Minutes of the Health Commission Meeting

Tuesday, April 6, 1999, 3:00 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 3:05 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 John I. Umekubo, M.D.


  • Commissioner Ron Hill


Action Taken: The Commission unanimously adopted the minutes of the regular meeting of March 16 and the Special Meeting of March 23, 1999.

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

(3.1) DPH-Central Administration – Request for approval of continuing modification to extend current DPH contracts on a month-to-month basis until December 31, 1999, or until the 1999-2000 Renewal Contract is certified, whichever comes first.

(3.2) DPH-Central Administration – Request for approval to release $86,950 held in reserve by the Board of Supervisors for building improvements for the CMED Building, which is the headquarters for the Community Health Network.

(3.3) DPH-Central Administration – Request for approval of a resolution to convert home health contracts to services provided by Department of Public Health Civil Service Health at Home employees.

Commissioner Sanchez requested final documents to be included in the Commission packets. The Commission adopted Resolution #10-99, "Authorizing the Department of Public Health to Expend Funds and Add Staff Resources to Replace Grant Funded Home Health Contractual Services with Services Provided by City Staff."

PHP-CHSS-EMSA – Request for approval of a combined request to accept and expend a new three-year grant from the State Office of Traffic Safety in the amount of $500,000, to establish a comprehensive child passenger safety program and a retroactive sole source contract with Bianchi Traffic Safety Services, in the amount of $4,200 for the period of February 1, 1999 through September 30, 2001.

(3.5) PHP-HIV Prevention Services – Request for approval of retroactive contract renewal with Westside Community Mental Health (WCMH), in the amount of $130,812 per year, for the provision of HIV prevention and general education services, for the period of July 1, 1998 through June 30, 1999. (DPH contracted with WCMH for services totaling $13,065,830 during FY 1997-98).

(3.6) PHP-HIV Prevention Services – Request for approval of retroactive contract renewal with Instituto Familiar de la Raza, Inc., in the amount of $71,188, for the provision of HIV prevention, venue-based, group outreach for the period of July 1, 1998 through June 30, 1999. (DPH contracted with Instituto for services totaling $2,522,404 during FY 1997-98).

(3.7) PHP-HIV Prevention Services – Request for approval of retroactive contract renewal with Asian & Pacific Islander Wellness Center (API), in the amount of $471,653, for the provision of HIV prevention services targeting behavioral risk populations, for the period of January 1, 1999 through December 31, 1999. (DPH contracted with API for services totaling $852,025 during FY 1997-98).

(3.8) PHP-HIV Prevention Services – Request for approval of retroactive contract renewal with Polaris Research and Development, Inc., in the amount of $266,947, to provide logistical and technical support to the HIV Prevention Planning Council for the continued development of a strategic HIV prevention plan, for the period of January 1, 1999 through December 31, 1999. (DPH contracted with Polaris for services totaling $857,579 during FY 1997-98).

Dr. Meredith introduced Michael Demayo, Director of HIV Prevention Services.

CMHS - Request for approval of retroactive modification to the contract with New Leaf Services for our Community to: 1) continue the provision of outpatient substance abuse methamphetamine treatment on demand services, as awarded through RFP #019-98, in the amount of $136,663 for the period of January 1, 1999 through June 30, 1999; and 2) replace Ryan White/CARE funds with mental health Short-Doyle/Medi-Cal match funds to continue the provision of outpatient HIV/mental health services for the period of March 1, 1999 through June 30, 1999 (annual amount of $371,465 to continue both services). (DPH contracted with New Leaf for services totaling $1,347,911 during FY 1997-98).

After much discussion on the pending Human Rights Commission report process, the Commission continued this item until the completion of the Human Rights Commission report process.

Action Taken: The Commission approved items #3.1 through #3.8. Item #3.9 will be continued to a future meeting after the Human Rights Commission has completed its report process on New Leaf.

4) DIRECTOR'S REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).


Health Department Transitions

As I know, many of you have heard Robert Prentice, Ph.D. will be leaving the Health Department on April 21st. I am very grateful to Bob for the many things that he has accomplished during his time in the Health Department and I know you will join me in wishing him the very best in the future.

