Minutes of the Health Commission Meeting

Tuesday, January 19, 1999, 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 3:15 p.m.


  • Commissioner Edward A. Chow, M.D.
  • Commissioner Ron Hill
  • Commissioner Lee Ann Monfredini
  • Commissioner Harrison Parker, Sr., D.D.S.


  • Commissioner Debra A. Barnes
  • Commissioner Roma P. Guy, M.S.W.
  • Commissioner David J. Sanchez, Jr., Ph.D.


Action Taken: The Commission unanimously adopted the minutes of January 5, 1999.

(Commissioner Ron Hill)

Note: Commissioner Hill chaired the meeting. President Monfredini was present at this meeting.

(3.1) CHN-LHH – Request for retroactive contract renewal and sole source with the UCSF School of Nursing, in the amount of $111,250, for the provision of primary care services by a gerontological nurse practitioner, and an equivalent advanced practice nurse or clinical nurse specialist to participants in the Adult Day Health Care Center, for the period of October 1, 1998 through September 30, 1999.

PHP-Housing Services – Request for approval of sole source and new contract with Tenants and Owners Development Corporation (TODCO), in the amount of $60,690, for the provision of support services to homeless people at the Grand Southern Hotel for the period of January 15, 1999 through June 30, 1999.

President Monfredini stated she looks forward to the completed survey as part of compliance to Policy #24.

PHP-CHSS – Request for retroactive approval to receive funds from the University of California Breast Cancer Research Program, in the amount of $73,486.50, to conduct a research study entitled "Study of Inadequate Follow-up of Mammography Abnormalities" for the period of July 1, 1998 through June 30, 1999, and a retroactive sole source approval for a new contract with Dr. Arthur Coleman in the amount of $11,532, to assist in this study by developing interview questions, identifying focus group questions, and assisting in the development of survey items, as well as participating in writing a research proposal based on this study, for the period of January 1, 1999 through June 30, 1999.

President Monfredini requested a follow-up report to this research.

(3.4) PHP-CMHS – Request for approval of the FY 1998-99 Mental Health Performance Contract between the State Department of Mental Health and the Department of Public Health, Division of Mental Health Services.

(3.5) PHP-CSAS – Request for approval of retroactive multiyear contract renewal with Driver Performance Institutes (DPI), at no cost to the Department, in the amount of $178,903 per year in client fees only, to provide group counseling and education services to persons convicted of first offense driving under the influence of controlled substances, for the period of July 1, 1998 through June 30, 2002.

(3.6) PHP-CSAS – Request for approval of retroactive multiyear contract renewal with National Council on Alcoholism-Driving Under the Influence First Offender Program (NCA-DUI), at no cost to the Department, in the amount of $172,156 per year, in client fees only, to provide prevention services for the Period of July 1, 1998 through June 30, 2002.

PHP-CMHS - Family Mosaic – Status Report from Victor Treatment Center on compliance to Health Commission Policy #24.

President Monfredini commented on the small number of Board members; and that an increase in the number of Board members would enable the contractor towards compliance to Policy #24.

Action Taken: The Commission approved the Consent Calendar of the Budget Committee.

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

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


Governor's Proposed 1999-00 State Budget

The following is a summary of Governor Gray Davis' health related provisions in his proposed 1999-00 State Budget.


Governor Davis released his proposed 1999-00 budget on January 8, 1999. The budget proposes total expenditures of $76.2 billion General Fund (GF), an increase of $3 billion over 1998-99. The majority of new funding is in the Governor's priority area of education, and includes a $444 million augmentation. The Governor states that if the May revise reflects higher revenues, consideration will first be given to increasing the reserve level, education, and employee raises.

The Governor is relying on increased revenue from the federal government of $432 million, including $100 million for the incarceration of undocumented felons, $210 million from an increased federal share of Medi-Cal costs, and $122 million of federal support for State-funded family planning programs. This increased revenue, in addition to the $560 million State share of the national tobacco settlement, limits on new expenditures, and savings in State GF expenditures, represents the Governor's proposal for averting a projected $2.3 billion shortfall. The projected shortfall is based on several factors, including a slowing in revenue growth, and tax cuts and spending increases adopted in the 1998 budget process.

In general, counties are concerned about several proposals to cut or defer state-county partnership programs, including a reduction of $48 million in trial court operations, a deferral of $44 million owed to counties to match federal dollars for flood control projects, and a reduction of fiscal incentives for the Child Support Enforcement Program.

The budget proposes $16.4 billion GF expenditures for health and human services, 27.1 percent of the total budget. Health and human services expenditures are estimated at $51.4 billion in combined federal and state funds.

Health-Related Provisions

Proposition 99: Revenues are projected to decrease significantly due to Proposition 10 and tobacco company increases in cigarette costs leading to decreased consumption -- $390 million is estimated in 1999-00, down from $539 million in 1998-99. Proposed expenditures in service categories other than research are reduced by nearly 40 percent, including a $58 million cut in the California Healthcare for Indigents Program (CHIP). The Governor's proposal is to entirely eliminate county funding for the Other Health Services (Unallocated) account. The administration plans to work with stakeholders to devise a plan to address the declining revenue for Prop 99 funded programs, including reevaluation of priorities, elimination of duplication, and potential consolidation. The proposed reductions would result in an overall decrease for San Francisco of approximately $3.4 million, including a $2.7 million cut to SFGH and removal of the primary funding source for the CHDP Follow-Up Treatment Mandate.

Realignment: Total realignment revenues are projected to be $3 billion, $2 billion from sales tax and $1.1 billion from the Vehicle License Fee, 25 percent of which is backfill from the General Fund due to 1998's VLF reduction. Of the total realignment revenues, $2.9 billion would fund the realignment base, and an additional $153 million in 1999-00 would be available to fund caseload growth plus growth for the equity, general growth, and County Medical Services sub accounts.

Health Care Reform: The Governor directs the Secretary for California's Health and Human Services Agency to develop a plan for health care reform based upon the following principles:

  • Maximize health coverage by ensuring that more uninsured children and their parents are insured;
  • Reaffirm and extend the state's commitment to preventing teenage and unintended pregnancy;
  • Promote a fair and open insurance marketplace; and
  • Promote quality and accountability for Californians enrolled in managed care plans.

To fund this plan, the budget relies on obtaining a federal waiver and funding for the current state-funded family planning program. The $122 million federal funding would reduce GF Medi-Cal expenditures by this amount, allowing $62 million to be used to assist in balancing the budget, leaving $60 million to be utilized for health care expansions, including the Healthy Families Program (HFP).

Managed Care Reform: The Governor directs the Secretary for the Business, Transportation and Housing Agency to assemble a team of experts to prepare options within 60 days for more effective regulation of the managed care industry. In general, the Governor's stated principles for managed care reform are: to restore and affirm the primacy of the physician in medical decision-making; hold managed care decision-makers accountable for their decisions; and guarantee consumers access to a second physician's opinion when medically necessary in critical or life-threatening situations.

Healthy Families Program: The Governor proposes a $2.7 million GF increase to apply Medi-Cal income deductions to Healthy Families Program (HFP) applicants, expected to result in coverage to an additional 17,500 children in 1999-00. The budget also includes an additional set-aside of $37.3 million GF for implementation of a plan under development by the administration which will consider:

  • Expanding eligibility to 250% of the federal poverty level;
  • State-funded eligibility for recent legal immigrant children;
  • Streamlining application documentation requirements;
  • Allowing families with Medi-Cal eligible children to instead enroll in HFP;
  • HFP coverage for family members of eligible children pursuant to federal cost neutrality provisions and extended beyond these provisions; and
  • Expanded outreach and education strategies.

Child Health and Disability Prevention (CHDP) and California Children's Services (CCS): The CHDP caseload is expected to increase 7.4 percent, and would be funded by $27.6 million GF and $52.9 million Prop 99. The CCS caseload is projected to increase 3 percent, and would be funded by $41.8 million GF.

Proposition 10: Revenues are estimated at $373 million in 1998-99 and $684 million in 1999-00, down from earlier estimates due to an expected decrease in consumption because of higher cigarette prices after the National Tobacco Settlement. The Governor indicates one of the highest priorities for the State Commission is to recognize the importance of health care to children in the developmental stage, and for County Commissions to consider utilizing Proposition 10 funds matched by federal funds to extend HFP eligibility beyond the statewide level. The Governor's other specific recommendation for use of Proposition 10 funding is new preschool reading programs.

Medi-Cal: Overall caseload is projected to decrease by 1% (50,000 monthly eligibles) but would be offset by cost increases. There are no proposals to revise the program in any way, and all Medi-Cal optional benefits would be continued. The Governor projects a GF decrease of $69 million, and an increase in federal and special funds by $1.1 billion; assuming an increased share of federal funding based on the State's population estimates.

Prenatal and Long-Term Care Services for Undocumented Residents: The budget includes full funding for both programs -- $63.8 million and $16.6 million, respectively -- pending outcome of litigation. Hearings are scheduled for January 21st and February 2nd, 1999 in two separate cases regarding prenatal care.

HIV/AIDS: The Governor proposes a reduction of $4.1 million GF from the AIDS Drug Assistance Program (ADAP), due to an $18.7 million increase in federal funds and drug manufacturer rebates. Although this results in a $14.6 million overall increase to cover rising ADAP demand and drug costs, there is concern that the $4.1 million state funds should be reallocated to other AIDS care services or HIV prevention programs. These programs have been flat-funded for several years, despite a 200 percent increase in the number of people living with AIDS since 1993. The GF decrease may also be problematic for California's continued fulfillment of the Ryan White CARE Act Maintenance of Effort (MOE) requirement. Moreover, the actual increase in non-state funds for ADAP has since been projected to be $5 million more than what is projected by the Governor, resulting in a total of $9.1 million GF that could be made available for other HIV programs.

Breast Cancer Early Detection Program: $4.2 million in Prop 99 funds which were allocated in last year's budget process for services in 1998-99 are proposed to be reallocated due to reduced demand for services.

Substance Abuse: The Governor proposes a reduction of $5 million GF which was appropriated in 1998-99 for youth treatment services, but has not yet been allocated to counties. The stated reason for this reduction is a $35.1 million increase in federal Substance Abuse Mental Health Services Administration funding.

Emergency Medical Services Authority: The budget proposes a $1.3 million GF augmentation to increase regional and statewide disaster medical coordination, provide grants to volunteer Disaster Medical Assistance Teams, and enhance the provision of field triage and medical treatment at disaster sites.

Housing: The Governor proposes an additional $10 million for housing programs, including a $5 million augmentation to create housing for CalWORKs families and $1 million to support local efforts to provide supportive housing services for persons with disabilities. In 1998, $25 million was initially proposed for supportive housing services statewide, and Governor Wilson vetoed the $5 million appropriated by the Legislature.

SSI and CalWORKs Grant Levels: The budget proposes a 1 percent SSI grant increase effective January 1, 1999, in addition to federal and state Cost of Living Allowances (COLAs). Also included is a required 2.8 percent COLA for TANF grants, effective July 1, 1999.

Vocational Rehabilitation: The budget includes a $0.8 million GF augmentation for the Department of Rehabilitation, to allow the state to access all estimated available federal vocational rehabilitation matching funds and meet the demand for increased services, including for persons with HIV who wish to return to work. In September 1998, the state stopped accepting vocational rehabilitation clients due to inadequate funding.


Center for Collaborative Planning, Public Health Institute

Tracy Moore, the Black Infant Health Program Coordinator has been selected to participate in the 1999 Class of the Women's Health Leadership program of the Center for Collaborative Planning, Public Health Institute. She is one of 50 of California's "emerging health leaders" selected to the yearlong program. The purpose of the program is to develop critical leadership skills, such as advocacy and policy development necessary for leadership in public health.

Mortality Analysis 1990-1995

Today we are distributing the final version of the San Francisco Burden of Disease and Illness: Mortality Analysis 1990-1995, the Department's most comprehensive and systematic analysis of San Francisco mortality. Preliminary results were presented last year by the authors, Tomas Aragon and Randy Reiter of Community Health Epidemiology and Brian Katcher of Community Health Promotion & Prevention. The report analyzes deaths to S.F. residents for the period 1990 through 1995. It emphasizes the burden of premature mortality, and shows leading causes of premature mortality for the City as a whole and for each population group by age, sex, ethnicity and neighborhood. There is a substantial Executive Summary that presents the major results of this study.

The report represents a substantial and unique effort by the Population Health & Prevention Division to present basic information on the health of the people of San Francisco. It goes beyond categorical data from programs dealing with a particular disease, group or area, and looks at mortality from all causes for the whole population and each constituent part of the population. The focus on the leading specific causes of premature mortality will allow users to consider preventive interventions that can have the greatest impacts on improving longevity in any particular group of interest, from the whole City to small neighborhoods. Consideration of prevention priorities will be further aided by prevention attribution matrixes, tables which link the leading causes of premature death to a small number of factors or determinants (such as tobacco, alcohol, inactivity, illicit drugs) known to contribute to a large proportion of deaths in the U.S.

We expect this report to be a great resource within the Department, and to researchers, providers and community groups interested in health conditions in any part of the City's population. Many health professionals and advocates at local, state and national meetings who have discussed it with the authors have already requested copies of the report. We hope it will be of great interest to the Commissioners, and provide you with a valuable resource that you'll be able to draw on repeatedly in the future as you consider many of the health policy issues that come before you.

Ambulance Diversion

The EMS Section reports that Critical Care Diversion of Ambulance decreased in December due to efforts hospitals made to prevent critical care diversion and the implementation of changes to the diversion policy that suspends critical care diversion when three or more hospitals are on critical care diversion. Critical care diversion was suspended three times for a total of 91 hours. This policy will remain in effect through February when we will evaluate the effectiveness of the policy. SFGH invoked trauma override on four occasions; this allows SFGH to remain open only to trauma when critical care suspension is in effect.

In December total diversion hours exceeded critical care diversion hours. We are seeing this pattern continue into January. We suspended total diversion for the first time last night. Additionally, there have been at least four occasions where EMS Section on call staff intervened to prevent suspending total diversion.

As a result of last year's Hospital overcrowding due to flu and flu like illnesses, the Department of Health Services, Division of Communicable Disease issues weekly reports monitoring the flu in Northern and Southern California. These reports are showing only slight increases in these illnesses.


Laguna Honda Hospital: Phase I Census Reduction Completed

Phase I census reduction at LHH, as negotiated with HCFA, was completed as of January 8, 1999. The Phase I reduction consisted of reducing the census from 30 to 26 in each open ward in the main building resulting in a total census reduction of 114 residents. The Hospital's current census is 1064 and should be sustained at approximately that level for the next several months.

Laguna Honda has negotiated a Phase II census reduction with HCFA which would further reduce the open ward census to 25. Implementation of the Phase II reduction is contingent upon State approval for relocation of selected resident units to other areas of the main building. This relocation proposal is currently under review by OSHPD. Upon response from OSHPD, the Hospital will develop implementation plans and a schedule for completion of any State required work, the resident relocations and the subsequent Phase II census reduction.

The CHN Bed Management Committee, chaired by Dr. Melissa Welch, is evaluating the optimal use of LHH beds within the CHN system as we begin exploring alternatives to institutionalized care. In the meantime, Laguna Honda Administrator, Larry Funk, has conveyed the census reduction information to HCFA in a comprehensive status report. I will continue to keep you apprised of the census issues at Laguna Honda.

LHH Average Daily Census Data, December 1998

Acute 6


SNF 1081

Total: 1087

DOJ Returns to Laguna Honda Hospital

In early 1997, the Department of Justice (DOJ) initiated an investigation of Laguna Honda Hospital (LHH) under the Civil Rights of Institutionalized Person Act (CRIPA). On January 13-15, the DOJ conducted their third site visit of LHH. During their visit, one attorney and two consultants reviewed documents, toured the facility, and observed and met with residents and staff.

During the visit, LHH and CHN representatives described the significance of accomplishments made by LHH over the past year and explained LHH's plans for further change during the short term, and intermediate future. The DOJ acknowledged the importance of the organizational development measures implemented and/or planned for LHH. They also informally stated that they were impressed with many members of the LHH leadership and clinical teams.

The DOJ asked that we continue to focus on improving education and training of staff, interdisciplinary teamwork, resident care plans, and a variety of other resident focused areas. We anticipate that the DOJ will conduct a return visit to LHH perhaps as early as late February to continue monitoring the progress of the Hospital. The DOJ also stated that it needed to review its findings and future plans with their supervisors in Washington, DC.

I will continue to keep the Commission informed of this important issue.

San Francisco General Hospital 

New Appointments






Reappointment Denials




Disciplinary Actions




Changes in Privileges


voluntary relinquishment



Current Statistics – 01/1-4/99
Active Staff


Affiliate Professionals (non-physicians)


Courtesy Staff


Referring Staff


Total Members


Applications in Process


Reappointments in Process


Reappointments Requested not Received (Due through 1/4/99


Commissioner Chow encouraged the Department to plan ahead for the anticipated loss of revenue from Proposition 99. He also noted the recent released data report on mortality rates could be used in the upcoming budget process as a tool to address population-based prevention.

President Monfredini encouraged Commissioners to request information meetings regarding the Governor's budget. She also thanked Larry Funk and his Laguna Honda Hospital staff for their extraordinary job for the Department of Justice site visit.


President Monfredini presented the Department of Public Health Employee Recognition Awards to the following:

Individual / Division / Nominated by

  • Sai-Ling Chan-Sew / PH&P/Mental Health / Collins R. Munns
  • Christia Mea / PH&P/Comm. Health & Safety Services, Bureau of Env. Health / John Martinez
  • Steve Purser / PH&P/Comm. Health Services, Children, Youth & Families / Bob Prentice
  • Elisa Wang-Gao / CHN/Mental Health Rehab. Facility / Michael J. Roach
  • Raul Ynami / PH&P/Comm. Health & Safety Services/STD Registration Unit / Andrew Williams

Team / Division / Nominated by

  • Norma del Rio, MSW, Cindy Lee, RN / CHN/Health at Home / Mary Kay McKown, RN, MS, April Lax, MSW, LCSW


Action Taken: The Commission unanimously continued this item to the February 2, 1999 meeting when all of the Commissioners could be present.


Gene O'Connell, SFGH Executive Administrator, introduced SFGH Human Resources Director Rod Auyang, who provided the following:


To achieve 100% completion of FY 1997-98 Performance Appraisal Reports in order to ensure that levels of job performance are reviewed, and mechanisms are in place to follow up on unsatisfactory performance. The ultimate goal is to ensure safe and competent care and services.

Steps Taken

  1. Human Resources provides administrative managers with lists of employees for whom they are responsible and updates on the status of these employees on a regular basis.
  2. The expectation that all Administrators and Managers are accountable for ensuring that reports are completed was communicated to all by having:
  • The Executive Administrator makes clear expectations of Administrators and Managers (including target dates for completion).
  • Human Resource Services follow up with each Administrator and Manager.
  1. Follow-up developmental plans will accompany copies of appraisals for employees whose performance is deemed unsatisfactory.


  1. Administrators and Managers will be held accountable for completing reports. Non-compliance will be reflected in the Administrator's or Manager's own performance appraisal report.
  2. Extent of compliance will be shared with all Administrators and Managers by Human Resources.
  3. Human Resources will assist Managers in reviewing and monitoring the progress of those employees who received unsatisfactory appraisals.

Mr. Auyang reviewed a summary of performance appraisals for City and County employees, an analysis of performance appraisals with unsatisfactory ratings, and competency compliance for contract services. He also reported the following on UCSF Contract Services:

  • 92% complete as of January 8, 1999. The remainder will be completed soon.
  • Three individuals have been rated as Failing to Meet Expectations. All had to do with attendance problems. All are subject to progressive corrective action. One individual had an additional component of the appraisal related to quality of work being un-satisfactory. This individual has received a letter of warning stating that if improve-ment is not forthcoming that further action, up to and including dismissal, will result.
  • Four individuals have been rated as Partially Meeting Expectations. Two were related to attendance problems. One of the two also had efficiency problems identified and received retraining and increased monitoring of work by the supervisor. While the quality of work improved to a satisfactory level, attendance still remains a problem and is being dealt with appropriately. The other two individuals were noted to have only partially met expectations because of their lack of attention to detail. Both have responded to their appraisals and are expected to receive satisfactory ratings for the next appraisal period.
  • The Dean's Office reviews the compliance of Departments with completing performance appraisals regularly. Department managers are contacted personally. Departments of divisions are subject to corrective action if deemed appropriate.

Commissioners' Comments:

  • Administrative level has not completed its competency report by 3.4%.
  • What is the impact of retraining on the improvement of employees?
  • Does the Department of Public Health have a standard rating system?
  • The environmental services competency report should be reviewed and discussed at the JCC-SFGH.
  • Are the employees new or long-time employees who receive "needs development" or "unacceptable" ratings?
  • Mr. Auyang reported that SFGH continues to improve organizational performance and meet JCAHO standards. He assured the Commission that the competency of all staff members is assessed, maintained, demonstrated, and continually improved.

Action Taken: The Commission accepted the SFGH Competency Report for FY 1997-98.


Anthony G. Wagner, CHN Executive Administrator, presented an overview of the CHN Strategic Planning process.

Mr. Wagner thanked the diverse participants in the Strategic Planning and acknowledged the planning work of Diane Miller, Judith Klain, and Anson Moon.

Commissioner Chow, who served on the CHN Strategic Planning Committee, emphasized the need to serve and focus on the safety net target population. He observed that although this is an ambitious plan, there is a commitment to a strong delivery system.

Commissioner Parker pointed out the community partnership that is needed to solve the many problems, including mental health and substance abuse. He commended the Planning Committee for its good work.

Action Taken: The Commission unanimously adopted Resolution #2-99, "Accepting and Approving the Community Health Network Strategic Plan", as amended by Commissioner Chow.


Monique Zmuda, Chief Finance Officer; David Counter, Information Technology Director for the Department of Public Health; Eric Miller, Facilities Director of CHN; and Gary Chilton, Systems Manager, gave a quarterly status of activities of the Citywide Committee on Information Technology, which coordinates and monitors Y2K (Year 2000) compliance. They covered the following activities: creating awareness, inventory, assessment, remediation, and contingency planning. For a copy of the full report, contact the Commission Office at 554-2666.

Ms. Zmuda reported a Y2K test day will be scheduled for mid-May. She reported that a Y2K communication plan has been developed and is under implementation. A complete inventory of equipment and systems has been developed, and Y2K assessment of all inventoried items is nearly complete. Medical equipment and most facility systems have been assessed to be either in compliance or non-impacted by century date changes. Major remediation requirements are funded and underway. Additional testing is scheduled or underway to ensure that systems deemed to be compatible will not fail. Finally, the Department has planned to advance the date on all its systems as an ultimate test of the MIS infrastructure, including all of its components.

Many technical and professional staff have allocated significant resources and attention to have already accomplished the tasks summarized thus far. The Department is committed to successfully complete all steps of the Y2K compliance plan to ensure continued integrity of its information and medical systems.

Commissioner Chow inquired about federal requirements, contractors' compliance, and outside vendors' compliance.

President Monfredini thanked the Department for the report.


Tangerine Brigham, Director of Policy and Planning, presented an overview of the Early Childhood Development Initiative.

Commissioner Chow proposed an amendment to the proposed resolution. He would advocate for the newly created San Francisco Children and Families First Commission to focus on specific areas (i.e., preventive and clinical health services).

Action Taken: The Commission unanimously adopted Resolution # 3-99), "Recommending that a High Priority be Given to Preventive and Clinical Health Services in San Francisco's Strategic Plan to Improve Early Childhood Development Pursuant to Proposition 10," as amended by Commissioner Chow.



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

Sandy Ouye Mori, Executive Secretary to the Health Commission