Minutes of the Health Commission Meeting
Tuesday, August 15, 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 P. Guy, MSW, at 3:06 p.m.
- Commissioner Edward A. Chow, M.D.
- Commissioner Roma P. Guy, M.S.W.
- Commissioner Lee Ann Monfredini
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
- Commissioner Ron Hill
- Commissioner Harrison Parker, Sr., D.D.S.
2) APPROVAL OF THE REGULAR MEETING OF JULY 18, 2000
Action Taken: The Commission adopted the minutes of July
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner Lee Ann Monfredini)
Note: Commissioner Monfredini chaired the Budget Committee.
(3.1) CHN-Primary Care Submittal of six-month report
on the status of the California Endowment-funded Partner Support Program
II at Balboa Teen Clinic.
(3.2) DPH-Central Administration Submittal of six-month
report on the status of the contract with Haight Ashbury Free Medical
(3.3) PHP-HIV Prevention Submittal of six-month report
on the status of the contract with Aguilas Inc.
(3.4) CHN-Medical Records/Radiology Request for approval
of a contract modification with Mediscript to increase the contract
by $150,000 to provide additional medical transcription services for
the Community Health Network, for a new contract total of $225,000,
for the period of December 1, 1999 through June 30, 2001. (DPH contracted
with Mediscript for services totaling $75,000 during FY 1998-99).
(3.5) CHN-Office of Managed Care Request for approval
for a fee for service performance agreement with the California State
Department of Corrections, San Quentin Prison, to provide medical services
to inmates and work furlough prisoners for the period of July 1, 2000
through June 30, 2003.
(3.6) CHN-Office of Managed Care Request for approval
of a contract renewal with the Regents of the University of California,
San Francisco (UCSF), in the amount if $1,700,000, to provide tertiary
care services targeting medically indigent adults and In-Home Supportive
Service workers, for the period of July 1, 2000 through June 30, 2001.
(DPH contracted with UCSF for services totaling $11,235,592 during FY
Commissioner Sanchez abstained on this item due to conflict of interest.
(3.7) PH&P-AB75 Project Request for approval to
apply for, accept and expend, retroactively, a grant allocation in the
amount of up to $4,846,670 from the State Department of Health Services,
through its California Healthcare for Indigents Program (CHIP), to provide
reimbursement for health services delivered to indigent persons for
the term FY 2000-2001.
(3.8) PHP-CMHS Request for approval of a sole source
contract renewal with Ramsell Corporation dba Professional Management
Development Corporation, in the amount of $707,010, to provide fiscal
intermediary services under the San Francisco Mental Health Plan, for
the period of July 1, 2000 through June 30, 2001. (DPH contracted with
Ramsell for services totaling $3,320,590 during FY1998-99).
(3.9) PHP-HIV Prevention Request for approval of contract
renewal with Larkin Street Youth Center (LSYC), in the amount of $110,436
per year for two years, for a total of $220,872, to provide HIV prevention
services targeting adolescents and young adults ages 13-23, for the
period of July 1, 2000 through June 30, 2002. (DPH contracted with LSYS
for services totaling $579,869 during FY 1998-99).
(3.10) PHP-HIV Prevention Request for approval of contract
renewal with Urban Indian Health Board (UIHB), in the amount of $138,023
per year for two years, for a total of $276,046, to provide HIV prevention
services targeting Native Americans, for the period of July 1, 2000
through June 30, 2002. (DPH contracted with UIHB for services totaling
$465,477 during FY 1998-99).
(3.11) CHPP-Promotion Section Request for approval of
contract modification with ORorke Public Relations and Advertising
in the amount of $246,700, for a total contract amount of $746,726,
to provide media services to the Tobacco Free Project, for the period
of July 1, 2000 through June 30, 2001. (DPH contracted with ORorke
for services totaling $222,328 during FY 1998-99).
(3.12) CHPP-Promotion Section Request for approval of
contract modification with Polaris Research and Development, in the
amount of $40,000 for a total contract amount of $110,000, to provide
evaluation services for the Tobacco Free Project, for the period of
July 1, 2000 through June 30, 2001. (DPH contracted with Polaris for
services totaling $853,779 during FY 1998-99).
(3.13) CHPP-Promotion Section Request for approval of
contract modification with San Francisco Study Center (SFSC), in the
amount of $444,257 for a total contract amount of $801,332, to provide
fiscal sponsor services for the Community Capacity Building Training
Center for the Tobacco Free Project, for the period of July 1, 2000
through June 30, 2001. (DPH contracted with SFSC for services totaling
$1,620,515 during FY 1998-99).
Action Taken: The Commission approved the Consent Calendar of
the Budget Committee, with Commissioner Sanchez abstaining on #3.6.
President Guy thanked Vice President Umekubo for chairing the July Commission
meetings while she was on vacation.
President Guy announced that in Commission meetings, individual public
speakers are limited to three minutes. She will not allow disruptive behavior.
Those disruptive individuals will be asked to leave and/or be escorted
out by institutional police officers. Disruptive behavior includes heckling
4) DIRECTORS REPORT
(Mitchell H. Katz, M.D., Director of Health)
At the last Health Commission meeting I reported to you in the Directors
Report an alarming increase in HIV incidence among men who have sex with
men (MSM) in San Francisco. The increase in incidence was seen in a study
done of MSM and who were tested at one of the alternative test sites in
San Francisco. The data had been reported in both the San Francisco Chronicle
and the New York Times. In that same newspaper coverage journalist reported
estimates of the number of new HIV infections in San Francisco based on
a meeting of experts in May of 2000. That information was leaked to the
newspaper. We did not intend for the data to be released at that time
because we had not yet finished our work.
During the latter two weeks of July and the first week of August the
Department of Public Health (DPH) in collaboration with the AIDS Research
Institute (ARI) of the University of California, San Francisco (UCSF)
worked to complete the report. In addition to reporting the actual data
that those estimates were based on it was very important to me that the
report include a plan on how we as a city would deal with the increases
in new HIV infections.
On August 8th, 2000, we met with a number of community leaders
to detail the findings of the report and our proposed plan to revitalize
HIV prevention for MSM in San Francisco. At that meeting were members
of the Ryan White CARE Planning Council, the HIV Prevention Planning Council,
staff from a number of HIV prevention agencies, and community activists.
Both the data and the guidelines for the 11 point plan were well received
by the group. Several suggestions were made and incorporated into the
document based on that meeting. That same day I had a teleconference with
CDC officials, to whom I had previously sent all of our data. They reviewed
our data and agreed that we had done a thorough job of characterizing
the HIV epidemic in San Francisco. On August 9th, 2000 we had
a hearing in front of the Finance Committee of the Board of Supervisors.
The hearing was called by President Tom Ammiano. In addition to President
Ammiano, Chair of the Finance Committee, Supervisor Leland Yee, Supervisor
Sue Bierman, and Supervisor Mark Leno joined the Committee hearing. At
the hearing we presented the data and our 11 point plan and heard testimony
in support of the plan from President Roma Guy, as well as from Dr. Tom
Coates, Director of the UCSF ARI and several community members. I have
attached to todays Directors Report the report in its entirety.
It includes our full presentation to the Board of Supervisors as well
as all of the data used to support our estimates of HIV incidence and
prevalence in San Francisco. The report is to my knowledge, the most extensive
compilation of data on a particular population in a local area. Because
any one study can be criticized for inherit biases the estimates by the
group of experts was made based on ten indicators. I have listed them
San Francisco HIV Prevention Indicators
Incidence of HIV among a cohort study
of Young MSM
Incidence of HIV among MSM seeking
anonymous HIV testing
Incidence of HIV among MSM-IDU seeking
Stable, high HIV incidence in MSM
seeking STD treatment
Reports of rectal gonorrhea among
Frequency of STDs among MSM living
Number of MSM living with AIDS
Consistent condom use among MSM
Multiple partners and unprotected
anal sex among MSM
MSM engaging in unprotected anal
sex with serodiscordant partners and/or with partners of unknown
The experts who reviewed these indicators in May of 2000
were epidemiologists, current and former HIV Care Council and HIV Prevention
Planning Council members, the Department of Public Health staff, staff
from San Francisco General Hospital, the Office of the Mayor, UCSF Researchers
and Clinicians, and community members. Based on all of these prevention
indicators the group of experts concluded that the incidence of HIV among
MSM has increased from 1.1% to 1.7%. The incidence of new infections among
MSM and use injection drugs has increased from 2.0% to 4.6%. The incidence
for injection drug users and for heterosexuals has decreased. The result
of these changes in incidence and improved estimates of the size of the
populations in San Francisco shows that the number of new infections among
MSM is estimated to have increased from 283 to 573 and for MSM who use
injection drugs it has increased from 53 to 143. The number of new infections
has decreased for injection drug users and for heterosexuals. Based on
this report the Health Department in collaboration with the ARI put together
an 11 point plan for HIV prevention in San Francisco. The action plan
is listed below.