Minutes of the Health Commission Meeting

Tuesday, October 20, 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 Commissioner Edward A. Chow, M.D., at 3:15 p.m.


  • Commissioner Edward A. Chow, M.D.  (arrived at 3:30 p.m.)
  • Commissioner Roma P. Guy, M.S.W.
  • Commissioner Ron Hill
  • Commissioner Lee Ann Monfredini
  • Commissioner Harrison Parker, Sr., D.D.S.


  • Commissioner Debra A. Barnes 
  • Commissioner David J. Sanchez, Jr., Ph.D.

Action Taken: The Commission unanimously adopted the minutes of September 29, 1998.


(Commissioner Lee Ann Monfredini)

President Monfredini chaired the Budget Committee meeting in the absence of Commissioner Sanchez.

(3.1) Update from The Lewin Group regarding compliance on Board diversity.

Commissioner Monfredini indicated her support for the letter in that the spirit of the policy is being addressed.

Commissioner Hill observed that no new information is provided in the letter.

Commissioner Guy commented that this letter has to be improved if the contractor continues to do business in San Francisco.

PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive renewal contract with San Francisco AIDS Foundation (SFAF), in the amount of $505,721, 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 SFAF for services totaling $5,204,521 during FY 1997-98).

President Monfredini requested all contractors to submit their documents in a timely fashion.

PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive renewal contract with Support Center for Nonprofit Management (SCNM), in the amount of $91,000, for the provision of organizational development and capacity building professional services for the period of July 1, 1998 through December 31, 1998.  (DPH contracted with SCNM for services totaling $695,567 during FY 1997-98).

PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive renewal contract with Black Coalition on AIDS (BCOA), in the amount of $246,687, for the provision of HIV prevention services for the period of July 1, 1998 through June 30, 1999.  (DPH contracted with BCOA for services totaling $914,604 during FY 1997-98).

President Monfredini commended the contractor for its progress.

(3.5) PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive renewal contract with Iris Center, in the amount of $127,747, 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 Iris for services totaling $1,626,811 during FY 1997-98).

(3.6) PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive contract renewal with Filipino Task Force on AIDS (FTFOA), in the amount of $65,282, 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 FTFOA for services totaling $194,810 during FY 1997-98).

PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive contract renewal with Urban Indian Health Board, Inc./Native American AIDS Project (UIHB), in the amount of $135,363, for the provision of HIV prevention services targeting behavioral risk populations for the period of July 1, 1998 through June 30, 1999.

President Monfredini requested a 3-month (January 19, 1999) update report on board diversity and program compliance issues.  She encouraged the Department to continue providing TA to this contractor.

(3.8) PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive renewal contract with Central City Hospitality House (CCHH) in the amount of $74,818, for the provision of HIV prevention program targeting behavioral high-risk youth for the period of July 1, 1998 through June 30, 1999.  (DPH contracted with CCHH for services totaling $595,397 during FY 1997-98).

President Monfredini requested a confirmation by letter of the addition of new board members at the October Board meeting.

(3.9) PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive renewal contract with Lavender Youth Recreation and Information Center (LYRIC), in the amount of $103,000, for the provision of HIV prevention program targeting behavioral high-risk youth for the period of July 1, 1998 through June 30, 1999.  (DPH contracted with LYRIC for services totaling $153,000 during FY 1997-98).

(3.10) PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive renewal contract with Stop AIDS Project, in the amount of $500,029, 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 Stop AIDS Project for services totaling $961,341 during FY 1997-98).

Commissioner Hill encouraged the contractor to include an HIV positive person on its Board.

(3.11) PH&P-CHP&P-HIV Prevention Services – Request for approval of retroactive new contract with Mobilization Against AIDS International (MAAI), in the amount of $190,737, 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 MAAI for services totaling $80,341 during FY 1997-98).

President Monfredini requested a 3-month (January 19, 1999) update report on the monitoring Report.

Larry Meredith stated that the quality assurance issues for these HIV prevention contracts will be referred to the Joint Conference Committee for Population Health and Prevention.

(3.12) PH&P-CHP&P-Behavioral Health Prevention Services – Request for approval of sole source and new contract with NICOS Chinese Health Coalition, in the amount of $100,000, for the provision of community capacity building services to identify, treat and prevent problem gambling in the Chinese community for the period of November 1, 1998 through June 30, 1999.

Commissioner Monfredini requested a written update report be submitted to the Commission in February 1999.

PH&P-CHS-SAS – Request for retroactive approval of the multiyear renewal contract with Mission Council on Alcohol Abuse for the Spanish Speaking, Inc. in the amount of $317,664 per year, to provide substance abuse outpatient and prevention services for the period of July 1, 1998 through June 30, 2002.  (DPH contracted with Mission Council on Alcohol Abuse for the Spanish Speaking, Inc. for services totaling $308,412 during FY 1997-98).

(3.14) PH&P-CHS-SAS – Request in conformance with Proposition I, public notification requirements for approval of a new site for Jelani House, Inc., at 1221 Newhall, for residential substance abuse services for families.  (DPH contracted with Jelani House, Inc., for services totaling $1,187,959 during FY 1997-98).

(3.15) Administration – MIS – Request for approval of two new sole source contracts with Shared Medical Systems, Inc. (SMS), to include mutual indemnification provisions in the amount of $19,686,189, for the remote computing option contract, for the period of January 1, 1999 through June 30, 2004, and in the amount of $6,192,691, for the product and services contract for the period of January 1, 1999 through June 30 2002.  (DPH contracted with SMS for services totaling $5,744,749 during FY 1997-98).

President Monfredini expressed her appreciation for the letter submitted by the contractor.

Commissioner Guy acknowledged the contractor needs to continue improvement on board diversity, noting that no ethnic minorities serve on the Board.

Commissioner Hill requested a follow-up letter to the Commission addressing the board diversity policy by March 1999.

Commissioner Parker stated that in order for the contractor to get on the right track, the contractor should have a plan in place as a response to Policy #24.

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

Commissioner Chow was not present for this vote.

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

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


When the State of California gave San Francisco money to implement Mental Health Managed Care, there was a very short timeline for startup.  To expedite the process and meet the State's timeline, DPH asked Westside to act as a fiscal intermediary while we geared up the Mental Health systems infrastructure for managed care.  As the Commission will recall, the Department's FY 1998-99 budget included the conversion of these contract employees from Westside to Civil Service status.

I want to express my appreciation for the tremendous job the DPH Human Resource staff, under Ed Gazzano and Rod Auyang's leadership, converting 103 fiscal intermediary contract employees to City employees in a very short period of time.

I want to acknowledge the team effort of key staff and their outstanding performance:

  • Joel Hurwitz and his staff, expeditiously reviewed, analyzed, and issued recommendations for the classification of 72 new jobs.  To date, we have no grievances.
  • Arleen Lum, Bob Thomas, Don Weidner, Steve Pacarar, and Lincoln Mah, conducted the Civil Service Exam process for 12 different job classifications in less than three months.  This team qualified hundreds of applicants. 
  • Regina Pera and her staff did a terrific job of issuing all the requisitions, shepherding them out of the Mayor's Office, controller, and DHR, securing and coordinating preemployment physicals, and developing individually tailored packets for each employee converting.  These packets were instrumental in gaining the respect and confidence of our system from our new employees.


Plan of Correction for Resurvey Submitted

On October 16th, LHH submitted its Plan of Correction for the September resurvey to the State

Licensing and Certification Office.  The Hospital anticipates a response from the State and HCFA within two weeks.  I will keep the Commission apprised of our progress on this important issue.

CHN Conducts Internal Assessment

As part of the internal assessment phase of its Strategic Planning process, Community Health Network (CHN) conducted a Cultural Pulse Check of Staff.  Part of an ongoing process to foster genuine dialogue, CHN leaders met with over 50 groups of CHN staff – City and UCSF employees from every site and level of the CHN – to learn what values, beliefs and assumptions drive everyday decisions and behavior.  CHN management is now determining what "disconnects" exist between our organizational goals and values, and what was learned from these discussions.

Appointment of Associate Administrator for Long Term Care and Laguna Honda Hospital Director of Nursing

I am pleased to announce the appointment of Mary Louise Fleming, RN, MSN, to the Community Health Network (CHN) position of Associate Administrator for Long Term Care and Director of Nursing for Laguna Honda Hospital. Mary Louise is well qualified to accept this position and brings a great deal of experience, knowledge, leadership ability and enthusiasm to meet the new challenges she will face.  Since 1993, she has held a number of different positions within the Department of Public Health.  Most recently she served as the Program Director for the Mental Health Rehabilitation Facility and led the program through its successful start-up process.  In her new greatly expanded role she will continue to have administrative oversight for the Mental Health Rehabilitation Facility (MHRF).

Mary Louise has been involved in the long-term care planning process with Community Mental Health Services since the early 1990's and has also participated with the CHN level of care assessment team for Laguna Honda this past year.  She is highly regarded for her commitment to consumer-focused care and her ability to develop and implement innovative programs.

Appointment of Compliance Officer for the Community Health Network

I am pleased to announce the appointment of Dominic Reo as the Compliance Officer for the Community Health Network.  This newly created position will be responsible for the oversight, design, development, implementation and evaluation of the compliance plan/program.  Mr. Reo comes to us from the private sector with a vast background as Director of Contracting, Managed Care Administrator, Health Care Consultant and Manager of Operations in the Bay Area and San Diego.  I am sure the Commission joins me in welcoming Dominic, as we look to him for guidance and leadership in the changing health care environment.

Jerry Rankin Resigns as Director of the Office of Managed Care

I'm sorry to report that Jerry Rankin resigned his post as the Director of the Office of Managed (OMC) Care for the CHN to join Healtheon, a healthcare information technology firm, as a consultant.

Jerry worked at San Francisco General/CHN for 18 years, starting in 1980 as an administrative resident from UCSF.  Over the years his contributions have included:

  • Helping to obtain staffing, equipment, space, and information systems for departments from Environmental Services to Nuclear Medicine;
  • Developing the 1994 CCSF/UCSF Affiliation Agreement Capital Development section, including the initial work on the Ambulatory Care and Research Facility, and bringing home the SFGH Garage Project;
  • The SFO Airport Medical Services Clinic;
  • The 911 Ambulance System, including acquisition of the building which now houses CHN Headquarters; and
  • Taking the CHN through its first two years of Managed Care, and establishing a firm foundation for the future.

Joanne Burik will assume the interim directorship of the Office of Managed Care; I have every confidence that the strong team in the OMC will continue its fine work.  I am sure you all join me in wishing Jerry continued success in his upcoming career change.

Surgical Services Reception for Primary Care

The CHN/UCSF Surgical Faculty at SFGH hosted a reception in honor of their CHN primary care colleagues October 8th.  Dr. William Schecter, Chief of Surgery, and Dr. David Ofman, CHN Medical Director for Primary Care, conceived the reception as a means to foster communication and collegiality amongst the Surgical and Primary Care Services. 

Over 100 individuals attended the reception with representatives from General Surgery, Orthopedics, Otolaryngology, Ophthalmology, Urology, Neurosurgery, Oral and Maxillofacial, Anesthesia, Obstetrics and Gynecology, Emergency Services, Primary Care Clinics, Mental Health Rehabilitation Facility, Forensics, and Laguna Honda Hospital.   Presentations were given by each service.  Soothing, live jazz music, provided by Dr. Bob Markison of the SFGH Surgical Service, added a touch of class to the affair.

A SFGH Surgical Specialty Source Book was developed by Dr. Schecter with the input of his surgical colleagues and distributed at the reception.  Additionally, the Department of Surgery developed a handbook introducing their faculty.  Drs. Schecter and Ofman are to be commended for their integration efforts.  The ability to meet and confer with colleagues in a relaxed, non-clinical setting was positive in fostering good working relationships.

Chinatown Public Health Center (CPHC) Participates in Disaster Drill

The CPHC participated in a successful neighborhood disaster drill October 7th, which involved several health agencies and was led by NICOS (coalition of health and mental health agencies serving the Asian/Chinese community) Disaster Preparedness Committee.  Community involvement included a Communication Coordinating Center located at Chinese Hospital; the Cathay Radio Clubs' Ham radio operators who provide mobile linkages among sites; the Fire Department and NERT (Neighborhood Emergency Response Team volunteers trained by the Fire Dept.) trained volunteers; and the Mayor's Office of Emergency Services.  During the last three years over 150 monolingual Chinese speaking volunteers have been trained in disaster response.  These drills are essential for public safety because Chinatown is densely populated and has many unreinforced masonry buildings.  The Health Center is an active member of NICOS and the disaster committee.

LHH Artists Honored at the De Young Museum

On October 14th, 18 resident artists from Laguna Honda were participants in the Annual Exhibit 'Art with Elders' at the De Young Museum.  The Activity Therapy Department collaborates with the 'Art with Elders' program to provide a professional art instructor for LHH residents.  These instructors help channel the artists endeavors into various visual art forms.

It was a special treat for the LHH residents who participated to have their artwork displayed at a world class museum like the De Young.  I wish to recognize Bill Frazier, Director of Activity Therapy, and all of his staff for the fine work they have done in enhancing programs for LHH residents.

LHH Annual Employee Recognition Dinner Dance

Last Thursday night the LHH hospital staff celebrated its annual Employee Recognition Dinner Dance event with a sumptuous buffet dinner and dance at the Patio Espanol.   Honors were given to 264 co-workers who celebrated employment anniversaries ranging from 5 to 35 years

Three employees with 35 years of service were recognized:  Lola Dembowski and Margaret Lebrane from Nursing Services, and Freida King from the Billing Department

Annual Hospitalwide Picnic

On October 24 Laguna Honda Hospital will host its annual hospitalwide picnic for all employees, family and friends, at Flood Park in Menlo Park.  The picnic will run from 10:30 am to 5:30 pm, with food being served between 11:00 am and 2:00 pm.  A variety of games and special entertainment events will be part of the festivities.  All members of the Commission are invited to attend.

CHN Participates in UCSF School  of Nursing Dean's Search Committee

Chancellor Michael Bishop of the University of California San Francisco (UCSF) appointed Anthony Wagner to the Search Committee for the Dean of the School of Nursing.  The UCSF School of Nursing is a leader in nursing education, research, and clinical practice.  The School is responsible for the preparation of teachers, administrators, advanced practice nurses, and research scientists who serve the profession nationally and internationally.  The Nursing School is among the top three in the country in terms of NIH research dollars.


HIV 'Detuned Eliza' Test

The HIV/AIDS Seroepidemiology and Surveillance Section of the San Francisco Department of Public Health has recently established a demonstration project to evaluate the use of a new HIV test, the 'detuned ELISA' at the HIV counseling and testing sites under the direction of the AIDS Health Project and at the municipal sexually transmitted disease clinic.  The detuned ELISA is a test which can determine if someone is likely to have acquired HIV infection in the past six months.  This test is a supplement, HIV blood test which is done only for persons who test positive for HIV.  The detuned ELISA is still under investigation and is expected to receive FDA approval soon.  San Francisco is the only city in the country offering this service.


It is with regret that I announce the resignation of Barry Brinkley, HIV Prevention Director.  We will miss Barry's commitment to HIV prevention services, vision of what was possible, and his collaborative problem solving perspective and leadership.

Although Barry's resignation is effective immediately, I am confident that the HIV Prevention staff will continue to achieve the goals and objectives of the unit.  Larry Meredith will assume day-to-day responsibilities as Acting Director while the search for a new Director is conducted.


President Monfredini presented the October Employee Recognition Awards to the following:


C. Jeffrey Bramlet

Willie Crawford

Rose Fuapopo

Richard Lee

Bonnie Seaman


DPH – Occupational Safety & Health

CHN – Facilities Maintenance

CHN – Facilities Maintenance

DPH - Population, Health & Prevention

SFGH – Rehabilitation Unit

Nominated by

Vickie L. Wells

Anne Kronenberg, Ex. Asst.

Richard Ortiz

John F. Brown, Medical Dir., EMS SectionStaff

Mission Rock Health Care Team Division Nominated by
Nancy Cropley, R.N.

Ann Dallman, M.D.

David Dietrich

Jan Goode, R.N.

Silver Hall

Andrew Hayes, MSW

Jean Cruz Holdaway,

Health Worker

Danielle Hurwitz, Health Worker

Bill LaRock, Nurse Practitioner

Kelly Surin, Clerk Typist

James Wagner

CHN - Homeless Programs (for all) Marian Pena, Acting Dir.

Tom Waddell Health Center (for all)

CommunityMental Health Services Team Division Nominated by
Claire Skiffington and Mary Covington-Walsh Community Mental Health Services Larry Doyle, Chief Finance Officer

Dr. John Brown, EMS Medical Director, provided a status report on the EMS Sections implementation of the Community Consensus Document, "Optimizing the Configuration of San Francisco's EMS", which was presented to the Health Commission on February 20, 1996.  He reported that of the 241 recommendations made in that document, 49 have been completed, 174 are in progress, 16 are in the process of being addressed, and we have been unable to complete two due regulatory changes in the EMS environment.  For a copy of the full report, call the Commission Office (554-2666).

Some of the important achievements accomplished to date have been:

  • Community Education:  The development of the Community Education Committee, the Stop Red Light Running Campaign, and the Development of Public Access Defibrillation Standards.
  • Communications:  The development and implementation of Criteria Based Dispatching.
  • Response and Transportation:  The merger of the Paramedic Division into the San Francisco Fire Department.
  • Destination and Specialty Care:  The addition of Chinese and the Veteran's Administration Hospital as alternative receiving hospitals, and the development of a Diversion Action Plan to improve the hospital diversion situation.
  • Disaster Medical Response:  The regionalization of disaster response, including the development of the Metropolitan Medical Task Force and the Bay Area Disaster Medical Assistance Team.
  • Regulatory Function:  The implementation of CQI in the Quality Improvement Council, and the implementation and ongoing evaluation of the new Standard Treatment Protocols.
  • Global Recommendations:  The cultivation of alternative funding sources for EMS (MMTF grant, Stop Red Light Running funds from DPT), and the expansion of EMS response (all calls answered regardless of ability to pay).

The 1998-99 Strategic Plan for the EMS Section was also presented.  This was generated with the input of staff and community advisory committees.  The emphasis for this fiscal year is on expanding involvement in community education, improving DPH and citywide disaster preparedness, and increasing our role in research and instituting the necessary improvements in data collection and feedback into decision making processes.

Richard Shortall, EMS Chief of the Fire Department, and Dr. Marshall Isaacs, EMS Medical Director of the Fire Department, presented a 6-month status report of the Fire Department's EMS activities.  For a copy of the full report, contact the Commission Office (554-2666). 

The report covered these areas:

  • Ambulance Deployment
  • Workforce Integration
  • Combined Communications Center
  • System Performance
  • Basic Life Support Pilot Study
  • Medical Direction
  • Quality/Risk Management
  • Firefighter/Paramedic Students
  • Multicasualty Incidents/Special Events
  • Response Times
  • Research

Mr. Shortall and Dr. Isaacs reported that the S.F. Fire Department is in a learning stage regarding EMS call volume, EMS system status management and its impact on the patients and the workforce.  The S.F. Fire Department is committed to working as a team with its EMS workforce to examine issues of workload and its relation to quality of patient care and quality of life issues for our paramedics.

The Department supports a number of recommendations that will decrease the workload on the busiest ambulances during the short-term, as well as long-term solutions that will result in a reasonable workload and quality of life for its employees.  This will ensure their ability to provide the highest quality rapid prehospital emergency medical care for the residents of an visitors to San Francisco.

Dr. Katz commended the EMS staff for their work.

The Commission thanked the staff for a comprehensive report that was a joint effort between the Fire and the Public Health Departments.


Dr. John F. Brown, EMS Medical Director, presented an update on hospital diversion at San Francisco Hospitals.

Mr. Nathan Nayman, Hospital Council, commented on the complexity of the issue, with staffing as the core issue along with the shortage of critical care nurses.

Commissioners Comments:

  • What is the role of the Pacific Coast Hospital and is there an innovative way to use beds at this hospital?
  • Are hospitals maintaining their beds?
  • Need for standardized diversion criteria data along with the diversion principles.
  • Something logical is not working.
  • Are we being asked to have a lower standard of care?
  • The leadership needs to address this diversion problem.
  • Because this has been going on for a while, a solution should be devised before December.  Much discussion now has to move to a solution.
  • A pilot project should be considered
  • Being on critical care diversion is a crisis situation; solutions are needed

Dr. Katz stated that the Department needs to use a different strategy from last year.

The Commission requested a plan be brought to the Commission at the November 17, 1998 meeting.

The Commission took a 10-minute recess.


Dr. John F. Brown, EMS Section Medical Director, provided a progress report of the Disaster Registry for Seniors and Disabled Persons.  For a copy of the full report, contact the Health Commission Office (554-2666).

Dr. Brown reported the following:

The Department of Public Health Emergency Preparedness Planning efforts focused on department-wide planning and coordination.  This project takes this expertise into the community.

A guiding principle of this and all of our disaster work, is an emphasis on personal preparedness.  This is a particular challenge for many of our seniors and disabled persons living in San Francisco.  In a continued effort to improve personal preparedness, we are working with community-based agencies to promote community preparedness.

To this end, the Disaster Registry Project builds upon the relationship that many of our community agencies have with these individuals.  Also, efforts are now being directed towards working with outreach agencies to find those seniors and disabled persons who may not yet have an established relationship with a community agency.

The San Francisco Disaster Registry Project is an unprecedented effort to address the disaster-related needs of seniors and persons with disabilities in the City.  Disaster planning experiences has shown the benefits of preorganized, specialized capability in disaster response, and the Registry presents a natural evolution of this concept in disaster response.  As such, the Registry has become an integral part of the Department of Public Health's overall disaster response strategy.  The Registry is well suited to facilitate disaster response within the focus populations in view of social and demographic trends that can be expected through the year 2020 and further into the new millennium.

The EMS Section of the Department of Public Health has assumed the lead role for program planning, implementation, and evaluation for the Disaster Registry Project.  Over the last several months, we have actively begun to implement the program.  We have reconvened the Disaster Registry Task Force and begun a pilot project to test a number of recruitment, data management, and response planning strategies.  This report contains the background of the project and an overview of the three main program components and their status:

  • Populating the registry via recruitment and outreach,
  • Registry databases, and
  • Response plan

The Disaster Registry Project began in 1987 with draft legislation that was introduced to the Board of Supervisors as a result of community concern over frail elderly and disabled persons' vulnerability to disasters.  The 1989 Loma Prieta earthquake highlighted the need for disaster preparedness within these populations.  In 1990, the Board of Supervisors passed Ordinance 259-90 directing the Department of Public Health to establish and maintain a registry identifying those persons who wish to be contacted after a major disaster.  DPH then assumed the responsibility for the Disaster Registry as part of its overall disaster planning efforts.

DPH participates in citywide preparedness efforts to reduce injury and earth in the event of a disaster.  In response to a major disaster, DPH may need to allocate services to provide emergency care to those in need.  The Department's mission includes restoration or continuation of public and environmental health services, (i.e., sanitation, safe food, potable water, vector control, infectious disease control, and laboratory services), and hazardous or toxic substance control.  Disaster response coordination by DPH is guided by the following principles:

  • No one should suffer avoidable health problems in the aftermath of a disaster because of an inability to maintain access to critical services or supplies, such as attendant care, life support equipment, medications, food, or water.
  • Agencies responding to a disaster should have access to information on persons who are especially vulnerable to disasters.  These persons include those who are homebound, require full-time attendant care, or require life support equipment or medications.

Public Speaker: Margaret Baran, IHSS Consortium Executive Director

Commissioners Comments:

  • A simpler system of information is needed
  • Data needs to be streamlined and available to all appropriate agencies
  • Specific simple information is important
  • Back-up people to the system is needed
  • This senior disaster registry could be a model for other vulnerable populations

President Monfredini requested a written follow-up report to the Commission in five months (April 1999).


Monique Zmuda, Chief Finance Officer, reported the following:

A surplus of $18.1 million is projected for the close of fiscal year 1997-98 based on actual expenditures and revenues received though June 30, 1998.  This is a $1.9 million increase from the 8-month projection of $16.2 million.

Major components of the projected surplus of $18.1 million include:  1)  $8.8 million in a one-time FQHC revenues received in FY 1997-98; and 2)  a $25 million savings in Medi-Cal SB 1255 intergovernmental transfer expense that will be deferred until FY 1998-99.  This is offset by:  1) $28 million in reserves against revenue estimates for contractual allowances and bad debt at San Francisco General Hospital; and 2)  a $2.2 million deficit at Laguna Honda Hospital.

Adjustments to the FY 1997-98 surplus of $18.1 million include:  1) a reserve of $8.1 million for future FQHC or other audit disallowances; and 2)  offset by elimination of the $6.4 million in reserves from prior year SB 90 revenue.  The net result of these two adjustments if a $16.4 million surplus available to close out to the City's General Fund.  This $16.4 million contribution to the City's General Fund will fulfill the Department's commitment to return funds to the City.  This contribution was assumed in the FY 1998-99 budget process and is necessary to balance the Department's current year budget.

Ms. Zmuda provided the following information on contractual allowances and bad debt at San Francisco General Hospital:

In early September 1998, the Department of Public Health Finance staff (with the help of our cost report consultants, Toyon and Associates) found that the reserve against revenues for contractual allowances and bad debt was significantly understated.  Contractual allowance is defined as the difference between the charges for services and actual reimbursement from Medi-Cal, Medicare and private insurance.  Bad debt is defined as the difference between the charges for services and the payments made by individuals who are assigned to the self-pay financial code.  Contractual allowances are made as adjustments (reductions) to revenues.  For accounting purposes, bad debt is considered an expense, rather than an offset to revenue.  However, in order to remain in balance, bad debt expense must always be offset by additional revenues.

In analyzing the discrepancies in earlier estimates, it was found that bad debt had either not been written off, or not written off in a timely manner in the past.  Additionally, estimates of Medi-Cal revenue were overstated due to several factors, including higher than actual projections of the conversion of Medi-Cal "pending" to Medi-Cal, understated contractual allowances for inpatient and ancillary charges, and understated allowances for charges in the Mental Health Rehabilitation Facility.

It is important to note that the Hospital's Finance staff have changed prior practices of estimating contractual allowances and writing off bad debt.  Hospital staff will now analyze contractual allowances and bad debt on a monthly basis and make monthly adjustments to financial reports.  In addition, the Hospital will install an automated procedure for posting contractual allowances in revenue accounts that will be monitored each month.  Also, monthly analysis will occur on the aging of accounts receivable to reduce the length of time that accounts remain as receivable.  Finally, the Controller's staff will conduct a review of our revenue postings on a monthly basis in order to validate DPH estimates.

Additionally, Ms. Zmuda reported on the deferral of 425 million for SB 1255 Intergovernmental Transfer:

In the year end close, the Department and the Controller's staff discussed the appropriate accounting of the SB 1255 expenditures (intergovernmental transfer of $25 million) and the revenues ($42 million, of which $25 million is used to offset the expense of the transfer, and $17 million is used as a general net revenue at SFGH.)  Because the expense is made in one fiscal year, and the revenue is received in the next year, the Controller recommended that the Department defer SB 1255 expenditures so that revenues and expenditures are recorded in the same fiscal year.  This deferral results in a net savings of $25 million if FY 1997-98, thereby offsetting the loss in revenue discussed above.  It should be noted that the Department will lose $17 million in revenue in the future when the program is cancelled, or replaced.  However, there are currently no indications that the SB 1255 program will be cancelled in the foreseeable future.  The deferral of the $25 million has been discussed and approved by the Mayor's Budget Director.

Commissioners' Comments:

  • The budget information regarding the bad debt is horrible
  • This budget report will have serious consequences on the commitments already made in the budget for FY 1998-99
  • The budget of SFGH should be reviewed closely at the Joint Conference Committee of SFGH
  • Not all of the Commissioners have had a conversation with the Chief Finance Officer on this budget problem

Dr. Katz stated that there will be dramatic impact on this year's budget.  On November 17, 1998, the Department will bring to the Commission a plan to address these budget issues.


Dr. Sylvia Villarreal, SFGH Chief of Staff, presented the proposed revisions to San Francisco General Hospital Bylaws – Rules and Regulations, Committee Manual and Credentialing Procedure Manual.  The revisions to all three were recommended for approval by the Medical Executive Committee on September 21, 1998, and by the Joint Conference Committee-SFGH on October 13, 1998.

Action Taken: The Commission approved the SFGH Medical Staff Bylaws for the Rules and Regulations Manual, the Credentialing Procedure Manual, and the Committee Manual.


Dr. Katz provided an update on the data and cost projections on the single standard of care for mental health services.

At this time, the Department proposes the policy on a single standard of mental health care be maintained.

President Monfredini referred the monitoring of this program to the Joint Conference Committee for Population Health and Prevention, which is chaired by Commissioner Guy.  President Monfredini commented that she would like the Department to come up with financial options first before asking the Board of Supervisors.

Public Speakers:

  • Evelyn Lee, NICOS
  • Reuben D. Goodman, mental health consumer
  • Jennifer Friedenbach, Coalition on Homelessness
  • Mary Sue Planck, Mental Health Board

Commissioner Guy thanked the Mental Health staff and Dr. Katz for acknowledging the reaffirmation of the Commission's single standard of mental health care policy.

Commissioners Hill and Chow thanked Dr. Katz and the Department staff for the excellent update report.

Commissioners Hill, Guy, and Parker will attend the Board of Supervisor's Health, Family and Environment Committee on October 22, 1998 for the hearing called by Supervisor Sue Bierman.







Action Taken: The Commission voted to hold a closed session.






Action Taken: The Commission approved the settlement only with the stipulation that the City Attorney obtain a specific document from the plaintiff.  If the document is not obtained, the Commission will reconsider this item.


Action Taken:The Commission voted to not disclose any discussions held in Closed Session.

The meeting was adjourned at 7:10 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission