Minutes of the Health Commission Meeting

Tuesday, November 3, 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 Debra A. Barnes 
  • Commissioner Edward A. Chow, M.D.
  • Commissioner Roma P. Guy, M.S.W.
  • Commissioner Harrison Parker, Sr., D.D.S.
  • Commissioner David J. Sanchez, Jr., Ph.D.


  • Commissioner Ron Hill
  • Commissioner Lee Ann Monfredini

Action Taken: The Commission unanimously adopted the minutes of October 20, 1998, with the correction that President Monfredini called the meeting to order.


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

Note: Commissioner Parker attended the Budget Committee meeting.

CHN–Primary Care Services-Homeless Programs – Continuance of progress report on Bayview Hunter's Point (BVHP) contract presented on September 29, 1998 and request for approval of retroactive renewal contract to provide mental health case management services for the homeless in the amount of $412,174 for the period of July 1, 1998 through June 30, 1999.

(DPH contracted with BVHP for services totaling $6,833,093 during FY 1997-98).

Commissioner Parker suggested more frequent monitoring (i.e., quarterly) of contractors having difficulties.

Commissioner Barnes requested the Budget Committee be kept informed about problem areas of this contractor.

(3.2) PH&P-AB 75 Project – Request for approval to authorize adoption of the County Description of Proposed Expenditure of California Healthcare for Indigents (CHIP) Program Funds for Fiscal Year 1998-99.

Commissioner Sanchez requested departmentwide information on dental services.

(3.3) PH&P-CHS-Mental Health – Progress report on St. Luke's Hospital demographic data as requested by the Budget Committee of the Health Commission on September 29, 1998 and request for approval of renewal contract for adult Medi-Cal funded psychiatric inpatient hospital services for the period December 1, 1998 through June 30, 1999.  The total dollar amount for Medi-Cal psychiatric inpatient hospital services for all six (6) hospital providers is $5,000,000.

Commissioners thanked the CEO of St. Luke's Hospital for his attendance at this meeting.

(3.4) PH&P-CHS-Mental Health – Request for approval of retroactive renewal of a multiyear contract with Regents of the University of California (UCSF), Dean's Office at SFGH, in the amount of $1,455,099 per year for the provision of mental health outpatient and case management services to clients who have been hospitalized at least twice in the past 12 months for the period July 1, 1998 through June 30, 2002.  (DPH contracted with UCSF for services totaling $14,794,533 during FY 1997-98.) 

Commissioner Barnes requested a letter be sent from the Commission to the U.C. Board of Regents regarding compliance to Policy #24, specifically on the collection of sexual orientation demographics.  Commissioner Barnes commented that the Department has many million of dollars in contracts, plus the U.C. Affiliation Agreement, with UCSF.

Commissioner Sanchez abstained due to conflict of interest on this item.

(3.5) PH&P-CHS-Mental Health – Request for approval of retroactive renewal of a multiyear contract with Ramsell Corporation, d.b.a. Professional Management Development Corporation, in the amount of $3,315,590 per year for the provision of fiscal agent services to reimburse residential care and geriatric care facility operators for clients living in certified State-licensed facilities and to reimburse providers who are not in the San Francisco Mental Health Plan provider network for the period July 1, 1998 through June 30, 2001.  (DPH contracted with Ramsell for services totaling $6,399,307 during FY 1997-98.)

PH&P-CHS-Mental Health – Request for approval of retroactive sole source and renewal of a multiyear contract with Crestwood Behavioral Health, Inc. in the amount of $3,003,950 per year for the provision of 24-hour and subacute locked mental health nursing facility services for the period of July 1, 1998 through June 30, 2001.  (DPH contracted with Crestwood for services totaling $4,341,508 during FY 1997-98.)

Commissioner Sanchez commended the contractor on its compliance to Policy #24.

(3.7) PH&P-CHS-MH & SAS – Request for approval of retroactive renewal of a multiyear contract with North of Market Senior Services, Inc., in the amount of $304,110 per year for the provision of outreach, outpatient, drop-in substance abuse services and case management, assessment and referral for mental health and social services for the period of July 1, 1998 through June 30, 2002.  (DPH contracted with NOMSS for services totaling $419,145 during FY 1997-98.)

(3.8) PH&P-CHS-MH & SAS – Request for approval of retroactive renewal of a multiyear contract with Family Service Agency of San Francisco (FSA) in the amount of $4,210,152 per year, to provide children's mental health services, adult care management, geriatric services, brief therapy services, and fiscal intermediary services for the period July 1, 1998 through June 30, 2000.  (DPH contracted with FSA for services totaling $4,698,820 during FY 1997-98.)

