Minutes of the Health Commission Meeting

June 5, 2001
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, M.S.W., at 3:05 p.m.

All Commissioners were present:

  • President Roma P. Guy, M.S.W.
  • Vice President Edward A. Chow, M.D
  • Commissioner Arthur M. Jackson
  • 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 adopted the minutes of May 15, 2001

(Commissioner David J. Sanchez, Jr., Ph.D.)
Commissioner Sanchez chaired, and Commissioners Monfredini and Jackson attended, the Budget Committee meeting.

(3.1) CHN - Request for approval of a contract modification with Asereth Medical Services, Inc., to increase the contract amount from $900,000 to $1,100,000, to provide as-needed supplemental pharmacy personnel services, for the period of July 1, 2000 through June 30, 2001.

(DPH contracted with Asereth for services totaling $1,190,000 during FY 1999-2000).

Commissioners’ Comments

Commissioner Parker asked if the modification, which was almost like moving funds from one pocket to another, was appropriate. Dr. Katz responded that the DPH budget is now almost $1 billion per year, and that it is difficult to anticipate needs in advance; therefore, to respond to areas of need, sometimes DPH must move money from one area to another.

(3.2) CHN-Medical Records and Radiology - Request for approval of two renewal contracts and one new contract, respectively, with the following firms: Mediscript, Transcription Stat, Inc. and Pacific Medical Transcription for a combined total amount of $1,005,000, to provide intermittent, as-needed medical transcription services for Medical Records and Radiology of the Community Health Network, for the period of July 1, 2001 through June 30, 2003.

(3.3) CHN-SFGH/Health Information Services - Request for approval of a sole source renewal contract with Deliverex, Inc., in the amount of $790,000, for the purpose of storing, retrieving and delivering medical records for San Francisco General Hospital’s Health Information Services, Medical Staff Services and Radiology Departments, for the period of July 1, 2001 through June 30, 2003. (DPH contracted with Deliverex for services totaling $275,000 during FY 2000-01).

Commissioners’ Comments

Commissioner Monfredini asked about the performance of the contractor. Barry O’Brien, a representative from the contractor, stated that it was difficult getting into the facility. Robert Brody, M.D., the DPH presenter, stated that he would check with the SFGH records manager to help ensure appropriate access for the contractor.

Commissioner Parker asked why there was a large increase in fees. Monique Zmuda, DPH CFO, responded that there has been an increase in regulatory requirements and in the volume of medical records.

(3.4) CHN-SFGH/Medical Staff Services - Request for approval of a sole source renewal contract with Medical Staff Services Registry, Inc. (MSSR), in the amount of $150,000, to provide as-needed credential verification for San Francisco General Hospital, for the period of July 1, 2001 through June 30, 2003. (DPH contracted with MSSR for services totaling $54,000 during FY 2000-01).

(3.5) CHN-Jail Health Services - Request for approval of a renewal contract with Haight Ashbury Free Clinics, Inc. (HAFC) in the amount of $3,582,760, to provide psychiatric and substance abuse treatment services targeting inmates in the San Francisco County Jail system, for the period of July 1, 2001 through June 30, 2002. (DPH contracted with HAFC for services totaling $10,631,027 during FY 1999-2000).

Commissioners’ Comments

Commissioner Jackson asked Joe Goldensen, M.D., Director of Jail Medical Services, if the Department provided follow-up treatment for inmates after discharge. Dr. Goldensen described the follow-up services provided.

(3.6) CHN-Primary Care - Request for approval of a renewal contract with St. Mary Pharmacy Management Services (SMPMS), in the amount of $135,000, for the provision of as-needed pharmacy services for clients of Youth Guidance Center and associated programs, for the period of July 1, 2001 through June 30, 2002. (DPH contracted with SMPMS for services totaling $1,779,756 during FY 1999-2000).

(3.7) PHP-Housing and Urban Health - Request for approval of a new contract with Baker Places, Inc., in the amount of $630,151, to provide supportive housing targeting formerly homeless tenants, for the period of July 1, 2001 through June 30, 2002.

(3.8) 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 $1,996,661, to provide Model Tuberculosis Education and Control Center services to local and national TB health care providers, for the period of July 1, 2001 through December 31, 2001. (DPH contracted with UCSF for services totaling $13,999,667 during FY 1999-2000).

(3.9) PHP-Mental Health/Substance Abuse - Request for approval of a modification to the contract with Positive Directions Equals Change, Inc. (PDEC), in the amount of $340,000, to provide substance abuse outpatient services with a family focus, targeting African Americans, for the period of May 1, 2001 through June 30, 2002. (DPH contracted with PDEC for services totaling $20,000 during FY 2000-01.)

Action Taken: The Commission approved the consent calendar of the Budget Committee, with Commissioner Sanchez abstaining on Item # 3.8, due to a conflict of interest.

(Mitchell H. Katz, M.D., Director of Health)


Mayor's Budget for FY 01-02

The Mayor's budget for FY 01-02 was transmitted to the Board of Supervisors last Thursday. Next year's Department of Public Health budget is proposed at $970.2 million, an increase of $77.4 million over the current year revised budget for $892.8 million. Please note that $25 million of this increase is attributed to the increase for next year's portion of the Laguna Honda Replacement project, funded from Tobacco Settlement Funds. The proposed budget includes funding to begin implementation of several very important Health Commission priorities. Highlights of the Mayor's Budget for the Department of Public Health include the following programs:

New Programs Funded with Additional State/Federal Revenues:


State funding to implement Prop 36 Drug Treatment Services.


State funding for increased methadone services.


Increased State and Federal allocation to expand substance abuse treatment services.


Increase in MediCal funding for expanded integrated mental health and substance abuse treatment programs.


State funding to annualize homeless Mental Health Services funded through SB2034.


Increase in MediCal funding to expand community based mental health services.


MediCal funding to increase mental health services for youth enrolled in Job Corps programs.


MediCal funding to expand pharmacy services, improve billing and collections, and improve contracting operations in mental health.


State funds to provide expansion to children in the California Children Services program.


Fee revenue increase to expand the adult immunization clinic.


Increase in fee revenues to fund a health impact assessment.


Tobacco settlement funding for the LHH replacement project.


State funds for emergency room physicians.


State funds to enhance information systems.


Increase in fee revenue to improve workflow at Vital Records.


State funds to fund vacant positions at community health.


Increased third party revenues for clinical pharmacy management services.


Increased third party revenues for behavioral focused unit at SFGH.


Increased third party revenues to fund trauma program enhancements.


Increased third party revenues to fund traumatic brain injury program.


Increased third party revenues to expand mammography services.


Increased third party revenues to fund over-night observation unit.


Increased third party revenues to fund medical high utilizer initiative.


MediCal revenues to reinstate costs associated with the continuation of the outpatient pharmacy.


Increase in third party revenues to fund enhancements to clinical information systems.


MediCal revenues to reduce salary savings, and to reinstate lost grant funded clinical position.


Increase to MediCal revenues to fund expansion of behavioral health services at Maxine Hall Health Center.


Increase to MediCal revenues to fund social work case management services in primary care centers.


Increase to third party revenues to expand home health services to children.

Funded with additional County General Funds


First year implementation of the HealthCare Accountability Act (Insurance program for contractors of the City)


First year implementation of the Children’s Insurance Initiative.


Increased funding for equipment. This includes state of the art diagnostic Laguna Honda, and a van for the mobile methadone program.


Funds for capital improvements at the Community based Primary Care clinics (on reserve). They include the following improvements:

  • $200,000 for Primary Care Clinic Signs

  • $437,000 for interior renovation, installation of an elevator and expansion of the dental space at Silver Ave. Health Center
  • $475,000 for interior renovation to reconfigure exam space, and install an elevator to maximize clinic space for Maxine Hall Health Center
  • $630,000 for expansion of exam rooms and patient waiting areas, and to upgrade mechanical systems at the North of Market Health Center expansion
  • 660,100 for renovations to construct additional exam rooms, expand patient waiting areas, and improve eligibility areas at Castro Mission Health Center
  • $338,900 for renovations to construct additional exam rooms and installation of an elevator to serve the existing second floor of Ocean Park Health Center
  • $750,000 for the replacement of existing mechanical systems and reconfiguration of eligibility areas at the Chinatown Health Center
  • $800,000 for the construction of an annex to increase counseling capacity and make improvements to ADA compliance at the Sunset Mental Health Clinic
  • $450,000 to fund a portion of the feasibility and design of the proposed expansion of the Southeast Health Center.
  • $259,000 for the replacement and upgrade of exterior wood siding and repair of various exterior areas at the Potrero Hill Health Center.


Funds (budgeted in PUC) for energy improvements, including replacement of lighting and air systems at health centers, a replaced cogeneration system at SFGH, and a replacement of the air system at SFGH.


Increased General Funds to pay for rent increases in civil service leased facilities.


Continuation of the SRO Hotel Collaborative for Fire Prevention Services.


Continue anti-gambling initiative.


Expansion mental health children’s services


Annualize start up programs and expand new Treatment on Demand substance abuse treatment services.


To fund a portion of the operating costs associated with the new Youth Shelter Program.


Local match for an HIV Prevention Grant.


Maintain the AIDS Office Reggie information and reporting system.


Personnel costs associated with the reinstatement of the outpatient pharmacy.


Maintenance of outreach services provided by Hospitality House.

These initiatives will enhance the Health Commission's policies aimed at reducing the number of uninsured, expanding community based alternative treatment services, increasing prevention services, and funding the Department's infrastructure.

District budget hearings were held in all eleven districts, and a final citywide public hearing on the budget is scheduled for June 16. The Finance Committee of the Board of Supervisors will hold departmental budget hearings in mid June. The dates for the hearings on the Health Budget are June 20 and 27. The full Board is expected to consider the budget in early July. I will keep the Commission informed about the budget as it progresses through the review and approval process.


Refugee Awareness Month Celebration

On May 30th, the Newcomers Health Program co-sponsored a "Refugee Awareness Month Celebration" for San Francisco County. Collaborating agencies included the International Institute of San Francisco, Private Industry Council of San Francisco, Refugee Transitions, Survivors International, Jewish Vocational Services, and Catholic Charities. Approximately 80 people attended the event, which was to honor and recognize the strengths and contributions of refugees in the San Francisco Bay Area.

Latino Asthma Awareness Media Project in San Francisco

The San Francisco Department of Public Health's Latino Asthma Media Project initiated its outreach to Latino asthmatics during World Asthma Day. Activities included bilingual PSAs for radio and TV, a press release, distribution of 29,000 bookmarkers and over 1000 posters sent to medical offices. Bay Area health agencies that serve Latinos affected by asthma are invited to participate by calling Leticia Medina,(415) 554-8930 x 12.

SFSU Health Education Program

On May 26, 2001 at the San Francisco State University Department of Health Education graduation ceremony, Tracy Moore, Program Coordinator for the Black Infant Health Improvement Project, was awarded the honor of Alumna of the Year. This honor is awarded based on the excellence in the practice of community health education and promotion. All of us in the Community Health Education Section and the department join Tracy and her family in celebration of this honor. Congratulations Tracy!

Domestic Violence Training

On May 11th, the Community Health Education Section's Children and Youth DV FREE, trained 48 community members who provide service to the parents of young children on the impact of witnessing domestic violence. For more information, contact Nora Goodfriend-Koven MPH, 554-2554.

At the conclusion of the Director’s Report, the Director and the Commission honored the recipients of the 2001 EMS Awards. The awards and recipients were:

  • EMS Field Provider Award, for outstanding performance in providing medical assistance on January 26, 2001, to a woman mauled by a dog: FF James Kucharszky, EMT-P; FF Frederick M. Salan, EMT-P; FF Carol L. Conley-Bodin, EMT-I; FF Robert D. Scheppler, EMT-I; and FF Chuck I. Watanabe, EMT-I
  • EMS Hospital Provider Award, for outstanding performance over a long career as the Nurse Manager of Kaiser’s Emergency Department: Carol Hayden BS, RN, Kaiser-Permanente Medical Center
  • EMS Community Member Award, for outstanding performance in advancing the causes of CPR and Public Access Defibulation: Karen Strain, American Heart Association; and Harrold Borrero, Ph.D., UCSF
  • Raymond Lim Excellence in EMS Award, awarded posthumously, for outstanding performance as an innovator in EMS systems in San Francisco and in California: Raymond Lim, King-American Ambulance Company

The Commissioners presented each recipient with a plaque, along with their congratulations and appreciation for their fine performance.


The Health Commission continued the Proposition Q Hearing that it began during its previous meeting of May 15, 2001.

Kenneth Steele reported that he is now the permanent President of St. Mary’s Medical Center (SMMC). In updating the Commission, he stated that the transfer of the adult inpatient psychiatric program to Saint Francis Memorial Hospital (SFMH) was proceeding. He added that SFMH has a better payor mix and is stable financially. Mr. Steele commented that SMMC had been in contact with Jo Ruffin, Administrative Director of Community Mental Health Services for DPH, who has provided expertise and assistance. Concerning staff relocation, Mr. Steele said that there were opportunities for SMMC nurses and other staff.

