Minutes of the Health Commission Meeting

Tuesday, June 1, 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 Vice President Roma Guy, MSW, at 3:05 p.m.


  • Commissioner Edward A. Chow, M.D.
  • Commissioner Roma P. Guy, M.S.W.
  • Commissioner Ron Hill
  • Commissioner Harrison Parker, Sr., D.D.S.
  • Commissioner David J. Sanchez, Jr., Ph.D.
  • Commissioner John I. Umekubo, M.D.


  • Commissioner Lee Ann Monfredini


Action Taken: The Commission unanimously adopted the minutes of May 18, 1999.

(Commissioner Ron Hill)

(3.1) PHP-CHS-Mental Health – Request for approval of modification to the contract with Seneca Center to reduce contract amount by $404,420, for the period of July 1, 1998 through June 30, 1999. The total amount of the contract is $680,236.

PHP-CHS- Substance Abuse – Request for approval of retroactive second modification to the renewal contract with Chemical Awareness and Treatment Services, Inc. (dba Community Awareness and Treatment Services, Inc. (CATS), in the amount of $689,269, for ongoing shelter and support services to homeless residents of San Francisco, for the period of July 1, 1998 through

June 30, 1999; and for winter shelter for near-homeless residents for the period of December 1, 1998 through March 31, 1999. (DPH contracted with CATS for services totaling $4,109,836 during FY 1997-98).

(3.3) PHP-CHS- Substance Abuse – Request for approval of retroactive modification to the contract with Haight Ashbury Free Clinics, Inc. (HAFC), in the amount of $436,640, to augment the provision of day treatment services to addicted mothers, for the period of January 1, 1999 through June 30, 1999; maintain outpatient substance abuse counseling at the Tom Waddell Center, for the period of September 1, 1998 through June 30, 1999; and add new residential center for recovery services for dual and triple-disordered substance abusers, for the period of February 1, 1999 through December 31, 1999. (DPH contracted with HAFC for services totaling $15,119,656 during FY 1997-98).

(3.4) PHP-CHS- Substance Abuse – Request for approval of retroactive second modification and sole source for the contract with Jelani House, Inc., in the amount of $93,420, to provide for the start-up of CalWORKs mental health and substance abuse services, residential and transitional care services, for the period of April 1, 1999 through June 30, 1999. (DPH contracted with Jelani for services totaling $1,187,959 during FY 1997-98).

In response to Commissioner Umekubo’s inquiry about the progress towards implementation of amended Policy #24, Galen Leung, Office of Contracts Management, reported that surveys from contractors are being collected and that training and technical assistance sessions for contractors will be scheduled.

Commissioner Hill requested an update on the implementation of amended Policy #24 be calendared for the September 21, 1999 Budget Committee.

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).

The Mayor released his FY99-00 budget today, including the budget for the Department of Health. I am very pleased to report that the Mayor has approved and appropriated funds for many programs and initiatives that were requested in the Department’s budget request, as approved by the Health Commission. In addition, the Mayor has increased General Funds to offset the structural revenue shortfall that led to the large deficit in the current year. The Department’s expenditure budget was increased from the current year approved amount of $813 million to $833.5, or an increase of 2.5%. Important to note is that the General Fund allocated to the Department increased by $40 million, from its original FY98-99 amount of $185.8 million to $225.9 million. The majority of this increase in General Fund will be used to offset reductions to State and Federal revenues at San Francisco General Hospital and Laguna Honda Hospital.

Significant new funding approved in the Mayor’s Budget for FY99-00 is as follows:

  • Revenue offset with new General Fund at SFGH: $16.00 million
  • Revenue offset with new General Fund at LHH: 9.00 million
  • Increased funding at SFGH to reflect increase in census: 3.75 million
  • Increased funding to Mental Health Equal Access to Care: 2.46 million
  • Increased funding (revenue generating) for Mental Health: 2.03 million
  • Increased funding (revenue generating) for Children Services: 1.47 million
  • Increased funding for Treatment on Demand: 1.00 million
  • Increased funding (revenue generating)for substance abuse: .43 million
  • Increased funding for homeless Mission Rock Program: .50 million
  • Increased funding for workers’compensation program: 2.30 million
  • Replacement of Mental Health Ryan White reductions: .70 million
  • COLA’s for contractors: 3.54 million
  • Increased funding for Outpatient Pharmacy at SFGH: .80 million
  • HIV Case Management Services to Latino clients: .12 million

The Department’s cost reduction and reallocation proposals within the Health Department’s budget request were also adopted by the Mayor. These proposals include reducing administrative costs, consolidating selected business functions, and reallocation of hospital based resources to community alternatives.

