Minutes of the Health Commission Meeting
Tuesday, November 2, 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 3:15 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 John I. Umekubo, M.D.
Absent: Commissioner David J. Sanchez, Jr., Ph.D.
- President Monfredini encouraged everyone to vote today.
2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF OCTOBER 19, 1999
Action Taken: The Commission unanimously adopted the minutes of October 19,
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Ron Hill)
(3.1) CHS HIV Health Services Update on the Filipino Task Force on
AIDS for the provision of HIV prevention services.
Dr. Larry Meredith reported on the excellent progress by the contractor in addressing
the issues in the monitoring report.
(3.2) CHS Update on the Bayview Hunters Point Foundation for Community
Improvement, Inc., for the provision of HIV services and an organization development plan.
Barbara Garcia, Director of Population Health and Prevention, gave an update on the
agencys Organizational Development Plan, which is being coordinated with the agency,
the Department, and the Support Center for Nonprofit Management.
Michelle Dixon, AIDS Office, gave an update on the HIV contract, expressing her
concerns on the contractors lack of documentation. The next step is to give a 30-day
period to come into compliance on the required documentation.
President Monfredini commented that the contractor is in serious trouble; and,
unfortunately, this is not the first time this contract has had difficulties. She
expressed her support for Barbara Garcia and Michelle Dixons recommendations to the
Karen Patterson Matthew, Executive Director of Bayview Hunters Point Foundation Board
of Directors, reported the progress made to address the monitoring report. She stated that
it is unfortunate that what has been identified as a problem with the specific HIV
contract is being extended to the total organization. She stated the overall work of the
organization is exemplary; and that she is working towards restructuring of services in
Dr. Wayzel Fuller, President of the Bayview Hunters Point Foundation, acknowledged the
Boards fiscal and legal responsibility over the agency.
Commissioner Hill indicated the Commission is not critical of the organization as a
whole and expressed his gratitude for the work of the organization.
Commissioner Umekubo requested a monitoring report in 30 days.
Commissioner Hill requested the Bayview Hunters Point Foundation Board of Directors
provide a resolution to the Commission in 30 days, indicating full disclosure and
knowledge of the proposed Organizational Development Plan, and concerns on the HIV
There was a discussion on Board structure and size. The Commission does not dictate the
size of a Board of Directors but suggests the size of the Board be commensurate with the
size of the agencys total budget.
(3.3) CHS HIV Health Services Request for approval of contract
modification with the Support Center for Non-Profit Management for one-time funds, in the
amount of $269,279, for a total contract amount of $519,279, to provide HIV CARE Planning
Council support and further development of the Reggie system to benefit HIV positive San
Francisco residents for the period of March 1, 1999 through February 29, 2000.
contracted with the Support Center for services totaling $1,106,985 during FY 1998-99.)
(3.4) CHS - Housing Request for approval of a new retroactive sole source
contract with Lutheran Social Services of Northern California to provide benefits
counseling to homeless persons and evaluation services for a demonstration project, in the
amount of $67,000, for the period of October 1, 1999 through June 30, 2000.
contracted with Lutheran Social Services for services totaling $1,127,952 during FY
(3.5) EMS Agency Request for approval to accept and expend retroactively
a continuation grant from Department of Health and Human Services in the amount of
$200,000, of which $30,000 will be used for new subcontracts with AMR/HUSK and TRW, for
the continued development of the Metropolitan Medical Response System for the period of
April 1, 1999 through April 30, 2000. (DPH did not contract with AMR/HUSK or TRW during FY
Action Taken: The Commission unanimously approved the Consent Calendar of the
Budget Committee, with specific requests for #3.2.
4) DIRECTORS REPORT (Mitchell H. Katz, M.D., Director of Health)
(Provides information on activities and operations of the Department).
Halloween Millennium Dry Run
The City used Halloween as an opportunity to test plans for the upcoming millennium
celebration. The Citys Emergency Command Center was activated using the Incident
Command System to coordinate and respond to Halloween celebrations. The Police Department
acted as the Incident Commanders, setting up a command post at the Eureka Valley
Recreation Center for the Castro Street celebration. The crowd was reported to be over
250,000 people. Health Department staff were at the ECC and the Police command post, and
the SFGH command post communicating with each other by 800mhz radios.
The Health Department staffed the Castro Mission Health Center as a Field Care
Clinic (FCC). The FCC officially opened at 6:00 p.m. remaining open until 3 a.m. Bilingual
staff were available on site. The FCC saw 16 patients: of these, 3 were mental health
patients, 5 were intoxicated, and 2 were transported to SFGH severely intoxicated.
Four teams of foot patrols (consisting of a Rock Medicine volunteer, an EMT, a
substance abuse and mental health worker) patrolled the crowds and responded to 9-1-1
calls forwarded by the command post. The foot teams were a huge success. Over 50 patient
contacts were recorded, although we believe that there were at least 15 additional
contacts. The heavy traffic on the radio made it difficult to call everything in. The foot
teams used stair chairs to transport the injured patients through the crowds. The two most
serious reported on-site injuries were a broken ankle, and a severed fingertip.
DPH learned a lot of valuable lessons for the millennium celebrations about staging,
team composition, supplies, difficulties in locating patients (and each other). Several
times when the foot teams were co-dispatched with EMS, the foot teams were actually first
on scene. For example, a foot team was first on scene to a report of an awning collapse.
When they arrived to find that the persons who had fallen had left, they were able to
cancel the SFFD response. The Emergency Room at SFGH reported its quietest Halloween in 7
years, we believe this can be directly attributed to our efforts at triage in the field.
Many thanks to all those who participated in this real life training drill. It is
fortunate that Halloween provided an exciting opportunity to test and refine the field
care model we have developed for the millennium weekend.
Congress and the President are still unable to come to agreement on the FY 2000 budget.
On October 29, the President signed the third continuing resolution, extending the FY 1999
budget through November 5, 1999. Just one day earlier, on October 28, the House passed the
final spending bill of the year, the Labor, Health and Human Services (Labor/HHS) budget
bill. However, the President has indicated that he will veto this bill.
There are a number of issues that still remain a barrier to finalization of the budget.
Among these are the environment, education, foreign policy issues, and spending limits
imposed by the Balanced Budget Act. Department staff will continue to monitor the federal
budget and work with the Citys federal lobbyist to ensure the maximum level of
funding for health care programs.
On October 27, Ron Prince, the chairman of the Proposition 187 movement, announced that
he will likely pursue a similar initiative for the November 2000 ballot. Proposition 187
would have barred the State from providing public services, such as education and
non-emergency health care services, to undocumented residents. Additionally, it would have
required various state and local agencies to report persons who are suspected of being
undocumented to the California Attorney General and the United States Immigration and
Naturalization Service. As you know, the City opposed Proposition 187.
The proposed 2000 ballot measure would prevent the Legislature from passing any laws
permitting the provision of State or local benefits to undocumented residents. A second
proposed ballot initiative would require the Governor to defend initiatives to the U.S.
Supreme Court, if necessary, and allow proponents to be co-defendants. As both ballot
initiatives would seek to amend the States constitution, they would need to be
passed by two-thirds of the voters.
Additionally, Prince is considering a third ballot initiative that would require public
schools to count the number of undocumented residents enrolled. He has not yet, however,
decided whether to pursue such an initiative.
The Department will monitor these proposed initiatives closely. Should this issue gain
momentum, the Department will develop a comprehensive strategy to educate the community,
staff and other City Departments on the position adopted by the Board of Supervisors to
provide health care services regardless of immigration status.
On October 28, the Secretary of State announced that an initiative to repeal
Proposition 10 had qualified for the March 7, 2000 ballot. As the Health Commission is
aware, Proposition 10 placed a 50 cents per pack tax on cigarettes and a similar tax on
other tobacco products. The money generated by this tax increase funds early childhood
development programs and programs that prevent or reduce tobacco, alcohol and other drug
use during pregnancy.
The official title and summary of the initiative is as follows:
Repeal of Additional Tobacco Surtax Enacted by Proposition 10. Initiative Statute
Repeals additional $.50 per pack tax on cigarettes and equivalent increase in state tax
on tobacco products previously enacted by Proposition 10 at November 3, 1998, election.
Provides for elimination of funding for Proposition 10 early childhood development and
smoking prevention programs. Prohibits imposition of additional surtaxes on the
distribution of cigarettes or tobacco products unless enacted by the state legislature.
Provides that all additional tobacco taxes previously collected under Proposition 10 shall
be appropriated and expended at which time the California Children and Families First
Trust Fund shall terminate.
The City, in particular the Department of Children, Youth & Their Families and
Department of Public Health staff, will monitor this issue closely and keep the Health
Commission apprised of its progress.
Departmental Strategic Planning Initiative
Last month the Departments Strategic Planning Steering Committee and its
sub-committees met twice to receive an orientation on the strategic planning initiative.
The first meeting provided all committee and subcommittee members with an opportunity to
review the key strategic issues facing the Department, discuss the planning process and
review the goals and objectives of this effort. The second meeting provided all committee
members with necessary background information on health trends, health status, health
mandates and the Departments revenues and expenditures. In addition, committee
members received a summary report of community advisory council recommendations.
The Finance sub-committee will present its proposed strategic approaches to fiscal year
2000-01 financing issues to the Strategic Planning Steering Committee on November 16,
1999. The Department is scheduled to present a proposed resolution to the Health
Commission at its December 7, 1999 meeting regarding these financing issues. The
Populations and Programs and the Communications sub-committees will hold their first
meetings within the next two weeks. The Departments strategic planning web site is
operational and information may be accessed by logging on to
COMMUNITY HEALTH NETWORK
Laguna Honda Resurvey Inspection Commences
On October 26th, a team of six State Licensing & Certification surveyors
arrived unannounced at Laguna Honda to commence a monitoring survey to check compliance of
the implementation of the Hospitals approved Plan of Correction. The Survey Team
reported that they anticipated being at the Hospital through this week. I will report on
the outcome of the resurvey as soon as the results are available.
LHH Annual Employee Recognition Dinner
On the evening of October 28th, Laguna Honda Hospital celebrated its annual
Employee Recognition Dinner honoring employees reaching 5-year milestones in tenure. Over
50 employees received honorable recognition, topped by Walter Ahrens who is celebrating
his 35th anniversary at Laguna Honda. Over 280 people attended the awards
presentation, banquet dinner, costume party and dance.
State Senator Speier, Mayor Brown and City Attorney Renne were recognized by DPH for
their efforts to rebuild Laguna Honda. The evening was a spectacular event that added to
the fervor of saving Laguna Honda for future generations while honoring the committed
staff who serve the residents of the Hospital.
Health at Home
November is National Home Care Month and DPH will celebrate by honoring the dedicated
staff and volunteers of Health at Home, the home health agency of the Community Health
Network. Health at Home's staff of RN's, social workers, occupational and physical
therapists, home health aides and volunteers make over 17,000 home visits annually to more
than 800 patients. I hope the Commission might join us and attend the Open House November
17th from 3-6pm, 45 Onondaga (corner of Alemany Blvd.)
POPULATION HEALTH AND PREVENTION
Women's Health Services
"Time for Healing, Time for Change," the second Bayview Hunters Point Town
Hall meeting on Breast Cancer, was attended by approximately 200 people October 27. The
Bayview Hunters Point Breast Cancer Quilt was on display and Our Lady of Lourdes Miracles
choir sang. The audience heard presentations from a breast cancer survivor, from the
spouse of a breast cancer survivor, an acupuncturist, and SFGH Oncologist Judith Luce.
This event was a collaborative effort between DPH staff, community based organizations
and community residents who came together following the first Bayview Hunters Point town
hall meeting. Special recognition goes to Barbara Cicerelli, Woman's Care Navigator with
Breast and Cervical Cancer Services for her outstanding leadership in organizing and
staffing this event.
The Health Promotion Section of the Community Health Promotion and Prevention was
awarded $48,000 from the Department of Health Policy and Management, Harvard School of
Public Health, to continue and expand our efforts in piloting the Multi-Agency Active
Firearm Surveillance Program. Over the last three years through several State grants and
through City general funds the Section has been collecting, analyzing, and reporting
firearm injury-related data.
Initial analysis of data demonstrated that a multi-agency approach is required for a
full appreciation of the nature and scope of firearm-related injuries. Over the past year
vital links have been established with the San Francisco Police Department, Medical
Examiner's Office, San Francisco General Emergency Department and Trauma Unit, Emergency
Medical Services, and University of California San Francisco Injury Center.
Developing a single comprehensive clearinghouse of all information pertaining to
firearm incidents will clarify the impact of firearm-related injuries occurring in San
Francisco. One of the primary goals of the funders at Harvard is to create a national
firearm injury surveillance system and San Francisco's success in developing a data
collection and analysis program has positioned us for the award of these funds. The San
Francisco project will serve as one of six national prototypes that are currently being
developed in Maine, Maryland, Utah, Atlanta, and Allegheny, PA.
5) UPDATE ON 1998-99 YEAR-END DEPARTMENT OF PUBLIC HEALTH FINANCIAL REPORT
Monique Zmuda, Chief Financial Officer, reported the following:
Based on preliminary fiscal year-end closing statements, the Department of Public
Health is projecting a surplus of $6.4 million for FY 1998-99. This is $5.6 million more
than the 0.8 million previously reported to the Health Commission in September, based on 4th
quarter projections. This increase in the fiscal year surplus is primarily as a result of:
- Additional prior year beginning balances at San Francisco General Hospital that were
higher than reported on the Citys accounting system;
- Additional closeouts of unspent capital project funding from prior years; and,
- Closeout of encumbrances for expenses which were not made during the fiscal year,
yielding an additional savings beyond that originally estimated.
|San Francisco General Hospital $
|Laguna Honda Hospital
|Population Health and Prevention
Ms. Zmuda reported the annual audits of the Department are being done. Results of the
audits are expected to be completed by November and will finalize the surplus for
the FY 1998-99.
6) FIRST QUARTER REPORT FY 1999-00 REVENUE AND EXPENDITURE REPORT
Monique Zmuda, Chief Finance Officer, reported the following:
The Department of Public Health is projecting a year-end deficit of $3.9 million for FY
1999-00 based on expenditures and revenues for the first quarter ending September 30,
1999. This amount represents less than half of 1% of the Departments total operating
budget of $923 million. Projections include revenue shortfalls of $2.5 million and over
expenditures of $1.4 million.
The following table shows projected fiscal year revenues and expenditures by division.
Projected FY 1999-00 Year-End Surplus/Deficit
Ms. Zmuda reported that the budget will be closely monitored. At Commissioner
Chows request, updates will go to the Joint Conference Committee of the Community
Health Network, looking at primary care, productivity, and revenues and expenditures. She
stated that the deficit for the first quarter is manageable.
In answer to Commissioner Hills question whether a supplemental will be needed,
Ms. Zmuda replied no.
Commissioner Chow raised the issue of the census at San Francisco General Hospital and
the impact of the Mount Zion closure on emergency services.
Commissioner Umekubo requested clarification on increased Medi-Cal revenues.
Commissioner Guy observed that underestimates on Medi-Cal revenues need to be watched.
The trend of more unsponsored patients is not decreasing.
7) PRESENTATION OF A LEGISLATIVE REPORT
Tangerine Brigham, Director of Policy and Planning, gave an overview of the 1999
California Legislative Session:
- Summary of Selected Enacted Legislation (1999)
- Summary of Selected Failed Legislation (1999)
- Summary of Selected Pending Legislation (2000)
- Disposition of 1999 Legislative Priorities
- Legislative Priorities for 2000
For a copy of the full report, contact the Commission Office (554-2666). Ms. Brigham
reported that the Planning staff will work with the State Department of Health Service and
the Governors Office to help formulate a health agenda.
- Commission should take a more active role in determining legislative priorities
- Commission is to advocate for health issues
- Commission needs to be informed and strategic
- Health advocacy partnerships between the public and private sectors should be encouraged
- Need to work with the newly-formed State Department of Managed Care
- Legislative report was thorough and extraordinary
Public Speakers: Nathan Nayman, Hospital Council, advocated the framing of
health care bills (i.e., access to health, cost of health care, health work force).
8) OTHER BUSINESS/PUBLIC COMMENTS
9) CLOSED EXECUTIVE SESSION:
A. PUBLIC COMMENT ON ALL MATTERS PERTAINING TO THE CLOSED SESSION.
Action Taken: The Commission unanimously voted to hold a closed session.
The Commission went into closed session at 4:30 p.m.
B. VOTE ON WHETHER TO HOLD A CLOSED SESSION TO CONFER WITH LEGAL COUNSEL. (SAN
FRANCISCO ADMINISTRATIVE CODE SECTION 67.11(a).)
C. CLOSED SESSION PURSUANT TO GOVERNMENT CODE SECTION 54956.9 AND SAN FRANCISCO
ADMINISTRATIVE CODE SECTION 67.11(b).
CONFERENCE WITH LEGAL COUNSEL - EXISTING LITIGATION.
1. DARCEL GRACE V. CCSF, IN THE AMOUNT OF $131,050, U.S. DISTRICT COURT NO. C98-3090
2. SHARON NORRIS V. CCSF ET AL, IN THE AMOUNT OF $50,000
The Commission came out of closed session at 5:15 p.m.
D. RECONVENE IN OPEN SESSION:
1. POSSIBLE REPORT ON ACTION TAKEN IN CLOSED SESSION. (GOVERNMENT CODE SECTION
54957.1(a)(2) AND SAN FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(b)(2).)
Action Taken: The Commission approved the settlement for Darcel Grace v. CCSF in
the amount of $131,050, and the settlement for Sharon Norris v. CCSF in the amount of
2. VOTE TO ELECT WHETHER TO DISCLOSE ANY OR ALL DISCUSSIONS HELD IN CLOSED SESSION (SAN
FRANCISCO ADMINISTRATIVE CODE SECTION 67.14(a).)
Action Taken: The Commission voted not to disclose any discussions held in
The meeting was adjourned at 5:20 P.M.
Sandy Ouye Mori, Executive Secretary to the Health Commission