Referring to a previous topic concerning the care and safety of residents of the SMMC AIDS Dementia Unit, Mr. Steele reported that the elevator improvements will be installed in two to three weeks, and will be integrated with the fire safety system. He also stated that the safety of wandering patients, and the activity opportunities for those patients, has improved.

Commissioners’ Comments

Vice President Chow asked about psychiatrist assignments. Mr. Steele responded that most of the psychiatrists have privileges at SFMH. He was not certain how many clinical psychologists would work at SFMH. Cheryl Fama, President, SFMH, responded that SFMH would provide culturally sensitive adult psychiatric services. She stated also that SFMH has more than adequate capacity to address needs.

Commissioner Jackson asked [relating to a discussion at the May 15, 2001, meeting] about the unit costs at SFMH. Ms. Fama replied that the unit costs at SFMH were $1.40 or $1.50 for each $1.00 provided in service. She added that SFMH has upgraded its adult inpatient psychiatric unit.

Vice President Chow asked about capacity in the ECT programs in San Francisco. Mr. Steele stated that there is no definitive answer. Dr. Katz stated that SFGH does not perform ECT, due to a Board of Supervisor prohibition, but that the Department can acquire the service elsewhere.

Public Comment

Brian Walden is a case manager and performs intake at SMMC. He spoke about trans-institutionalization, when patients go from inpatient psychiatric beds to jails.

Action Taken: The Commission considered each of the two Resolved clauses of the proposed resolution separately. Four votes are needed for passage. Commissioner Umekubo abstained from participation due to a conflict of interest.

On the motion, “Resolved, that the closure of the Adult Inpatient Psychiatric Program at St. Mary’s Medical Center will not have a detrimental impact on the health care service of the community,” six Commissioners (Guy, Chow, Jackson, Monfredini, Parker, and Sanchez) voted aye. The motion passed.

On the motion, “Resolved, that the closure of St. Mary’s Medical Center’s Electro Convulsive Therapy (ECT) program will not have a detrimental impact on the health care service of the community,” six Commissioners (Guy, Chow, Jackson, Monfredini, Parker, and Sanchez) voted aye. The motion passed.

The Resolution approved by the Commission was attached.

Commissioners’ Comments

Commissioner Sanchez commented upon the open dialogue by all involved parties.

President Guy and Vice President Chow thanked the parties for their participation.


Dr. Katz began by thanking all of those involved in conducting the research and preparing the analysis for the Commission. He added that union workers and members of the religious communities helped this effort, and thanked members of the business community for their participation.

According to Dr. Katz, the City struggles with the question of how to provide universal health insurance. He stated that the health insurance coverage under the Health Care Accountability Ordinance (HCAO) is one step in that direction. Dr. Katz then provided a brief overview of the HCAO. The HCAO adds a new section to the San Francisco Administrative Code, requiring contractors that provide services to the City or enter into certain leases with the City (including certain subcontractors and subtenants) to do one of the following:

  • Offer health insurance benefits to employees working on City contracts or leased property. The employee must work 20 hours or more per week (in effect the first year of the HCAO); reduce to 15 hours by July 2002.
  • Make payments to the City ($1.50 per employee/hour worked) for use by the Department of Publics Health to help partially offset the cost of services for uninsured workers, or
  • Participate in a health benefits program that will be developed by the Department of Public Health.

Under the Ordinance, the Health Commission must determine the:

  • Effective date of coverage
  • Percentage of premium paid by employer and employee
  • Benefits offered under the coverage, and
  • Employee co-payments when accessing services

Dr. Katz then described the Department’s recommendations, which he stated the Health Commission is free to accept or modify. The Department’s recommendations, described by Dr. Katz and included within his Memorandum to the Health Commission (May 29, 2001), and the Department’s Proposed Resolution, are as follows:

  • The effective date of coverage shall be no later than the first day following the first complete calendar month worked by the employee.
  • The employers must offer at least one health plan option in which the entire monthly premium is paid for by the employer.
  • The health benefits shall include a mix specifically identified in the Memorandum and Proposed resolution.
  • The co-payments shall be a maximum of $10. for outpatient visits, and other amounts identified in the Memorandum and Proposed Resolution.

The Memorandum and Proposed Resolution was attached.

Dr. Katz emphasized several points. He stated that the Department is worried that paying a premium may deter some people from purchasing health insurance. He added that point of service co-payments may also reduce the utilization of necessary health services. Dr. Katz emphasized that the Department is not trying to create a new product, and that there are examples of businesses and non-profits offering plans with no employee premium.

Dr. Katz added that the HCAO covers only employees, not dependents. He also clarified that businesses with 20 or fewer employees, and non-profits with 50 or fewer employees, are exempt.

Public Comment

Taylor Emerson, from the Mayor’s Office, spoke about the budgetary implications. She stated her office conducted a conservative calculation of the costs. Ms. Emerson then informed the Commission that the Mayor’s Office has identified $4 million to address pass-through costs for certain contracts. She added that this figure assumes 100% pass through on non-profit contracts, and 65% pass through on for-profit contracts. Ms. Emerson added that tenants have no pass-through mechanism. In addition, Ms. Emerson suggested that Department contract managers will not allow contracts to pass through health insurance costs for insurance already provided and costs already absorbed.

Steven Cornell, President of Small Business Commission, states that small business is always looking for health insurance for its members and employees. The cost of insurance, and access, is very important to small business. He stated that there are 62,000 small businesses in San Francisco. He commented on what he considered the quick pace of the HCAO, and that it was never presented to an organized small business group. Mr. Cornell also voiced several concerns with the HCAO, including:

  • the exemptions’ affect on small business;
  • exemptions for businesses with long term contracts with the City (such as Pier 39 tenants and the San Francisco Giants);
  • the ways in which the $1.50 per employee/hour worked is calculated;
  • the availability of health insurance coverage for employees who work 15 hours per week [the HCAO standard in effect for next year];
  • the ways in which employees are counted;
  • whether the employer owes the City $1.50 per hour if the employee is covered under a spouses plan or Medi-Cal;
  • premium payments made by part time employees;
  • whether an employer would have to pay the City $1.50 per hour for three months in the situation where the employer’s health plan has a ninety day waiting period;
  • bookkeeping requirements for small businesses; and
  • added responsibilities for small businesses over their sub-contractors.

Mr. Cornell added that most small businesses do not have multiple plans for their employees. He stated that small business has not been asked to participate in planning for this Ordinance. Mr. Cornell asked the Commission to bring together all parties, and recognize the competitive impact of the HCAO on small businesses, which often operate on small profit margins. A copy of Mr. Cornell’s letter to the Commission (June 5, 2001) and recommendations was attached.

Dale Hess is the Executive Vice President of the San Francisco Convention and Visitors Bureau, and spoke as an individual contractor. He complimented the Commission for having the first hearing where there was due notice where contractors could make comments and ask questions. He stated that businesses need time to shop for coverage. Mr. Hess stated that his organization has a very good PPO plan, but that under the new standards it may need to acquire an HMO plan. He asked for 90 days to plan, or for a workshop session with staff. In addition, Mr. Hess stated that his organization uses 145 convention registrars, on-call and part time. He asked how the HCAO covers those people, and how the HCAO coverage relates to Medicare.

Scott Hauge is the founder of the San Francisco Small Business Advocates, and owns a small business. He believed that the HCAO moved too fast through the Board of Supervisors. He added that businesses are not irresponsible if they don’t provide recommended benefits, they sometimes cannot afford it. Mr. Hauge stated that some employers now have a 30-hour per week minimum to qualify for health insurance. He asked the Commission to work closely with the Small Business Commission.

Elizabeth Frantes stated that employer-based incremental health care coverage will not work. She stated that this proposal was another way for the Mayor to eliminate non-profits. Ms. Frantes added that this proposal covers only a tiny percentage of uninsured. She stated that the proposal won’t work and can’t work, but more bureaucracies will be created.

Father Peter Sammon is the Pastor at St. Teresa’s Church, and a representative of the Bay Area Organizing Committee. He stated that people have worked on this issue for over two years, and that there was an agreement in principle concerning this Ordinance. Fr. Sammon stated that the Ordinance is a work in progress, and that all organizations should work together. He argued against a sizable premium or co-payment; which he said would blunt the purpose of the Ordinance. Fr. Sammon stated that he meets people who must decide whether to buy food, pay the rent, or pay for health care.

Edelwina Mallari is a customer service worker at the Airport. She asked for the Commission’s support, and stated that many workers do not purchase the health insurance offered to them because it is too expensive.

Rosario Macapidlac is a sales associate at the Airport. She stated that she needs medical insurance because of her husband, and that she pays $90. every two weeks. She asked for the Commission’s support.

Charito Alviz works at the Airport, and stated that she is not enrolled in health coverage because it is expensive. She informed the Commission that she is receiving treatment at San Francisco General Hospital because she cannot afford insurance.

Father David Purdy is the Pastor at St Peter and Paul Church, North Beach, and is also a co-chair of the Bay Area Organizing Committee. He commended Dr. Katz’s presentation. Fr. Purdy stated that employers should not be allowed to shift costs to employees.

Rose Marie Ostler is a member of the Bay Area Organizing Committee. She stated that her husband is self-employed, and pays as much as $600. per month for health insurance. Ms. Ostler asked the Commission to pass the proposal.

Sister Kathleen Healy is a co-chair of the Bay Area Organizing Committee. She spoke in support of the Department’s proposal. She stated that a demand that low wage workers pay some part of their premium will not work because they must spend their money on other things. Sister Healy added that the Ordinance will be meaningless if that happens. She added that a co-payment higher than $10 will not make preventive care possible for low wage workers.

Rory Desmond, member of St. Teresa’s Church, and spoke in support of the proposal. He thanked Dr. Katz for his work. He said that there is an erroneous perception that input from the small business community was not sought. Mr. Desmond added that the Ordinance deals with people living on the edge concerning their budget, and some people may not access health care if they need to pay a co-payment.

Dale Butler is a staff person for Local 790, and a member of the BAOC governing board. He stated that there had already been agreement not have co-payments. Mr. Butler stated that the intent of the Ordinance is to provide health care and not use the SFGH emergency room. He stated that the only way to maximize the number of participants is to have the co-payment as low as possible; otherwise, people will drop out. He advocated a Kaiser-type HMO, which he said he recently negotiated for $1.03 an hour. He added that increasing the premium or co-payment would damage union workers.

Josie Mooney is the President of the San Francisco Labor Council and a member of BOAC. She stated that she spent a very long time in the Mayor’s Office negotiating with the business community, including the Committee on Jobs, the Chamber of Commerce, and the Golden Gate Restaurant Association. She said that she was surprised that members of business community claimed that they were not represented. Ms. Mooney hoped that the Commission would adopt standards for low-income workers; no premium costs, and no more than $10 co-payment.

Ron Smith is the Vice President of the Hospital Council. He thanked the Mayor, the Board of Supervisors, Dr. Katz, and the Health Commission. He stated it has long been the goal of the hospitals in San Francisco to have universal health insurance. Mr. Smith raised two points: 1) the $1.50 per employee/hour worked should go to each hospital emergency room, based on patients handled; and 2) he wanted to recommend a benefit program to the Commission.

Barry Hermanson spoke in favor of the Department’s proposal. He stated that the numbers of people insured drops as the costs of insurance increase. According to Mr. Hermanson, the population that the standards will cover make $20,000 per year or below. He believes that the $10 co-payment is appropriate.

John Gressman, from the San Francisco Community Clinic Consortium, talked about implementation strategies. He believed that community hearings were necessary, and that providers should be heard to determine who has interest and who has capacity. He advocated for culturally-competent community-based facilities, and to follow the Health Families model. He also stated that patients with special needs should be considered.

Gladys Sandlin, Executive Director of the Mission Neighborhood Health Center, applauds the Mayor and staff on this issue. She stated that the ordinance is groundbreaking legislation for the rest of the country. Ms. Sandlin added that reimbursement rates to providers must be adequate, to ensure that the safety net will not erode.

Kent Woo is the Executive Director of the NICOS Chinese Health Coalition. He applauds the effort to have health care for all San Francisco. He is concerned about how the ordinance will affect non-profit organizations, and suggested that a study be done. Mr. Woo wants to ensure adequate pass-throughs, and he has heard that some pass-throughs have cost some non-profits as much as $80,000 per year. He urged input from the non-profit organizations.

Patricia Breslin is the Executive Director of the Golden Gate Restaurant Association. She urged the Commission to consider the practical and financial affect of the proposed standards on small business. She stated that the insurance should not be prohibitively expensive for the employers to implement and fund. Ms. Breslin added the City’s small businesses, especially restaurants, are facing multiple fee and tax increases, rising energy costs, increasing garbage rates, and increased Health Department fees. She asked whether an employer will receive an exemption, if the employee has insurance coverage from another source, such a spouse or second job, or whether employers will have to make a double contribution. She asked the Commission to consider the size of the business, stating that no small business can cover an employee at the same per-person cost as the City. She urged a minimum 90-day waiting period, in light of administrative and indirect costs.

At this time, Dr. Katz stated that the employer’s obligation is not to provide insurance, but to offer insurance.

Glynn Washington is from the Human Services Network, a group of 65 non-profit entities in the City. His organization supports the Ordinance. He stated that in the Ordinance’s second year, coverage rolls back to 15 employee/hours worked per week, and that this is an issue because insurance is not available in the marketplace at that 15-hour level. He asked the Commission to make a priority on establishing the insurance pool, so that non-profits can cover their employees. Mr. Washington believed the Ordinance needs to specify how an employees hours are calculated for purpose of coverage. He stated that he will provide position papers to the Commission later.

Nathan Nayman, the Executive Director, Committee on Jobs, wanted to correct the testimony made by others and to set the record straight. He stated that the Committee on Jobs was a part of a coalition of small business and non-profit entities on the living wage issues, but was not invited to later meetings, except one the previous week and that they were not included in this last effort. He urged that Commission to pay attention to small business concerns.

Commissioners’ Comment

Commissioner Monfredini stated that workers should not have to pay health insurance premiums, but that they should be responsible for a co-payment. She asked which employer would be responsible for offering health insurance in the situation when the employee works for more than one employer. Dr. Katz responded that the City may need to get real experience with the ordinance before it can respond to theoretical questions. He added that after the Health Commission approves the minimum standards, that the Office of Contract Administration would be responsible for implementation.

Commissioner Jackson asked about coverage for employees who work for business with long-term contracts or leases with the City. Dr. Katz raised the possibility of contract amendments.

Commissioner Sanchez inquired concerning oversight of the standards. Monique Zmuda clarified that the responsibility of the Health Department would be to collect and gather information on the standard benefit package, and would forward any changes to the Commission. She stated that the Health Department will work closely with the Department of Administrative Services throughout the year.

President Guy commented upon the many assumptions that went into the Ordinance. She stated that it is important to work with the Department of Administrative Services to collect the appropriate information to monitor and evaluate this process for the next two years. She stated that the Commission and Department need to determine which scope of benefit questions need to be monitored and answered. President Guy asked the staff to recommend to the Commission what information needs to be collected.

Commissioner Sanchez suggested maintaining a comprehensive database pertaining to those areas for which the Commission is held responsible.

Vice President Chow stated that he was struck by the testimony concerning the people for which the Ordinance was targeted. He asked for assurance from staff that options are actually available, especially those that are culturally appropriate. Ms. Zmuda stated that the health Department attempted to survey the top 12 non-profits with which DPH contracts. She said that for the most part, the non-profits provide a generous package for full-time employees. She added that most non-profits provided a choice of an HMO and PPO. She said that the Department did not test the linguistic or cultural capabilities. Vice President Chow stated that the issue was whether, with one option at the minimum price, employees will be able to reach the providers appropriate for them.

President Guy commented on the historic aspect of the Ordinance. She stated that the Commission will undertake its homework, and will use the time until the next Commission meeting to understand the issues and recommendations presented.

Commissioner Umekubo left the meeting during the discussion, at 6:00 p.m.


Anthony G. Wagner provided the Commission with an overview of the Laguna Honda Hospital Replacement Project, as follow-up on the progress made since the last report to the Commission. He stated that the Replacement Project Team would present quarterly updates to the Commission.

Terry Hill, M.D, is the Medical Director of Laguna Honda Hospital. He stated that LHH clinical leadership views the replacement project as unique opportunity to reexamine LHH’s clinical programs, and to redefine LHH’s commitment to resident-centered care, reintegration with the community, and maintenance of resident independence. He stated that the LHH rehabilitation programs, outpatient clinics, Adult Day Health program, Alzheimer’s day care program, and senior nutrition program will be located at the physical heart of the new campus. Dr. Hill added that LHH will have 140 assisted living units on campus.

Michael Lane, Project Manager, delivered a quarterly report. He spoke about the design process, linkages to the community, project management update, and work in progress. According to Mr. Lane, the new LHH will include the complete continuum of long term care services. He stated that the Project Team is now more closely looking at issues of operating costs, dietary and materials management. Mr. Lane stated that the new LHH will be the first hospital in the country to possess a “green” certification.

Mr. Lane further reported that the project visited several different long term care sites in the Bay Area, New York, Chicago, and Wisconsin. He stated that the Team then ranked design criteria in the following way: resident rooms and windows; nursing units; family-style dining; access to outdoor; efficiency of operation; low first cost; community integration and community-based programs; clear organization and wayfinding, and reuse of historic buildings. He then discussed the present site plan and timetable.

Mr. Lane reported that the City has hired Turner Construction Company/CPM Services. He stated that construction inflation has been greater than originally forecast, and that the Project Team has looked at various measures to ensure cost-effectiveness. He anticipates that a full estimate will be available towards the end of July.

Commissioners’ Comments

Commissioner Monfredini reminded the Project Team of promises made to the voters concerning the new facility.

Vice President Chow inquired about the acute portion of LHH. Larry Funk, Executive Administrator of LHH, responded that the acute beds will be located on the 2nd floor of Esplanade, along with support services for those beds. He stated that is important for LHH to continue its acute licensure.

Vice President Chow asked about food service. Mr. Funk responded that food service is very important to long term care residents, and that the Project Team, looking at operating and capital costs, will try to bring the best quality food service and dining experience to the residents. He added that the Team is studying different food service methods, and contingency plans if the budget will not support preferred options.

President Guy supported periodic reports to the Commission, and thanked everyone for their work


Monique Zmuda, DPH CFO, stated that United States Treasury regulations require that the governing body approve and declare its intent to reimburse the costs of the projects already incurred from the proceeds of the bonds. She stated that the resolution will ensure that the Department complies with the regulations.

Action Taken: The Commission approved the Resolution unanimously, (Guy, Chow, Jackson, Monfredini, Parker, and Sanchez). (Commissioner Umekubo had previously left the meeting and did not vote).

A copy of the Resolution was attached.




A. Public Comment on All Matters Pertaining to Closed Session


B. Vote on Whether to Hold a Closed Session to Confer With Legal Counsel. (San Francisco Administrative Code Section 67.11(a)

Action Taken: The Commission voted to hold a closed session.

The closed session began at 7:10 p.m.

C. Closed Session Pursuant to Government Code Section 54956.9 and San Francisco Administrative Code Section 67.11(b)

Conference with Legal Counsel - Existing Litigation

Proposed total settlement of $24,500 in the Carol Ann Thomas vs. CCSF, United States District Court, Case # 00-3299

D. Reconvene in Open Session

1) Possible Report on Action Taken in Closed Session (Government Code Sections 54957.1(a)(2) and San Francisco Administrative Code Section 67.14 (b)(2)

Action Taken: The Commission (Guy, Chow, Jackson, Monfredini, Parker, and Sanchez) approved the proposed settlement of $24,500. (Commissioner Umekubo had previously left the meeting and did not vote).

2) Vote to Elect Whether to Disclose Any or All Discussions Held in Closed Session (San Francisco Administrative Code Section 67.14(a))

Action Taken: The Commission (Guy, Chow, Jackson, Monfredini, Parker, and Sanchez) voted not to disclose any discussions held in closed session. (Commissioner Umekubo had previously left the meeting and did not vote).

The closed session ended at 7:50 p.m.


A. Public Comment on All Matters Pertaining to Closed Session


B. Vote on Whether to Hold a Closed Session Pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b)

Action Taken: The Commission voted to hold a closed session.

The closed session began at 7:56 p.m.

C. Closed Session Pursuant to Government Code Section 54957 and San Francisco Code Section 67.10(b)

Public Employee Hiring: 1551 Executive Secretary to the Health Commission

D. Reconvene in Open Session

Possible report on action taken appointing the Executive Secretary to the Health Commission (Government Code Section 54957.1(a)(5), and San Francisco Administrative Code Section 67.14(b)(4))

Vote to elect whether to disclose any or all discussions held in closed session (San Francisco Administrative Code Section 67.14(a))

Action Taken: No report issued. The Commission voted not to disclose any discussions held in closed session.

The closed session ended at 8:00 p.m.


The Commission adjourned the meeting at 8:00 p.m.

Arthur R. Greenberg, Interim Health Commission Secretary