At this time I am pleased to announce that Barbara Garcia, has agreed to serve as the Deputy Director for Population Health & Prevention. Barbara has been with the San Francisco Health Department for three years. Barbara served as Associate Administrator for AIDS at HHS-SAMHSA prior to her tenure with DPH and she brings a breadth of knowledge about the workings of federal government. She came to the Department to run homeless programs and was then promoted to be the Director of Community Substance Abuse Services. In that role she has brought significant progress towards our goal of treatment on demand while increasing the cultural competency of substance abuse services. During this time she has also managed the Mission Rock Shelter, which is the City's largest shelter for homeless persons and has played a critical role in the Health Department's response to several emergencies. I am certain that Barbara will do a superb job as the Director of Population Health & Prevention and I ask you to give her your full support.

I would also like to take this opportunity to formally appoint James Loyce, Jr., currently Director of the Office of Integrated Care, to the position of Deputy Director of the Department of Public Health. In this role I have asked him to work closely with Barbara Garcia and Anthony Wagner, Director for the Community Health Network (CHN), to develop a strategic plan for the Health Department.

In particular I am interested in our looking at how we can better integrate the Department as a single department. The creation of two separate functional units, the CHN and Population Health and Prevention, has been successful in a number of ways. In particular, the CHN now truly functions as a network. There is close cooperation between San Francisco General Hospital, Laguna Honda Hospital, and the primary care clinics. This cooperation has improved the quality of services and increased the efficiency of delivering them. In a similar way the creation of the Population Health and Prevention Division has served to integrate functions in community health services. By locating substance treatment, mental health, HIV services, maternal child health services, and housing in one functional unit, our client services have become more integrated. However, at times, having two separate divisions has distanced our community-based services from the services of the network. Although the energy and creativity of our managers in our two divisions has been somewhat successful in overcoming the organizational barriers, I, nonetheless think we should look at ways to bring our two divisions more closely together as one department.

The strategic planning process, convened by James Loyce, Jr., will look at these questions and will bring recommendations to the Health Commission on the best model for achieving this integration.

On an interim basis I am very pleased to announce that James Stillwell has agreed to serve as the Interim Director for Community Substance Abuse Services. Jim has been with the Health Department for seven years. In his current position as Fiscal Director for CSAS, he has been responsible for the oversight and development of the treatment on demand budget. He is well respected in the field and brings many talents to the position. We will conduct an open search for choosing the permanent Director for Community Substance Abuse Services.

Transition times are always difficult and I ask for your continued support in helping to make this transition as smooth as possible.

1999 Beverlee A. Myers Excellence in Public Health Award

I am pleased to announce that the former Director of Health, Dr. Sandra R. Hernández, was awarded yesterday the 1999 Beverlee A. Myers Excellence in Public Health Award. This award is given annually by the State Department of Health Services to recognize individuals who have exhibited outstanding leadership and accomplishments in public health in the State and nationwide. The program was established in 1993 to honor Ms. Myers, who was the Director of the State Department of Health Services from 1978 to 1983. I believe that all members of the Health Commission are familiar with Dr. Hernández's accomplishments and join me in congratulating her on this well-deserved recognition.

California Healthy Families Program

The Department continues to work on efforts to extend enrollment in the Healthy Families Program. As of March 1999, 3,806 children had been enrolled into the program. As part of the San Francisco Bringing Healthy Kids Coalition, the Department and others have developed materials to inform the community about Healthy Families. The Coalition is working with the San Francisco Unified District to distribute a health insurance flyer, which describes Healthy Families, Medi-Cal and the Kaiser Cares for Kids Program.

In addition, we have developed a community listing of all Healthy Families application assistors by neighborhood. As part of the coalition effort, we are working with community-based agencies in the Mission, Bayview Hunter's Point and Chinatown/Tenderloin areas to expand Medi-Cal and Healthy Families enrollment. San Francisco has received two grants to expand Medi-Cal and Healthy Families enrollment.

Based on long-standing concerns, the State has streamlined the Healthy Families application down to four pages. It is hoped that this simplified application will make it easier for families to apply for the program. The Department shares community concern over the lack of improved enrollment within certain San Francisco communities. We strongly believe that localized outreach, involvement of community-based agencies and local government create more opportunities to reach populations that, for various reasons, may be disinclined to enroll in these programs. The Department of Public Health will continue to keep the Health Commission apprised of this program.

Take Your Daughter To Work Day

DPH will participate in the annual Take Your Daughter To Work Day celebration along with other City Departments. This important day provides the opportunity to expand the horizons of young girls and introduce them to a variety of careers and role models. The Department is welcoming the children of employees (sons and daughters) on Thursday, April 22nd.


Disaster Registry for Seniors And Persons With Disabilities

The Emergency Medical Service Section will exercise the field response component of the Disaster Registry in a disaster exercise on Saturday, April 17th, from 9:00 a.m. to 2:00 p.m. The exercise involves personnel from the Auxiliary Communications Service, the EMS Section, Mayor's OES, NERT, and the Volunteer Center of San Francisco. Disaster Registry response units, comprised of NERT team members, CBO staff, and volunteers from the Volunteer Center will assemble at designated locations in four Emergency Response Districts - Glen Park, Inner Richmond, South of Market, and the Haight-Ashbury. They will then "respond" to pre-determined locations, complete reports and participate in an after-action debriefing.

This is a milestone in the development of response capability, specifically for Disaster Registry enrollees. It is unique in that the response does not depend upon police, fire department, or ambulance personnel. Rather, it is comprised of CBO staff who work with the target populations on a regular basis, who will, in an emergency, collaborate with NERT members and volunteers and will, for purposes of this exercise, do a simulated check on Disaster Registry enrollees. Questions about the Disaster Registry program or the upcoming exercise can be directed to Ron Lopez at 554-9732.

Citywide Exercise

The Office of Emergency Services is now operating out of the newly constructed Combined Emergency Communications Center located at 1010 Turk Street. They are hosting their first orientation/exercise for command center staff this Friday, April 9th. I will participate in this orientation along with other DPH staff.


San Francisco General Hospital Pharmacy Update

The SFGH Pharmacy is continuing its ongoing initiatives to reduce its registry expenditures and to implement the resolution passed by the Health Commission at its February 16th meeting. On March 3, the Outpatient Satellite Pharmacy in Building 80-90 closed its operations and consolidated services in the Main Pharmacy. Medi-Cal and other sponsored patients were advised that they had the option to fill their prescriptions at outside pharmacies. On Monday, April 5, the Hospital implemented a collection process from patients with a Medi-Cal share of cost and for co-payments ($2.00/prescription up to a maximum of $10/visit) from patients without health insurance.

The Pharmacy and Patient Accounts departments worked closely together to develop procedures to facilitate the process. A Cashier's window was opened in the Main Hospital lobby to accept collections. Additional signs have been posted to help direct patients to the correct Pharmacy and Cashier windows. Patient information flyers in English, Spanish, Cantonese, Vietnamese and Russian have been developed, posted in the Main Lobby, and distributed to patients to assist them in the new procedure. The flyer also has a listing of community pharmacies for patients who have Medi-Cal or other coverage and wish to go elsewhere. Provider information was distributed and reviewed at various staff meetings. A provider education effort is planned for implementation over the next few weeks. The Hospital will review and evaluate the operations on a daily basis and make continuous efforts to improve the system. Pharmacy and Patient Accounting will address the needs of individual patients on a case by case basis.

On the first day of implementation, patient flow and operations went relatively smoothly. Due to the poor weather, overall Pharmacy volume was down, with approximately 1,200 prescriptions submitted versus 1500 daily average. Several insured patients elected to go elsewhere when informed of other community resources. Almost all patients who had a share of cost or co-pay did, in fact, make their payments. The Pharmacy collected $1,117.75. The Pharmacy and Patient Accounts departments are to be commended for their hard work and collaborative efforts.

Resignation of Dr. Maria Rivero

It is with regret that I announce the resignation of Dr. Maria Rivero as the Laguna Honda Hospital Medical Director, a position that she has served well in since May 1998. It is her wish to return to her previous position as a Senior Physician Specialist serving the residents at LHH. Although this is a great loss to the CHN, we support her personal decision to retain her role as a clinician and are fortunate that she will continue as a member of the LHH medical staff. Her resignation will be effective June 14, 1999.

Laguna Honda Hospital Building Replacement

On March 24th, St. John's United Church of Christ and the San Francisco Organizing Project (SFOP) sponsored a meeting for the building replacement of LHH. The SFOP is a federation of 33 congregations and schools from neighborhoods, representing 40,000 families. The SFOP is a faith-based organization that believes that by putting faith into action, the quality of life for all families in San Francisco can be improved. The following quality of life issues regarding the LHH building replacement were raised during the meeting:

  • Sufficient space should be included to create a sense of community and support social relationships.
  • There should be safe convenient access for employees, visitors and residents.
  • Green space should be maintained for neighbors and residents to enjoy.
  • Community representation should be included in the planning process and input should be solicited to assure smooth construction.
  • There should be teamwork between elected officials at the city, state and federal levels.

At the meeting, members posed questions of commitment to Mayor Brown, City Attorney Louise Renne and myself. We are solidly committed to supporting the above quality of life issues.

Trauma Center Director

Dr. Robert Mackersie, Trauma Center Director, who serves on the American College of Surgeons Committee on Trauma, was recently elected as Chair of the Association's National Committee on Trauma Education.

California Healthcare Interpreters Association

The California Healthcare Interpreters Association celebrated its second anniversary and recognized SFGH and CHN as a founding organization. Gloria Garci-Orme, RN, Director of Patient Referral and Assistance, Interpreters and Visitor Center serves on the organization's Board of Directors.

Laguna Honda Hospital

Bill Moyers, writer and host of many award-winning PBS series, will be coming to Laguna Honda Hospital Hospice to interview and film caregivers on April 13, 1999.

San Francisco General Hospital Clean Up Day

Saturday April 10 is "General Clean Up" day sponsored by Partners in Improving Care and Services (PICS). Campus Hospital Employees Activities Resource Services (CHEARS) will nourish the volunteers with pizza and soft drinks. All are invited to volunteer. Laguna Honda Hospital has organized a contingent to assist in the effort. This is truly a CHN family project. The time is 8:00 a.m. to noon. Meet in 2A6 and you will be assigned to a team led by a member of the Housekeeping staff.

Giselle Opening Night

Thanks to the generosity of Mr. and Mrs. F. Warren and Coleman Advocates,

13 CHN children and their families will get reserved seating at the San Francisco Ballet's opening night performance of Giselle on Thursday, April 18, 1999, at the War memorial Opera House.

Bath Houses

After urging from members of the public, President Monfredini requested a report from Dr. Katz on a community meeting regarding bath houses. He provided information on the discussions at the meeting.

Public Speakers:

Advocated to reopen the bath houses and relook at the regulations on sex clubs.

  • Steve Filandrinos
  • Stephen O. Murray, Ph.D.
  • Richard Cornwall
  • Lincoln Madison
  • Reed Condit
  • Mark Freeman advocated continued employment of Bob Prentice, Ph.D.
  • April Martin Chartrand, member of S.F. Mental Health Board, spoke about the long waiting lines at the SFGH Pharmacy.

Commissioners' Comments:

Commissioner Parker suggested there should be a rewording of "Take Your Daughter to Work Day" to "Take Your Child to Work Day". He also pointed out the importance of patient education on the pharmacy changes.

Commissioner Chow pointed out the possible misunderstanding among clinicians regarding the pharmacy policy. There should be accurate information given to all of the clinicians. The objective of the policy is not to deprive patients of their medication.

Commissioner Guy urged the Department to keep customer satisfaction in the forefront. She also encouraged the Department to solve the outreach problem in the Healthy Families Program. She would like a status report in the Director's Report or as an agenda item at a future Commission meeting. Additionally, she acknowledged the many years of leadership from Bob Prentice, Ph.D., and congratulated Jimmy Loyce and Barbara Garcia on their new positions.

Commissioner Chow commented on the importance of the continued integration within the Department.

Commissioner Sanchez would like a continuous assessment of the pharmacy issue based on patient population and patient outcomes.


Dr. Katz acknowledged the following advisory groups to the Department:

  • Adult Sexual Assault Services Planning Group
  • Airport Noise Committee
  • Black Infant Task Force
  • Bringing Up Healthy Kids Coalition
  • Castro Mission Health Center Advisory Board
  • Children's Mental Health Systems of Care Council
  • Chinatown Health Center Advisory Board
  • CHIPPS Council
  • City Wide Advisory Board
  • City Wide Alcoholism Advisory Committee
  • Come Into the Sun Coalition
  • Drug Abuse Advisory Board
  • EMS Clinical Advisory Committee
  • EMS Community Education Committee
  • EMS Field Provider Advisory Committee
  • EMS Receiving Hospital Liason Committee
  • EMS Research Committee
  • EMS Traffic Safety Coalition
  • Family Mosaic Advisory Board
  • Gay, Lesbian, Bisexual, Transgender, Queer and Questioning Substance Abuse Committee
  • HazMat Advisory Committee
  • Lead Hazard Reduction Citizen's Advisory Comm.
  • Lead Poisoning Prevention Citizen Adv. Committee
  • Maternal, Child, Adolescent Health
  • Advisory Board
  • Maxine Hall Health Center Comm. Advisory Board
  • Medicaid 115 Waiver Planning Committee
  • Mental Health Board
  • Mental Health Leadership Workgroup
  • Mental Health Quality Policy Committee
  • Newcomer's Advisory Board
  • North of Market Senior Services Advisory Board
  • Ocean Park Health Center Advisory Board
  • Ocean Park Health Center Advisory Board
  • Potrero Hill Health Center Comm. Advisory Board
  • San Francisco Immunization Coalition
  • San Francisco Violence Prevention Committee
  • San Francisco's Promise
  • SF TB And Homelessness Task Force
  • SF Tobacco Free Coalition
  • South East Health Center Advisory Board
  • Special Programs for Youth Advisory Board
  • STD Community Action Coalition
  • STD Program Advisory Committee
  • STD Youth Community Action Coalition
  • Substance Abuse Epidemiology Adv. Committee
  • Substance Abuse Task Force
  • Substance Abuse Treatment on Demand Council
  • Tom Waddell Health Center Community Advisory Board

On behalf of the Commission, President Monfredini thanked the advisory groups for their volunteer work with the Department.

Action Taken: The Commission adopted Resolution #12-99, "Honoring the Contribution of the Advisory Groups to the San Francisco Department of Public Health Celebration of Public Health Week, April 5-9, 1999."


Dr. Jeff Klausner, Director of STD Services, provided information on the Department's education efforts on sexually transmitted diseases, especially at Balboa, Wallenberg, Downtown, and Washington High Schools. He pointed out, based on the available resources at various schools, the Department would like to include other high schools and middle schools.

Action Taken: The Commission adopted Resolution #13-99, "Proclaiming the Month of April in San Francisco as Sexually Transmitted Diseases Awareness Month."


Henry Louie, Program Manager, Environmental Health, Solid Waste Section; and William Chan, Deputy City Attorney, presented the following:

The City's refuse Collection and Disposal Ordinance of 1932 ("Initiative Ordinance"), required, among other things, that persons who collect refuse in the City secure a permit from the Department. In 1992, the Department adopted the 1992 Regulation and extended the initiative Ordinances permitting requirement to include federal facilities located within the City. In 1997, the federal government transferred management authority for most of the federal facilities on Treasure Island and Yerba Buena Island ("Islands") to San Francisco ("City"). The change in status of the Islands requires persons who collect refuse from non-federal facilities on the Island to secure a refuse collection permits from the City. Currently, the City does not have in place substantive procedures for the issuance of such permits.

The proposed "TI & YBI Regulation" will provide the City with substantive procedures for the orderly issuance of refuse collection permits so that refuse may be collected from the non-federal facilities on the Islands, pursuant to the requirements of the Initiative Ordinance.

The proposed revision of the 1992 Regulation is necessary to eliminate inconsistencies in the regulations governing the issuance of refuse collection permits for federal and non-federal facilities, i.e., the 1992 Regulation and the proposed "TI & YBI Regulation". Additionally, the revision will address administrative shortcomings experienced by Department staff while implementing the 1992 Regulation.

The proposed revision of the 1992 Regulation and the proposed "TI & YBI Regulation" mirror each other in most respects, with the exception that thee 1992 Regulation pertains to federal facilities located in the City, while the "TI & YBI Regulation" applies to non-federal facilities on the Island.

Public Speakers:

Albert Bianchi, representative for Bay Cities Refuse, submitted a letter dated April 1, 1999, raising issues and questions pertaining to the proposed adoption of new regulations for the issuance of refuse collection permits regarding "TI & YBI".

Richard Jacobs, representative for Sunset Scavenger and Golden Gate Disposal and Recycling Co., submitted a letter dated April 6, 1999, indicating that the proposed regulations involve material changes in the interpretation of the Refuse Collection and Disposal Ordinance of 1932.

Commissioner Guy raised the concern that adequate hearings on this issue are needed. Mr. Louie indicated this Commission meeting is intended to be a public forum for input from interested parties.

Dr. Katz suggested continuance of this item and after discussions with the interested parties, the Department will come back to the Commission with recommendations. The Department will attempt to bring this back on April 20, 1999.


Sue Cone, Manager, Hazardous Materials, presented a revised fee schedule for the Hazardous Materials Unified Program Agency (HMUPA). She presented documents consisting of a brief summary of changes, legislative digest, and proposed ordinance amendments to Articles 21, 21A and 22 of the San Francisco Health Code.

Commissioner Chow observed that no one was present from the public to object to the fee increases.

Commissioner Parker questioned the Department's claim that the State data did not reflect the current business activity, thereby, resulting in decreased revenues and inability to cover the operating costs of the program.

Action Taken: The Commission (Monfredini, Guy, Chow, Sanchez, Umekubo) adopted Resolution #11-99, "Recommending the Approval of Ordinance Amendments to Articles 21, 21A and 22 of the Health Code Containing Fee Increases for Businesses Regulated Under the Hazardous Materials Unified Program Agency." Commissioner Parker voted no.

President Monfredini left at 5:50 p.m.


Dr. Sylvia Villarreal, SFGH Chief of Staff, presented revisions to the SFGH Medical Staff Bylaws. The revisions were recommended for approval at the March 8, 1999 Medical Executive Committee and the March 9, 1999 Joint Conference Committee of SFGH.

Commissioner Chow requested clarification on the harassment section and the attendance requirements.

Action Taken: The Commission unanimously approved the revisions to the SFGH Medical Staff Bylaws.

Dr. Villarreal presented proposed revisions to the Clinical Service Rules and Regulations, which were recommended for approval, as required in the Bylaws Article XI, by the Quality and Utilization Management Committee and the Medical Executive Committee. The accompanying Privilege Sheets were also approved by the Credentials Committee.

  • Community Primary Care
  • Emergency Department
  • Ob/Gyn
  • Neurosurgery
  • Radiology Revised

Commissioner Parker pointed out that all dentists are certified for CPR. He also pointed out the duplication of the Chief of Obstetric Services.

Commissioner Chow commented on the importance of being clear regarding the Community Primary Care Physicians in relationship to what is being surveyed. He also pointed out the emergency section should be more generic, not number-specific.

Action Taken: The Commission unanimously approved the revisions to the Clinical Service Rules and Regulations and Privilege Sheets.


Public Speakers:

(Opposed the termination of Bob Prentice, Ph.D.)

  • Paul Boden, Coalition on Homelessness
  • Josh Brandon, Coalition on Homelessness

The meeting was adjourned at 6:15 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission