Minutes of the Health Commission Meeting
Tuesday, March 21, 2000
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 Roma Guy,
MSW, at 3:15 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 John I. Umekubo, M.D.
- Commissioner Lee Ann Monfredini
- Commissioner David J. Sanchez, Jr., Ph.D.
2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF MARCH 7, 2000
Action Taken: The Commission unanimously adopted the minutes of the meeting
of March 7, 2000.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Ron Hill)
(3.1) PHP-CMHS Request for retroactive approval to accept and expend
federal Substance Abuse and Mental Health Services Administration (SAMHSA) funds received
by, and passedthrough, Asian American Recovery Services, Inc. (AARS), a community-based
agency currently providing substance abuse and mental health services to San
Franciscos Asian community, for Comprehensive Asian Preschool Services.
(3.2) PHP-CMHS Request for approval of a new sole source contract with
Support for Families of Children with Disabilities (SFCD), in the amount of $270,000, to
provide mental health outreach and counseling services targeting families of children with
mental health issues and special needs, for the period of April 1, 2000 through March 31,
(3.3) PHPHIV Prevention Request for approval of a two-year contract
renewal with Regents UCSF AIDS Health Project (UCSF) in the amount of $455,676 per year
for a total of $911,352, to provide HIV counseling, testing, risk reduction and partner
counseling and referral services targeting behavioral risk populations, for the period of
January 1, 2000 through December 31, 2001. (DPH contracted with UCSF for services totaling
$6,442,691 during FY 1998-99).
Commissioner Parker asked about outreach to the African American community.
The Department will provide a report on statistics and trends for testing and
The Department can also provide an overview of the HIV Prevention Program.
(3.4) PHPHIV Prevention Request for approval of a two-year contract
renewal with Haight Ashbury Free Clinic Inc. (HAFC), in the amount of $81,689 per year for
a total of $163,378, to provide HIV counseling, testing, risk reduction and partner
notification services targeting behavioral risk populations in San Francisco, for the
period of January 1, 2000 through December 31, 2001. (DPH contracted with HAFC for
services totaling $13,406,339 during FY 1998-99).
Commissioner Parker pointed out more efforts need to be made in the African American
community. He would like to follow the trends from year to year.
(3.5) PHPHIV Prevention Request for approval of contract renewal with
CompassPoint Nonprofit Services (formerly Support Center for Nonprofit Management), in the
amount of $300,000, ($180,000 for the term of 1/1/2000-12/31/00, and $120,000 for the term
of 1/1/01-12/31/01), to provide organizational development and capacity building services
for HIV prevention community-based organizations, for the period of January 1, 2000
through December 31, 2001. (DPH contracted with Support Center for services totaling
$1,106,985 during FY 1998-99). A follow-up status report will be calendared for May
(3.6) PHPHIV Prevention Request for approval of a two-year contract
renewal with Asian Pacific Islander Wellness Center (APIWC), in the amount of $471,653 per
year for a total of $943,216, to provide HIV prevention services targeting various Asian
and Pacific Islander behavioral risk groups, for the period of January 1, 2000 through
December 31, 2001. (DPH contracted with APIWC for services totaling $1,178,221 during FY
(3.5) PHPHIV Prevention Request for approval of a two-year
contract renewal with California AIDS Intervention Training Center (CAITC), in the amount
of $142,398 per year for a total of $284,796, to provide HIV prevention services for the
period of January 1, 2000 through December 31, 2001. (DPH contracted with CAITC for
services totaling $263,217 during FY 1998-99).
(3.8) PHPHIV Prevention Request for approval of a two-year contract
renewal with California AIDS Intervention Training Center (CAITC), in the amount of
$138,001 per year for a total of $276,002, to provide HIV prevention/street outreach
services targeting various behavioral risk groups, for the period of January 1, 2000
through December 31, 2001. (DPH contracted with CAITC for services totaling $263,217
during FY 1998-99). A follow up status report will be calendared for May 16, 2000.
(3.9) PHP-Special Projects (HIV Seroepidemiology) Request for approval to
accept and expend new funding in the amount of $214,584 from John Snow, Inc., to support
personnel for the HIV Postexposure Prophylaxis (PEP) Registry Project, for a period of
April 1, 2000 to September 30, 2001; and a sole source contract with UCSF for research
assistance in the amount of $188,405 for the same time period. (DPH contracted with UCSF
for services totaling $6,442,691 during FY 1998-99).
(3.10) PHP-BEHM Request for approval of new contract with Dillard
Environmental Services, in the amount of $200,000 per year for a total of $450,000, to
provide hazardous waste management and transportation services, for the period of April 1,
2000 through June 30, 2002.
Action Taken: The Commission approved the Consent Calendar of the Budget
4) FOR DISCUSSION ONLY: DIRECTORS REPORT (Mitchell H. Katz, M.D., Director
(Report on activities and operations of the Department, and may include activities within
the Community Health Network and Population Health and Prevention Divisions).
Departmental Strategic Planning Update
The Department has made a lot of progress with strategic planning since my last Health
Commission presentation. The Populations and Program Subcommittee developed priorities for
populations the Department should serve in the future. The Subcommittee will finalize its
recommendations today and these preliminary recommendations will be presented to the
Health Commission at is next monthly update. The Finance Subcommittee met on March 10th
to review infrastructure needs and options for financing infrastructure improvements. The
meeting focused on the needs at San Francisco General Hospital, the community health
centers and contractors within Population Health and Prevention. The Health Commission
will receive a presentation on infrastructure needs at todays meeting.
Internal DPH town hall meetings have been scheduled to familiarize staff with the
planning initiative and to obtain input on our strategic direction. The meetings start
this week and continue through April 7th. Attached is a flyer with the meeting
DPH submitted a grant application to the San Francisco Foundation to fund community
engagement for the strategic planning process. The grant will fund outreach efforts to
ensure that demographically and geographically diverse community participants are involved
in the Departments strategic planning.
Lastly, the Steering Committee co-chairs met with seven of the Departments
community advisory boards to solicit input and suggestions for strategic planning. Three
more advisory board meetings are scheduled over the next several weeks, and additional
board meetings are being set.
CMA Drug Treatment Reform Resolutions
I was pleased to participate as an Alternate Delegate for the SF Medical Society on the
California Medical Association's House of Delegates. The delegation passed five exciting,
progressive drug treatment reform resolutions. As you know, CMA is the largest state
medical association in the country. Policy statements from CMA can be used in a number of
different venues to effect changes, particularly to persuade governmental agencies and
medical institutions to act in accordance with the statements. In summary the resolutions
- Law enforcement and emergency medical services agencies adopt and publicize policies
which encourage the appropriate medical rescue response to illicit drug overdose and which
minimize the fear of legal retribution for persons making 911 calls.
- Controlled trials of take-home naloxone to further evaluate the acceptability of
naloxone to heroin users in preventing overdoses.
- Transplant centers to abrogate policies that automatically exclude patients maintained
on methadone from liver transplant recipient waiting lists.
- County and city jails make appropriate treatment modalities, including methadone
maintenance, available to opioid-dependent inmates.
- Governmental agencies to establish programs of office-based physician prescription or
physician order of methadone maintenance.
Appointment to Local Board
I have asked Anne Kronenberg to act as my surrogate and coordinate the homeless
programs we provide throughout the Department. Anne has been very involved with the Single
Room Occupancy Fire Disaster response, and sits as my representative on the citywide SRO
Task Force. For the past year, she has worked closely with other city departments and
community advocates on a number of issues related to homelessness. As you know, both the
PH&P and the CHN provide homeless services. It is my belief that Anne, who resides in
neither division, will be able look at the services DPH provides with a global
perspective. She will pull together a DPH homeless working group with the goal of more
efficiently coordinating and delivering services to this vulnerable population. In
addition, I asked Anne to be DPHs representative on the Local Board, replacing
Marian Pena whose term expired in February. I am sure you all join me in thanking Marian
for the dedication, hard work and deep commitment she brought to the Local Board for the
years she served as the DPH representative.
POPULATION HEALTH AND PREVENTION
Violence in the Workplace Training
The Department completed the first phase of its "Preventing Violence in the
Workplace Training Program". Over 500 supervisors and managers were trained in this
phase durring the last six months. I would like to thank trainers Doreen Dare, John Fazio,
Jennifer Dahlstrom, Lucy Fisher, Susan Gearhart, Mabel Jung, Penney Mitchell, Jean
Miranda, Kitty Mah, Erica Smentowski, Jeff Lintner, Alex Mackenzie and Linda Wang.
Phase two of the Violence Prevention training will target line staff. The training will
focus on DPH's policy prohibiting violence in the workplace, employee responsibility to
report, and the role of the Management Response Teams in consulting on threats/incidents
The Newcomers Health Program of Community Health Promotion and Prevention Branch was
selected to conduct a roundtable presentation at the California Conference of Local
Directors of Health Education Annual Conference April 13-14. The presentation, entitled
"Community Assessments of New Immigrant Populations: A Critical Factor in Program
Planning and Community Capacity Building" will focus on the importance of conducting
assessments to develop links into a new community, to learn about community issues and to
effectively interact with members. Based on experiences of the Newcomers Health Program,
results of such assessments can lead to successful development, funding and implementation
of community-based preventive health programs. For more information contact Patricia Erwin
through e-mail or at 705-8552.
Through a grant from the CDC, the Community Health Promotion and Prevention Branch and
the San Francisco Injury Center at UCSF, will sponsor two Injury Prevention events as part
of the celebration of Public Health Week, April 3-9.
A half-day conference on "Injury Prevention: a Public Health Approach" will
be held April 5th, 8:30 am to 12:30 pm, at the Civic Center Conference Room,
455 Golden Gate. The morning Conference is a brief introduction to the principles and
practices of injury prevention, for advocates, community activists, agency managers,
program staff, and public health professionals.
Carolyn Fowler, Ph.D., from Johns Hopkins Center for Injury Research and Policy, the
Director of Injury Prevention Programs for Baltimore County, Maryland, will be the Keynote
Speaker. Other speakers include Barbara Alberson, MPH, Chief of the State & Local
Injury Control Section, and Roger Trent, Ph.D., Chief of the Injury Surveillance and
Epidemiology Unit, California Department of Health Services, and Andrew McGuire, Executive
Director of the Trauma Foundation.
The afternoon program April 5th is "Skills for Community-Based Injury
Prevention." This focuses on San Francisco specific issues and programs and will
provide professionals and residents the opportunity to work on specific prevention
approaches. These will include Finding and Using Data, Creating Safe Communities,
Community Capacity Building and Advocating for Change. Pre-registration is required for
both morning and afternoon sessions. For a complete conference brochure and application,
contact Tomas Marrero at 554-2740.
Please join the Community Health Education Section in celebrating Public Health Week at
a drop-in Open House April 7th, 1-4pm, 101 Grove Street, room 118.
STD Prevention and Control
Effective, March 7th the Department began to use the Becton Dickenson
Probe-Tek urine test to diagnose chlamydia at City Clinic. All STD screening sites in the
City will be using this method of testing by May. The primary advantage to this test is
that the DPH Lab can test one specimen for both gonorrhea and chlamydia at the same time
for approximately one third less money. The Lab will also be able to process more tests
with less risk of contamination than with the previous method.
World TB Day
Friday is World TB Day and San Francisco is, once again, the West Coast site for World
TB Day activities. In observance of World TB Day, the Department's TB Control Program will
be hosting a press conference in Chinatown on Friday at 10 a.m. After five years of steady
decline in TB cases, San Francisco's 1999 figures show an increase of 13%.
We will be kicking off a long term effort directed at reducing the reservoir of
potential TB cases by concentrating on individuals with dormant TB infection. TB Control
hopes to increase awareness and assure access to TB screening and treatment for any
resident who has been in San Francisco less than five years and comes from a country with
a high incidence of TB.
Dr. Chow will be representing the Health Commission. He will be joined by Dr. Masae
Kawamura, Director of TB Control for this Department, Dr. Sarah Royce, Director of the
State's TB Control Branch, and Supervisors Mabel Teng, Leland Yee, and Michael Yaki. Dr.
Alex Moy, medical director of Chinatown Public Health Center, will be speaking on behalf
of the Department.
COMMUNITY HEALTH NETWORK
Maintain Licensing & Accreditation
The annual Title XV Survey of the SFGH Jail Health acute care units, 7D, 7L, 7B and the
Institutional Police holding cell took place January 31st. There were minimal
findings/deficiencies noted during the survey, which were quickly corrected.
As we are all aware, there is a shortage of RNs throughout California, particularly in
high-tech/specialty areas. In 1998, Perioperative Management recognized this as a major
problem for SFGH and began meeting with representatives from other Bay Area hospitals. A
training program was developed which included sending selected nurses through the
Consortium Education Network O.R. Nursing Training Program. Nurse training for the O.R. is
extensive taking 6 months to complete all training objectives. By July, SFGH will have 7
new skilled nurses in Perioperative Nursing.
Condolences to the Family of Sandy Porter & the Staff at Potrero Hill Health Center
Jessica (Sandy) Porter, HWII/Outreach Worker at Potrero Hill Health Center
unexpectedly March 18th, at the age of 45. Ms. Porter was among the original
employees of PHHC when it opened in 1976. She lived across the street from the Health
Center, in a SF Housing Authority unit for the past 25 years, and was a trusted link to
the Hills high-risk target populations. She assisted in recruiting for and staffing
the Community Advisory Board at PHHC a continuously functioning CAB since 1976.
Following the tragic shooting death of the Centers former Director, Dr. Bob Ross, in
1983, Sandy helped maintain the Centers primary care focus and continuity. Her
tireless efforts at organizing community input and support through many budget crises over
the years were well known. Ms. Porter is survived by her twelve-year -old son, Sterling.
Memorial services place and date will be known later this week.
|SFGH Credentials Report
|Changes in Privileges
| Voluntary Relinquishment
Commissioner Chow encouraged the Department to publicize the TB treatment protocols
Commissioner Umekubo inquired about the timeline for implementation of the physician
prescription orders for methadone maintenance. Dr. Katz foresees implementation in the
next fiscal year.
President Guy requested the Commission to send condolences to the family of Sandy
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE RECOGNITION AWARDS FOR
On behalf of the Commission, President Guy presented the March Employee Recognition
Awards to the following employees:
||Central Administration, MIS
||Vicki Zulueta and Monique Zmuda
||Population Health and Prevention
||John F. Brown EMS Section
|Louise Murphy, RRA
||CHN, Health Information Services, Health Information
||SFGH Services Staff
||CHN, Health Information Services, Health Information
||SFGH Services Staff
Bobbie Herron accepted the award for Louise Murphy.
6) PRESENTATION OF STATUS OF THE DEPARTMENT OF PUBLIC HEALTH FACILITIES
At the request of the Commission, Dr. Katz provided information on the capital
requirements for the Department. A copy of the full report is available in the Commission
Dr. Katz reported the following:
The Department of Health has evaluated the capital needs for its clinical facilities
for the next rthree to five years, and has prepared proposals for the consideration by the
Health Commission, the Board of Supervisors and the Mayor. The following pages summarize
the capital needs for the Department of Public Healths acute care hospital and
clinics. This report excludes capital projects for Laguna Honda Hospital since it will be
rebuilt over the next seven years. Also, we have identified capital needs for private
non-profit agencies that deliver health services to the Departments patients and
clients. We will work with the Citys departments and bureaus to develop revenue
streams thata can assist non-profit agencies in accessing funding to meet their capital
Our initial assessment of facilities indicates that the Departments of Health requires
capital investments for repair and renovation of our primary care clinics throughout the
community. Renovations are required to provide additional examination rooms and other
clinical space, to improve patient flow, and to expand dental service areas. In the area
of acute care, the Deparatment of Health must comply with the SB 1953 Facilities Seismic
Safety Act which requires San Francisco General Hospital to meet a higher standard of
seismic performance. This requirement will result in seismic retrofit or replacement of
San Francisco General Hospital. The Department also proposes to build a new ambulatory
care and research facility on the grounds of the San Francisco General Hospital Campus.
This facility will relocate outpatient clinical services and medical research activities
(for which the Department collects rental income) that are currently in the seismically
compromised masonry buildings to this new facility. Finally, the Department proposes to
complete seismic renovation of the masonry buildings at San Francisco General Hospital.
These buildings, once renovated, could be used for administrative and other non-clinical
uses, as well as for intermediate care, independent living or other supportive services.
The report contained four components:
- A list of capital improvements required for SFGH, the hospital based clinics, and the
community based clinics;
- A summary of the implementation of SB 1953 for SFGH;
- A summary of the proposed construction of the medical clinic and research facility; and
- A summary of the need to complete seismic renovation of the masonry buildings at SFGH
As the Commission is aware, the Departments strategic planning process will
define the level and scope of services that will be provided over the next several years.
These recommendations will be presented to the Health Commission by year ending 2000. The
recommendations from the strategic planning process may result in revisions to the capital
plan presented in this report.
In addition, the Department is in the process of conducting a facility seismic
assessment of San Francisco General Hospital. This includes a geotechnical evaluation,
detailed structural review and analysis of the frame, and a survey of non-structural
systems serving non-ambulatory patients. Results of this assessment will better define the
components of the SB 1953 project for the next several years. The Department is also
involved in a detailed ADA assessment of all of our facilities. As such, these projections
of capital requirements for the Department of Health should be considered preliminary
until the results of the strategic planning process and the seismic assessment studies
have been completed.
- These estimated costs do not include inflation factors
- Complimented Department for report; need to rebuild these buildings
- Need to look at the U.C. partnership and its effect on the rebuilding of SFGH
- Need to know how many primary care clinics and what services will be provided in primary
- Will look to the Strategic Plan of the Department for direction of primary care
- Need to consider recommendations from consultants regarding SFGH
- Discuss these issues at the JCC-SFGH and JCC-CHN before coming to full Commission
- Serious questions on 101 Grove seismic retrofit
- Cost factors need to be realistic
- Different timetables need to be considered
Nathan Nayman, Hospital Council, referred to his letter to the Board of Supervisors,
reported that all hard costs for hospitals will be submitted to the State, discussed SB
1953 issues, and recommended the Commission to look at temporary waivers for antitrust
Commissioner Hill left at 5:00 p.m.
7) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH HOUSING SERVICES UNIT
Marc Trotz, Director of Housing Services, presented the activities of the Housing
Commissioner Umekubo asked how much would it cost to house the homeless population? The
Department estimates at $150,000 per unit for capital costs only, it would cost $1.5
billion to build housing for 10,000 homeless people.
Dr. Katz commended Mr. Trotz and his hard working staff for their work with the
community. Dr. Katz sees health and housing being so connected and pointed out the Housing
Services Unit substantially changing peoples lives.
8) CONSIDERATION OF A RESOLUTION APPROPRIATING PROPOSITION A FUNDS FOR TOBACCO
PREVENTION AND CONTROL ACTIVITIES IN 2000-01 FISCAL YEAR
(This item was considered after agenda items #5).
Ginger Smyly, Deputy Director for Health Promotion and Prevention, presented the
proposed FY 2000-2001 plan and budget for tobacco prevention and control to be funded with
$1 million annual allocation of tobacco settlement funds, earmarked by Proposition A. Ms.
Smyly acknowledged this as a joint effort of the Department, the Tobacco Coalition, the
School District, community representatives, Environmental Health, Police Department, and
the City Attorneys Office.
A copy of the full report is available in the Commission Office.
Ms. Smyly reviewed the targeted populations, the guidelines for use of the funds, and
recommendations for the use of funds. She pointed out in the proposed budget there will be
less funds going to the City Attorneys Office and more to Environmental Health
Commissioner Umekubo suggested the education materials and information would be helpful
to all healthcare providers. He recommended partnering with the S.F. Medical Society.
Commissioner Chow recommended going back to remind private practitioners about the
available materials. He also suggested using many different newspapers, medical groups,
and managed care programs.
Commissioner Hill complimented the Department for its work and collaboration with the
Action Taken: The Commission adopted Resolution #3-2000, entitled
"Appropriating Proposition A Funded for Tobacco Prevention and Control Activities in
Fiscal Year 2000-01."
Ms. Smyly acknowledged Alyonik Hrushow and her staff.
Dr. Katz stated the Department will move this approved resolution to the Board of
- Karen Licavoli Farnkopf, American Lung Association of San Francisco/San Mateo, Co-
Chair of the Tobacco Coalition, thanked the Commission for its support; commented this is
a consensus document with input from the community.
- Kirk Kleinschmidt, American Heart Association, commented that the enforcement provisions
are very important; there is a way to go on the smoking ban in bars.
9) OTHER BUSINESS/PUBLIC COMMENTS
The meeting was adjourned at 5:45 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission