Minutes of the Health Commission Meeting

Tuesday, March 7, 2000
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 Roma Guy, MSW, at 3:15 p.m.

In memory of Henry (Hank) Tavera, the Health Commission had a moment of silence. Mr. Tavera died on February 27, 2000 at the age of 56. He was a Chicano gay activist, cultural worker, archivist, and AIDS intervention specialist at S.F. City Clinic. Born in East Los Angeles, he lived in San Francisco for 21 years. He was cofounder of National LLEGO and LLEGO California, empowering Latino GLBT. He co-authored the Multicultural Plan for Dignity/San Francisco; he was a voting delegate to LIFE; director of several Latino plays; and artistic director of the AIDS Theater Festival. Hank was beloved by his friends, colleagues, and those whose lives he touched.


  • 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.


Action Taken: The Commission unanimously adopted the minutes of the special meeting of February 8, 2000.

Action Taken: The Commission unanimously adopted the minutes of February 15, 2000, with an amendment to the Health Commission Resolution #1-2000, "Approving the Department of Public Health’s Proposed Budget for FY 2000-01, Approving the Reallocation of Funds to Develop New Programs to Reduce the Need for Acute and Emergency Care, and Approving Cost Reductions Necessary to Absorb Cost Increases," by adding: "WHEREAS, decreases in acute care beds and services will occur as community based and skilled nursing alternatives are achieved.", (Attachment A).

(Commissioner Ron Hill)

(3.1) DPH Administration – Request for approval of a supplemental appropriation to fund Laguna Honda Hospital plans for the hospital rebuild. (Funded through the Tobacco Settlement Fund.)

This item was postponed to a future meeting.

(3.2) CHSS-BEHM – Request for consideration and approval of proposed fee schedule amendment for the special events and temporary food facilities program, adjusting fees for inspections and permits for special events food handling, effective July 1, 2000.

See Resolution #2-2000, "Increasing Fees to Cover the Cost of the Food Safety Program," (Attachment B.)

(3.3) PHP-CSAS – Request for retroactive approval to accept and expend $246,500 in funds from UCSF Institute of Health Policy Studies, for evaluation of treatment on demand policies, for the period of September 28, 1999 through September 27, 2000.

Commissioner Sanchez abstained on this item due to conflict of interest.

(3.4) CHS-Children Youth & Families – Request for approval of a modification to the three-year contract with Polaris Research and Development, Inc. to add $140,000 for the period of January 1, 2000 through December 31, 2000, for the provision of home visitor services, bringing the third year contract amount to $176,800. The total amount of this three-year contract is $372,516 for the period of January 1, 1998 through December 31, 2000. (DPH contracted with Polaris for services totaling $730,150 during FY 1998-99).

(3.5) CHPP-HIV Prevention Services – Request for approval of a two-year contract renewal with Instituto Familiar de la Raza in the amount of $138,146 per year, to provide HIV prevention services targeting Latino men who have sex with men (MSM) and men who have sex with men and women (MSM/F) for the period of January 1, 2000 through December 31, 2001. (DPH contracted with Instituto for services totaling $4,526,738 during FY 1998-99).

(3.6) CHPP-HIV Prevention Services – Request for approval of a two-year contract renewal with CAL-PEP in the amount of $268,533 per year to provide HIV prevention program services targeting behavioral risk populations, evaluation services and venue-based individual outreach, for the period of January 1, 2000 through December 31, 2001. (DPH contracted with CAL-PEP for services totaling $268,533 during FY 1998-99).

The Department is confident that the contractor will meet its March 15, 2000 deadline.

Commissioner Hill requested an update at the May 2, 2000 Budget Committee meeting.

(3.7) CHPP-HIV Prevention Services – Request for approval of a contract renewal with Black Coalition on AIDS (BCOA) in the amount of $86,379 to provide HIV prevention services targeting the African American Transgender population, for the period of January 1, 2000 through December 31, 2000. (DPH contracted with BCOA for services totaling $822,098 during FY 1998-99).

The Commission requested an update on outstanding documents at the May 2, 2000 Budget Committee meeting.

(3.8) CHPP-HIV Prevention Services – Request for approval of a two-year contract renewal with Tenderloin AIDS Resource Center (TARC) in the amount of $163,047 per year to provide HIV prevention services targeting behavioral risk populations (MSM, MSM-IDU, FSM, FSM-IDU) for the period of January 1, 2000 through December 31, 2001. (DPH contracted with TARC for services totaling $557,430 during FY 1998-99).

Due to a clerical error, there were other appropriate materials missing for this item.

(3.9) CHPP-HIV Prevention Services – Request for approval of a multi-year contract renewal with Mission Neighborhood Health Center (MNHC) in the amount of $260,442 to provide HIV prevention services targeting behavioral risk populations (MSM and who are HIV+) for the period of July 1, 1999 through December 31, 2001. (DPH contracted with MNHC for $890,609 during FY 1998-99).

Due to a clerical error, there were other appropriate materials missing for this item.

The Department reported responses to the monitoring report were submitted.

(3.10) CHPP-HIV Prevention Services – Request for approval of a two-year contract renewal with Regents UCSF/Urban Health Study (UCSF/UHS) in the amount of $564,263 per year to provide HIV prevention services targeting behavioral risk populations (MSM-IDU, MSM/F-IDU,

FSM-IDU, MSF-IDU, FSM/F-IDU and FSF-IDU) for the period of January 1, 2000 through December 31, 2001. (DPH contracted with UCSF/UHS for services totaling $564,263 during FY 1998-99).

Due to clerical error, there were other appropriate materials missing for this item.

Commissioners requested an update to this contract at the May 2, 2000 Budget Committee.

Commissioner Sanchez abstained on this item due to conflict of interest.

(3.11) CHS-HIV Health Services – Request for approval of a sole source new contract with Continuum HIV Day Services in the amount of $828,360 to provide transitional case management services targeting HIV+ inmates being released from the San Francisco County Jail system, for the period of March 15, 2000 through June 30, 2001. (DPH contracted with Continuum for services totaling $669,648 during FY 1998-99).

(3.12) PHP-HIV Health Services - Request for approval of the FY 2000-2001 Ryan White Comprehensive AIDS Resources Emergency Act (CARE) of 1990 Title I, Title II and General Fund contracts for a combined total of $38,018,791 for the period of March 1, 2000 through February 28, 2001 for Title I funds, April 1, 2000 through March 31, 2001 for Title II funds and July 1, 2000 through June 30, 2001 for General Fund programs with the following agencies:

AIDS Emergency Fund $ 662,392
AIDS Legal Referral Panel $ 200,952
American College of Traditional Chinese Medicine $ 276,827
Asian Pacific Islander Wellness Center $ 540,961
Baker Places $ 177,000
Bar Association of San Francisco $ 77,868
Catholic Charities $ 159,815
Chemical Awareness & Treatment Services, Inc. $ 594,042
Community Dental Care, Inc. $ 651,429
Compass Point Nonprofit Services (formerly The Support Center) $ 200,833
Continuum HIV Day Services $ 993,516
Dolores Street Community Services $ 184,273
Family Support Services of the Bay Area $ 300,231
Haight Ashbury Free Medical Clinics, Inc. $1,005,557
Immune Enhancement Project $ 223,668
Instituto Familiar de la Raza $ 255,310
Iris Center $ 150,000
Legal Services for Children $ 190,915
Lutheran Social Services $ 559,479
Lyon Martin Women’s Health Services $ 381,727
Maitri AIDS Hospice $ 981,880
Marin County $1,501,296
Mission Neighborhood Health Center $ 113,563
New Leaf (mental health services) $ 147,212
Positive Resource Center $ 498,455
Project Open Hand $1,348,637
Quan Yin Healing Arts Center $ 127,327
Saint Mary’s Medical Center. $1,234,862
San Francisco Community Clinic Consortium $ 341,042
SFDPH Community Health Network -Forensics Services $ 356,524
SFDPH Community Health Network -Health at Home $ 590,244
SFDPH Community Health Network - Primary Care $2,709,422
SFDPH Community Health Network -SFGH $2,229,052
SFDPH Community Health Network-SFGH-Positive Health Pract. $ 144,784
SFDPH Community Health Network-Tom Waddell $ 175,353
SFDPH PHP Mental Health Services $ 288,234
SFDPH PHP Public Health Laboratory $ 58,560
SFDPH PHP STD Services $ 176,929
SFDPH PHP Substance Abuse Services $ 250,000
SFDPH PHP Housing Services $ 8,704,836
Ark of Refuge, Inc - $ 282,480
Baker Places - $1,577,064
Black Coalition on AIDS – $ 373,912
Catholic Charities - $1,393,216
Larkin Street Youth Center - $ 643,357
Lutheran Social Services - $ 145,488
San Francisco AIDS Foundation - $4,213,562
Walden House - $ 75,757
San Francisco Suicide Prevention $ 107,784
San Mateo County $ 2,300,965
Shanti Project $ 892,897
Tenderloin AIDS Resource Center $ 349,962
UCSF/AIDS Health Project $ 977,701
UCSF/Center on Deafness $ 40,236
UCSF/Pediatric AIDS Program $ 170,945
UCSF/Substance Abuse Services $ 662,134
UCSF/ Women’s Specialty Clinic $ 222,000
University of the Pacific-School of Dentistry $ 543,600
Urban Indian Health $ 72,780
Walden House $ 1,699,928
Westside Community Mental Health Services $ 212,850

Michelle Dixon, AIDS Office, reported that she will bring four remaining contracts to a future meeting.

Commissioner Sanchez abstained on the five UCSF contracts; and Commissioner Umekubo abstained on the St. Mary’s Medical Center contract due to conflicts of interest.

As requested earlier, Commissioner Chow requested a report on the evaluation of alternative treatments for HIV.

Commissioner Parker requested clarification on units of service for each contractor.

Action Taken: The Commission approved items #3.2 through #3.12, with the specific follow-up requests.

(Mitchell H. Katz, M.D., Director of Health)
(Report on activities and operations of the Department, and may include activities within the Community Health Network and Population Health and Prevention Divisions)


Conference on Medical Marijuana

The University of California School of Medicine will be presenting a full day conference June 10th on medical marijuana entitled, "Cannabis Therapy: Science, Medicine and the Law."

The program is intended to provide practicing physicians with useful and accurate information about the benefits and risks of cannabis therapy for specific types of patients and/or medical conditions. Speakers will discuss the elements of informed consent doctrine, appropriate documentation in the patient medical record of a physician's discussion/approval of cannabis therapy, and state and federal legal considerations. The program will address professional liability coverage, the relevant standard of care and the development of pharmaceutical-quality cannabis extracts and nonsmoking delivery devices.


HIV Prevention

It pleases me to announce that Steven Tierney, Ed.D., began his tenure as the new Director of HIV Prevention March 6th. Many of you already know Steven from his work on the HIV Prevention Planning Council, his Executive Directorship of Health Initiative for Youth (HIFY), and his leadership on national HIV/AIDS policy issues. Please join me in welcoming Steven to HIV Prevention and the Department of Public Health.

STD Prevention and Control

An agreement was reached this month with the San Francisco Unified School District to expand STD screening among the public high school students. DPH will begin screening students at all alternative and community day schools in the City. Screening will also be done at selected mainstream high schools that participated in the pilot screening project.

Homeless Outreach Prevention Effort (HOPE)

Along with the new initiatives that the Health Department is proposing for the next fiscal year and underscoring the change in the way we deliver services the former Death Prevention Team has recast itself to emphasize prevention. We will not continue to focus on body count. The former Mission Rock shelter health care team joined with the Homeless Death Prevention Project's Health Outreach team to form the new Homeless Outreach Prevention Effort (HOPE) team. The eight-person team includes social workers, health workers, physicians, a nurse, nurse practitioners, and an eligibility worker.

The HOPE team targets individuals with one or more medical or psychosocial problem who have difficulty accessing support on their own. The team provides health care on the streets and in SRO hotels with a special focus on the Mission and Jefferson hotel where many former Mission Rock residents now reside. The nature of these patients’ problems calls for time consuming and intensive work. The team's goal is to provide assistance, which enables each patient to access ongoing primary care as well as stable, and supportive living environments. Questions and referrals can be made to Damon Eaves, MSW, at 554-2731.

Women's Health Services

The Commission on the Status of Women held a hearing February 23rd on the status of women's health. Commissioner Roma Guy articulated DPH’s commitment to women's health. Kate Monico-Klein, Coordinator of Women's Health, provided background and introduced presentations by Mildred Crear, Director of the Bureau of Children, Youth and Family, Cynthia Selmar, Coordinator of the African American Health Initiative, and Jan Murphy, Director, Primary Care. Feedback from the COSW was very positive. Thanks to all who participated.

Lesbian Health Summit /Lesbian Health Forum

A summit on lesbian health sponsored by the Mayor's Office and Supervisor Leslie Katz will be held April 7th. The summit is in response to the Institute of Medicine’s recent report on lesbian health. If you are interested in participating, please contact Kate Monico-Klein, at 554-2608.

African American Health Initiative

The Bayview Hunter's Point Health and Environment Resource Center held a Conference February 19th for the African American Men’s Health Initiative-Prostate Cancer Project at Southeast Community College. Presenters included survivors and experts in the field. Three well known African American Physicians, Arthur H. Coleman, M.D. Family Practitioner; Edward Collins, M.D. Urologist; and Joycelyn Speight, M.D., Ph.D. Clinical Fellow Radiation Oncology spoke at the conference. The American Cancer Society, Health and Environment Resource Center and the African American Health Initiative provided resource tables.

Breastfeeding Accommodation Policy at Silver Avenue Health Center

Silver Avenue Family Health Center has signed a new policy titled "Breastfeeding Accommodation". The purpose of the policy is to provide guidelines to assist any breastfeeding staff person to continue breastfeeding upon their return to work. It provides a space, and allows time for the staff person to use a breast pump during work hours. This is in accordance with the American Academy of Pediatrics Policy Statement on breastfeeding, which encourages employers to provide facilities and time in the workplace for breast pumping.

If anyone wants assistance in writing a policy for his or her worksite, please contact Gail Davis, at 715-0370.

Tobacco Free Project

We have been advised by the White House that President Clinton is sending a letter of recognition to the youth advocates from Booker T. Washington Community Services Center and the African American Tobacco Free Project. The Commission may recall that members of these groups—which are funded by the Tobacco Free Project—were instrumental in bringing the subject of bidis before the Federal Trade Commission and the US Customs Service.

The efforts of these youth advocates led to a special segment on "60-Minutes" and resulted in the US Customs Service banning certain bidis because of evidence that they were being produced with bonded child labor. It is also worth noting that the outcome of the initiative these youths demonstrated is an example of the unexpected benefits of the Tobacco Free Project’s approach to prevention. To be able to support and witness the creative activities of local youth advocates that brings about a significant change in national public policy is a rewarding and confirming event for our prevention program and for the youths who will inherit this tradition. I will be joining this very fine group of youth advocates to present the President’s letter on March 15th. The Health Commission will be receiving an invitation to this event. I hope you will join us.


Laguna Honda Hospital's Waiver

The Health Care Financing Agency [HCFA] has approved Laguna Hospital’s request for a waiver to maintain the census by keeping the open wards and private/semi-private rooms at the current capacity. We had strongly argued the importance of maintaining the city's capacity of skilled nursing beds because of the overall loss of over 100 SNF beds in the last two years.

Robert Christmas Moves to LHH

I am very pleased to announce that Robert Christmas has joined the Laguna Honda team as the Associate Administrator for Operations effective March 1, 2000. Robert has served on the administrative team at San Francisco General Hospital for the past 18 years. During his tenure, he served as Director of Ambulatory Services for ten years, Acting CEO for one year, and for the past two years, Robert has been responsible for accreditation and licensure for the entire SFGH campus. Robert is nationally recognized for his expertise in educating and preparing staff for health care system surveys by various regulatory agencies.

As Associate Administrator at LHH, Robert will be responsible for the Pharmacy, Nutrition Services, General Services, Materials Management, Plant Services, Capital Projects, Institutional Policy, Telecommunications and the hospital’s Safety and Emergency preparedness programs. He will also play an integral leadership role in preparing for future DOJ visits and State and Federal surveys as well as participating in the planning of the new facility. Please join me in congratulating Robert on his new assignment and thanking him for his many years of contribution to SFGH.

Laguna Honda Nursing Division Personnel Changes

Anne Hughes, RN, MS, FAAN has joined the Laguna Honda Nursing Division as the Clinical Specialist for Palliative Care Services. In her new role she will be developing the quality, educational and clinical practice programs for this service area. Anne comes to LHH after many years of distinguished service and leadership at SFGH. We are delighted to have Anne choose LHH as the place to develop this new role and move her career in the direction of Long Term Care.

Nursing Awards

Two nursing leaders have received recognition for their expertise and contributions to Nursing. Mivic Hirose, RN, MSN has been selected as a finalist for this year's Nursing Excellence Award sponsored by NurseWeek publication. Ron Walent, MS, RNCS was selected by the Journal of Gerontological Nursing to serve as a member of the review panel for the national publication. Congratulations to both for their accomplishments.

Chancellor’s Award

Donna Howell, Finance and Business Manager for the School of Medicine Dean's Office at SFGH, is being honored as a recipient of the Chancellor's Award for Exceptional University Management. The three recipients will be honored at the annual UCSF Founder's Day luncheon on March 21. Donna's reputation for service and mentoring is legion at SFGH to CHN and UCSF employees.

Early Intervention Program at Southeast Health Center

The State of California, Department of Health Services, Office of AIDS (DHS/OA) awarded DPH a $350,000 augmentation to its Early Intervention Project (EIP) grant. The new grant will respond to the growing concern of residents of Bayview Hunter’s Point that HIV/AIDS is among the top three health problems facing the community. The new project will be located at Southeast Health Center, 2401 Keith Street. EIP is expected to start in April 2000.

The new HIV/AIDS services will include medical evaluation and treatment, psychosocial case management, and health education aimed at reducing high risk behaviors among infected individuals and community residents in the Southeast section of San Francisco. Southeast Health Center will work with other Bayview Hunter’s Point HIV/AIDS prevention providers to develop a system of coordinated HIV/AIDS services for the Southeast Community of San Francisco.

Expanded STD Screening at Potrero Hill Health Center

The Potrero Hill Health Center (PHHC) recently began a special one-year project of Chlamydia screening among asymptomatic male patients, ages 14 - 30 years. Jeffrey Klausner, M.D., STD Prevention and Control Director contracted with PHHC because of the extremely high Chlamydia incidence among its patient population. Among women, PHHC has the highest prevalence of Chlamydia in all of the City’s health centers, even higher than the City's STD Clinic. It is hoped that by screening asymptomatic male urine, Chlamydia will be identified earlier in males and their female sexual partners, thereby decreasing the serious complications of female pelvic inflammatory disease and infertility.

Commissioner Monfredini expressed her gratitude to all who sent supportive messages and cards to her and her husband Jim.


The Commission presented the February Department of Public Health Employee Recognition Award to:

Individual Nominee
Norm Nickens

Central Administration, EEO

Nominated by
Barbara Garcia


Dr. Rajiv Bhatia, Director of Environmental Health and OSH, presented the annual report on the status of environmental health in San Francisco. A copy of the report is available at the Commission Office.

Dr. Bhatia reported that State, Federal and local regulations and mandates are generally effective in protecting San Franciscans from traditional environmental threats, such as polluted air and contaminated food and water. Emerging environmental health issues include indoor air quality and its relationship to asthma morbidity and novel pathogens as contaminants in municipal water. Programs and polices need to shift and develop in recognition of changing concerns.

The Department of Public Health will continue to pursue research and develop initiatives to address social and environmental justice concerns.

Dr. Bhatia reported updates on key environmental indicators, such as air quality, childhood lead exposure, asthma, water and food borne diseases, water quality, solid waste generation, and rodent activity.

He also presented key program activities and accomplishments; and described the planning for future initiatives.

Commissioners raised issues around development of asthma data, the ongoing problem of rodent control and infestation, environmental health education in communities and with the School District, environmental clean-up on City properties, water safety, effects of radio frequency radiation, toxic waste on Bayview Hunters Point, lead exposure, causes of mold, and priorities of environmental health.

Dr. Katz and Commissioner Chow emphasized the importance of having a physician looking at a wide range of activities and with a special expertise in environmental health and occupational medicine. The Division’s direction is to look at the disease determinants and communities.


Alyonik Hrushow, Tobacco Free Project Director, presented an overview of the Tobacco Free Project, including the background on the Prop 99 funded component; outcomes at the State level and in San Francisco; staffing; contracts; the Tobacco Free Coalition; and evaluation. Information on the California Tobacco Control Program was also provided.

A copy of the full report is available in the Commission Office.

Public Speakers:

  • Carol McGruder, S.F. African American Tobacco Free Project, submitted her document "Tobacco’s Global Ghettos: Big Tobacco Targets the World’s Poor." She expressed her support for the Tobacco Free Project and its importance for diverse communities.
  • Kirk Kleinschmidt, American Heart Association, commended the project and its staff for being comprehensive.

Commissioners discussed penalties and fines for selling tobacco to minors, pending ordinances for local tobacco control, and the importance to regulate the sales of tobacco to minors by increasing fines and impacting the business licenses.



The meeting was adjourned at 5:00 p.m.

Sandy Ouye Mori, Executive Secretary to the Health Commission