The budget now proceeds to the Board of Supervisors for approval. The Finance Committee of the Board will hold a budget workshop on the Health Department’s budget on Thursday of this week. Budget hearings on the Health Department budget will take place on June 17 and June 24. A public hearing of the entire City budget will be held by the Finance Committee on June 19.

I will keep the Health Commission informed on the developments in the next phase of the approval process.

Proposed INS Rule Regarding Public Charge

Last week the Department of Justice published a proposed rule in the Federal Register concerning the inadmissibility and deportability of immigrants on public charge grounds. The rule indicates that a non-citizen’s receipt of health benefits is irrelevant for public charge determination. Specifically, the INS will not consider participation in Medicaid, CHIP or similar State-funded programs for public charge purposes. The Immigration and Naturalization Service (INS) is implementing this definition immediately through field guidance to its offices.

The proposed rule is designed to provide non-citizens and their families with information on their ability to apply for certain benefits without fear of becoming a public charge for the purposes of admission into the United States, adjustment of status to legal permanent residence and deportation. As the Health Commission is aware, a number of non-citizens have been reluctant to enroll their children in California’s Healthy Families program, apply for the Medi-Cal and/or use public health services, such as immunizations for their children, as a result of public charge concerns.

The proposed rule defines public charge for the first time to mean an "alien" who has become (for the petition purposes) or is likely to become (for admission or adjustment of status purposes) "primarily dependent on the government subsistence as demonstrated by either the receipt of public cash assistance for income maintenance, or institutionalization for long-term care at government expense." The proposed rule indicates that this definition alone cannot be used to determine if a non-citizen is a public charge and that other issues must also be taken into account. The other factors that must be considered by INS and the Department of State include: the non-resident’s age, health, family status, assets, resources, financial status, education and skills. No single factor will determine whether a non-resident is a public charge, including past or current receipt of public cash benefits for income maintenance.

The proposed rule specifies that the cash assistance for income maintenance includes: SSI, TANF and local/State general assistance program. In addition, public assistance, including Medicaid, that is used to support non-citizens residing in an institution for long-term care will also be considered by INS and the Department of State as part of any public charge determination. Short-term institutionalization for rehabilitation is not subject to public charge consideration.

The following benefits are not subject to public charge consideration because they are not intended for income maintenance:

  • Medicaid,
  • Children’s Health Insurance Program (CHIP),
  • Food Stamps,
  • the Special Supplemental Nutrition Program for Women, Infants and Children (WIC),
  • immunizations,
  • prenatal care,
  • testing and treatment of communicable diseases,
  • emergency medical assistance,
  • emergency disaster relief,
  • nutrition programs,
  • housing assistance,
  • energy assistance,
  • child care services,
  • foster care and adoption assistance,
  • transportation vouchers,
  • educational assistance,
  • job training programs, and
  • non-cash benefits funded under the TANF program.

The proposed public charge rule also clarifies the following:

  • there is not public charge test for naturalization,
  • public charge is not a factor of whether a non-citizen can sponsor relative to come to the United States,
  • the INS and State do not have authority to request that non-citizens repay public benefits in connection with Visa issuance, admission or adjustment of status (any repayment is overseen by the agency that granted the benefits) and
  • benefits received by one member of the family are not attributed to other members for public charge purposes unless the cash benefit amount is sole support of the family.

In addition to the proposed rule, the INS has issued a fact sheet and Q&A on public charge. Comments on the proposed rule will be taken until July 26, 1999. At that time, it will be determined whether the proposed rule is final or if modifications will be incorporated must be issued.

There will be significant activity on the State level in publicizing this information to community-based agencies and non-citizens who are potentially eligible for government-sponsored programs. The Department will be creating a workgroup to determine how to communicate the proposed regulations to our staff and our clients. The Health Commission may recall that the Department undertook a similar effort after the passage of State Proposition 187. At that time, we informed our staff and clients that the Department was still providing health services to undocumented residents. The Department will work closely with the City Attorney to ensure that any material distributed by the Department are correct and reflect the current proposed guidance of the federal government. The Department will submit written comments to the federal government on the proposed rule by the July 26, 1999 deadline. The Department will review the implications of the long-term care component of the proposed rule.

On a Citywide level, the Bringing Up Healthy Kids Coalition will work with its members and other immigrant organizations and ethnic health organizations and associations to communicate the proposed rule. We believe that the proposed rule provides much needed clarity for undocumented residents and legal immigrants who have children eligible for Healthy Families, Medicaid, and other public health and nutrition programs. On the federal level, there may be some opposition to the proposed rule. House of Representative’s Immigration Sub-Committee Chair, Representative Lamar Smith (R-Texas), has stated his opposition to the rule, alleging that it will increase the number of immigrants on welfare who may bring in more immigrants who seek welfare. The Department will provide feedback to our Washington, D.C., delegation on the proposed rule.


Violence Prevention Planning Conference

Over 75 individuals representing community agencies, the faith community, non-profit organizations, private individuals, the police department, and DPH staff, met for an all-day violence prevention planning session. SFPD ASST. Chief Earl Sanders, and Director of CHP&P Larry Meredith welcomed them. Andres Soto of the Pacific Center for Violence Prevention gave illustrations of how those coming from different perspectives can collaborate and the need to do so. Chinese and Spanish language and Filipino community press covered and reported the event in print and television media.

The purpose of the conference was to set goals and objectives for a community-based violence prevention plan for San Francisco addressing three risk factors: alcohol, guns, and witnessing acts of violence. During the coming program year, action teams will develop activities and strategies that will address the plan's objectives. Technical assistance will be offered by the DPH for each team and a year-end review and evaluation is planned.

Children’s Environmental Health Promotion Asthma Program

The Children's Environmental Health Promotion Section has initiated a new service for Community Health Network medical providers, which allows pediatric asthma patients to be referred for assessment of environmental triggers in their home environment. In addition, a public health nurse will provide teaching and counseling for the family to reinforce the medical management plan for that child. Please contact the program at 554-8930 (ext. 19 or 22) for further information.

STD Prevention and Control Testing

As part of STD Awareness Month, 664 students at 4 public high schools in San Francisco (Balboa, Washington, Wallenberg and Downtown) were tested for gonorrhea and chlamydia with urine tests. Sixteen infections were identified - 14 chlamydia infections and 2 gonorrhea infections. All infected students were successfully treated.

Of special importance is that all of these infections were among students who had no symptoms, and who might have developed serious consequences if they had not been treated. The results of the testing indicate that approximately 1 out of 25 young women were infected with chlamydia and demonstrates that chlamydia infection is a problem among adolescents in San Francisco.

Over the next few months, the STD Program will be working closely with the San Francisco Unified School District, the PTA, students, teachers and other interested parties to determine the best way to manage this serious problem among our City's youth.

Health Promotion and Education Award

On May 29th, the San Francisco State University, Health Education Department will honor Buffy Bunting, as alumni of the year. Ms. Bunting has served as the Health Education Training Center Coordinator for the last two years and has worked for 15 years as a "district" public health educator. Buffy is well known for her work on the Video "Los Ojos Que No Ven" (Eyes That Do Not See) and for her more recent contributions to the SFSU undergraduate health education program as adjunct faculty and field internship supervisor.

Environmental Health Award

The American Heart Association (AHA) San Francisco Division has announced that Tom Rivard, Senior Environmental Health Inspector, has been selected as their recipient of the 1998-99 Advocacy Award. Last year's winner was Louise Renne of the City Attorney's office for her work on the tobacco lawsuit. AHA staff, Board members, volunteers, and community nominated Tom for his continued hard work in the Department's no-smoking program. He is especially acknowledged for his leadership in implementing the smoke-free bar portion of the California Smoke-Free Workplace Act.

The award will be presented to Tom at the San Francisco Division 69th Annual meeting. The event will be held on Monday, June 7 at Café 52, 52 Belden Place, from 5:30-7:00 p.m.


Laguna Honda Annual Survey Begins

Laguna Honda Hospital's annual re-certification survey conducted by the State Licensing & Certification Division began on Tuesday, May 25, 1999. By the second day of the survey, a total of 17 State Licensing Surveyors, including a variety of specialty consultants and one Healthcare Financing Administration Representative, convened at Laguna Honda to participate in the comprehensive survey. The survey team reported that the duration of the survey is expected to be approximately 2 weeks.

The LHH Executive Team is convening twice daily to monitor and manage the survey process. I will advise the Commissioners of the date and time of the survey exit conference so that you may attend if you wish to do so. I will also summarize the information presented at the exit conference in my next report.


San Francisco General Hospital Medical Center completed an intensive five-day review as part of the accreditation process by the Joint Commission on the Accreditation of Health Organizations (JCAHO), the California Medical Association, and California State Licensing & Accreditation. Gene O'Connell emphasized the importance of the survey, not only because its accreditation outcome is a requirement for Medi-Cal and Medicare reimbursement, but also because the standards are the foundation for our own evaluation process.

The review team assessed the work of the last three years, by reviewing policies and procedures and documentation records, and most importantly, through staff interviews. Surveyors commented on the strong commitment of staff at every level of the organization - nurses, housekeepers, social workers and doctors. Strong commitment and intense advocacy were evident as staff described their work, their patients and, in some cases, their concerns. The surveyors noted the complexity of the organization, the well-informed and cohesive staff, and communication among the Health Commission, the Health Director and the Community Health Network Leadership.

The closing conference held May 21st gave the staff a preliminary summary of the surveyors' recommendations. Although the final report will itemize any findings requiring a plan of correction or potential revisits, the surveyors have indicated that SFGH and the MHRF will be accredited for the next three years.

I am particularly pleased with the leadership of Gene O'Connell. She led our team well in preparing for the survey. I am also proud of the SFGH staff who work hard everyday to provide excellent care to our patients.

California Hospital Association Skilled Nursing Facility Rate Lawsuit

I am pleased to report that the San Francisco Superior Court has ruled on the side of the plaintiff in the case, California Hospital Association v. Belshe lawsuit. The California Hospital Association (CHA) filed suit against the State Department of Health Services for arbitrarily freezing the nursing facility reimbursement rate. In 1995, the State DHS, without legislative authorization, elected to freeze rates at 1994 level rather than grant an increase that would have been dictated. The CHA challenged the State’s unauthorized rate freeze in both federal and state court. The federal action was resolved in favor of the CHA.

The details of the settlement must now be worked out. At this time, it appears that the proposal will be to increase the reimbursement rate by $15 to $20 per day per resident for the next five years.

The Department will work closely with the State and our legislative delegation to ensure that this rate increase is incorporated into the Governor’s fiscal year 1999 budget. The Department would like to acknowledge the tremendous work of the California Hospital Association and Mr. Craig Cannizo, Esq., of Hansen, Bridget, Marcus, Vlahos and Rudy for litigating this case. I would also like to acknowledge the work of Anthony Wagner who has worked closely with the CHA and Mr. Cannizo on identifying the importance of this lawsuit for the City and County of San Francisco.


The following speakers presented an overview of the "San Francisco Community Assessment" report and updated the Commission on the efforts of the Building a Healthier San Francisco Collaborative which developed the report:

  • Nathan Nayman, regional Vice President, Hospital Council of Northern and Central California, Bay Area Division
  • Sherry Sherman, Director of Community Benefits, California Pacific Medical Center
  • Marcia Argyris, President of the McKesson Foundation and Chair of The United Way San Francisco County Leadership Board

For a copy of the report, contact the Department of Public Health Office of Policy and Planning (telephone 554-2626).

The Community Assessment includes methodology; demographic profile; 15 critical issues; three frameworks including equity, the life cycle, and risk factors; and follow-up.

The representatives of the Collaborative requested the Commission to consider accepting and endorsing the report. The Department will bring a proposed resolution to the Commission at the June 15th meeting.

Vice President Roma Guy commented that the Department could use this document and information for its Strategic Plan that has been requested by the Commission.


Anne Kronenberg, External Affairs and Executive Assistant to the Director of Health, presented the Department’s response plan, both to the declared and the undeclared emergency. The Department, along with the Department of Human Services as the lead agency, the leadership of Carl Hedelston of the Office of Administrative Services, the Red Cross, community-based organizations, survivors, and advocates, has institutionalized its response plan and has added a proactive component to the emergency response plan.

The plan includes teams responsible for policy, assessment, and response. Under the direction of Supervisors Tom Ammiano and Amos Brown, the Emergency Response Policy Coordinating Committee (PCC) convened in March 1999 to develop specific proposals for the Board of Supervisors for long-term improvement of the response system. The PCC has identified eight areas of recommendations: better coordination, sheltering options, 800 number, internet information, replacement housing, one stop service, storage and movement of personal goods, and verification of residency.

The collaborative effort has resulted in the creation of short term citywide strategies for prevention, preparation, response, and recovery efforts. The PCC continues to work in developing and implementing long-term solutions.

Ms. Kronenberg stated that this citywide model will be used for the upcoming millennium events.

Commissioner Chow commended the PCC for its creative efforts.

Commissioner Sanchez complimented staff for an excellent model. He encouraged this model to be a supplemental for children.

Vice President Guy thanked the Department for its report.


Note: This item was heard after the Director’s Report.

Dr. Katz presented a modified replacement proposal for Laguna Honda Hospital. The modified building plan and financing plan has decreased the cost of the Laguna Honda Hospital bond issue from $437 million to $299 million.

The factors that decreased the amount:

  • Decreased the number of single rooms and increased the number of 4-bed rooms, saving $27 million
  • Put off contracting for some parts of the project long enough to earn interest on some of the bond money that will be collected
  • Use some of the tobacco settlement proceeds to pay for construction costs rather than solely to pay interest on the bonds
  • Begin collecting taxes to pay off the bonds immediately after the measure passes

Dr. Katz reported that the Board of Supervisors would set aside $1 million per year for tobacco education and prevention programs, as long as there are outstanding debt services.

Vice President Guy thanked Dr. Katz and staff for the modified plan.

Commissioner Chow suggested the inclusion in the resolution of the $1 million/year set-aside for tobacco education and prevention programs. Dr. Katz commented that this point is implicit in the resolution.

Action Taken: The Commission adopted Resolution #19-99, "Endorsing Modifications in the Laguna Honda Hospital Replacement Bond Project."

Dr. Katz and Vice President Guy left the hearing room to be interviewed by the press.

Commissioner Chow chaired the meeting for Item #5. Vice President Guy resumed chairing the meeting with Item #6.


Dr. Larry Meredith, Director of Community Health Promotion and Prevention, reported that at the May 18, 1999 meeting of the Health Commission, the Department presented its Briefing Paper on San Francisco Youth Suicide Prevention. A resolution was requested by the Health Commission.

The proposed resolution was developed by the Youth Suicide Prevention Study Group, a group convened by the Department of Public Health and Youth Commission to respond to the Board of Supervisors resolution "to examine youth suicide and make recommendations to the San Francisco Board of Supervisors".

Dr. Meredith noted that although the Golden Gate Bridge, site of over 1,200 known suicides, represents a major public health hazard as noted in our presentation to the Health Commission, it has not been included in the resolution since it is not associated in any particular way with youth. The Health Commission may wish to consider public health and safety issues associated with the Golden Gate Bridge at some future time.

Commissioner Chow recommended a friendly amendment in the first resolved to read, "Resolved, that the Health Commission supports the recommendations of the Youth Suicide Prevention Study Group …."

Vice President Guy raised the idea of including the Golden Gate Bridge as a major public health hazard in this resolution or taking it up separately at a future agenda.

Commissioner Sanchez expressed mixed feelings about including the Golden Gate Bridge in this resolution.

Commissioner Parker recommended the Golden Gate Bridge issue be considered at a later time.

Public Speaker: Eve Meyer, Suicide Prevention, supported the resolution and supports removing hazards in order to prevent suicides.

Action taken: The Commission adopted Resolution #20-99, "Supporting Measures to Reduce Youth Suicide and Related Risk Behaviors that Place Youth at High Risk of Injury and/or Death," as amended by Commissioner Chow.



The meeting was adjourned at 5:40 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission