Minutes of the Health Commission Meeting

May 15, 2001
3:00 p.m.
at 101 Grove, Room 300
San Francisco, CA 94102



  • President Roma P. Guy, M.S.W.
  • Commissioner Arthur M. Jackson
  • Commissioner Harrison Parker, Sr., D.D.S.
  • Commissioner David J. Sanchez, Jr., Ph.D.
  • Commissioner John I. Umekubo, M.D.


  • Vice President Edward A. Chow, M.D.
  • Commissioner Lee Ann Monfredini


Action Taken: The Commission approved the Minutes of May 1, 2001.


(3.1) CHN-Jail Health Services - Request for approval of a new contract with Medical Diagnostic for the provision of mobile X-ray services for inmates of the County Jail and clients of the TB control unit of the Department of Public Health, in the total amount of $660,000, for the period of June 1, 2001 through June 30, 2005.

(3.2) CHN-Dept. of Education and Training - Request for approval of a new contract with HealthStream, Inc. to provide access to internet-based healthcare regulatory training courseware for employees of the Department of Public Health, Community Health Network, for the total amount of $418,250, for the period of June 1, 2001 through June 30, 2005.

(3.3) CHN-SFGH - Request for approval of a contract modification with Healthcare Financial Solutions in the amount of $53,532, for a total amount of $110,734, to provide reimbursement and revenue optimization services for San Francisco General Hospital, Health at Home Agency and Laguna Honda Hospital, for the period of April 1, 2001 through March 31, 2002.

(3.4) PHP-CSAS - Request for approval to retroactively accept and expend a new five-year grant from the State of California, Department of Drug and Alcohol Programs, in the amount of $1,107,660 ($221,532 annually) to enhance and expand Juvenile Drug Court services, for the period of December 29, 2000 to December 28, 2004.

(3.5) PHP-CSAS - Request for approval of a contract modification with Japanese Community Youth Council, Inc. (JCYC), in the amount of $1,899,365, for a total four-year amount of $2,508,942 to provide substance abuse prevention services to Asian American youth, for the period of July 1, 1998 through June 30, 2002. (DPH contracted with JCYC for services totaling $621,867 during FY 99-2000).

(3.6) PHP-CMHS - Request for approval of a new contract with Harder+Company Community Research in the amount of $149,983 to develop a model program for dually diagnosed youth, for the period of April 1, 2001 through December 31, 2001. (DPH contracted with Harder for services totaling $28,000 during FY 1999-2000).

(3.7) PHP-CMHS - Request for approval of a retroactive sole source contract renewal with Alameda County Health Care Service Agency (ACHCSA), in the total amount of $3,300,960 for four years, to provide fiscal management services and access to 24-hours skilled nursing neurobehavioral care and adolescent subacute mental health services targeting individuals with Organic Brain Syndrome impairment, for the period of July 1, 2000 through June 30, 2004. (DPH contracted with ACHCSA for services totaling $979,967 during FY 1999-2000).

(3.8) PHP-Health Promotion - Request for approval of a retroactive contract modification with CAHEED, Inc. in the amount of $70,800, for a contract total of $207,090, to provide augmented Black Infant Health Improvement Program services targeting African American families and communities, for the period of July 1, 2000 through June 30, 2001. (DPH contracted with CAHEED for services totaling $136,290 during FY 1999-2000).

Action Taken: The Commission approved the Consent Calendar of the Budget Committee.

(Anne Kronenberg, Acting Director of Health, presented the Director's Report on behalf of
Mitchell Katz, M.D., Director of Health)


General Overview

On May 14, 2001 the Governor issued the May Revision to his budget. The May Revision projects a $1.144 billion increase in revenues for the current fiscal year (2000-01) and a $4.592 billion decrease in revenues for 2001-02. This results in a combined two-year reduction of $3.448 billion. As a result, the May Revision reduces General Fund expenditures by $3.177 billion. (All reductions and increases reported here are in comparison to the Governor’s January budget.)

It is important to note that these cuts are the result of the economic downturn and do not reflect any reductions due to energy expenditures. Revenue increases from capital gains, stock options, personal income tax, corporate sales tax, and sales tax are slowing down. On May 10, 2001, the Governor signed a $13.4 billion revenue bond package that will repay the General Fund for amounts advanced to purchase power for the State. The May Revision assumes that these revenue bonds will be sold in August and will reimburse the General Fund at that time.

As in previous documents, the budget declares a declining need for health care funding at the local level because of:

  • Expansion of Medi-Cal and Healthy Families “shifting responsibility for health care coverage from county to federal and state funded programs”;
  • Availability of local Tobacco Settlement Funds;
  • “Growing” health Realignment funds; and
  • $53.7 million directed to breast cancer treatment, research and screening.

Budget subcommittees will be holding their final hearings this week, including consideration of the many items placed on their suspense files pending the May Revision. Below is a synopsis of health related provisions of the May Revision.

Tobacco Settlement Funds

The State expects to receive approximately $475 million in tobacco settlement revenues in 2001-02 ($7 million more than projected in the Governor’s January budget). The Governor’s May Revision continues to support earmarking all of the State’s tobacco settlement revenues for health programs. However, this has the effect of supplanting State General Funds with tobacco settlement funds and resulting in decreased State General Fund commitment to health services. The May Revision continues funding for Medi-Cal, Child Health and Disability Prevention Program (CHDP), breast and prostate cancer treatment, and youth anti-tobacco at the same levels as in the January budget.

The May Revision reduces 2001-02 spending for Healthy Families by $44 million as a result of a delay in federal waiver approval to expand the program to include uninsured parents of children enrolled in Healthy Families or Medi-Cal and children with family incomes between 200% and 250% of the federal poverty level. The May Revision assumes an October 1, 2001 start date.


The May Revision decreases the current year (2000-01) Medi-Cal budget by $266.4 million and increases the 2001-02 budget by $367.7 million. The majority of this shift can be attributed to $175 million of the Orthopaedic Hospital settlement expense that has been shifted from the 2000-01 fiscal year to the 2001-02 fiscal year. Additional expenditure reductions in the current year are a result of smaller than anticipated increases in the cost of nursing facility care, savings in county administration costs due to reduced caseload activity, and drug costs increasing more slowly than projected.

In 2001-02, $225.1 million of the projected $367.7 million increase in Medi-Cal spending is for the Orthopaedic Hospital settlement. Additional expenditures of $46.1 million for long-term care rate increases (including a 2.15% increase for nursing homes), $43.5 million for increased county administration costs, and $25 million for a managed care rate increase (2%) are also included in the May Revision.

Healthy Families

Current year General Fund spending for Healthy Families is expected to be $6.4 million lower than projected in the January budget due to slower than anticipated caseload growth. In 2001-02, overall General Fund expenditures are expected to increase by $10 million. However, net expenditures are expected to decrease by $76.9 million, in part as a result of the delay in federal approval of the State’s waiver. The General Fund expenditure increase is due to a higher than anticipated enrollment of children with family incomes between 100% and 200% of the federal poverty level.

Public Health

In comparison to the January budget, the May Revision reduces current year public health expenditures by $5.6 million and 2001-02 public health expenditures by $27.2 million.


The May Revision eliminates the $2 million increase in public health subvention included in the Governor’s January budget. This reduces public health subvention to fund communicable disease control and surveillance at the local level to $1 million statewide.

Caseload Programs

Current year reductions of $6.1 million are attributed to reduced caseload in California Children’s Services (CCS), CHDP and Genetically Handicapped Persons programs. An additional $3.9 million is deducted from these budgets in 2001-02 due to further declines in caseload and health care costs in these programs.

Proposition 99

The Governor anticipates a reduction of $77,000 in Proposition 99 revenues for 2000-01 and a reduction of $14.7 million for 2001-02. In 2001-02, the May Revision proposes program reductions of $18.3 million to accommodate reduced revenue and increased caseload in the Access for Infants and Mothers (AIM) program. These reductions include a $12.7 million decrease in the California Healthcare for Indigents (CHIP) program. The May Revision continues to budget $24.8 million for emergency physicians and $114.5 million for an anti-tobacco media campaign.

The May Revision also proposes trailer bill language to limit the discount given to tobacco wholesalers and distributors for affixing tax stamps to tobacco products. This will result in approximately $9.7 million in revenue, which the Governor proposes to use to supplement the Proposition 99 and Proposition 10 funds, as well as contribute to breast cancer prevention and research, and the State’s General Fund.

Behavioral Health

Mental Health

The May Revision includes a net increase of $26 million (a $5.3 million reduction in General Funds) for community service programs in 2001-02. This increase includes a $9.5 million federal block grant allocation and $15.4 million in federal reimbursements for the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program and for a San Mateo County test program. General fund programs in the Department of Mental Health are reduced by $22.4 million. These reductions include $5 million to withdraw the discretionary 3% cost of living adjustment for mental health managed care and a $5 million decrease in the supportive housing program. The budget continues $20.1 million in supportive housing programs and $55.6 million for Integrated Services for Homeless Adults. The remaining reductions of $12.4 billion are for deferred maintenance projects at State hospitals.

Alcohol and Drug Programs

The May Revision projects a $10 million reduction in current year expenditures due to a delay in approval of the State Medicaid Plan amendment that would provide for additional Drug Medi-Cal services as of January 2001. The 2001-02 General Fund budget for alcohol and drug programs is reduced by a net of $34.7 million. The May Revision increases General Fund spending by $12 million for Perinatal Drug Medi-Cal, as well as, caseload growth and new unit cost services in Drug Medi-Cal. However, proposed reductions include $7.7 million in adult treatment services, a $5.7 million in youth treatment services, $8.5 million for drug court substance abuse treatment, and $24.3 million to reflect the delay in State Plan Amendment approval.

Aging with Dignity

The Governor’s May Revision includes an additional $57 million General Fund for 2001-02 for the In-Home Supportive Services (IHSS) program to increase the State share-of-cost of employee wages for Public Authority (PA) and non-PA providers, fund the State share of benefits up to $.60 for various PA providers, and increase Maximum Allowable Contract Rates. The May Revision also an additional $46.1 million for increased long-term care rates and eliminates the $1.5 million augmentation for the Linkages program.

Federal Health Insurance Portability and Accountability Act (HIPAA)

The May Revision includes $152.1 million ($37 million General Fund) for HIPAA implementation within the Health and Human Services Agency, the Department of Health Services, the Department of Mental Health, the Department of Developmental Services and the Department of Alcohol and Drug Programs.


Newcomer's Program

As one of the newest refugee groups in the San Francisco Bay Area, little had been documented on how Bosnian refugees are faring and how they have adjusted to their new country and its health care, education, and employment systems. The Newcomers Health Program has recently published a report entitled "Bosnian Refugees in San Francisco: A Community Assessment". This project was undertaken to assist staff in program planning, grant writing, and developing community collaborations. This report, also posted on the Department's website, presents a baseline picture of the Bosnian refugee population in San Francisco County.

Senior Pedestrian Awareness Day

Staff from the Department's Community Health & Safety Section hosted a rally at noon today on the steps of City Hall in recognition of Senior Pedestrian Awareness Day. The event also kicked off a new senior pedestrian safety poster campaign and featured several of the seniors whose photos appear on the posters. Senior pedestrians are being killed at three times their proportion of the population and once they're hit in a collision, seniors are four times as likely to die. Today's rally was an opportunity to focus on the hazards to all pedestrians, and especially the most vulnerable. Representatives from the Board of Supervisors, Parking & Traffic and the San Francisco Police Department joined members from a variety of senior and safety advocacy groups for the event.

Nutrition Services Raises $1000+ for March of Dimes

The Nutrition Services Program raised over $1000 at this year’s March of Dimes "Walk America." The nutrition services team promoted their healthy eating and physical activity message wearing "Feeling Good" t-shirts.

WIC and “Feeling Good” Team up at Farmers’ Market

The WIC Program and the "Feeling Good" Project will be doing outreach at both the Heart of the City and the Ferry Plaza Farmers’ Markets this summer. WIC participants will receive coupons for fresh produce. Staff will be providing colorful aprons to vendors, distributing samples of fruits and vegetables and sharing information about healthy eating. WIC staff will be looking to enroll clients into the WIC program at the markets from June through September.

Minor Consent

The Department recently approved a new policy on "Minor Consent for Non-Emergency,

Primary Care and Mental Health Services. The purpose of the policy is to provide uniform guidance to the Department's health care providers who work with dependent minors ages 12 to 17 who present for services with or without parental consent. This policy will enable primary care and mental health providers to work together with youth and their families to address adolescent health issues and offer much needed support.

The policy was developed by the Department's Coordinating Council for Children, Youth, and Families with input from parents, social workers, physicians and Nurses. The policy is also available on DPHNet.



2001 YTD

New Appointments



  Reinstatements 1








  Reappointment Denials:






Disciplinary Actions



Restriction/Limitation- Privileges



Changes in Privileges




  Voluntary Relinquishments



Immediately preceding the Director's Report, President Guy stated that two senior staff people were leaving the Department to accept other opportunities. President Guy and Ms. Kronenberg honored Tangerine Brigham, Director of Policy and Planning, and later in the meeting, Melissa Welch, M.D., Chief Medical Officer for the Community Health Network, for their many years of service, advocacy, and accomplishments.


On behalf of the Health Commission, Commissioner Sanchez presented the following awards:

Individual Nominees


Nominated by

Mela Yee, Pharmacy Technician

DPH - Community Health Services

Yuki Kubo-Hendricks, Director, Pharmaceutical Services

Team Nominees


Nominated by

Ning Aguirre
Blanca Canjura
Frances Culp
Bill Haskell
Colleen Johnson
Joanne Kimata
James Soos
Emeline Zapanta

DPH - Central Administration

Tangerine Brigham, Director, Policy and Planning


Monique Zmuda presented the Revenue and expenditure Report for the 3rd Quarter of FY 2000-01. Based upon revenue collected and billed, and expenses incurred for the first nine months of the fiscal year (until March 31, 2001), the Department projects a fiscal year end surplus of $2.1 million. However, the Department has not included increased energy costs in this projection. Based on expected increases to cover and energy costs in the current year, the Department anticipates that the entire surplus, plus additional supplementals, will be used to fund energy increases. The Report was Attachment A.

Commissioners' Comments:

  • Commissioner Sanchez asked whether COLAs (cost of living adjustments) for non-profits next year were included in the budget. Ms Zmuda replied that COLAs were requested, but not yet funded.

Public Comment:

  • Nora Roman, Emergency Coalition to Save Public Health, stated (in connection with a Commissioner's comment concerning hiring freezes) that DPH actually did have a hiring freeze, because it does not have enough staff. Ms. Roman stated that the picture is not okay, merely because the budget is in balance.


Barbara Garcia, DPH Deputy Director of DPH for Population Health and Prevention, and Co-Chair of the City's Population 36 Steering Committee, presented on behalf of the Department.

Proposition 36 requires probation and drug treatment in lieu of incarceration, for conviction of possession, use, transportation for personal use, or for being under the influence of a controlled substance, and related parole violations. The Act goes into effect statewide on July 1, 200 1.

Ms. Garcia began by honoring and thanking San Francisco District Attorney Terrence Hallinan for supporting Proposition 36 and for being an advocate for treatment. District Attorney Hallinan thanked Ms. Garcia, and the unique team of prosecutors and public health that worked on implementation issues. Mr. Hallinan stated that addiction and abuse are primarily medical problems. He added that he saw Proposition 36 as not just refraining from locking up people for using drugs, but also seriously begins to cure addiction and abuse in California.

Ms. Garcia described the provisions of Proposition 36, which applies to individuals convicted of certain non-violent drug possession offenses are eligible. She emphasized that during the planning process, the various subcommittees were co-chaired by representatives of criminal justice and health. According to Ms. Garcia, DPH, as the County Lead Agency, has coordinated the development of a county plan. She added that the Department will now need to provide for services or contract for services, administer funds, coordinate data collection and reporting, and coordinate evaluation of county programs. Ms. Garcia discussed other issues, such as programs, budget, stakeholders, and timetables.

A copy of the report delivered by Ms. Garcia before the Commission was Attachment B.

Public Comment:

  • Marcia Rosenbaum was one of the drafters of Proposition 36. She said that San Francisco is implementing Proposition 36 the way that the drafters envisioned. She stated that Ms. Garcia visualized treatment in a way that gets to the root of the problem.
  • Barbara Farrell, Executive Director of the OhIhoff Recovery Programs, thanked Ms. Garcia and Mr. Hallinan for their inclusiveness on this issue. She said that this is a wonderful opportunity to document how treatment benefits the community.
  • Nancy Cooper is the Director of the Ohlhoff Women's Residential program. She stated that women often feel disgrace with their drug and crime situation, and that it is important to help these women. She stated that the plan presented was a great job, and urged the Commissioners to support it.
  • Frederick Hobson appeared on behalf of the San Francisco Drug Abuse Advisory Board, an official body reporting to the Board of Supervisors. He thanked the Department for participating and conducting the Town Hall Meetings. He asked the Department to identify funding for treatment slots.
  • Nora Roman, Emergency Coalition to Save Public Health, asked the Commissioners to look at the peoples budget proposal for this year, where she said are several exciting culturally competent treatment programs.

Commissioners' Comments:

  • Commissioner Sanchez commended the two Co-Chairs as demonstrating what counties can do in this area. He complimented the inclusiveness of the planning effort. The Commissioner added that the bigger challenge will be the quality assurance to be sure that all systems are operational.
  • Commissioner Jackson echoed Commissioner Sanchez's words. He stated that this type of program is essential, and a long time in coming.
  • Commissioner Parker believes that this program will add a sense of justice to the overall system. He stated that the documentation was outstanding, and that the stakeholders were enthusiastic.
  • Commissioner Umekubo thanked everyone for leading the way with this innovative program. He asked Ms. Garcia what happens after the presently available 1000 slots are filled. She replied that DPH would try other capacities. She cautioned that, from a funding perspective, DPH wants to balance the voluntary treatment programs that the City maintains now with the Proposition 36 slots because DPH does not want people to have to face jail to seek treatment.
  • President Guy added her support to the leadership that created and implemented the Proposition 36 policy. She asked how DPH will evaluate and monitor this program for impact. President Guy stated that DPH must be ready in a year or two with quality analysis.


The Proposition Q hearing concerned a plan by St. Mary's Medical Center (SMMC) to close its 22-bed Adult Inpatient Psychiatric Program and to transition those patients and staffing needs to the 35-bed Saint Francis Memorial Hospital (SFMH) Adult Psychiatric Services Department. In addition, SMMC plans to close its Electro Convulsive Therapy Program that affects approximately 32 patients per year. MSMMC also plans to increase its Adolescent Psychiatric Inpatient Program from 17 to 21 beds.

Several representatives from SMCC made presentations to the Commission during the Proposition Q hearing. Ken Steele, Interim President at SMCC, introduced other SMCC representatives, including: Stephen Krause, M.D., Medical Director of McAuley Institute at SMMC; Cheryl Fama, President, SFMH; Mel Blaustein, M.D. Medical Director for Psychiatric Services, SFMH; and Jim Illig, Chair, SMMC Community Advisory Committee.

Mr. Steele stated that SMMC is not closing, and expects to break even financially. He views the closure of the Adult Inpatient Psychiatric Program as a transfer. Mr. Steele said that although the unit has 22 beds, its average census is 14 patients. He added that the SFMH facility was recently renovated. Dr. Blaustein stated that SFMH can absorb the transferred patients, and that three physicians are transitioning from SMMC.

Mr. Steele spoke about the level of reimbursements that SMMC receives from the City, and that the program costs SMMC $1.60 for every $ 1.00 that it receives in revenue. Mr. Steele stated that SMMC is seeking a rate increase from the City. Ms. Fama added that SFMH loses money on adult inpatient psychiatric services.

Attachment C had more information.

Public Comment:

  • Helga Carlton, has been a psychiatric nurse at St. Mary's Medical Center for 21 years. She questioned why St. Mary's would close a needed unit, and why San Francisco would allow it.
  • George Oulette is a CNA at St. Mary's. He stated that staff were told to keep the unit's census low. He believed that the consequences of the closure would be that clients would be on the street.
  • Stephanie Hadabaus, R.N., spoke about the bed closures. She stated that patients are sicker today, with fewer staff to care for them. She questioned the safety of the patients, with each nurse caring for 6 - 8 patients. Ms. Hadabaus added that St. Mary's has long provided specialized services for patients; and that Saint Francis Memorial Hospital cannot adequately treat the same patients.
  • Lynn Herring read a statement on behalf of Naomi White of St. Mary's. She stated that under the St. Mary's proposal, patients will be warehoused and receive less care.
  • Pam Ernst, R.N., is the Manager of adult psychiatric inpatient services at St Mary's. She believed that the unit's closure would be a tragedy.
  • Nancy Cox, has been a RN, at St. Mary's for 19 years. She asked that the closure be reconsidered. She further stated that many people depend on the unit for care and will find themselves in trouble.
  • Nora Roman, Emergency Coalition to Save Public Health, said that she was concerned with all services, and that cutting any beds is not sound health care policy. She asked that health care not be viewed as a commodity, and to support legislative efforts to increase charity care.
  • Ray Castro has been an R.N. at St Mary's for 17 years. He is concerned about St. Mary's ability to respond to a community emergency.

Commissioners' Comments:

  • Commissioner Parker stated that he was concerned about the downsizing, but that the Commission was receiving mixed messages: 1) that there are not enough patients to keep the unit open, and 2) that the reimbursement rates are too low to keep the unit open. Kenneth Steele responded that payors are not willing to pay full costs of services, and that the City controls many beds.
  • Commissioner Sanchez noted that St Francis upgraded its 35 bed adult psychiatric unit. He stated that the efficacy and quality of care are the primary issues. Diane Roberts, Clinical manager of Psychiatric Services at Saint Francis, stated that the adult psychiatric units at SMMC and St. Francis have operated at 50% capacity for years, and that St. Francis Unit was never full. Ms. Roberts stated that the patients were selected by need, not by payor mix. She offered reassurance that St Francis will be able to accommodate new people
  • Commissioner Parker stated that if St. Mary's does not survive, then it will be of no use to anyone. He asked whether the low number of beds was due to financial concerns or related to patient health. Ms. Roberts responded that, over the last 10 to 15 years, there has been tremendous changes affecting psychiatric patient treatment and hospitalization. She added that payors have restrictive criteria for when they will pay.
  • President Guy asked if the beds have ever been filled to capacity. Cheryl Farna of SFMH, did not think that the 35-bed capacity had been reached. In response to President Guy's further question, Ms. Fama stated that there was probably not a need for additional adult acute psychiatric care beds.
  • Commissioner Jackson asked several questions regarding rates and rate increases. He questioned whether the elevator in the AIDS Dementia Unit, discussed during a previous Commission meeting, was now working. Mr. Steele answered no, that the elevator technology was not yet installed. Commissioner Jackson then stated that from a business standpoint, a $1.60 service cannot be provided for $1.00.
  • President Guy clarified the purpose of that day's Proposition Q hearing, which was whether the closure of the SMMC programs would have a detrimental impact upon the public health of San Francisco. She stated that the Commission does not oppose SMMC maintaining its priority on adolescent psychiatric inpatient services.

Linda Wang, Director, Adult and Older Adult Systems of Care, DPH, discussed the future needs for adult psychiatric inpatient beds. Ms. Wang prepared a Memorandum for the Commission in which she concluded that the City probably would not be short on adult psychiatric inpatient beds next year. She discussed average usage, but warned that psychiatric needs do not always follow averages. Ms. Wang identified peak usages, and out of county placements. She added that SMMC has provided extremely valuable services to City.

  • President Guy stated that what once was excess capacity is now consolidated. She questioned whether, with low reimbursement rates, the City will be faced again with the same situation. Ms. Fama responded that consolidating 25 to 30 patients would help to bring costs down. She anticipates improved rates from some of the managed care companies. Ms. Fama would like to cover the operating costs. President Guy added that one lesson of Proposition Q is that different parties must work as allies, for example in seeking higher Medi-Cal reimbursement rates, instead of competitors.
  • Commissioner Sanchez stated that these are difficult hearings. He suggested looking at alternative sources of funding, such as foundations and religious institutions.

President Guy thanked everyone for participating in the hearing, which will be continued to the next meeting.


Public Comment

Elizabeth Frantes commented on the Director's Report. She stated that people need better access to health care, and that the Commission should listen to providers, and to stop listening to the same people who got the Department into the current mess. Ms. Frantes also stated that the Healthy Families program discriminates against childless people.

President Guy adjourned the meeting at 6:35 p.m.

Arthur R. Greenberg, Interim Health Commission Secretary