Minutes of the Health Commission Meeting
Tuesday, March 16, 1999, 3:00 p.m.
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 3:10 p.m.
- Commissioner Edward A. Chow, M.D.
- Commissioner Roma P. Guy, M.S.W.
- Commissioner Ron Hill
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF MINUTES OF THE SPECIAL CLOSED SESSIONS OF FEBRUARY 26 AND MARCH 2,
1999, AND THE REGULAR MEETING OF MARCH 2, 1999
Action Taken: The Commission unanimously adopted the minutes of the Special Closed
Sessions of February 26 and March 2, 1999, and the regular meeting of March 2, 1999.
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Ron Hill)
Status update on Shared Medical Systems, Inc.'s compliance to Policy #24 regarding
Commissioner Hill requested the contractor to return in 6 months (September 21, 1999)
with another update.
(3.2) PHP-HIV Prevention Services Request for approval of retroactive
renewal contract with Haight Ashbury Free Clinic, Inc. (HAFC), in the amount of $105,649,
for the provision of HIV- prevention, venue-based, individual outreach for the period of
January 1, 1999 through December 31, 1999. (DPH contracted with HAFC for services totaling
$15,119,656 during FY 1997-98).
Commissioner Hill requested a progress report be brought back to the Commission in 90
days (June 15, 1999).
Commissioner Sanchez requested the report to include an update on retention and staff
(3.3) PHP-CHS-Special Projects Request for approval of Sole Source and
new contract with San Francisco AIDS Foundation (SFAF), in the amount of $357,023 for the
provision of site management and case management services for the period of March 17, 1999
through June 30, 2000. The sole source request is for an annual amount of $223,178 per
year, for the period of March 17, 1999 through June 30, 2003. (DPH contracted with SFAF
for services totaling $4,136,118 during FY 1997-98).
PHP-HIV Prevention Services Request for approval of retroactive renewal contract
with Glide Foundation, in the amount of $232,495, 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 Glide for services totaling $523,418 during FY 1997-98).
(3.5) PHP-HIV Prevention Services Request for approval of retroactive
renewal contract with Stop AIDS Project, Inc. (STP), in the amount of $214,129 for the
provision of HIV-prevention program services targeting behavioral-risk populations, for
the period of January 1, 1999 through December 31, 1999. (DPH contracted with STP for
services totaling $863,894 during FY 1997-98).
(3.6) PHP-CSAS Request for approval of retroactive Sole Source and
modification to the contract with Haight Ashbury Free Clinics, Inc.-San Francisco Target
Cities Project (HAFC), in the amount of $541,314 to augment the provision of acupuncture
services and start up to provide new intensive outpatient services for persons in the
Personal Assisted Employment Services (PAES) program for the period of October 1, 1998
through June 30, 1999. (DPH contracted with HAFC for services totaling $15,119,656 during
(3.7) PHP-CSAS Request for approval for a modification to the contract
with the Latino Commission, in the amount of $647,000, to provide community substance
abuse residential and aftercare services for Latino men, and to extend the contract term
through June 30, 2000. The total contract amount will be $675,000 for the period of
October 1, 1998 through June 30, 2000. (DPH did not contract with Latino Commission during
Public Speakers: (supported or opposed the site for this contractor)
- Jose M. Santiago, Jr. Casa Aztlan
- Orlando Cuadra, Casa Aztlan
- Victor del Llano
- Conrad Navarro
- Thomasa Canon
- Dan Hill
- Abigail Rodas, Latino Commission
- Richard Rendon, S.F. Pretrial Diversion
- Pedro Soto, Casa Aztlan
- D. Rodriguez
- Elaine Deck, Adult Probation Department
- William Morrow, citizen
- Gisella Morrow, citizen
- Shirlee Silva
- Josyshine Richau, citizen
- Fatu Taula, neighborhood
- Helen Smith, citizen
- Manuel Sanchez
Letters from Adele Lewis and the Lowell Market, and a neighborhood petition with 200
signatures were submitted in opposition to this site.
Commissioner Sanchez requested a 6-month (September 21, 1999) update on this contract.
Commissioner Umekubo inquired about other site opportunities.
Commissioner Hill encouraged the neighbors to reach out to the residents of this
President Monfredini expressed her support to those in need and pointed out that
24-hour supervision is included in this program.
Commissioners Guy and Chow encouraged the contractor and Department to work with the
community on its concerns.
(3.8) PHP-CSAS Request for approval of retroactive Sole Source and
modification to the contract with Jelani House in the amount of $280,000, for residential
and outpatient substance abuse services to women and their children for the period of July
1, 1998 through June 30, 1999. (DPH contracted with Jelani for services totaling
$1,187,959 during FY 1997-98).
(3.9) PHP-HIV Health Services - Request for approval of the FY 1999-2000 Ryan
White Comprehensive AIDS Resource Emergency Act of 1990 (CARE) Title I, Title II and
General Fund contracts for a combined total of $37,717,304 for the period of March 1, 1999
through February 29, 2000 for Title I funds, April 1,1999 through March 31, 2000 for Title
II funds and July 1, 1999 through June 30, 2000 for General Fund programs with the
- AIDS Benefits Counselors . . . . . . $279,288
- AIDS Emergency Fund . . . . . . $662,392
- AIDS Legal Referral Panel . . . . . . $200,952
- American College of Traditional Chinese Medicine . . . . . . $276,827
- Asian Pacific Islander Wellness Center . . . . . . $555,705
- Baker Places . . . . . . $1,574,209
- Bar Association of San Francisco . . . . . . $77,868
- Black Coalition on AIDS . . . . . . $373,912
- Catholic Charities . . . . . . $1,511,458
- Chemical Awareness & Treatment Services, Inc. . . . . . . $594,043
- Community Dental Care, Inc. . . . . . . $651,429
- Continuum HIV Day Services . . . . . . $1,081,275
- Dolores Street Community Services . . . . . . $138,205
- Family Service Agency . . . . . . $194,694
- Family Support Services of the Bay Area . . . . . . $207,555
- Glide Foundation . . . . . . $138,732
- Haight Ashbury Free Medical Clinics, Inc. . . . . . . $1,005,557
- Immune Enhancement Project . . . . . . $223,668
- Instituto Familiar de la Raza . . . . . . $255,310
- Iris Center . . . . . . $150,000
- Larkin Street Youth Center . . . . . . $637,130
- Legal Services for Children . . . . . . $190,915
- Lutheran Social Services . . . . . . $794,966
- Lyon Martin Women's Health Services . . . . . . $381,727
- Maitri AIDS Hospice . . . . . . $736,410
- Marin County . . . . . . $1,506,758
- Mission Neighborhood Health Center . . . . . . $140,919
- New Leaf . . . . . . $309,138
- Project Open Hand . . . . . . $1,348,637
- Quan Yin Healing Arts Center . . . . . . $127,327
- Saint Mary's Medical Center . . . . . . $1,234,862
- San Francisco AIDS Foundation . . . . . . $3,992,666
- San Francisco Community Clinic Consortium . . . . . . $341,042
- SFDPH Community Health Network - Forensics Services . . . . . . $356,524
- SFDPH Community Health Network - Health at Home . . . . . . $434,319
- SFDPH Community Health Network - Primary Care . . . . . . $2,287,696
- SFDPH Community Health Network - SFGH . . . . . . $3,186,419
- SFDPH PPH Mental Health Services . . . . . . $288,234
- SFDPH PPH Public Health Laboratory and STD Services . . . . . . $239,697
- SFDPH PPH Substance Abuse Services . . . . . . $250,000
- San Francisco Food Bank . . . . . . $97,220
- San Francisco Suicide Prevention . . . . . . $107,784
- San Mateo County . . . . . . $2,279,135
- Shanti Project . . . . . . $882,369
- The Support Center . . . . . . $250,000
- Tenderloin AIDS Resource Center . . . . . . $179,120
- UCSF/AIDS Health Project . . . . . . $1,002,692
- UCSF/Center on Deafness . . . . . . $40,236
- UCSF/Pediatric AIDS Program . . . . . . $170,945
- UCSF/Substance Abuse Services . . . . . . $721,942
- UCSF/ Women's Specialty Clinic . . . . . . $222,000
- University of the Pacific-School of Dentistry . . . . . . $543,600
- Urban Indian Health Board . . . . . . $261,378
- Walden House . . . . . . $1,775,685
- Westside Community Mental Health Clinic . . . . . . $244,733
Commissioner Hill pointed out that agencies with program performance problems are not
being included at this time.
Commissioner Umekubo abstained on the St. Mary's Hospital item.
Commissioner Sanchez abstained on the UCSF items
Action Taken: The Commission approved the Budget Committee items, with
Commissioners Sanchez and Umekubo abstaining on UCSF and St. Mary's Hospital items
respectively on #3.9
4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).
Last week a number of newspaper articles appeared describing our financial situation. I
wanted to review with the Commission our current position.
In preparing potential budget cuts to bring to you on the March 23rd Special
Health Commission Meeting, Health Department executive staff discussed proposals with
affected staff, union leaders, and community members. The goal of these discussions was to
make sure that we were choosing the least painful cuts for the Health Department and to
gain greater insight into the implications of these cuts. As these discussions broadened,
we received newspaper inquiries about our financial situation. I was reluctant to discuss
our proposals with the media because the proposals had not yet been brought to the
After hearing in greater detail about some of the proposed service cuts that the Health
Department might have to make, Mayor Brown asked me on Friday, to work with his Budget
Office to attempt to identify sufficient dollars to prevent any further service cuts. He
asked that I continue to pursue administrative savings and delete positions through
attrition that could be used to close the deficit. In addition he asked DPH to continue to
implement the Commission's prior policy decisions with regard to the pharmacy, 4P Detox
Unit, and placing the SFGH hospital ED on diversion when we are at our staffed and
budgeted census. We are working closely with Matthew Hymel, the Director of the Mayor's
Budget Office, and Ed Harrington, the Controller, to close the revenue shortfall.
The Health Department will still bring to the Health Commission on March 23rd,
a full report, detailing the sources of the Health Department deficit. We plan on coming
back to the Commission in April when we have further information about how much of the
deficit the Mayor is able to help to close.
On a related front, lines at San Francisco General Hospital Outpatient Pharmacy were
extremely long last week. This was due to several causes. First, many patients who have
MediCal and could receive their prescription at another pharmacy were not fully aware that
they could go to a neighboring pharmacy. To alleviate this problem we are actively
educating Medicaid patients that they have a right to have their prescriptions filled at
the neighborhood pharmacy of their choice. We know that in the short time that this
pharmacy program has been implemented, already half of our MediCal patients who used use
our pharmacy are now having their prescriptions filled at neighboring pharmacies. As the
education effort continues and the other half have their prescriptions also filled at
neighboring pharmacies, we believe that the lines at the Outpatient Pharmacy will
significantly shorten. Last weeks lines were also lengthy because three pharmacy staff
were sick and a computer malfunctioned on Tuesday night.
Congratulations go to the Commission's own secretary, Sandy Mori who was honored
yesterday in Sacramento as one of the State's "1999 Women of the Year". Each
Assembly member and Senator selects a woman from their respective districts. From the 12th
Assembly District, Assemblyman Kevin Shelley selected Ms. Mori for her community work in
the areas of aging, civil rights and public policy. On behalf of the entire Department of
Public Health, congratulations Sandy on your outstanding work and efforts, it's an honor
to know you are part of our team.
POPULATION HEALTH AND PREVENTION
75 Housing Units for Homeless Open in Tenderloin Hotel
The Pacific Bay Inn, located at 520 Jones, between O'Farrell and Geary, will officially
welcome its first new tenants, along with the Mayor and other City and agency officials,
on Tuesday, March 23rd at an Open House from 11:30 1:30 pm. A project of
Episcopal Community Services (ECS) of San Francisco, the hotel is the City's first
facility to open under the new Direct Access to Housing Program.
Utilizing a successful formula for combining private ownership, non-profit service
providers and public efforts, the Pacific Bay Inn is a collaborative between Episcopal
Community Services (ECS) of San Francisco, the San Francisco Department of Public Health,
Baker Places, Inc., and Mercy Services Corporation.
Pacific Bay Tenants, all of whom are making the transition from life on the streets,
exiting homeless shelters and completing treatment programs, will find a service-rich
As you are well aware, genesis for the Pacific Bay Inn began with $1.5 million in new
funding from the City's FY 1998-99 budget for the Direct Access to Housing Program.
Additionally, the Hilton Foundation, through the Bay Area Office of the Corporation for
Supportive Housing, provided the project with a $625,000 grant.
The second Direct Access to Housing project is scheduled to open in May 1999, bringing
94 additional units of supportive housing on line. We would be honored to have the
Commission present at the celebration next Tuesday.
Nurseweek Excellence Award
Congratulations to Maternal Child Health Director Mildred Crear, a winner in Nurseweek
magazine's 1999 Nursing Excellence Award competition. Mildred was selected in the
Management and Administrative category from a pool of well over 300 candidates statewide.
Winners were announced at a gala awards dinner at the Westin Hotel, Los Angeles, on March
Underground Storage Tank Upgrade Deadline
Staff of the Hazardous Materials Unified Program Agency (HMUPA) have worked closely
with the City Attorney's Office to develop an effective enforcement strategy for those
underground storage tank (UST) sites that did not comply with the December 22, 1999
upgrade deadline. By March 1, 1999 only 11 of 309 UST sites remained out of compliance.
None of these out of compliance sites were City facilities. This extraordinary compliance
result is due largely to the collaborative effort of the Department of Public Works Bureau
of Construction Management and those city departments that operate UST's. For those sites
remaining out of compliance, HMUPA staff will be aggressively pursuing appropriate
enforcement actions in collaboration with the City Attorney's Office.
COMMUNITY HEALTH NETWORK
The Senate Rules Committee, of which Senator John Burton is Chairman, has appointed
LaFrancine Tate to the State Board of Registered Nursing. She will be one of the two
Public Members. Her term will end June 1, 2000. Fran serves as Special Assistant to Gene
O'Connell and Anthony Wagner. I am sure you join me in congratulating her on the
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR
On behalf on the Commission, President Monfredini presented the Employee Recognition
Award to Ron Patton, of the Community Health Network/San Francisco General Hospital,
6) PUBLIC HEARING AND CONSIDERATION OF AMENDMENTS TO THE HEALTH COMMISSION POLICY
#24 REGARDING ETHNICITY, GENDER, AND SEXUAL ORIENTATION DIVERSITY OF CONTRACTORS
Dr. Katz presented the amendments to the current Policy #24 with the change in the
title of the policy to Contractors' Compliance with Antidiscrimination Protection and
Dr. Katz reported that the Department will work with contractors to work out the
implementation tools. The goal is not to increase bureaucracy but to develop user-friendly
tools to implement this policy.
Each Commissioner expressed support for the amended policy and thanked the Department
and City Attorney's Office for their work on this important policy.
Commissioner Chow requested the Department to look at the interpretation of the
relevant work force, not to have duplicative requirements from contractors, and not to
create more bureaucracy and paperwork for contractors.
Commissioner Hill stated that this policy will have legal strength with a better
reporting system. He also reminded the Commission of the importance of sexual orientation
diversity of the workforce and to be mindful of the spirit of the original policy.
Commissioner Parker expressed his comfortableness with the revised policy.
Commissioner Guy encouraged the Department to be proactive in getting feedback from
contractors and that there be on-going interface with Department staff and contractors.
Commissioner Sanchez felt the cultural competency area could be an operational model
for public health.
Commissioner Umekubo stated that specific accountability tools are included.
President Monfredini thanked Dr. Katz for maintaining the spirit of the original Policy
#24. She felt it would take six months to a year for implementation.
- Jim Illig, S.F. HIV Contractors Association, emphasized importance of sexual orientation
as part of the diversity of Board and staff of contractors.
- Richard Heasley, Mental Health Contractors Association, acknowledged receipt of amended
Action Taken: The Commission unanimously approved Resolution #9-99,
"Contractors Compliance with Antidiscrimination Protections and Cultural
7) PRESENTATION OF THE ANNUAL EMERGENCY MEDICAL SERVICES RECONFIGURATION REPORT
Dr. John Brown, Director of the Emergency Medical Services Agency; Dr. S. Marshall
Isaacs, Emergency Medical Services Medical Director; and Richard Shortall, Emergency
Medical Services Chief, presented an Executive Summary of the San Francisco Fire
Department and the Emergency Medical Services Division Annual Report. For the past 18
months, the San Francisco Fire Department has been responsible for the operational
provision of Emergency Medical Services (EMS) dispatch and communications, first response,
early defibrillation, basic life support (BLS), advanced life support (ALS), ambulance
transport, multicasualty incident (MCI) management, and specialized rescue services for
the residents of and visitors to San Francisco.
Since the merger of the Department of Public Health Paramedic Division into the San
Francisco Fire Department in July 1997, a number of significant changes have taken place
with regard to the delivery of prehospital emergency medical services. The dedication and
skill of the Department's paramedics, emergency medical technicians, firefighters and
officers who now work together to meet the Department's vision, are a part of the
commitment of the Department's EMS Division.
The report includes an update on the merger; response to rising EMS call volume and
workload; overview of the EMS Section, including operations, special operations,
administration, in-service training, and the EMS Academy; medical direction; and the S.F.
International Airport and the Airport Rapid Resuscitation Early Shock Trial Program.
Commissioner Parker thanked the Health and Fire Departments for their integration of
Commissioner Chow thanked the staff for the good report and expressed concern on the
location of defibrillators at security check points.
Commissioner Guy observed that no data has been presented regarding response times. She
also is interested in what are the challenges in the fourth phase.
The staff will return on May 18, 1999 to present a comprehensive EMS Section as part of
8) PRESENTATION OF AN ASSESSMENT AND EVALUATION OF TREATMENT MODALITIES FOR
Barbara Garcia, Director of Community Substance Abuse Services, and Dr. Herminia
Palacio, Special Assistant to the Director of Public Health, made presentations on the
Substance Abuse Modalities. The report provided an overview of substance abuse services
and new and future trends in the provision of integrated services to reduce harm from drug
For a copy of the report, contact the Commission Office at 554-2666.
Dr. Palacio reported that recommendations regarding physicians prescribing of methadone
will be brought to the Commission.
Commissioner Guy requested data and statistics around the Treatment on Demand services
in order to assess and analyze whether the Department is still going in the right
direction. She is supportive of looking at more treatment modalities, with the
understanding that the Department provide appropriate information to the Commission.
Commissioner Chow requested a presentation and data on acupuncture as a treatment
After hearing the Commissioners' requests, he will provide the following information
for the March 23 meeting on the 1998-99 budget:
- Treatment on Demand budget
- Role of the Department of Public Health acupuncture program in drug treatment
- Treatment on Demand slots
Dr. Katz also emphasized that any recommendations from the workgroups on physicians
prescribing methadone will come to the Commission prior to reporting to the Board of
9) CONSIDERATION OF PROPOSED REVISIONS TO THE SAN FRANCISCO GENERAL HOSPITAL MEDICAL
STAFF BYLAWS ACCOMPANYING MANUALS:
RULES AND REGULATIONS
CREDENTIALING PROCEDURE MANUAL
Dr. Sylvia Villarreal, Chief of Staff at San Francisco General Hospital, presented the
proposed revisions, which were recommended for approval at the March 8, 1999 Medical
Executive Committee, and March 9, 1999 JCC-SFGH.
Action Taken: The Commission unanimously approved the revisions to the San
Francisco General Hospital Medical Staff Bylaws - Accompanying Manuals:
- Rules and Regulations
- Credentialing Procedure Manual
- Committee Manual
Dr. Villarreal thanked the Commission for its support and for being there to listen to
the concerns of the Medical Staff.
10) OTHER BUSINESS/PUBLIC COMMENTS
The meeting was adjourned at 5:40 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission