Minutes of the Health Commission Meeting
December 5, 2000
San Francisco General Hospital
22nd Street and Potrero Avenue
San Francisco, CA 94110
1) CALL TO ORDER
The regular meeting of the Health Commission was called to order by President Roma P. Guy,
MSW, at 3:10 p.m.
- Commissioner Edward A. Chow, M.D.
- Commissioner Roma P. Guy, M.S.W.
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
On behalf of the Commission, President Guy presented a special certificate of appreciation
to Joanne Burik on her retirement after 20 years with the Department. Ms. Burik has had
various positions, with the most recent as the head of the Office of Managed Care. Gene O’Connell,
SFGH Executive Administrator; and Tony Wagner, CHN Executive Administrator, thanked Ms. Burik
for her many years of dedication and commitment.
2) APPROVAL OF MINUTES OF THE REGULAR MEETING OF NOVEMBER 21, 2000
Action Taken: The Commission unanimously adopted the minutes of November 21, 2000
3) CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner David J. Sanchez, Jr., Ph.D.)
DPH Administration – Request for consideration of a modification to the FY
2000-01 Patient Rates Ordinance to increase selective patient rates at San Francisco General
Hospital in order to maximize MediCal reimbursement.
Ms. Zmuda reported that these patient rate increases will bring in $1 million to SFGH.
(3.2) PHP-HIV Research – Request for approval to accept and expend retroactively
$247,970 in funds from Public Health Foundation Enterprises (PHFE), for the first year of a
five year project to fund the San Francisco Department of Public Health portion of "San
Francisco HIV Vaccine Clinical Trials", for the period of June 1, 2000 to May 31, 2001.
(3.3) PHP-Environmental Health – Request for approval to accept and expend
retroactively a new two-year grant in the amount of $98,399, from the U.S. Environmental
Protection Agency, to fund a project for adults and children with asthma and their families
entitled "Healthy Homes for Healthy Airways", for the period of November 1, 2000 to
October 31, 2002.
Commissioners expressed concern on outreach to targeted low income communities (i.e.,
Latino and African American) and asthmatics with allergic sensitivities.
(3.4) PHP-TB Control – Request for approval of a contract renewal with the Regents of
the University of California at San Francisco (UCSF), in the amount of $1,450,839, to provide
Model Tuberculosis (TB) Education and Control Center services to local and national TB health
care providers, for the period of November 1, 2000 through June 30, 2001.
(DPH contracted with
UCSF for services totaling $11,454,369 during FY 1999-2000.
Commissioner Sanchez abstained due to conflict of interest.
(3.5) PHP-CMHS – Request for approval of a retroactive contract renewal with
Instituto Familiar de la Raza, Inc. (IFR), in the total amount of $9,277,054, to provide
mental health and administrative support services targeting adults, children and families, for
the period of July 1, 2000 through June 30, 2002. (DPH contracted with IFR for services
totaling $5,741,385 during FY 1999-2000).
Commissioner Parker requested clarification on the total number of clients served under
this contract. Estella Garcia, Instituto staff, reported a total of 350 adult/children are
Commissioner Sanchez noted this 2-year contract renewal is for past performance. He noted
the Department needs to continue providing TA to non-profit contractors. Ms. Garcia reported
that cultural competency is an important part of the social fabric; the diversity of the work
force is also important.
(3.6) PHP-CMHS – Request for approval of a retroactive sole source contract renewal
with Continuum HIV Day Services, in the amount of $98,000 per year, for a four-year total
contract of $392,000, to provide adult mental health services targeting HIV-positive adult
residents of San Francisco with severe mental health diagnoses, for the period of July 1, 2000
through June 30, 2004. (DPH contracted with Continuum for services totaling $1,752,456 during
(3.7) PHP-CMHS & CSAS – Request for approval of a retroactive contract renewal
with Bayview Hunters Point Foundation for Community Improvement, Inc. (BVHPCI), in the amount
of $6,949,872, to provide substance abuse and mental health services targeting adults and
children, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with BVHP
Foundation for services totaling $7,109,248 during FY 1999-2000).
Commissioner Monfredini requested a 6-month follow-up to this contract, (June 5, 2000).
Commissioner Sanchez supported the unique efforts of Bayview and the Department in order to
rectify the issues.
(3.8) PHP-CMHS & CSAS – Request for approval of a retroactive contract renewal
with Walden House, Inc., in the amount of $6,724,326, to provide residential mental health and
substance abuse services, for the period of July 1, 2000 through June 30, 2001.
contracted with Walden for services totaling $8,623,924 during FY 1999-2000).
Commissioner Sanchez encouraged the Department to provide technical assistance to CBO’s.
For Item #3.7, Commissioner Chow requested any more data on the evaluation of acupuncture
and the use of acupuncture for substance abuse. Dr. Katz will come up with more quantitative
data. Dr. Katz pointed out it is difficult to quantify the impact of acupuncture on substance
Action Taken: The Commission unanimously voted to accept the consent calendar of the Budget
Committee. Commissioner Sanchez abstained on #3.4
4) DIRECTOR’S REPORT
(Mitchell H. Katz, M.D., Director of Health)
CDC Satellite Broadcast on HIV Prevention for Men Who Have Sex With Men
Last Wednesday and Thursday, I participated in a Centers for Disease Control and Prevention
Satellite Conference on HIV prevention for men who have sex with men. I was invited as the
sole representative of local health departments because of the work that we have done in
characterizing the increases in unsafe sex among men who have sex with men and in recommending
new directions for HIV prevention. The program was telecast to 400 sites in the United States
and Canada and was watched by 6400 persons.
Back on the SFGH Wards again
Last Friday, I began my annual month as an inpatient attending on the medical wards at San
Francisco General Hospital. It has been wonderful to see old friends among the medical and
nursing staff some of whom I have known since 1986 when I began as an intern at the hospital.
Working at the hospital full time always makes me proud of the high quality care we provide at
the hospital. It also gives me insight into the pressing unmet needs of our clients,
especially the housing and outpatient mental health and substance abuse treatment. I want to
thank the members of the Health Commission for giving me the freedom to pursue my love of
clinical medicine and also thank my dedicated staff for filling in for me in a variety of ways
Trial of SF ACT-UP Members Ends
A week and a half ago, two members of SF ACT-UP were found guilty of disturbing the peace
based on their actions at the June 9th Board of Supervisors’ Finance and Labor
Committee hearing. This is to my knowledge, the first time that members of SF ACT-UP have been
tried in criminal court for their actions, and the first time that they have been found
guilty. I believe that this court ruling will make it less likely that SF ACT-UP members will
continue to intimidate persons at public meetings.
POPULATION HEALTH AND PREVENTION
Last week, the State of California Department of Health Services received the final portion
of its annual shipment of vaccine to distribute to local health departments for vaccination of
low-income, high-risk individuals. Although DPH now has our full allotment of nearly 40,000
doses, this does not meet the demand for an estimated 250,000 doses needed to vaccinate the
City’s high-risk population. Other large suppliers of vaccine in San Francisco include
Kaiser, UCSF, Visiting Nurses Association (VNA), Catholic Health Centers West, and private
providers. Many of these groups have received little, if any, of their vaccine.
The 40,000 doses have been distributed to CHN, nursing homes, and other groups that serve
high-risk clients. The Adult Immunization Clinic has given 2,000 doses of vaccine to high-risk
individuals. They currently do not have vaccine and are awaiting a shipment of an addition
On the West Coast, we begin to see influenza cases beginning in late December through
March, with the highest number of cases between the end of December and January. Once someone
has received the flu vaccine, it takes approximately 2 weeks to develop antibodies to the
Given the dearth of vaccine in San Francisco, as well as the time needed to respond to the
vaccine, we anticipate that there will be an increase in hospitalizations and deaths in San
Francisco due to influenza and its complications this year compared to previous years. In
anticipation of an increase in number of infections and complications of influenza, we are
planning an Influenza Prevention Press Conference with other City hospitals in the near
Housing and Urban Health
An article appeared in the Sunday Chronicle describing a DPH sponsored project that trains
people in jail in rescue breathing and CPR as part of a program to reduce deaths from heroin
The Environmental Health Section recently took administrative action against a contractor
who removed asbestos material improperly from a home in San Francisco creating the potential
for public exposure. Notably, the contractor is licensed by the state to do asbestos abatement
and advertises themselves as the "nations largest residential abatement company." We
anticipate that the settlement of this action for $37,000 will have a strong deterrent effect
against such negligent behavior among contractors working with hazardous materials. EHS will
continue to cooperate closely with the Department of Building Inspection, the Bay Area Air
Quality Management District, Cal-OSHA, and other enforcement agencies to identify violators
and coordinate enforcement activities.
On November 29, the Department of Public Health and the District Attorney's office
cosponsored a one-day conference on implementation of Proposition 36. Over the course of the
day panelists addressed the implications of Proposition 36 on the criminal justice system and
the treatment system. The day was extremely well attended and received attention in the media.
District Attorney Hallinan and Barbara Garcia will spearhead the process of turning the
recommendations into action.
HIV Prevention Section
On November 29th the HIV Section was host to Zhao Wang, the Director of Disease Control for
the Ministry of Health in the Peoples Republic of China. Prevention staff and Drs. Willi
McFarland and Grant Colfax provided Dr. Wang and 10 members of her staff with information on
HIV prevention and research here at DPH. As testimony to the level of interest and quality of
information, the delegation stayed two hours over the planned visit.
COMMUNITY HEALTH NETWORK
DOJ Revisits LHH –
A team of Federal Department of Justice representatives revisited Laguna Honda Hospital
from November 28 through December 1st. The DOJ team was comprised of two attorneys,
one paralegal, two nursing experts and one expert administrator.
The DOJ team did not provide a formal debriefing. We expect to hear from the DOJ within the
next few weeks. I will keep the Commission informed.
LHH Annual Holiday Show
The Laguna Honda Hospital volunteers are sponsoring the Annual Holiday Show for all
Residents on Friday, December 15th at 2:00 PM in Simon Auditorium. All
Commissioners are invited to attend.
LHH Institutional Police Annual Toy Drive
The Institutional Police at Laguna Honda Hospital have kicked off their annual toy drive.
This annual program is always a success and your support will guarantee that 2000 will be our
best year yet.
For more information, contact Lt. Gary Kong 759-2319.
Director of Nursing, Emergency Department
I am pleased to announce that Mary Jo Webb, RN has returned back to San Francisco General
Hospital to continue serving as the Emergency Department's Director of Nursing. She returned
to SFGH on Monday, December 4th.
SFGH Discharge Lounge
On December 11th, new SFGH discharge lounge will be opened to provide a safe environment
for patients that are medically stable and have been discharged. Hours of operation are
Monday-Friday 11 am - 5 pm (closed on holidays and weekends).
The discharge lounge will serve patients waiting for transportation and/or social service
assistance. These patients must be independent or require minimal assistance with transfers.
Many thanks to Gillian Otway, RN, Nurse Manager of 5A, for all of her hard work in
developing the SFGH discharge lounge program.
Commissioner Monfredini asked for clarification of how information is communicated to
families of patients in the Discharge Lounge. She also encouraged flu shots be prioritized for
bedside staff at SFGH and LHH. Discussions with private hospitals are also taking place.
Commissioner Chow advocated for enforcement of the message for flu vaccine availability.
- Michael Petrelis asked what happened to the $1 million from Dupont in 1999 for HIV
- Yolanda Chavez, Local 250, asked about the use of all levels of nursing in the Discharge
5) PRESENTATION OF THE SAN FRANCISCO GENERAL HOSPITAL ANNUAL UPDATE
A. Gene O’Connell, Executive Administrator, acknowledged her senior management and
medical staff. The following areas were presented for Commission approval:
- Hospital Plan for Provision of Patient Care by Sue Currin
- Quality Improvement Plan by Hiro Tokubo
- Utilization Management Plan by John Luce, M.D.
- Competency Plan by Rod Auyang
- Environment of Care Update by Terry Salz
These reports are available in the Commission Office. The Commission is required by JCAHO
to approve all of the above plans.
Commissioners commented on the following:
- Clarification needed in the two different Executive Administrators for SFGH and the
CHN on page 5A.6.
- Need for correction on C1 on page 5A.24
- Need for follow-up to the 0.2% unacceptable for patient care performance evaluations;
what actions were taken and what were consequences; goal is to have 0% in the
unacceptable category and should be in writing
- Question of when will these be 100% of performance evaluation completed?
- Requested assurance that the higher level of standard is the goal for environment of
B. The following reports, which are available in the Commission Office, were presented
- Medical Staff Report by Alan Gelb, M.D.
Dr. Gelb emphasized the importance of the Commission advocacy at the Federal level.
Commissioner Chow expressed his appreciation for the recitation of information everyone
knows; but, aside from increasing or adding more revenues, what are the urgent issues; he
encouraged the physicians to come forth with innovative answers and a long term view of SFGH
for the next 10 to 20 years.
Commissioner Sanchez pointed out he is here to listen and assured staff that SFGH will
not be on the back burner. He advocated to look at the infrastructure, how to sustain
services, what kind of facility should we have, and how the public would pass a bond
- Capital Planning Process at SFGH by Carlos Villavel
Mr. Villavel presented the five options for SFGH facility planning:
- New conforming hospital at SFGH by 2013
- Interim fix of existing hospital by 2008
- Retrofit in place to SPC-5 by 2013
- Phase out acute care at SFGH by 2008
- New conforming hospital by 2013 and build somewhere else in San Francisco.
A timetable was presented
- Annual Update on SFGH Medical Center by Gene O’Connell
Areas covered included facts and figures, preparation for the 2001 Master Plan,
descriptions of any given day at SFGH, the Level 1 Trauma Service, the U.C. Affiliation, the
Public Health role, staffing levels, and future planning.
Ken Jensen, CHN Chief Financial Officer, presented the Analysis of Revenues and
Expenditures and the City/County Subsidies to SFGH, the October SFGH Statement of Revenue
and Expenses, and the October SFGH Summary Statistical Information.
- Review of the Partnership Between UCSF and SFGH by Phil Hopewell, M.D.
Dr. Hopewell reviewed the UCSF/SFGH Affiliation Agreement. The full report is available
in the Commission Office. The $66 million budget for the U.C. Affiliation was provided to
- Kevin Grumbach, M.D., knows that the City leadership supports SFGH but it is important
politically for the Department, the Commission, and the Mayor, to advocate for the
uninsured and needy; makes sense for the City to sustain the level of care.
- Nora Roman, R.N., Emergency Coalition to Save Public Health, indicated DPH is in crisis;
patients, workers and community are being hurt; addressed issues around the pharmacy
privatization plan, inadequate staffing, crisis in emergency and urgent care services,
rejection of the Strategic Plan, and Commission to play an active role in Sacramento and
Washington advocating for universal health care.
- Eric Isaacs, M.D., encouraged Commission to talk to the Mayor about ER; gave patient
examples; barely avoiding malpractice suits; not getting single standard of care;
encouraged Commission to stand up to the Mayor.
- Howard Graves, M.D., gave overview of patients, diversion rates, overloaded ER;
political courage is needed.
- Lynn Bui, M.D., described conditions in ER Department; advocated for help to medical
- Chris Barton, M.D., SFGH ED, described realities in the ER, diversion rates, and census
- Teresa Palmer, M.D., LHH, represented physicians at LHH; submitted letters from Dr.
Maria Rivero, Dr. Charles Stinson, Dr. Monica Banchero-Hasson, Dr. Derek Kerr, Dr.
Christopher Hinnant, Dr. Brenda Ansher, Dr. Laura Duskin, Dr. Rene Thomas, Dr. C. Lee, Dr.
Lisa Hoo, Dr. Vicky Young, and Dr. James Budke; expressed concerns on staffing in
medicine, nursing, activity therapy, rehab, social work, dietary and housekeeping. Letters
are available in the Commission Office.
- Brad Shapiro, M.D., Family Practice Residency Program, alarmed at Dr. Katz’s statement
on seeing improvements at SFGH; described examples of patients not receiving care.
- Mark Jacobson, M.D., SFGH, expressed importance of SFGH physicians who believe in public
health, research, and respected colleagues at SFGH; best and brightest house staff; SFGH
is becoming unattractive to bring in new physicians; suggested to change the Strategic
- Richard Haber, M.D., SFGH Department of Medicine, has been on faculty for 25 years; was
a patient at SFGH; real crisis now; funding gap has not been made up by the City; gave
examples of clinic patients.
- Joel Ernst, M.D., Department of Medicine, gave examples of having academic researchers
at SFGH (i.e., TB, AIDS).
- Michael Lyon, former SFGH employee, is concerned about the Strategic Plan; health care
is being taken away from the working class; if nothing is done, DPH has to scale back.
- Jim Kahn, M.D., SFGH, single standard of care should not be below the standard of care;
morale is at an all time low; Commission is inadequately informed.
- Meg Newman, M.D., SFGH, quoted Dr. Katz; San Francisco is in a position to remedy the
problem; City should take the lead in public health; do not further erode public health
- Rick Hecht, M.D., SFGH, says it is demoralizing for faculty; described how he spends his
physician time; he essentially volunteers his clinical time.
- Courtney Broaddus, M.D., SFGH, wants to maintain excellence of physicians; recruitment
and retention of top faculty at SFGH/UCSF; faculty largely pay their own way; law morale;
the Strategic Plan will not allow a full functional hospital.
- Robert Jasmer, M.D., SFGH, talked about a major meltdown in ICU; not enough beds for
critical care patients; inadequate number of respiratory therapists; level of denial by
- Todd May, M.D., Family Medicine Department, says things are not better this year; not
humanistic care; do not deny what is happening.
- Sue Carlisle, M.D., SFGH, gave her own history; described problems in area of
anesthesiology with recruitment and retention.
- Guy Paiement, M.D., SFGH, described specialized services and difficulty in providing
specialty services; only one kind of health – not public vs. private; poor people are
- Stephanie Tashay, Committee of Interns and Residents, urged high quality health care to
indigents; health care is a right; doesn’t support a Strategic Plan that limits care.
- Teresita C. Gatan, Local 250, stated the care for patients is being decreased by budget
cuts; need for adequate oversight or health care and need to work with community
organizations; private hospitals are dumping patients to SFGH.
- Lynn Carman (submitted written testimony) given by Nora Roman; restore level of care in
ER; expressed objections to the Department’s Strategic Plan; gave notice of potential
lawsuit on behalf of a client.
- Margaret Wheeler, M.D., SFGH, commented on Strategic Plan; fears the emperor has no
clothes; focus on primary prevention is difficult to measure.
- Richard Price, M.D., SFGH, would like to deliver first class care; need to maintain a
critical mass of patients and providers in order to serve indigent; reverse downsizing of
- Dean Shepherd, M.D., SFGH, described a large community of scientist physicians who give
many hours of patient care; these physicians want to be here.
- Chip Chambers, M.D., described a disconnect in the Strategic Plan regarding the trauma
unit and infectious disease clinic; looks forward to fixing the situation.
- Bob Lull, M.D., incoming President of S.F. Medical Society, is proud to be with the
physicians in the CHN/SFGH; CHN is vital to the health system of the City; maintain all
services at SFGH; willing to be part of future planning in the City.
Action Taken: The Commission unanimously approved the following documents with the
- Hospital Plan for Provision of Patient Care
- Quality Improvement Plan
- Utilization Management Plan
- Competency Plan
- Environment of Care Update
President Guy stated decisions regarding capital planning for SFGH will be made at a future
date. More public discussions will occur in January 2001.
Commissioner Monfredini requested an access pass to SFGH so that she can make visits to
SFGH. She needs to know more.
Commissioner Sanchez stated the testimony heard today is historical because two years ago a
similar message was delivered; the SFGH model is at risk and we need to move forward with a
bond initiative. He is touched by the dedication of staff.
Commissioner Chow offered to meet with any of the speakers; what are alternatives to
deliver care in a different mode; what should the size of SFGH be in order to allow for
academic and a university presence? He is not sure of the issues of reduction at SFGH in the
Strategic Plan. He thanked the speakers.
Commissioner Umekubo thanked the speakers and expressed his commitment to maintain SFGH as
a crucial role in the health care system in the City. He advocated for a collaborative
strategy with all parties, including the S.F. Medical Society. He expressed that Option 4 if
not an option (i.e., phasing out SFGH).
Commissioner Parker advocated to come together and decide what to do. There are too many
turf issues and in fighting. He feels everyone will survive and SFGH will not fade away; but
we cannot continue to find blame.
Dr. Katz thanked the speakers and expressed his appreciation to the Commission for its
understanding of the hard realities. He and the Commission believe that health care is a right
for all, but our country does not believe this. The Federal government does not support this.
Everyone, other than the City, has abandoned SFGH. To some degree, UCSF has abandoned SFGH
(i.e., residents). The University funding is less due to its own funding decreases and its own
hard times. Dr. Katz reiterated the housing crisis in the City, the increase is homelessness,
all hospitals having recruitment/retention problems, and the nursing shortage. However, the
City has increased support for SFGH, but the amounts removed by the Federal and State levels
cause a huge problem. He qualified his comments on improvements at SFGH in that he is
referring to improvements in moving patients from SFGH to LHH. He also believes that the
affect on morale has to do with increasing needs and decreasing State and Federal support. The
City and County are committed and are supporting SFGH. The facts and figures do not support
that the City/County is not supportive. The City and County is not the enemy.
President Guy expressed appreciation to the speakers for their input and commitment. She
believes there is deterioration in public health. Primary care is important; and we cannot say
no to the African American Health Initiative. Housing is a health issue; prevention, primary
and tertiary care do work. She encouraged problem-solving not to be competitive and will go
anywhere to talk to people. She is willingly a Commissioner and as the President. She
expressed appreciation for the U.C. Affiliation Agreement and the fact that a formal
presentation and crucial information on the Affiliation Agreement was provided to the
Commission. She appreciates the UCSF leadership. She also encouraged the Department to work on
improving payment methodologies. Additionally, she encouraged staff to prepare information for
the Commission in the direction of building a new SFGH by 2013.
All of the Commissioners indicated their support for a new conforming SFGH by 2013.
Commissioner Chow cautioned that the Commission needs to have logic and support for a specific
direction and size of SFGH with support from the public.
Dr. Katz will bring back to the Commission sometime in January with a potential policy
direction. There may be a need for a special Commission meeting in January.
6) OTHER BUSINESS/PUBLIC COMMENTS
The meeting was adjourned at 7:50 p.m.
Sandy Ouye Mori, Executive Secretary to the Health Commission