Minutes of the Health Commission Meeting
1, 1998, 3:00 p.m.
at 101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The regular meeting of the Health Commission was called to order by President Lee
Ann Monfredini, at 3:15 p.m.
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 Debra A. Barnes
Commissioner Ron Hill
2) APPROVAL OF MINUTES OF THE MEETING OF NOVEMBER 17, 1998
Action Taken: The Commission unanimously
adopted the minutes of November 17, 1998.
Tony Wagner, Executive Administrator of the Community Health Network, introduced the
internationally known chef Martin Yan, the author of 20 cook books, and Catherine Wong,
R.D., nutritionist at the Chinatown Public Health Center. Chef Yan and Ms. Wong are
co-authors of a new 80-page, bilingual Chinese and English cookbook, which is a product of
the "Lean to Health: Low Fat Chinese Cuisine" campaign. This campaign
emphasizes public education and promotion of healthy eating in order to lower heart
disease and cancer risks. Sample cookbooks were presented to the Commissioners and
Commissioner Chow thanked the guests for their unique collaboration in the community to
promote healthy eating.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE (Commissioner David J.
Sanchez, Jr., Ph.D.)
Note: Commissioner Parker attended the Budget Committee.
(3.1) Central Administration-Finance Request for approval of a resolution
authorizing San Francisco General Hospital to accept and expend a gift of $243,670, and
for Laguna Honda Hospital to accept and expend a gift of $82,809, both from John
(3.2) CHN Request for approval of new contracts with Acker & Guerrero
Roofing, Anderson Carpet & Linoleum, Floortrends, Monticelli Painting, Sabel Painting,
Baca & Sons Painting, Robert W. Poyas Landscaping, John J. Shooter Landscaping,
Agbayani Construction, McClure Electric, Sierra Electric, Pribuss Engineering, Ayoob &
Peery Plumbing, Adolph Schmidt General Contractors and Angotti & Reilly, Inc., for the
provision of supplemental Tradespersons and Maintenance Project Services for a combined
amount not to exceed $3,000,000 for the period December 1, 1998 through June 30, 2000.
PH&P-CHS-Housing Request for approval of new contract with Episcopal
Community Services in the amount of $1,455,858 for the provision of supportive housing to
homeless people at the Pacific Bay Inn for the period of December 1, 1998 through June 30,
(3.4)PH&P-CHS-MH & SAS Request for approval of retroactive renewal of a
contract with Alameda County Health Care Services Agency in the amount of $825,180 for the
provision of neuro-behavioral care through the regional Organic Brain Syndrome (OBS)
program and treatment for adolescents through the Sub-acute Treatment for Adolescents with
Rehabilitation Services (STARS) programs for the period of July 1, 1998 through June 30,
1999. (DHP contracted with Alameda County for services totaling $332,628 during
(3.5) PH&P-CHS-MH & SAS Request for approval of retroactive renewal of a
contract with Seneca Center in the amount of $1,084,656 for the provision of Alternatives
Unlocked Treatment Unit and Locked Sub-acute Treatment Unit for adolescents, for the
period of July 1, 1998 through June 30, 1999. (DHP contracted with Seneca
for services totaling $938,446 during FY 1997-98).
(3.6) PH&P-CHS-MH & SAS Request for approval of retroactive renewal
contract with Japanese Community Youth Council, Inc. (JCYC) in the amount of $609,577 for
the provision of substance abuse prevention services to Asian American youth for the
period of July 1, 1998 through June 30, 2002. (DPH contracted with JCYC for
services totaling $591,822 during FY 1997-98).
PH&P-CHS-MH & SAS Request for approval of second modification to the
contract with Westside Community Mental Health Center, Inc. (WCMHC) for the provision of
mental health and substance abuse services for the CalWORKS program in the amount of
$396,416 for the period of December 1, 1998 through June 30, 1999. The total amount of
this contract, including this modification is $829,999. Term of contract is May 1, 1998
through June 30, 1999. (DPH contracted with WCMHC for services totaling $11,784,134
during FY 1997-98).
(3.8) PH&P-CHS-MH & SAS Request for approval of retroactive multi-year
renewal contract with Center for Human Development, Inc. (CHD) in the amount of $126,367
per year for the provision of substance abuse prevention and education services to youth
in San Francisco schools for the period of July 1, 1998 through June 30, 2002.
contracted with CHD for services totaling $148,019 during FY 1997-1998).
(3.9) PH&P-CHS-MH & SAS Request for approval of new site at 474 Valencia
Street and first modification to the multi-year renewal contract with Mission Council on
Alcohol Abuse for the Spanish Speaking, Inc. (MCAA) to increase the amount by $453,334 per
year for the provision of family day treatment, aftercare and outpatient substance abuse
services for the period of December 1, 1998 through June 30, 2002. The total contract
amount including this modification is $770,998 for fiscal year 1998-99.
contracted with MCAA for services totaling $308,412 during FY 1997-98).
(3.10) PH&P-CHS-MH & SAS Request for approval of retroactive renewal
contract with National Council on Alcoholism and Other Drug Addictions-Bay Area
the amount of $196,564 per year for the provision of substance abuse outreach, assessment,
information, referral, education and prevention to adults and youth for the period of July
1, 1998 through June 30, 2002. (DPH contracted with NCA for services totaling
$190,839 during FY 1997-98).
(3.11) PH&P-CHS-MH & SAS Request for approval of retroactive sole source
and renewal contract with Mt. St. Joseph - St. Elizabeth/Epiphany Center (MSJ-SE) in the
amount of $315,000 per year for the provision of outpatient substance abuse treatment
services to women, their children and families for the period of July 1, 1998 through June
30, 2002. (DPH contracted with MSJ-SE for services totaling $$400,000 during FY
PH&P-CHS-Mental Health Request for approval of retroactive Annual Renewal
Contract with Family Mosaic Project contractor in the Amount of $268,300 to Contract for
Services for the Period of July 1, 1998 through June 30, 1999 through the following
Agency: Victor Treatment Centers.
Commissioner Sanchez stated the present Board is out of compliance with Policy #24 and
encouraged the agency to expand its Board. He requested the contractor to return
with a letter indicating a plan for compliance in 45 days (January 15, 1999).
Commissioner Parker stated that an agency who does not want to comply with Policy #24
should not apply for a contract.
Commissioner Sanchez, Budget Committee Chairman, requested the Department and
contractors to include appropriate documents in the Commission packet, not on the day of
the Commission meeting. Contracts not including appropriate documents will be held
over to the next meeting.
President Monfredini commented on #3.5, the Seneca contract, that its Board membership
of six should be increased, given the amount of the contract.
Commissioner Chow and President Monfredini requested the Department to look into the
idea of acknowledgement letters from the Commission President to the donor of individual
gifts to the Department.
Action Taken:The Commission approved the Consent Calendar of the Budget
Committee, with the specific requests of Commissioners.
4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).
Long-Term Care Pilot Project
- I am pleased to report that the Department has secured second year funding for the
Long-Term Care Pilot Project. The grant was awarded by the California HealthCare
Foundation and covers the time period January 1, 1999 to December 31, 1999. The
grant funds are necessary for San Francisco to complete its planning for an improved
long-term care services delivery system for frail elderly and disabled residents. In
the second year of planning, the Task Force will:
- explore and resolve the governance structure,
- develop administrative structures and functions,
- work with the State to create an expenditure and service utilization database, and,
- resolve and obtain waiver authority needed for fee-for-service managed care.
We would like to acknowledge the support of The California Endowment, which funded the
first year of planning activity.
SFHP IHSS/Healthy Workers Insurance Program Update
The San Francisco Health Plan's application for the IHSS/Healthy Workers Program
license remains under review at the Department of Corporations (DOC).
The DOC has indicated it is concerned that the Healthy Workers Program does not offer
SFHP has submitted its response to the DOC, noting that providing dependent coverage
for this population could affect the relationship between the provider and the client, as
well as the client's Medi-Cal benefits, because the provider of service is often a blood
relative of the client. SFHP also argued that since most of the IHSS workers are
medically indigent, they will be unable to pay for dependent coverage, thus offering
coverage is of little real value.
Conditions at the DOC are in flux because of the pending change of Governors and the
increased scrutiny recently focused on the licensing of health care service plans.
The DOC has until approximately the third week in December to respond. SFHP
cannot begin marketing the IHSS/Healthy Workers Program until approval is obtained.
Although a start date cannot be accurately predicted, the DOC examiner handling this
application is enthusiastic about the program and a February 1, 1999 start date is not
POPULATION HEALTH AND PREVENTION
California Endowment Application
A proposal jointly developed by the Department of Public Health and the Mental
Health Contractors Association has been submitted to the California Endowment to support
the expansion and evaluation of mental health services to people without insurance.
The proposal would enable us to achieve our goal of providing a single standard of
mental health care, and it is consistent with priorities of the CommunitiesFirst
initiative from the California Endowment. CommunitiesFirst includes improved access
to health care, community innovation in the provision of services, improvement in
community health and well being and promotion of multicultural health. The proposal
includes an evaluation component that will focus on clinical, population and system
outcomes. I have provided a copy of the proposal for each of the Health
The Department's Community and Home Injury Prevention Program for Seniors (CHIPPS)
was honored at the American Public Health Association (APHA) meeting by being asked to
participate in a special Poster Session. The session was organized for runners-up in
the Archstone Foundation Award Program for Excellence in Program Innovation. Michael
Radetsky presented on "Injuries to Seniors: Defining the Problem and Prioritizing
COMMUNITY HEALTH NETWORK
Laguna Honda Passes Resurvey
On November 18, the Healthcare Financing Administration (HCFA) notified Laguna
Honda that as a result of the resurvey the Hospital was found to be in substantial
compliance with Federal requirements. Therefore, the reimbursement revenue stream
will continue uninterrupted, and none of the penalties mentioned in earlier correspondence
will be imposed. I wish to commend all of the staff at Laguna Honda for their
ongoing efforts to continue providing quality care to the residents during this intense 10
month survey process. The Hospital is scheduled for its next annual survey in March
Threat to Teaching Facilities from Medi-Cal Interpretation of Billing Regulations
Late last year, the U.S. Department of Justice and the California Attorney
General's Office opened an investigation into the billing practices of San Francisco
General Hospital. The investigators told the City Attorney and staff that this is a
standard Physicians At Teaching Hospitals ("PATH") audit. During this
investigation, it was discovered that Medi-Cal takes a very different view than San
Francisco of the ability of hospitals to bill for medical services rendered by physician
residents to Medi-Cal patients in outpatient settings. The resolution of this issue
will have serious financial implications for all teaching hospitals in California.
Title 22, section 51509(g)(1)(A) of the California Code of Regulations specifically
allows hospitals to bill Medi-Cal for outpatient services rendered by "interns,
residents or hospital-compensated physicians." Thus, there is clear authority
for hospitals to bill Medi-Cal for outpatient professional services rendered by residents.
Medi-Cal is insisting, however, that section 51503(1), which relates to billing by
teaching physicians, supersedes section 51509 by imposing a requirement that the teaching
physician be physically present in the room while the resident provides the service.
We believe this position is wrong legally. In addition, it serves no valid public
policy since it would penalize teaching hospitals by requiring two professionals to
participate in every outpatient medical encounter while paying for only one.
Should San Francisco lose this argument, Medi-Cal appears poised to implement the
change retroactively. While this would be a devastating financial blow to San
Francisco General Hospital, the effect would not be limited to San Francisco. We
would expect Medi-Cal to open similar investigations at every teaching facility.
Thus, the outcome of this dispute could seriously undermine the ability of California
medical facilities to continue to operate as teaching centers.
We have requested a meeting with Medi-Cal and the Attorney General's Office to discuss
this matter. To make that presentation as effective as possible, we are seeking the
support of other teaching hospitals.
Expanded Social Work Coverage in the Emergency Department
The Medical Social Work Department of SFGH is please to announce expanded social
work coverage in the Emergency Department as of December 1st, 1998. Medical Social
Workers will now be available to E.D. patients and their families for 16 hours a day, 7
days a week.
The E.D. Social Work staff is comprised of Medical Social Workers with experience in
violence and hate crimes, trauma, substance abuse, and women and children's
services. The services of the social worker is available to patients admitted to the
E.D., their significant others, and their families.
Primary Care Community Health Center Site Visits
Anthony Wagner conducted a round of site visits to the following Health Centers:
Silver Avenue, Southeast Health, Ocean Park, Chinatown, Tom Waddell, Maxine Hall, Potrero
Hill and Castro-Mission. One of the overriding concerns raised by Center Directors
and other staff was the need for capital funds to improve the physical plant of the
Tony joined Commissioner Harrison Parker in meeting with the Advisory Board of
Southeast Health Center to review a number of concerns they had raised previously with
Center management staff. Jackie McWright is serving as Southeast Interim Director
until a new Director and a Medical Director for the Center are hired.
5) A. CONSIDERATION OF PROPOSED REVISIONS TO THE SFGH CLINICAL SERVICE RULES AND
REGULATIONS AND PRIVILEGE SHEETS Dental/Oral Maxillofacial Surgery
Family and Community Medicine
The above mentioned Clinical Service Rules and Regulations were recommended for
approval, as required in the Bylaws Article XI, by the Quality and Utilization Management
Committee on October 28, 1998, by the Medical Executive Committee on November 9, 1998, and
by the Joint Conference Committee-SFGH on November 10, 1998. The accompanying
Privilege Sheets were also approved by the Credentials Committee on October 16, 1998.
Action Taken: The Commission approved the revisions to the above referenced SFGH
Clinical Service Rules and Regulations and Privilege Sheets.
B. CONSIDERATION OF SFGH ADMINISTRATIVE POLICIES AND PROCEDURES Patient Transfer of Other Acute Care Facilities
Management of Pain in the Cancer Patient
Telephone Calls by On-Call Physicians
Telephone Lines, restricted/Unrestricted
The above mentioned Administrative Policies were reviewed and recommended for approval
by the Joint Conference Committee-SFGH on November 10, 1998.
Action Taken: The Commission approved the SFGH Administrative Policies and Procedures.
President Monfredini reminded the Department staff not to forget the CPR issue.
6) PRESENTATION OF THE ANNUAL DEPARTMENT OF PUBLIC HEALTH 1997-1998 AFFIRMATIVE
Gloria Louie, Manager of Equal Employment Opportunity and Affirmative Action
Programs, presented the Annual Report.
Ms. Louie introduced members of her staff: Charlotte Meister, Sam Shindler,
Mariana Valdez, and Dana Van Gorder.
Ms. Louie reviewed the following:
- Departmentwide labor force data
- Labor force information by DPH three major divisions
- Underutilization statistical information of the administrative job category over a
10-year period, and
- Department's affirmative action program activities for fiscal years 1997-98 and planned
activities for 1998-99
President Monfredini complimented staff for an excellent, clear and comprehensive
Commissioner Guy acknowledged the need to outreach the American Indian community.
Commissioner Sanchez suggested a couple of Native American and Hispanic professional
groups as resources for outreach in these two communities.
7) CONSIDERATION OF A RESOLUTION FOR LEAD ORDINANCE COMPLIANCE
Larry Meredith, Ph.D., Director of Community Health Promotion and Prevention,
presented the 1998 Director of Health's Annual Report on the Comprehensive Environmental
Lead Poisoning Prevention Program, as mandated by Health Code Article 26, Section
1609. The report outlines current policy and practice issues on preventing childhood
lead poisoning for the City as a whole, as well as for specific City agencies. Each
agency is assessed as to how well they have ensured lead prevention education for clients
who are parents of young children, and how well they have ensured lead-safe public
facilities. For a copy of the full report, contact the Commission Office at
Karen Cohn, Coordinator for Lead Prevention Programs, reported the key findings:
- Amongst one and two year olds, there are six zip codes in San Francisco, where
surveillance data shows 12-16% of children tested have elevated blood lead levels greater
than or equal to tem micrograms per deciliter (the Centers of Disease Control level of
concern), over the 1991-97 time period.
- The Childhood Lead Prevention Program still faces two major obstacles in assessing the
extent of childhood lead poisoning in our community:
- Less young children are tested for lead poisoning than is warranted, a Targeted Lead
Screening Policy will soon be issued to address this gap.
- Universal data capture does not exist until the State issues regulations requiring
laboratories to provide electronic reporting of all lead test, not just those elevated
above 25 micrograms per deciliter.
- Extensive community education efforts by the Department of Public Health, as well as
many other governmental and private agencies, have made an impact on public awareness of
lead hazards and lead poisoning prevention.
- Case management services provided to lead-poisoned children, as well as the associated
enforcement program requiring that property owners repair lead hazards identified during
case investigation, are both working effectively.
- Due to the extent of lead paint, dust and soil hazards in San Francisco, greater
resources and incentives are needed for property owners to conduct primary prevention lead
Ms. Cohn stated the data being collected is as good as it gets. She reported
there are three targeted screening groups:
- present CHDP patients
- 1-2 year olds
- 3-6 year olds
Public Speakers: Neil Gendel, Healthy Children Organizing Project
Commissioner Guy observed that the role of schools appears to be less than
The Department has a good working relationship with school line staff, but the school
District does not respond. The School District is also not adequately staffed.
Action Taken: The Commission adopted Resolution #37-98, "Endorsing the Findings
and Recommendations on the 1998 Director of Health's Annual Report on the Comprehensive
Environmental Lead Poisoning Prevention Program".
8) OTHER BUSINESS/PUBLIC COMMENTS
Public Speaker: Michael Petrelis, AIDS Accountability Project
9) CLOSED EXECUTIVE SESSION:
A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION.
B. VOTE ON WHETHER TO HOLD CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN
FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a).)
Action Taken:The Commission voted to hold a Closed Session.
C. CLOSED SESSION PURSUANT TO GOVERNMENT CODE SESSION 54956.9 AND SAN FRANCISCO
ADMINISTRATIVE CODE SECTION 67.11(b).
CONFERENCE WITH LEGAL COUNSEL - EXISTING LITIGATION.
NAME OF CASE: DENNIS TODD ROBERTS V. CCSF ET AL., CASE NO. 985-362: $15,000 PROPOSED
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 approved the settlement for $15,000.
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 voted not to disclose any discussions held in Closed
The meeting was adjourned at 5:00 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission