal to improve patient protection in the health care industry. This
proposal is now in the form of patient rights' legislation. This federal bill seeks
to improve payment for emergency room visits, access to pediatricians and
obstetricians/gynecologists and patient's ability to appeal health plan treatment
denials. The legislation is currently being debated in the Senate unresolved
issues concern expanding the number of medical savings accounts and a patient's ability to
sue their health plan for malpractice.
Early Treatments for Low-Income People with HIV
Congressional leaders are urging the Department of Health and Human Services to
expand Medicaid to low-income people who are HIV-positive but have not yet developed
symptoms of HIV disease. The effort is being lead by Congressman Gephardt and
The 12th World AIDS Conference provided additional evidence that early
treatment of HIV infection is both medically appropriate and cost-effective.
Expanding Medicaid to allow individuals to have access to combination antiretrovial
therapy could prevent thousands of deaths annually. There has been precedence for
Medicaid expansion of this type. In 1993, Medicaid was expanded to cover TB-related
services to low-income persons infected with TB who did not qualify for Medicaid. A
Medicaid expansion for HIV would follow the same logic early treatment for TB and
HIV is highly recommended by the medical community.
The Department fully supports this effort because it improves access to care for
asymptomatic, HIV-positive, low-income persons.
Proposition 10 California Children and Families Initiative
Proposition 10 -- California Children and Families Initiative (CCFI), also known as
the Rob Reiner Initiative, has qualified for the November 1998 California ballot.
The CCFI would fund a comprehensive health and social service program for children under
five years of age. The CCFI would help fund county organizations providing prenatal
care, nutrition services, domestic violence prevention and treatment, and health
care. The initiative would also create a new State Commission called the California
Children and Families First Commission (CCFFC).
CCFI hopes to accomplish the following objectives:
- create a comprehensive and integrated delivery system of information and services to
promote early childhood development,
- provide funds to existing community based centers or establish new service centers,
- educate Californians on the importance of early child development, and
- provide assistance to pregnant women and parents of youth who want to quit smoking
In order to acquire the necessary funding for this effort, CCFI proposes an additional
50 cents tax on each pack of cigarettes purchased. If this initiative were to pass,
California would have the third highest cigarette tax in the nation (following Alaska and
Hawaii). CCFI estimates that the cigarette tax would generate $700 million statewide
in 1999-2000 ($8.7 million for the City and County of San Francisco). All
counties receiving funds will be required to annually submit work plans.
Because tobacco taxes often disproportionately affect the poor who purchase a large
percentage of cigarettes (in relation to their income), questions have been raised about
whether the tax will encourage smuggling or illegal trade of cigarettes.
POPULATION HEALTH PREVENTION
Update on AIDS/HIV Return to Work Program:
The Mayor's Summit on AIDS, held on January 27, 1998, recommended the establishment
of workplace reentry programs for persons with AIDS/HIV. The Mayor's Office has
convened a forty person Community Advisory Committee on AIDS/HIV Employment Development to
assist in the development of work place reentry programs. The Community Advisory
Committee includes representatives from the Mayor's Office; the Departments of Public
Health, Human Rights and Human Services; the California Department of Rehabilitation;
non-profit agencies providing vocational, career, legal and benefits counseling; AIDS
service organizations; employers and business associations; and, persons with
AIDS/HIV. The Community Advisory Committee has held two meetings, and a third
meeting is scheduled for mid-August.
In coordination with the Community Advisory Committee, the Department has developed and
released a job announcement for a Coordinator of AIDS/HIV Return to Work Program; the
position announcement closes on August 14, 1998. The position will be responsible
for the coordination and development of Return to Work services for persons with
AIDS/HIV. This will include providing technical assistance to existing
community-based organizations providing services to persons with AIDS/HIV who are seeking
to return to work; providing assessment, benefit counseling and job counseling services to
persons with AIDS/HIV; and, developing, planning and evaluating new Return to Work
The Community Advisory Committee is also working with the Mayor's Office to coordinate
a new media campaign designed to encourage private sector employers to provide job
training and placement opportunities for persons with AIDS/HIV. A more detailed
report on the Return To Work Program will be presented to the Commission at a future
President Monfredini commented that advisory committees should be small and not
large. From a practical viewpoint, she believes that large committees are too
Commissioner Guy stated that the Joint Conference Committee for Population Health and
Prevention is looking at the role of Advisory Committees to the Department.
SAMSHA Funding for Treatment on Demand Research
I am happy to announce that the Substance Abuse and Mental Health Services
Administration (SAMSHA) has granted $250,000 to CSAS, and $250,000 to UCSF, to assist in
the development of research projects for Treatment on Demand.
In April of this year, the Department of Public Health/CSAS, along with the San
Francisco Foundation, and Dr. Phil Lee, hosted a Treatment on Demand Research Update
Meeting with representatives from the Substance Abuse and Mental Health Services
Administration (SAMSHA), the Centers for Disease Control (CDC), the Robert Wood Johnson
Foundation, and Dr. Andy Mecca, Director of the State Department of Alcohol and
Drugs. This meeting focused on the number of research projects that have been
developed by CSAS' Research Group, which include distinguished substance abuse researchers
from UCSF, S.F. State, and Stanford.
TeenSMART Outreach Grant
The Department of Public Health has received a three-year grant award from the
State Department of Health Services; Office of Family Planning,, to provide specialized
outreach and clinical services to communities with high teen pregnancy rates. The
project is designed to remove some of the barriers to accessing clinical counseling for
sexually active high risk youth by promoting awareness of family planning services and the
need to prevent high risk behavior. The proposal was a combined effort between
Maxine Hall Health Center and the Family Planning Program. The project will focus
outreach activities in the 94115 zip code and will initiate services on August 1, 1998.
Disaster Registry for Seniors and Disabled Persons
The Emergency Medical Services section has kicked off the Disaster Registry for
Seniors and Disabled Persons by gaining the commitment of two community agencies to
participate in a pilot program to begin later this month. On Lok Senior Services and
In-Home Support Services have agreed to assist by asking their clients to consent to
enroll in this project. The EMS section staff will then gain access to information
that will assist them to carefully assess the actual and potential needs of these clients
which will help develop a meaningful plan for responding to these persons in the event of
a disaster. The EMS section will provide a thorough report to the Health Commission
at the September 29th meeting.
COMMUNITY HEALTH NETWORK
Laguna Honda Hospital
The last two weeks were tumultuous ones for Laguna Honda Hospital. The Board
of Supervisors initially passed a resolution supporting the rebuilding of a 1200-bed
facility for Laguna Honda Hospital, as well as a retrofit for Clarendon Hall. This
was the same resolution that was approved by this Health Commission. Unfortunately,
the matter was tabled by the Board at the second meeting. A number of Supervisors
spoke eloquently and passionately about the need for rebuilding Laguna Honda
Hospital. However, the sense from the Board was that there was not enough time
between now and November to garner the support of two-thirds of the voters.
On Thursday, July 30, the Health, Family and Environment Committee held a three-hour
hearing on Laguna Honda Hospital. In addition to extensive presentations from
departmental staff, a number of Laguna Honda residents came to the hearing and testified
on their own behalf. They spoke of the wonderful care that they had received at
Laguna Honda Hospital and their profound desire to see the building rebuilt. In the
coming weeks we will be working closely with members of the Board of Supervisors and the
Mayor to determine the best time to bring forward a ballot measure for rebuilding Laguna
Honda Hospital. The Department will also use the additional time to bring policy
discussions and resolutions to the Health Commission regarding the rebuilding of Laguna
5) CONSIDERATION OF A RESOLUTION UPDATING THE DEPARTMENT OF PUBLIC HEALTH MISSION
Dr. Katz made the following presentation:
As you are well aware, the Department of Public Health underwent a major restructuring
within the last two years. A new organizational structure emerged from these efforts
with two divisions: Population Health and Prevention (PH&P), and the Community
Health Network (CHN). It recently came to my attention these divisions were working
on Mission Statements to help define their new roles in the organization. Before
these efforts progressed further, I felt it was important to revisit the Department of
Public Health Mission Statement to see if it adequately reflected the current priorities
and direction of the Department. In addition, I believe it is important that any
divisional Mission Statement flow from the Department's Mission Statement to ensure a
unified message and approach to public health programs.
The management team of PH&P and Central Administration, jointly reviewed the most
recent Mission Statement passed by the Commission in June 1994. We thought that the
sentiments expressed in the statement were still relevant. However, there was
consensus that the Department'' Mission Statement should specifically acknowledge the
Department's provider role, which was omitted from our earlier Mission Statement. In
addition, the statement "protect and promote the health of all San Franciscans"
indicates proactive preventive approach to service care delivery. Finally, we wanted
to shorten our Mission Statement so that it would be easier for staff to remember and so
that it would fit on stationary, business cards, and plaques hanging throughout the
The proposed Department of Public Health Mission Statement is:
The Mission of the Department of Public Health is to protect and promote the health
of all San Franciscans.
The Department of Public Health shall:
Assess and research the health of the community
Develop and enforce health policy
Provide quality health services and ensure equal access to all
Commissioner Parker stated that the Mission Statement should not be changed merely to
respond to a restructuring within the Department; and that he does not support changing
Mission Statements frequently.
Commissioner Guy liked the addition of research to the Mission Statement. She
also proposed a friendly amendment to add "physical and mental" to be more
precise in describing quality health services.
Commissioner Barnes commended the Department in re-looking at the Mission Statement to
assess its appropriateness and relevancy. She also emphasized that the reading
of the Mission Statement should be made easier for patients and frontline workers.
Additionally, she strongly supported the wording of "ensure equal access to
Commissioner Hill stated the proposed Mission Statement is more clear and concise.
Commissioner Sanchez commented on the clarity, brevity, and pointedness of the
statement. Due to the importance of this matter, he recommended the Commission
continue this item to a future meeting when all of the Commissioners are present.
By consensus, this item was continued to the September 1, 1998 meeting when all of the
Commissioners are scheduled to be present.
6) UPDATE ON THE MENTAL HEALTH REHABILITATION FACILITY
Mary Louise Fleming, R.N., M.S.N., Hospital Associate Administrator for the Mental
Health Rehabilitation Facility (MHRF), gave an update on the MHRF program. Since its
opening in 1996, the program has been changed to meet the needs of the patients whose
levels of acuity now require different staffing patterns.
Commissioner Guy requested financial information on unit costs based on the changing
service needs of the patients. Ms. Fleming will be working with our Chief Finance
Officer, Monique Zmuda, to look at the financing aspects of the facility. The
financial information will be presented to the Commission.
Commissioner Barnes emphasized the importance of the MHRF being part of the continuum
of care departmentwide for mental health services.
Dr. Katz commended Ms. Fleming for her leadership and flexibility in administering this
program, especially since this is the first experience for the Department to operate a
CONSIDERATION OF A RESOLUTION AFFIRMING COMMITMENT OF THE HEALTH COMMISSION AND THE
COMMUNITY HEALTH NETWORK TO COMPLIANCE WITH ALL APPLICABLE FEDERAL AND STATE LAWS, AND THE
PROGRAM REQUIREMENTS OF FEDERAL, STATE AND PRIVATE HEALTH PLANS, AND DIRECTING THE
COMMUNITY HEALTH NETWORK TO DEVELOP AND IMPLEMENT A COMPLIANCE POLICY
Gene O'Connell, CHN Administrator for Patient Care Services, presented the following
There has been increased focus on hospitals to develop a formal compliance program to
assure that all federal and state laws and program requirements are adhered to, and that
all billings and reimbursements are consistent with these regulations.
In order to implement an effective compliance program the Community Health Network will
designate a compliance officer, will develop written compliance policies, procedures and
federal standards of conduct, will develop and implement a training program on compliance,
will maintain a hotline and other communication mechanisms to receive complaints, and will
develop a system for prompt investigation and resolution of identified problems. We
will also develop policies on discipline and evaluation of employees on issues of
compliance, will update the Department's records retention policy, and will retain legal
counsel to assist us in the compliance plan.
The Department will report its progress on the compliance plan in six months, and will
provide ongoing updates on our performance in this area thereafter.
Mivic Hirose, Clinic Nurse Specialist, reported that an educational program for the
compliance program has started in the Health Centers.
Commissioner Guy raised the question of labor and UCSF involvement with the compliance
program. Ms. O'Connell assured the Commission of their inclusion.
Mr. Anthony Wagner, CHN Executive Administrator, acknowledged the support from Deputy
City Attorney Jean Fraser and City Attorney Louise Renne for this compliance program.
Action Taken: The Commission adopted Resolution #29-98, "Affirming Commitment of
the Health Commission and the Community Health Network to Compliance with all Applicable
Federal and State Laws, and the Program Requirements of Federal, State and Private Health
Plans, and Directing the Community Health Network to Develop and Implement a Compliance
8) OTHER BUSINESS/PUBLIC COMMENTS
9) CLOSED EXECUTIVE SESSION:
A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION
B. VOTE ON WHETHER TO HOLD A CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN
FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a).)
Action Taken: The Commission unanimously voted to hold a closed session.
CLOSED SESSION PURSUANT TO GOVERNMENT CODE SESSION 54956.9, AND SAN FRANCISCO
ADMINISTRATIVE CODE SECTION 67.11(b)
CONFERENCE WITH LEGAL COUNSEL - EXISTING LITIGATION
BEACH V. CITY AND COUNTY OF SAN FRANCISCO ET AL, SUPERIOR COURT CASE #994-505,
CONSIDERATION OF SEX DISCRIMINATION AND UNION GRIEVANCE APPEALING TERMINATION, PROPOSED
SETTLEMENT OF $79,739.31
D. RECONVENE IN OPEN SESSION:
1. POSSIBLE REPORT ON ACTION TAKEN IN CLOSED SESSION. (GOVERNMENT CODE SECTION
54957.1(a)(2), AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(b)(2).)
Action Taken: The Commission unanimously voted to approve a settlement of $79,739.31 in
the Beach v. CCSF et al, Superior Court Case #994-505.
2. VOTE TO ELECT WHETHER TO DISCLOSE ANY OR ALL DISCUSSIONS HELD IN CLOSED SESSION (SAN
FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(a).)
Action Taken: The Commission unanimously voted not to disclose any discussions held in
The meeting was adjourned at 4:55 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission