Minutes of the Health Commission Meeting

Tuesday, September 1, 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 3:03 p.m.


  • Commissioner Debra A. Barnes
  • Commissioner Edward A. Chow, M.D.
  • Commissioner Roma P. Guy, M.S.W.
  • Commissioner Lee Ann Monfredini
  • Commissioner Harrison Parker, Sr., D.D.S.
  • Commissioner David J. Sanchez, Jr., Ph.D.


  • Commissioner Ron Hill 

Action Taken: The Commission adopted the minutes of August 18, 1998.

President Monfredini, on behalf of the Commission, made a special presentation to Martha Henderson upon her retirement from Community Substance Abuse Services for 19 years of service to the Department.


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

(3.1) PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive renewal contract with Larkin Street Youth Center (LSYC) in the amount of $108,477 for the provision of HIV prevention services targeting behavioral risk populations for the period of July 1, 1998 through

June 30, 1999.  (DPH contracted with LSYC for services totaling $1,064,019 during FY 1997-98).

PH&H-CHP&P-Health Promotion – Request for approval of retroactive new contract with Polaris Research and Development, Inc., in the amount of $150,000 for the provision of Perinatal Outreach and Education support services, for the period of July 1, 1998 through June 30, 1999.  (DPH contracted with Polaris for services totaling $782,955 during FY 1997-98).

Commissioner Sanchez commended the contractor for its compliance to Board diversity.

(3.3) PH&P-CHS-HIV Services – Request for approval of retroactive renewal contract with San Francisco AIDS Foundation (SFAF), in the amount of $231,436, for the provision of housing wait list services for people with HIV, for the period of July 1, 1998 through June 30,1999. 

(DPH contracted with SFAF for services totaling $5,204,521 during FY 1997-98).

(3.4) PH&P-CHS-HIV Services – Request for approval of retroactive renewal contract with San Francisco AIDS Foundation (SFAF), in the amount of $200,000, for the provision of partial rental subsidy services for people with HIV who are imminently homeless, for the period of

July 1, 1998 through June 30, 1999.  (DPH contracted with SFAF for services totaling $5,204,521 during FY 1997-98).

(3.5) PH&P-CHS-CMHS – Request for approval of retroactive multiyear contract renewal with Community Vocational Enterprises, Inc. (CVE), in the amount of $830,725 per year, to provide vocational rehabilitation services for the period of July 1, 1998 through June 30, 2002.  (DPH contracted with CVE for services totaling $1,058,513 during FY 1997-98).

(3.6) PH&P-CHS-CMHS – Request for approval of retroactive modification to multiyear renewal contract with Volunteer Center of San Francisco (VCSF), increasing the contract in the amount of $33,797 per year, to provide community outreach services for the period of July 1, 1998 through

June 30, 2001.  The total contract amount, including this modification, is $188,694 for the fiscal year 1998-99.  (DPH contracted with VCSF for services totaling $154,987 during FY 1997-98).

This item had previously been approved by the Commission.

Action Taken: The Commission approved the Consent Calendar of the Budget Committee, except #3.6

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

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


State Budget

On August 21, 1998, the Governor signed a $72 billion State budget for fiscal year 1998-99.  The Governor vetoed $1.52 billion in spending approved by the Legislature.  The vetoes were necessary to accommodate the $1.4 billion tax reduction package and to provide a $1.25 billion State reserve.

As I stated in my last Director's Report, the Department supported a number of the Legislature's health-related funding proposals – particularly those that sought to increase funding for county services.  The following health-related items were approved by the Governor and budgeted for 1998-99:

  • $40 million reduction of the Disproportionate Share Hospital (DSH) administrative fee;
  • Elimination of the 33 1/3 percent "takeback" in the Medi-Cal Administrative Activities/Targeted Case Management (MAA/TCM) program, representing an annual savings to counties of approximately $12 million statewide;
  • $1.2 million to expand transitional Medi-Cal for CalWORKs families from 1 to 2 years;
  • Medi-Cal rate increases for primary care and preventive services (10% for adults, 20% for children), Home Health nursing services, and emergency ambulance services; and
  • $1.1 million augmentation for local assistance grants to support long-term care local planning efforts under AB 1040.

In spite of these gains, there were a number of public health and health care funding initiatives that the Governor vetoed.  In total, over $52 million in augmentations were not put into the approved budget.  The following are not in the 1998-99 State budget:

  • $7.7 million augmentation for communicable disease control efforts;
  • $8 million augmentation to expand the drug court program;
  • $3 million augmentation to expand the number of children eligible for the Healthy Families Program;
  • $6 million augmentation for HIV/AIDS services and programs (namely, AIDS Drug Assistance Program, anonymous HIV testing at family planning clinics and organ transplant research for people with HIV)
  • $794,000 for the Breast Cancer Early Detection program (the Governor indicates that he will sign legislation to fund the program from Prop 99 funds); and
  • $5 million for the California Statewide Supportive Housing Initiative.

In addition, the Governor reduced Medi-Cal rate increases proposed by the Legislature for hospital outpatient services (10% increase reduced to 5%), and optometry services (25% increase reduced to 12.5%).  The Governor did not approve a Medi-Cal rate increase for non-emergency transportation.

The Governor vetoed $36.8 million for prenatal care to undocumented women beginning January 1, 1999.   However, this does not mean that the State will not cover the costs of prenatal care after that date.  Undocumented women will still be eligible for this State-funded program. The Governor has placed $36.8 million in a State Reserve Account that will continue to pay for the costs of providing prenatal care to undocumented women after January 1, 1999 until the State litigation is resolved.

The Department is concerned by the Governor's decision to veto mental health funding under CalWORKs.  In 1997-98, San Francisco received $300,000 to provide mental health services to CalWORKs participants.  The proposed 1998-99 budget allocated $21.9 million in State funds needed to match $22.6 million in federal funds to provide mental health services for CalWORKs recipients.  The Governor's veto of this initiative results in unspecified funding for mental health services in the CalWORKs program.  It is critical that families transitioning from welfare to work have access to a full array of support services if they are to be successful in this transition.  The Department is working with the State, County Welfare Directors Association of California and the California Mental Health Directors Association on this issue.

Municipal Fiscal Advisory Committee Award

I am extremely pleased to announce that Monique Zmuda, our Chief Financial Officer, was one of five City winners of the Municipal Fiscal Advisory Committee Award.  This very well deserved award acknowledges the tremendous contribution Ms. Zmuda made to the Health Department during the prior year.  These contributions include:  centralizing fiscal reporting in the Department, developing user-friendly financial reporting for the Department and the public, redesigning the Medi-Cal Administrative Claiming Program, managing a revenue maximization program in Short-Doyle Medi-Cal revenues for Mental Health and recommending and receiving approval to secure a revenue contingency reserve for the Department.

I also want to take this opportunity to again acknowledge the Department's other award nominees. They were:

  • Tangerine Brigham, Director of Policy and Planning
  • Barbara Garcia, Director of Community Substance Abuse
  • Health at Home Management Team:
    • Kathy Eng, MPH; Pam Bohman, RN; M.K McKown, RN NP; Lisa Johnson, MD;
    • April Lax, MSW; and, Mary McCutcheon, RN
    • Yuki Kubo-Hendricks, Supervising Pharmacist, Jail Health Services
    • Nancy Presson, Associate Director/Managed Care, Mental Health Services


Breast Cancer Study

Today the Center for Disease Control and Prevention (CDC) is holding a public meeting in San Francisco to present and discuss their Congressional report entitled CDC Review of the Northern California Cancer Center Report: "Status of Breast Cancer Research in the San Francisco Bay Area."  Our Community Health Epidemiology and Disease Control Branch, under the direction of Dr. Tomás Aragon, has been involved in the project.  In addition to Department staff attending the meeting, Dr. Daramola Cabral-Evins and Karen Pierce are participating in the community panel to respond to questions and answers. 

Breast cancer is the most common cancer among women.  As you are aware, over the past several years concern has been raised that the rate of breast cancer is higher in the Bay Area than in other regions.  There is also concern that the mortality rate of breast cancer among African-American women is higher than for other women.  Finally, within the Bayview Hunters Point community there has been longstanding concern over the relationship between environmental toxins and the incidence of disease, cancer being one of them.  

Congress instructed the CDC to work with the Agency for Toxic Substances and Disease Registry to review breast cancer incidence and mortality in the San Francisco Bay Area (SFBA).  Their findings and recommendations are as follows:

  • The incidence of invasive breast cancer in SFBA has decreased since 1987 and is comparable to the rates in other areas of the United States,
  • Higher rates of breast cancer in SFBA were due in part to higher use of mammography, a greater number of women screened and a greater number of cancer being detected.  In addition, the higher prevalence of known risk factors in the SFBA may have contributed to the elevated rates,
  • Incidence of invasive breast cancer is decreasing in SFBA,
  • Death rates for breast cancer in the SFBA have decreased since 1991 and are now comparable to the United States rates,
  • Nearly 40 research studies are under way in the SFBA to better understand the occurrence of breast cancer, and
  • Cancer surveillance in the SFBA has included very complete case identification and high quality case information.
  • The following is being recommended:
  • Continue to closely monitor cancer surveillance,
  • Analyze mammography utilization since 1991,
  • Develop a broad-based approach to breast cancer research given the multiple potential causes of the disease, and
  • Have the CDC develop a field-test and implement a Cancer Inquiry Response System.

The public meeting is still in session.  I will be able to provide the Health Commission with more insight into the community's response to the CDC report at a later date.  The Department will continue to work with others to track the incidence of breast cancer and provide health care services to those who have the disease.

New Appointment

I am happy to announce the appointment of Rajiv Bhatia, M.D., as Medical Director of Environmental Health and Occupational Safety.  This new position was created from my prior position of Director, Health and Safety.  The decision to fill the position in this way was my perception that the Health Department needed more expertise in the area of environmental and occupational health, especially given the concerns of various community groups about environmental exposures in their neighborhoods.  Dr. Bhatia will also provide supervision to the Occupational Safety staff at San Francisco General Hospital, Laguna Honda Hospital, and the Community Clinics.

Dr. Bhatia is a graduate of Stanford Medical School, received an MPH from the University of California at Berkeley, was a postdoctoral fellow in the Division of Occupational and Environmental Medicine at UCSF.  He has completed several important research projects in environmental health.  In addition, Dr. Bhatia has provided care to patients at Tom Waddell Clinic for several years, and intends to continue to provide primary care within the Community Health Network.  Please join me in welcoming Dr. Bhatia to the Department.

Tobacco Free Project

The Department's Tobacco Free Project has been selected as a runner-up for the 1998 National Association of County and City Health Officials (NACCHO) Champion for Tobacco-Free Youth Award.  This is the second year that the association is making awards to give national recognition to outstanding, significant and creative initiatives by local health departments to reduce youth access to and use of tobacco.  The awards will be presented at the NACCHO Annual Meeting in St. Louis, Missouri, on September 25.


LHH Pharmacy Research Protocol Presentation

A research protocol developed by the LHH Director of Pharmacy and Clinical Pharmacists, Sharon Kotabe, Michelle Fouts, and Eunice Lo was accepted for presentation as "research in progress" at the Midyear Clinical meeting of the American Society of Health-Systems Pharmacist.   The research protocols are used to evaluate the predictive validity of risk factors for drug related problems in elderly long-term care residents.   The meeting takes place December 6-10, 1998 in Las Vegas.  The study will assess residents of LHH over the age of 65 for the presence of risk factors and follow them for drug-related outcomes over the course of one year.  The results of the study will help identify at risk residents who may benefit from intensified pharmaceutical care services.

Pharmacy Update

The Community Health Network (CHN) is proceeding with an extensive evaluation of the operation and finances of the SFGH Pharmacy.  Ken Jensen, the new Chief Financial Officer of the CHN, will be looking at all aspects of pharmacy finances including billing, purchasing, and labor budgets.  Sharon Kotabe, Pharm.D., Pharmacy Director of Laguna Honda Hospital, will provide valuable expertise in assessing aspects of both inpatient and outpatient operations.  Sharon is also a member of the CHN Pharmacy Council and will work with the Council to analyze the clinical implications.  The evaluation will be presented to the CHN Joint Conference Committee at the end of September.

1998 Consumer Friendly Business Award

On August 27, the Mental Health Board of San Francisco presented the "1998 Consumer Friendly Business Award" to Walgreens and to Roses Deli and Grocery.  A reception and awards ceremony was held at the Mental Health Rehabilitation Facility.  The San Francisco Health Commission and the San Francisco Board of Supervisors also presented Certificates of recognition.  The awards were made in recognition of the "warmth, patience and respect" these Potrero Avenue businesses have demonstrated to the residents of the Mental Health Rehabilitation Facility while they shop at their stores.

The award ceremony was attended by the residents and staff at the MHRF, members of the Mental Health Board, Supervisor Amos Brown, and staff from Community Mental Health Services.  Owner, Andy Ateyeh, accepted the award for Roses Deli and Grocery.  The award for Walgreens was accepted by Luis Padilla, local manager, he was accompanied by other staff and by representatives of the district office.

President Monfredini, on behalf of the Commission, congratulated Monique Zmuda on being one of the five winners of the Municipal Fiscal Advisory Committee Awards.

Commissioner Chow requested a presentation of the CDC Congressional Report on Breast Cancer in the Bay area.


Dr. Katz reported the following:

On August 4, 1998, I presented an updated Mission Statement to the Health Commission for consideration.  The department believes that it is important to ensure that its Mission Statement accurately communicates and describes our role and responsibility.

Our Mission Statement must acknowledge the valuable role that the Department plays as both the agency overseeing the public's health and as a provider of care.

At the last Health Commission meeting, Health Commissioners provided feedback on the Mission Statement.  The Department has attempted to incorporate those comments.

With that in mind, the Department thought it might be helpful to reaffirm the Department's Vision Statement as it considers updating the Mission Statement.  We believe that the Vision Statement provides the context for how the Department carries out its mission – it constitutes our guiding principles and values.  I believe that it is important for any mission statement to be understandable to not only by our staff but also the public.  As I indicated at the Health Commission hearing, the Mission of the Department remains the same.  However, we believe that the proposed version more succinctly describes our fundamental role.

Action Taken: The Commission unanimously adopted Resolution #30-98, "Reaffirming the Department of Public Health's Vision Statement and Restating the Mission Statement."


Mr. Robert Christmas, Special Assistant for Accreditation Services, presented the following report:

Every three years San Francisco General Hospital is surveyed for JCHO accreditation.  In preparation, members of the Commission are oriented in small groups to inform them of their responsibilities as members of SFGH's Governing Body.  Today's presentation will serve as an orientation for all Commissioners.

The presentation will give you a status report on the readiness of SFGH for the survey process.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is a private, not-for-profit organization, which evaluates and accredits nearly 18,000 health care organizations and programs in the United States, including more than 11,000 hospitals and home care organizations, and over 7,000 other health care organizations that provide long term care, behavioral  health care, laboratory and ambulatory care services.  The Joint Commission also accredits health plans, integrated delivery networks, and other managed care entities.  In addition, the Joint Commission provides a broad array of educational and consultative services and products to accredited organizations.  More than 5000 employees work in the JCAHO Central Office, and approximately 690 surveyors perform the surveys of health care organizations.

The Consolidated Accreditation and License Survey (CALS) combines three required surveys into one five-day survey.  These three surveys are:  JCAHO, Department of Health Services (Title 22), and the California Medical Association (CMA).

The purpose of accreditation surveys is to ensure that the quality of care provided by health care organizations meets the standards set by accrediting organizations.  Our facilities stand for accreditation surveys primarily for three purposes:  1)  to improve the quality of care provided to the public we serve;  2) to ensure we receive reimbursement from Federal, State and private payors, and  3) support an approved residency teaching program.

There are eight accreditation decision categories:  Accreditation with Commendations, Accreditation, Accreditation with Recommendations for Improvement, Provisional Accreditation, Conditional Accreditation, Preliminary Non-Accreditation, and Not Accredited.  It is our goal to receive an Accreditation with Commendation Decision.

The Joint Commission will make available, upon request, an organization's Performance Report, which includes organization-specific performance data.  The Accreditation Decision Report remains confidential unless otherwise provided by law.

Although we are now a network, only components covered by SFGH's license will be surveyed.  Those components include the following areas:

  • General Acute Care
    • Perinatal
    • Intensive Care
    • Pediatric
    • Intensive Care New Born Nursery
    • Coronary Care
    • Unspecified General Acute Care (M/S)
    • Acute Psychiatric
  • Other Services
    • Cardiac Cath Lab
    • Dental
    • Emergency Services
    • Audiology
    • Speech Pathology
    • Respiratory Care
    • Physical Therapy
    • Occupational Therapy
    • Nuclear Medicine
    • Outpatient Services
  • Skilled Nursing
    • Mental Health Rehabilitation Facility
    • Ward 4-A

The responsibilities of leadership at SFGH are defined by the CALS Survey Process.  The following groups and individuals are defined as leadership:  The Health Commission, the Director of Health, the Chief Executive Officer of the CHN, and the Chief Executive Office of SFGH.  Their responsibilities are listed below:

  • Health Commission
    • Set Policy
    • Strategic Planning
    • Promote Performance Improvement
    • Approve Medical Staff Appointment/Reappointment
    • Establish/Maintain Staff Competency
    • Assure Compliance with Applicable Laws and Regulations
    • Approve Resources (Budget)
    • Provide Focused Governance (JCC)
  • Director Public Health
    • Implement Policy
    • Develop Budget
    • Appoint CEO/CHN and Delegates Appointment Responsibilities
    • Approve Medical Staff Appointment/Reappointment
    • Strategic Planning
    • Implement Policy
    • Strategic Planning
    • Appoint CEO-SFGH, CEO-LHH, CMO-CHN
    • Develop Budget
    • Implement Policy
    • Strategic Planning
    • Appoint Senior Leader
    • Develop Budget

There are a number of CALS and JCAHO preparation activities to be accomplished prior to the CALS and the JCAHO Accreditation Surveys.  Those activities include:  Mock Surveys of Patient Care Areas; Function Interview; Education/Staff Impact Sessions and Focus Group Interviews; Professional Consultations and Audits.  I am pleased to report SFGH is doing well in these preparatory activities.  Currently, 63% of these activities have been accomplished.  The remaining activities will be concluded by January 1999.

The Mock Surveys will be held November 2, 3 and 4.  The full CALS Survey will be held in March 1999.

Mr. Christmas reviewed the following areas:

  1. Overview of Joint Commission
  2. Consolidated Accreditation and License Survey (CALS)/Accreditation Decision Process
  3. Standards and Survey Process
  4. 1998 JCAHO Leadership and Governance Standards
  5. Survey Readiness/Activities
  6. Official Accreditation Decision Report
  7. Memo on Most Frequently Cited Standards

Commissioners' concerns:

  • Given the recent stringent HCFA oversight of Laguna Honda Hospital, is there a concern for this survey?
  • Are physical facilities an issue?
  • Clarification was requested on what encompasses a review for medications management for inpatients and outpatients.
  • In the context of managed care, is there capacity in the Emergency Department, Pharmacy, in relation to the demand in these areas?  How is this evaluated through the survey process?
  • It is better to inform the Commission of any problem areas to avoid surprises to the Commission.
  • The governing body, through the Director of Health, approves the medical staff appointments and is the appeal body for the physicians.
  • The Competency Report for 1998 would come to the Commission in December 1998.
  • Consumer and Commission involvement would be included in strategic planning.

Mr. Christmas stated that the hot issues for JCAHO surveys include patient rights, ADA access, environment, facility safety, and life safety.

President Monfredini and Commissioner Barnes commended the Department for a comprehensive, well laid out plan for the JCAHO survey.



The meeting was adjourned at 4:55 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission