Minutes of the Health Commission Meeting


Tuesday, March 23, 1999, 3:30 p.m.

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 3:35 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.


Monique Zmuda, Chief Financial Officer, presented an overview of the Department's FY 1998-99 budget, indicating a projected $19.6 million deficit by year end, June 30, 1999.

Ms. Zmuda also reviewed supplementary financial information which included:

  • First Quarter 1998-99 Report
  • Second Quarter 1998-99 Report
  • 7-Month 1998-99 Report
  • Deficit Reduction Plan – November 1999
  • Resolution Endorsing the Dept. of Public Health Plan to Reduce Deficit – November 1999
  • Deficit Reduction Plan Update – November 1999
  • Historical Comparison Capital Budgets 1994-95 through 1999-00
  • Capital Budget Request 1999-00
  • Approved Capital Budget 1998-99
  • Capital Budget Request 1998-99
  • Capital Budget Request 1997-98
  • Statement of Revenues and Expenditures SFGH/PC/Forensics – 7-Month 1998-99
  • Labor Spending Projection – SFGH – February 1999
  • Statement of Revenues and Expenditures LHH – 7-Month Report 1998-99
  • Summary of PHP Variances – 1998-99
  • Statement of Revenues and Expenditures PHP – 7-Month Report

Public Speakers:

Note: Half of the public speakers gave testimony prior to the Department's presentation.  The speakers addressed budget issues at SFGH, including the Pharmacy, the 4P Detox Ward, inpatient psychiatry programs, substance abuse, public health cuts, infrastructure cuts, less Federal and State revenues for health care, nationwide health care budget crisis, physical plant issues, and staffing issues.

  • Ken Gee, Asian Focus Unit at SFGH
  • Jo Ellen Brainin-Rodriguez, SFGH Psychiatry
  • Pamela Fisher, CAB, Dept. of Psychiatry
  • Maria Lieb, Chairperson of Mental Health Board
  • Cher Darice Brown, 6B Psychiatry at SFGH
  • Bruce Vasquez
  • Perri Franskoviak, Psychiatry
  • Dr. Lara Penny, SFIRA
  • Ed Kinchley, SEIU Local 790, SFGH
  • Jamie Noone, SFIRA
  • William C. Brady, President, Alliance to Empower the Latino Community
  • Enola D. Maxwell, Potrero Hill Neighborhood House
  • M.P.R. Howard, Tom Waddell Community Advisory Board
  • Dean Shillinger, M.D., SFGH Adult Medical Clinic
  • Steven Batki, M.D., SFGH
  • Kate Bemrer, M.D., SFGH Psychiatry Emergency
  • Robert Halvorsen, M.D.
  • Sherri Ann Swift
  • Jacqueline von Brentano
  • Michael Lyon
  • Jeff Wong, Pharmacy
  • Fern Ebeling, SFGH Medical Clinic
  • Lewis Robinson, SFGH Internal Medicine
  • Martha H. Dominguez, SFGH
  • Nora Roman, S.F. Immigrant Health Action Network
  • Pat Smiley, District Advisory Council, Senior Central
  • Hali Hammer, SFGH Family Health Center

The medical staff leadership:

  • Melissa Welch, M.D., Chief Medical Officer of the CHN
  • Bob Okin, M.D., Interim Chairman of the CHN Medical Practice Group
  • Phil Hopewell, M.D. Associate Dean of UCSF
  • Sylvia Villarreal, M.D., SFGH Chief of Staff

Note: A copy of Dr. Okin's presentation is available in the Commission Office.

Chiefs of Services:

  • Alan Gelb, M.D., SFGH Emergency Department
  • Philip Darney, M.D., SFGH Obstetrics and Gynecology
  • Guy D. Paiemont, M.D., SFGH Orthopedics

President Monfredini, noting that the Department will be in this budget crisis again within the next six months, directed the Department to come back to the Commission with plans (two or more) and figures reflecting a Public Health Department in the new world of less revenues.

Dr. Mitch Katz, Director of Health, thanked the public speakers for their testimony.   He pointed out that the Department and the Commission had made conscious decisions to choose services over infrastructure.  He will continue to provide information to the Commission on the status of the budget and will continue to work on administrative cuts.  He will bring back to the Commission  on April 20th specific long term plan proposals.

Commissioners' Comments:

Commissioner Sanchez thanked the public speakers who raised quality of care, one single standard of care, and safety net issues.  It is important to hear from the patients, staff, and medical staff.

Commissioner Guy expressed her appreciation for the staff work.  She believes the conditions of health care today need to be turned around.  However, we cannot be defensive but need to go to the public with the cost information.  She believes the general fund has to help.  She encouraged the Department to indicate what kind of health care system do we want in this new world.  What are the best health practices in this environment and ask the public officials and the voters for the funds.

Commissioner Umekubo stated that the Commission shares the same level of concern as the patients and the providers – we are all in this together.  With the revenue shortfalls, there is a need for more Federal and State advocacy.

Commissioner Parker strongly urged that we stop doing business as usual, do something different, and come up with a long range plan.  The patients are sicker, reimbursements have decreased, and more emphasis on prevention is needed.  The Commission, public officials, the Department, and consumers need to work together to address this crisis.

Commissioner Hill expressed his appreciation for the input and moving testimonials today.  He has been trying to advocate for a long-term plan which would take care of the most vulnerable populations in conjunction with the political realities.  We cannot compromise our values but need to seek out more funds.

Commissioner Chow expressed appreciation to the speakers and dedicated staff.   These issues are not new to the Commission.  We need to look at the new reality of public health; to look at the size not based on demand; to come up with creative solutions.  The Commission is responsible to set an agenda for public health in the City and County of San Francisco.

The Commission directed the Department to bring two or more plans, looking at a minimum and maximum levels of care with their costs and impact on services; to look at the real census at SFGH with factual costs; and to prioritize services with their costs.

The meeting was adjourned at 6:50 p.m.