Minutes of the Health Commission Meeting
Tuesday, October 19, 1999
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 3:05 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 REGULAR MEETING OF OCTOBER 5, 1999
Action Taken: The Commission unanimously adopted the minutes of October 5,
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Ron Hill)
(3.1) Update on the Black Coalition on AIDS for the provision of HIV prevention
(3.2) CHN-Pharmacy Request for approval of contract renewal with Asereth
Medical Services, Inc. in the amount of $800,000, for the provision of as-needed
supplemental pharmacy personnel services, for the period of October 1, 1999 through June
30, 2000. (DPH contracted with Asereth for services totaling $2,600,000 during FY 1998-99.
(3.3) CHN-SFGH Request for approval of new contract with Catalyst
Systems, LLC, in the amount of $56,000, for the provision of software, training, and Title
22 mandated system validation services for the patient Classification System in use by the
Department of Nursing at San Francisco General Hospital, for the period of November 1,
1999 through June 30, 2000.
(3.4) CHPP-Health Promotion Request for approval of contract modification
with Polaris Research and Development, in the amount of $20,825 for a total contract
amount of $118,330, to provide comprehensive evaluation services to the Tobacco Free
Project, for the period of July 1, 1999 through June 30, 2001. (DPH contracted with
Polaris for services totaling $730,150 during FY 1998-99).
(3.5) CHPP-Health Promotion Request for approval of contract modification
with San Francisco Study Center (SFSS), in the amount of $341,905 for a total contract
amount of $680,800, to provide fiscal sponsor services for the Community Capacity Building
Training Center for the Tobacco Free Project, for the period of July 1, 1999 through June
30, 2001. (DPH contracted with SFSS for services totaling $1,444,242 during FY
Commissioner Umekubo inquired about evaluations for these programs.
(3.6) CHPP-Health Promotion Request for approval of contract renewal with
Men Overcoming Violence (MOVE), in the amount of $84,643, for the provision of family
violence prevention services, for the period of October 1, 1999 through September 30,
2000. (DPH contracted with MOVE for services totaling $93,914 during FY 1998-99).
(3.7) CHPP-Health Promotion Request for approval of renewal contract with
San Francisco Neighborhood Legal Assistance Foundation (SFNLAF), in the amount of $55,000,
for the provision of family violence prevention support services, for the period of
October 1, 1999 through July 31, 2000. (DPH contracted with SFLAF for services totaling
$95,000 during FY 1998-99).
(3.8) CHPP-HIV Prevention Request for approval of retroactive contract
renewal with Central City Hospitality House (CCHH), in the amount of $76,438, for the
provision of HIV prevention services targeting behavioral risk youth, for the period of
July 1, 1999 through June 30, 2000. (DPH contracted with CCHH for services totaling
$595,397 during FY 98-99).
(3.9) CHS-Substance Abuse Request for approval of sole source award and
modification to the four-year contract with Asian American Recovery Services, Inc.
adding: $1,735,822 for the term of October 1, 1999 through June 30, 2000 for a total
amount $3,053,870 in the second year of the four-year contract, and $1,230,866 for each of
the remaining two years of the contract for a new annual amount of $2,548,914 for a
revised total four-year agreement of $9,469,746 to maintain the provision of San Francisco
Target Cities Projects Drug Court, Acupuncture, PAES Treatment Access, and
administrative support services. (DPH contracted with AARS for services totaling
$1,318,048 during FY 1998-99).
(3.10) CHPP-STD Prevention and Control Request for approval to accept and
expend a new two year grant from the Centers for Disease Control and Prevention in the
amount of $514,106 for evaluation of the program entitled Screening Males for Chlamydia
Trachomatis, for the period of September 30, 1999 to September 29, 2001.
(3.11) CHN-Primary Care-Dental Services Request to enter into an
agreement between the Delta Dental Plan of California and the Department of Public Health
through the Community Health Network as a participating provider to provide specific
dental services to enrollees in the Healthy Families program, in the amount of up to
Commissioner Chow requested an update on the evaluations for the tobacco projects.
President Monfredini referred this to the appropriate Joint Conference Committee and then
to the full Commission in December.
Commissioner Parker requested clarification on the operations of the Delta Dental Plan.
President Monfredini commended the Black Coalition on AIDS for its progress in the
Action Taken: The Commission unanimously approved the Consent Calendar of
the Budget Committee.
President Monfredini sadly reported the passing of Jean Jacobs, a leader in children
and youth services and the founder of Coleman Advocates for Children and Youth.
4) DIRECTORS REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).
President Strengthens Outreach for CHIP and MEDICAID
Last week President Clinton announced plans to increase enrollment in Childrens
Health Insurance Program (CHIP) and in Medicaid. As the Health Commission is aware,
Healthy Families is Californias CHIP program. Approximately 12 million children lack
health insurance nationally and half are eligible for either CHIP or Medicaid.
Acknowledging the barriers to enrollment, President Clinton has directed the Secretaries
of Health and Human Services, Education, and Agriculture "to focus children's health
insurance outreach on a place where we know we can find uninsured children: schools."
The President has asked the Department of Health and Human Services to coordinate this
effort and develop a set of recommendations to improve enrollment through schools. The
report is due to the President in six months. The Department will follow the development
of these recommendations.
COMMUNITY HEALTH NETWORK
Senator Feinstein Announces $750,000 for Laguna Honda Hospital
On October 16th, Senator Dianne Feinstein toured Laguna Honda Hospital.
Senator Feinstein announced $750,000 of new federal money for the development of
assisted living units at Laguna Honda Hospital. The money is part of a package which the
U.S. Senate approved as a joint House-Senate conference report to fund the departments of
Veterans Affairs, Housing and Urban Development, and related agencies for fiscal year
2000. The money will ease the cost to rebuild the public hospital if voters pass a bond
measure in this November's election.
Department staff will continue to monitor legislation and supplemental funding from the
Federal and State government that can be applied to the cost of replacing Laguna Honda,
and further defray increases to local property tax. I will keep the Commissioners apprised
of progress on this important issue.
POPULATION HEALTH AND PREVENTION
Community Conference in Bayview
On October 9th, the BVHP Health and Environmental Project (HEAP) and the
Southeast Alliance for Environmental Justice (SAEJ) sponsored a conference to review
health and environmental issues in the Bayview called "The Landscape of our
Dreams." The conference focused on the BVHP Health and Environmental Task Force
Community Survey, funded by grants from the California Endowment and San Francisco
Foundation. Residents, researchers, agency staff, health educators and public health
representatives met at the conference to discuss survey results. This interactive dialogue
with community residents not only ensures HEAPs accountability to the BVHP community
but also enables residents to direct HEAPs 2000-2001 agenda. The Conference
unanimously endorsed development of a comprehensive and multifaceted approach to alcohol
and drug prevention and treatment as next years top priority.
Particular thanks go to Karen Pierce, Coordinator, BVHP-HEAP and Kevin Grumbach, MD,
UCSF. Copies of the Community Survey are attached.
Community Health Promotion and Prevention Award
The California Telehealth and Telemedicine Center have awarded Community Health
Promotion & Prevention and the Booker T. Washington Community Service Center in the
Western Addition $8,800. These California Endowment funds will be used to buy computers
and provide training to neighborhood residents so that they can better access and use the
Internet for interactive health communication. Congratulations to Brian Katcher and Ginger
Smyly, who wrote the grant.
Health Promotion and the Children, Youth and Families Sections have been awarded a
one-year community-planning grant to support RAISE (Raise African American Infant
Survival: Erase disparities). The purpose of the project is to develop a Community Action
Plan to decrease the disparity in infant mortality rates between African Americans and all
other racial-ethnic groups. The project is funded under the Centers for Disease Control
and Prevention, REACH 2010 Initiative to decrease health disparities among racial ethnic
groups in key health issues.
Isabel Auerbach (Perinatal Outreach/HP,) Tracy Moore (Black Infant Health Improvement
Project/HP,) Joanne Kimata (Policy and Planning), Mildred Crear (CFY) and Ginger Smyly
(HP) developed the grant and will be involved in its implementation. The planning will
involve community participants, providers, and advocacy groups, starting with review and
analysis of data and other assessments, review of best practices and development of the
plan and evaluation for the San Francisco project. A two-three year demonstration grant is
anticipated to follow Phase I, planning.
Youth United Through Health Education
The STD Program will receive a total of $31,950, over the next three years, for their
participation in a University-wide AIDS Research Program. This collaborative project with
the University of California, San Francisco will evaluate the Youth United Through Health
Education Project (YUTHE). The YUTHE Project is a community-based peer led HIV/STD
prevention program focused on increasing STD screening and treatment among African
American adolescents in the Bayview Hunters Point neighborhood. The proposed research will
include recruiting adolescents to complete a total of 600 street based surveys and 600
anonymous questionnaires in selected clinic-based settings in Bayview and in the control
community of the Western Addition. The proposed evaluation research will use
multiple data collection methods to assess changes in STD rates, and STD screening
behavior in the intervention community compared with the control community.
September 17th the San Francisco Collaborative Organized to Prevent Abuse
sponsored a conference titled, "Behavioral Health and Domestic Violence: Creating
Treatment Plans that Work." Over 200 individuals from the Department participated in
the conference held at the State Building. The conference began looking at developing
protocols and procedures to formally address domestic violence issues for our clients.
Instrumental in the planning process of the conference were PHP personnel from various
branches: Karen Ashcraft from Target Cities, Sylvia de Trinidad and Nora Goodfriend-Koven
from the Health Promotion Section, Jean Miranda from the EAP, Rudy Aguilar from Community
Substance Abuse Services, Mark Walden from Community Mental Health Services/Children's
section, and Deputy Director Maria X Martinez.
1999 SF Kindergarten Retrospective Study
The Communicable Disease Prevention Unit has completed the 1999 Kindergarten
Retrospective Study that looks at the rates of immunization of kindergartners at the time
they were two years old. The overall immunization rate for San Francisco is 70%, with
rates among African-American children and Latino children at 57% and 63% respectively.
Statewide the overall rate is 64% with African-American children at 55% and Latino
children at 60%. All of San Francisco's numbers reflect an improvement from the last
Kindergarten Retrospective Study done in SF in 1996; the overall rate was 60% and
African-American and Latino children were at 54% and 55%, respectively.
While we are doing better than the state average and reporting in significantly better
than we were three years ago, the rates among African-American and Latino children show
there is still much work to be done in reaching out to these communities. The Department,
working with the San Francisco Immunization Coalition, has determined that low-cost
immunization services are widely available throughout the City. We will continue our work
and outreach with the Coalition to target the populations at greatest risk of falling
behind their immunizations.
|SFGH Credentials Report
|Changes in Privileges
| Voluntary Relinquishment
Commissioner Chow requested immunization data within the Department and requested the
Department to report the data to the full Commission.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR
On behalf of the Commission, President presented the October Employee Awards to:
||Directors Office Staff
Contact: Monique Zmuda
||CHN/SFGH-Medical Surgical Nursing
||Gene OConnell 206-3517
A surprise award was given to Anne Kronenberg, Executive Assistant to the Director of
Health, nominated by Dr. Mitch Katz.
6) PRESENTATION OF SCHOOL-BASED HEALTH SERVICES
Jimmy Loyce, Deputy Director of Health, presented this update:
During the FY 1999-2000 budget process, the Board of Supervisors placed $550,000 on
reserve (one- time only) in the Department of Children, Youth and their Families (DCYF)
budget for School-Based Health Services. The Board asked DCYF to convene a School Health
Task Force with representatives from the Department of Public Health, the San Francisco
Unified School District and numerous public and private agencies including private health
plans, youth advocates, and health service providers.
The Task Force was charged with developing an implementation plan for the delivery of
school-based health services with fiscal sustainability beyond FY 1999/2000 because the
reserved funds were one-time only.
DPH, as an active participant on the Task Force, is presenting the report to the Health
Commission before it is presented to the Board of Supervisors of DCYF. The presentation to
the Board will detail school-based health service plans and ask for a release of funds
Commissioner Guy would like to see active coordination and management of this plan,
including the costs for the plan. She still senses too much fragmentation for
Commissioner Sanchez would like to see a model where the school is a point of
reference, with community resources being brought in with teachers and health providers.
Private foundations could be outside resources.
Anne Okubo, DPH Task Force member, stated that the Task Force is recommending a model
that links community resources and existing school sites, with the intent to avoid
Commissioner Chow expressed his concern on the lack of a coordinated approach. He sees
a lot of data but no road map for the future.
- Ali Weinhouse, Lincoln High School, supports health services on site
- Kate Favetti, Parent Teacher Student Association, supports work of Task Force
- Taj James, Coleman Advocates, supports the collaborative efforts
- Gilbert F. Criswell Cable Channel 53 Public Access, encouraged fiscally sound and
Commissioner Parker encouraged built-in incentives for all involved parties.
Commissioner Guy requested cost information if the Department is in charge and from
where monies would come.
Dr. Katz stated the Department will give the Commissions feedback to the Task
Force and will bring back to the Commission a futher developed proposal. The Department
will bring any policy change to the Commission for consideration.
7) PRESENTATION OF THE ANNUAL DEPARTMENT OF PUBLIC HEALTH REPORT
Joanne Kimata, Planner with Policy and Planning, presented the 1998-99 Annual DPH
Report. Ms. Kimata stated the report will be widely disseminated to officials,
contractors, community-based groups, and administrators. The report is available on the
The following individuals were acknowledged for their contributions to the contents of
the report: Jessica Wolin, Randy Reiter, Diane Miller, Louise Nathe, Ken Cobry and his
journalism students at SFSU, and Tangerine Brigham.
The Annual Report includes:
TABLE OF CONTENTS
- Message from the Director
- Health Commission
- Organizational Chart
- Hearing From You
- Assess and Research the Communitys Health
- Develop and Enforce Health Policy
- Provide Quality Health Services
- Partner with the Community
- The Departments Advisory Groups
- The Departments Contractors
- Demographics of Our City
- Health Status of San Franciscans
- The Departments Clients and Services
- 1998-99 Financial Information
- The Departments Workforce
President Monfredini and Commissioners Guy and Sanchez commended the staff for an
excellent, well laid-out report.
8) PRESENTATION OF HARM REDUCTION: A NEW APPROACH TO SUBSTANCE ABUSE SERVICES
Dr. Alice Gleghorn and Dr. Josh Bamberger gave an overview of harm reduction, and its
implementation in the Departments activities.
Dr. Gleghorn stated the philosophy of harm reduction is that the Department of Public
Health programs and staff work with clients to improve their health status within the
context and limits of their behaviors. The Department recognizes that individuals may
engage in behaviors that can recognize their health and well-being. Staff take an approach
that helps clients understand the risks associated with their behaviors, and encourages
them to make choices which will reduce the total physical, social, economic, and emotional
harm to themselves, their family, and their community.
The issues around harm reduction are:
- Harm reduction interventions do not include condoning illegal activities, but do not
make moral judgements about individual actions.
- Harm reduction strategies stress self-determination and individual responsibility for
- Program eligibility criteria can make harm reduction practices difficult to implement
The principles for integrating harm reduction into health services and traditional
substance abuse treatment services are:
- Providers of services for those who misuse or abuse alcohol or other drugs shall deliver
care in a culturally competent, nonjudgmental manner which demonstrates respect for
individual dignity, personal strength, and self-determination.
- Service providers are responsible to the wider community for delivering interventions
which will reduce the economic, social and physical consequences of substance abuse and
- Because those engaged in active substance use are often difficult to reach through
traditional service venues, in order to reduce risk and service continuum must seek
creative opportunities and develop new strategies to engage, motivate and intervene with
- The goal of services for those who misuse and abuse substances is to decrease the short
and long term adverse consequences, even for those who continue to use drugs.
- Comprehensive services for those who misuse or abuse drugs and/or alcohol must include
strategies that reduce harm for those clients who are unable or unwilling to stop using
and for their loved ones.
- Relapse or periods of return to substance use should not be equated with or
conceptualized as "failures of treatment."
- Medical services are an important component of comprehensive services; those who misuse
or abuse drugs and/or alcohol should not be denied medical services, and patients
prescribed medications for the treatment of medical and psychiatric conditions, including
addiction, must have full access to substance abuse treatment services.
- Each program within a system of comprehensive services will be stronger by working
collaboratively with other programs in the system.
Dr. Katz pointed out criticisms on harm reduction: enabling, promoting the legalization
of drugs, and the numbers may not decrease. He specifically gave the harm reduction
example of the methadone programs.
- acknowledge there are more questions than answers to the problem
- one size does not fit all
- recognition that theres no 100% cure
- need for specificity in any proposed resolution on where to utilize harm reduction
- principles and research data need to be included in the proposed resolution
- financial implications need to be addressed
- success in needle exchange with strong documentation
The Department will come back to the Commission with a proposed resolution.
Commissioner Parker expressed how hes impressed with Barbara Garcias
leadership over the Population Health and Prevention division.
9) OTHER BUSINESS/PUBLIC COMMENTS*
- Gilbert F. Criswell, Cable 53 Public Access, again encouraged the Commission to televise
its meetings; requested signage for the November 16th Prop Q hearing on Mt.
Zion Hospital; and encouraged the Commission to improve health services for children.
Commissioner Sanchez emphasized the Departments local and national leadership in
public health (i.e. school based health programs, asthma programs in the African
The meeting was adjourned at 5:30 P.M.
Sandy Ouye Mori, Executive Secretary to The Health Commission