This item was postponed to a future meeting.

(3.9) PH&P-CHS-Substance Abuse – Request for approval of retroactive renewal of a multi-year contract with Potrero Hill Neighborhood House, (PHNH) in the amount of $273,826 per year, to provide substance abuse day treatment services for the period July 1, 1998 through June 30, 2002.  (DPH contracted with PHNH for services totaling $265,850 during FY 1997-98.)

Commissioner Barnes requested a progress report in 90 days on the survey of clients.

(3.10) PH&P-CHS-Substance Abuse – Request in conformance with Proposition I, Public Notices, for approval of proposed day treatment project site in San Francisco at 965 Mission Street, Suite 640, for use by Standing Against Global Exploitation, Inc., (SAGE), and retroactive contract renewal with SAGE, in the amount of $373,319 per year to provide outpatient substance abuse services for women and transgender individuals, start-up services for the new project site, and day treatment services for prostitutes or sex workers for the period of July 1, 1998 through June 30, 2002.  (DPH contracted with SAGE for services totaling $80,000 during FY 1997-98.) 

(3.11) PH&P-CHP&P-HIV Prevention -- Request for approval of retroactive renewal of a contract with Regents of the University of California San Francisco (UCSF) AIDS Health Project in the amount of $436,560 for the provision of HIV counseling, testing, referral and partner notification (CTRPN) for the period of July 1, 1998 through June 30, 1999.  (DPH contracted with UCSF for services totaling $14,794,533 during FY 1997-98.)

Commissioner Sanchez abstained due to conflict of interest on this item.

(3.12) PH&P-CHP&P-HIV Prevention -- Request for approval of retroactive renewal of a contract with Regents of the University of California (UCSF) AIDS Health Project in the amount of $176,914 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 UCSF for services totaling $14,794,533 during FY 1997-98.)

Commissioner Sanchez abstained due to conflict of interest on this item.

(3.13) PH&P-CH&SS -- Request for approval of retroactive sole source and renewal of a multi-year contract with Regents of the University of California (UCSF) in the amount of $207,736 per year for the provision of physician and radiology services at the Tuberculosis Clinic at San Francisco General Hospital for the period of July 1, 1998 through June 30, 2002.  (DPH contracted with UCSF for services totaling $14,794,533 during FY 1997-98.)

Commissioner Sanchez abstained due to conflict of interest on this item.

(3.14) PH&P-CHP&P-HIV Prevention – Request for approval of retroactive renewal of a contract with Black Coalition on AIDS, Inc. (BCOA) in the amount of $181,499 for the provision HIV prevention services for the period of October 1, 1998 through June 30, 1999.  (DPH contracted with BCOA for services totaling $914,604 during FY 1997-98.)

(3.15) CO-Finance – Request for approval of contract extension with Health Management Systems, Inc., (HMS) for electronic claims processing, retroactive claims reprocessing, and managed care consulting and data processing services for the Community Health Network for the period of November 1, 1998 through March 31, 1999; reimbursement for all services is based on contingency fees from revenues collected.

Action Taken: The Commission approved the Consent Calendar of the Budget Committee, except #3.8, with the specific requests.

Commissioner Sanchez abstained on #3.4, 3.11, 3.12 and 3.13.

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

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


Federal Budget

Last month the President and Congress struck agreement on the 1999 federal fiscal year budget, October 1, 1999 – September 30, 2000.  The Title II Department of Health and Human Services (DHHS) budget total  $211.6 billion.  DHHS oversees the Health Resources and Services Administration, Ryan White AIDS Programs, Center for Disease Control and Prevention, National Institutes of Health, Substance Abuse and Mental Health Services Administration, Agency for Health Care Policy and Research, Health Care Financing Administration, Administration for Children and Families and Administration on Aging.  The following summarizes key health components of the federal budget:

HIV/AIDS -- The Ryan White Care Act appropriation is $1.4 billion, which is $262 million more than the 1998 appropriation and $99 million more than the Administration requested.  The Ryan While totals include $505 million for grants to areas with high numbers of AIDS cases, $670 million for comprehensive care programs, $94 million for early intervention programs and $44 million for pediatric demonstration projects.  Additional funds were also appropriated to the HOPWA program. 

The President and Congress also appropriated $130 million to address AIDS/HIV in communities of color.  African-Americans constitute the fastest growing portion of HIV/AIDS caseload (44% of all new HIV cases nationally).  The funds will be used to improve prevention efforts in high-risk communities to expand access to HIV drug therapies and other treatment.

Public Health -- An additional $222 million has been appropriated to the Centers for Disease Control (total FY 1999 appropriation is $2.4 billion).  The funds will be used to fight emerging infectious diseases, combat new resistance to antibiotics and improve prevention in such areas as diabetes, heart disease and HIV/AIDS.

Quality Health Care – The Agency of Health Care Policy and Research will receive an additional $25 million to conduct research on the quality, costs and outcomes of the health care delivery system.  The goal is to identify critical health care problems and educate all those involved in providing clinical care about solutions that can lead to improved quality.

Health Status – The approved budget will allow DHHS to fund grants for communities to eliminate racial health disparities.  This is a multi-year initiative to address health disparities in six health areas including cancer, HIV/AIDS, diabetes and immunizations.

Lead Poisoning Prevention – The Fiscal Year 1999 budget includes a $20 million increase for lead poisoning prevention.  The funds are needed to reduce the threat of childhood lead poisoning and other housing-related environmental health hazards.

Food Safety – Approximately $79 million has been appropriated for the Food Safety Initiative to help implement improvements in the surveillance of food borne illnesses, education about proper food handling, research and inspection of imported and domestic foods.

Bioterrorism – An emergency public health and social services fund was allocated $216.9 million for bioterrorism and related activities.  Funds will also be used to improve public health infrastructure, conduct studies on health and national security and to combat certain infectious diseases.

Healthy Families

As of late October, 29,801 children had been enrolled in the California Healthy Families Program (2,371 in San Francisco – 8% of total enrollment).  The total number of children eligible for the program statewide has been revised to 400,000.  An estimated 3,000 to 6,000 children are eligible for the program in San Francisco.  Statistics indicate that over 60% of the children who apply for Healthy Families are ineligible because they qualify for no-cost Medi-Cal.

The program has been in operation for three months and the State is undertaking efforts to enhance the enrollment given that it has enrolled less than 1% of the eligible population.  Specifically, the State is:

Revising the joint application for Healthy Families/ Medi-Cal for Children,

Strengthening community outreach and education by increasing assistance fee, implementing a school-specific enrollment strategy, providing support in geographic areas where community-based organizations need assistance,

Expanding outreach to the Latino community by obtaining clarification on the public charge issue for the immigrant community, conducting application assistance training in Spanish and increasing partnerships with Spanish language media, and

Expanding corporate sponsors to gain more exposure for the program.

The U.S. Immigration and Naturalization Services has clarified that citizen children will not create "public charge" liability for parents regardless of their immigrant status.  However, it is unclear if this provision applies to immigrant children with immigrant parents. 

Last month, the Managed Risk Medical Insurance Board (which oversees Healthy Families) was presented with a report on San Francisco's outreach effort in the Chinatown area.  The majority of San Francisco's Healthy Families enrollment has been within the Asian community.  The report indicated that of those surveyed, most enrollees became aware of the program either through the media (47%) or a provider – many cited North East Medical Services (23%).  Only 3% of those surveyed cited English media as the source of their information about Healthy Families.  This report is particularly enlightening in that it provides data on how certain communities receive information and which outreach strategies are or are not successful.

Flu Season Kick Off

The Department hosted its annual flu season kick off event this year at Chinatown Public Health Center on October 27th.  Three TV stations covered the flu clinic that immunized over 300 seniors on its first day in operation.  Flu clinic hours and schedules in Spanish, Chinese and English have been distributed widely throughout the city and the Flu Hot Line will continue in operation until December 31st at nine Community Health Network clinic sites.



I am most pleased to announce that the First Offender Prostitution Program, administered by SAGE in conjunction with the District Attorney's Office, has received the prestigious Innovations in Local Government award from the Ford Foundation and the Harvard University Kennedy School of Government.  It is the first time a program from San Francisco has received the $100,000 award.  We are all very proud of Norma Hotaling, founder and director of SAGE, for this well-deserved honor.  As you know, SAGE is a contractor with Community Substance Abuse Services, and Norma Hotaling is an active member of the Substance Abuse Treatment on Demand Planning Council.  We join with the Ford Foundation and Harvard University in congratulating Norma for her dedication and excellent work.

Cynthia Selmar Joined the Community Health Promotion and Prevention

I am pleased to announce that Cynthia Selmar has joined the Community Health Promotion & Prevention Branch of Population Health and Prevention.  As many of you know, Cynthia has ably served the department in several capacities over the years, including Perinatal Services Coordinator, Director of Senior Services and, most recently, as Director of the Southeast Health Center.  Her new assignment will make her responsible for the development and oversight of African-American health initiatives, including monitoring the development of the Health and Environmental Resource Center in Bayview/Hunters Point.  We are very fortunate to have someone of Cynthia's stature in the community agree to take on such an important assignment.  We are both grateful for her past stewardship of the Southeast Health Center and eager to have her take on her new responsibilities.  We all offer a hearty welcome to Cynthia in her new role.

Domestic Violence Awareness Month

San Francisco Collaborative Organized to Prevent Abuse (SF-COPA) in collaboration with the Family Violence Council's community education committee, SF-COPA has produced two posters for Domestic Violence Awareness month.  The poster designs were produced by San Francisco students in middle and high school, who participated in the contest "Color Us Safe!" which was conducted by the Family Violence Council.  One poster has the message "FAMILY VIOLENCE HURTS EVERYONE', the other says "FAMILY VIOLENCE IS ILLEGAL.  PLEASE STOP IT."

The posters are intended to raise community awareness of domestic violence, and in particular, its impact on children.  This effort contributes to the Department's emphasis on the reduction of intentional injury.  Although only a small number of posters were printed in the first "round", additional copies are currently being produced.   I attached copies of the posters to this report for your perusal. 

Annual Data  Summary on Tuberculosis


Laguna Honda Survey Status Report

As reported at our last meeting, LHH submitted its Plan of Correction for the September resurvey October 16th.  On October 22nd, the Licensing & Certification Division of the California State Department of Health Services notified the Hospital that its Plan of Correction was unacceptable, and requested additional information.  The Hospital resubmitted an amended Plan of Correction October 28th and is waiting for a response from the State.  The State and HCFA have continued to invoke the threat of monetary penalties and program termination pending receipt of an acceptable Plan of Correction.  I will keep you apprised of the status of this important issue.

Appointment of CHN Medical Director, Laguna Honda Hospital

It is with great pleasure that I announce the appointment of Dr. Maria Rivero as the CHN Medical Director for Laguna Honda Hospital (LHH), effective immediately.  Dr. Rivero has been a part of the medical staff at LHH since 1988. She served as the Assistant Medical Director between February and June of 1998 and has been Acting Medical Director of LHH since July.

Dr. Rivero received her clinical training at Highland General Hospital in primary care and served as Chief Resident in Internal Medicine in 1993-1994.  She also completed a fellowship in Pain Management at Harvard School and a Residency Program in Anesthesia.  She completed her medical degree with honors at UCSF and is a graduate of the Cornell University of Arts and Sciences.  Dr. Rivero is on the clinical faculty at UCSF and teaches UCSF medical students at all levels of training.  Please join me in welcoming Dr. Rivero to her new position.

Appointment of CHN Director for Pharmaceutical Services

I am pleased to announce the appointment of Sharon Kotabe, Pharm.D., to the position of CHN Director for Pharmaceutical Services.  For the last five years, Dr. Kotabe was the Pharmacy Director at Laguna Honda Hospital.  In her new capacity, Dr. Kotabe will have responsibility for administrative oversight of pharmaceutical services for San Francisco General Hospital, Laguna Honda Hospital, the Mental Health Rehabilitation Facility, Forensics, and the  Primary Care Centers.  Already an active member of many CHN-wide groups that include the Pharmacy Council, Health at Home Professional Advisory Board, and the hospital pharmacy and therapeutics committees, she will also serve on the patient Care Council.

Dr. Kotabe has published articles in peer-reviewed national pharmaceutical journals, been invited to speak to pharmacy and other health care provider groups, and been appointed to serve on numerous committees for state-wide and national pharmaceutical organizations. Dr. Kotabe is also Assistant Dean and Assistant Clinical Professor of Pharmacy at the University of California, San Francisco School of Pharmacy, and Fellow in the California Society of Health-system Pharmacists and the American Society of Consultant Pharmacists.  Please join me in welcoming her to her new position.

CHN Chief Assistant

I am pleased to announce the selection of Arthur Greenberg to the Community Health Network (CHN) as Chief Assistant to the CHN Executive Administrator.  In this capacity, Arthur will continue to serve as Deputy City Attorney, working in coordination with Paula Jesson and the other Deputies assigned to the City Attorney's Health and Human Services Team to provide legal advice to CHN staff and other City Officials.  He will also continue his primary role assisting Laguna Honda Hospital with the U.S. Department of Justice investigation, and related federal and state regulatory agency issues.

Independent Special Features

The Independent Newspaper began featuring a series of articles by Michelle Terwilliger this past month on LHH residents.  These features show the human dimension of the hospital, specifically the residents who are willing to share their stories.

Healthy Families Halloween

The Community Health Network celebrated Halloween with parties aimed at boosting enrollment in Healthy Families, the state's insurance program for children of low-income families.   Over 175 kids attended these parties at San Francisco General Hospital Medical Center and the Castro-Mission Health Center.   Neighborhood children from Buena Vista and Cesar Chavez elementary schools, Good Samaritan Day Care Center, and St. Peter's Parish School attended with parents and teachers.  Healthy Families information was distributed in goodie bags to all, and staff made contact with about 35 families whose children lack health coverage.

Laguna Honda Hospital Picnic Rescheduled

Laguna Honda Hospital's annual picnic was rescheduled to November 7th due to rain.  The event will be at Flood Park in Menlo Park from 10:00 to 5:00.  Food, games, and entertainment will be provided.  All Commission members, staff and friends of LHH are invited to attend.

Commissioner Barnes requested a copy of the letter from HCFA and State Licensing and Certification and a copy of the Department's response.

Commissioner Chow acknowledged the TB data and requested the Population Health and Prevention Division to include some analysis and comments on the data.

Commissioner Sanchez requested the Department to consider looking at ways to provide aid to the Nicaragua disaster.

Commissioner Parker asked the Department how it plans to address the increasing HIV rates in the African American community.  Dr. Katz stated the Department will be looking at this issue.

Commissioner Chow stated that the Department was recently acknowledged at the S.F. Medical Society.


Commissioner Chow, Chairman of the Joint Conference Committee-SFGH, reported that the Clinical Service Rules and Regulations are being recommended for approval, as required in the Bylaws Article XI, by the Quality and Utilization Management Committee on September 28, 1998; by the Medical Executive Committee on October 19, 1998; and by the Joint Conference Committee-SFGH on October 13, 1998.  The accompanying sheets were also approved by the Credentials Committee on August 10, 1998.

Action Taken: The Commission approved the revisions to the Clinical Service Rules and Regulations and Privilege Sheets for Anatomic Pathology and Laboratory Medicine.


Monique Zmuda, CFO, gave an update on the Department's retroactive contracts, (Attachment A).

Commissioners' Comments:

  • Requested the Department to relook at the $50,000 threshold and the type of contracts that may not be required to go to the Commission.
  • Is there a question of personnel in-house resource allocation?
  • Status report is an informative response.
  • Efficiency in the contracting process is important.
  • When is the appropriate time in the contract cycle to look at policy issues?
  • More data should be brought back to the Commission for analysis in January/February.
  • Goal is to have fewer retroactive contracts.

Dr. Katz stated the Commission may use its option of not approving a retroactive contract for the remainder of the fiscal year.


Mildred Crear, Director of Children, Youth and Families Section, Population Health and Prevention Division; Joanne Kimata, Planner, Office of Policy and Planning; and Ginger Smyly, Deputy Director, presented the fourth report for the Health and Well Being of Children and Youth in SanFrancisco.

Public Speaker: Neil Gendel, Healthy Children Organizing Project

Commissioner Sanchez thanked members of the Council.  He emphasized the report can be used to focus on prevention and intervention models.

Commissioner Chow stated the document is invaluable for demographics.  He encouraged the Department to use the report as an opportunity for Population Health and Prevention programs.

Commissioner Guy would like to have a more in-depth discussion of the report at her Joint Conference Committee.  This report begs the question of the role of school health and the impact on policy issues.

Ms. Crear commented that she would like to bring information to the Commission on Starting Points, the Childcare Initiative.

Commissioner Sanchez pointed out that many foundations are looking at childcare issues.

Ms. Crear reported that the Coordinating Council considers the completion of this report to be the first step in a process to ensure that the health issues of children and youth are in the forefront.  The Council will now begin facilitating discussions within the Department to examine the findings of the report, and, in concert with the Department's leadership and staff, develop a set of policy and program recommendations concerning child and youth health.  The Council anticipates that a central aspect of its recommendations will be increased coordination and integration of its children and youth programs across the Department's divisions and programs, as well as throughout the City.



The meeting was adjourned at 5:30 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission