Minutes of the Health Commission Meeting
September 4, 2001
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The meeting was called to order by President Roma P. Guy, M.S.W., at
- 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.
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF AUGUST 21, 2001
Action Taken: The Commission approved the minutes of August 21, 2001.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner David J. Sanchez, Jr., Ph.D.)
Commissioner Sanchez chaired, and Commissioner Monfredini and
Commissioner Jackson attended, the Budget Committee meeting.
(3.1) DPH-Administration - Annual Report of Gifts Received in FY
(3.2) CHN-Primary Care - Request for approval of a four-year contract
with the Bar Association of San Francisco Volunteer Legal Services
program to provide SSI advocacy and overall administration of the
Homeless Advocacy Program, in the amount of $445,808, for the period of
July 1, 2001 through June 30, 2005.
(3.3) PHP-CSAS - Request for approval to accept and expend
retroactively a Center for Substance Abuse Treatment grant in the amount
of $1,105,000, to expand and evaluate substance abuse treatment
services, for the period of August 1, 2001 through July 31, 2002, with a
sole source contract with the Regents of the University of California
San Francisco for $177,300 for evaluation services for the same period.
Commissioner Sanchez abstained on this item.
(3.4) PHP-AIDS Office - Request for approval of a contract renewal
with Shanti Project in the amount of $395,324, to provide emotional and
practical support services, for the period of July 1, 2001 through June
(3.5) PHP-AIDS Office - Request for approval of a contract renewal
with San Francisco AIDS Foundation HIV Prevention Project in the amount
of $585,782, to provide HIV prevention and needle exchange services, for
the period of July 1, 2001 through June 30, 2002.
(3.6) PHP-AIDS Office - Request for approval of a contract renewal
with San Francisco AIDS Foundation in the amount of $135,988, to provide
HIV Prevention Telephone Hotline services, for the period of July 1,
2001 through June 30, 2002.
(3.7) PHP-AIDS Office - Request for approval of a contract renewal
with San Francisco AIDS Foundation in the amount of $744,880, to provide
client advocacy and financial benefits services, for the period of July
1, 2001 through June 30, 2002.
(3.8) PHP-AIDS Office - Request for approval of a sole source and new
contract with Better World Advertising in the amount of $337,707, to
provide a social marketing and media campaign for HIV testing, for the
period of September 1, 2001 through December 31, 2001.
(3.9) PHP-AIDS Office - Request for approval of a contract
modification with Better World Advertising in the amount of $250,000 to
provide services for the ‘HIV Stops with Me’ campaign, for the
period of January 1, 2001 through December 31, 2001, bringing the
contract total to $307,000 for the year.
- With regard to agenda items 3.8 and 3.9, Commissioner Monfredini
asked during the Budget Committee when outcome reports from the
campaign efforts would be available. Commissioner Monfredini expressed
concern that infection rates are increasing more quickly than
anticipated, and wants to know if these efforts are working. Steven
Tierney responded that it will take less than a year for the outcome
- Commissioner Sanchez stated that the advertising campaigns being
developed by Better World Advertising will meet the needs of the
Department’s multi-lingual outreach efforts.
- Commissioner Chow asked if the contractors for agenda items 3.7, 3.8
and 3.9 had submitted the required cultural competency reports.
Commissioner Sanchez responded that, at the Budget Committee, staff
had said that the reports had been submitted.
- Commissioner Parker, commenting on the Annual Gift Report, gave
special recognition to the volunteers at San Francisco General
Hospital and Laguna Honda Hospital for their work and monetary
donations over the years.
Action Taken: The Commission approved the Consent Calendar of the
Budget Committee, with Commissioner Sanchez abstaining on Agenda Item 3.3.
4) DIRECTOR’S REPORT
(Mitchell H. Katz, M.D., Director of Health)
2001 Public Managerial Excellence Award Winners Announced
I am proud to announce that Marc Trotz, Director Housing and Urban
Health is one of the five winners of this year’s Public Managerial
Excellence Awards for San Francisco City managers. When he joined the
Health Department four years ago, the conventional wisdom was that it was
impossible to take people directly from long-term homelessness and place
them in permanent housing. The concern was that people who had been
homeless for a long time would be unable to adjust to living with others.
Marc has proven that you can take people directly off the street and
provide them with permanent housing, as long as you do so with supportive
services. He has also proven that it can be done affordably. I am sure you
all join me in congratulating Marc on this well deserved honor. Each
winner will receive a monetary award, be highlighted in a video production
sponsored by KPIX Channel 5 and recognized at an Awards Luncheon on
October 24th at the Westin St. Francis Hotel.
Hospital Seismic Safety Legislation
SB 842 (Speier), a key seismic safety relief bill, passed another
committee hurdle last week. As you know, current seismic safety law
requires hospitals to meet significant compliance milestones in 2008 and
2030. Seismic relief legislation last year extended the 2008 deadline to
2013 for hospitals meeting certain requirements. SB 842 would provide
further relief by granting hospitals a five-year extension of 2008
requirements if they agree to meet 2030 requirements by 2013. SB 842 would
also allow a five-year extension of the 2008 requirements by mutual
agreement between the hospital and the Office of Statewide Health Planning
and Development, in accordance with a work progress plan. SB 842 would
become operative only if a hospital seismic safety bond bill is also
enacted by the Legislature in 2001 and placed on the ballot in 2002. SB
717 (Speier), which would enact that bond measure, is currently on
suspense in Assembly Appropriations. The Assembly Appropriations Committee
must still pass SB 842 and then the full Assembly before it is presented
to the Governor.
A 3-alarm fire broke out Friday afternoon in a 37-unit four-story
apartment building at the corner of Stanyan and Frederick Streets. DPH/EMS,
DHS, Mayor's Office on Homelessness, OES and Recreation and Parks were all
on scene along with the Red Cross. The 46 residents were primarily
younger, no frail elders, children or people with disabilities. Rec/Park
opened Kezar Pavilion as a temporary reception center for residents. Some
residents were vouchered into hotels, but for the most part were able to
find temporary housing on their own initiative. The owner intends to
repair the building as quickly as possible and reopen it to the tenants.
We have good news to report about the fire last month at Capp and 20th
Streets. The City Team, with DHS caseworkers taking the lead role, has
been successful in placing all but 2 of the original 15 families into new
permanent housing. We will continue to work with the two remaining family
I am pleased to share with you the following comments from the
California EMS Authority:
"This is to acknowledge receipt of the City and County of San
Francisco Trauma Care System Plan 2001. You have the distinction of
being the first agency to submit your plan as of the deadline and we
appreciate your timeliness. A preliminary review of the plan indicates
that it is generally consistent with the requirements of the California
Code of Regulations. A detailed review of the plan will now be conducted
and you may be contacted for additional information if necessary. The
final decision regarding the plan will be submitted to you in
Congratulations to our EMS team for a job well done!
Red Light Running Campaign
This is National STOP Red Light Running Week and the Department has a
number of prevention activities planned with DPT, SFFD, SFPD and private
The front of the building here at 101 Grove St. has a "STOP on
Red...You'll only kill a few seconds" banner hung across the
entrance. Public service announcements will be running on several radio
stations and on Thursday, staff from the STOP Red light Running campaign
will distribute "RED means STOP" antenna balls to the public at
noon on the corner of Polk and Grove Streets. A copy of the Department's
press release is attached to the Health Commission's packet. We also have
samples of the give aways available for you and encourage you to put the I
STOP FOR RED LIGHTS bumper stickers on your vehicles.
- Commissioner Sanchez commended Dr. Katz for having invited Dr. Diana
Bontá, Director of the California Department of Health Services, to
spend three days in San Francisco. Commissioner Sanchez continued that
it was astounding to see Dr. Bontá meet with San Francisco’s
communities, its non-profit agencies and Department staff, and really
get an understanding of the needs of the community.
- Commissioner Umekubo asked for staff’s assessment of whether or
not Senate Bill (SB) 717 would be successful. Colleen Johnson, Acting
Director of Policy and Planning, responded that there is motivation at
the State level to get some seismic safety relief. However, because
the State is having fiscal problems, legislative relief will be easier
than monetary relief.
- Commissioner Chow asked for clarification about SB 717 being tied to
Senate Bill (SB) 842, and if both needed to be approved by the
Legislature to go forward. Ms. Johnson responded that if SB 842 is
approved but SB 717 is not, then SB 842 would not go forward. However,
the Legislature can amend the language in SB 842 to allow for SB 717
to be approved in 2002, rather than in 2001, as it currently states.
Commissioner Chow then asked what the Department’s position is on
the extension offered by SB 842. Dr. Katz responded that the
Department is going to proceed with the plan for San Francisco General
Hospital regardless of the bill, because it is clear that the hospital
needs to be replaced. However, Dr. Katz continued, a State bond
measure would make financing a lot easier.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE
RECOGNITION AWARDS FOR THE MONTH OF AUGUST
Commissioner Monfredini presented the employee recognition awards.
Hector (Anthony) Almanza, Institutional Police Officer
CHN - SFGH, Institutional Police
Sgt. Craig Koss, Institutional Police, SFGH
Gerard (Jerry) Komp, Supervising Pharmacist
CHN - SFGH, Pharmaceutical Services
Fred Hom and Sharon Kotabe, SFGH/CHN Directors, Pharmaceutical
6) MEDICAL MARIJUANA PROGRAM UPDATE
(Colleen Johnson, Acting Director, Policy and Planning)
Colleen Johnson, Acting Director of Policy and Planning, presented the
Commissioners with an update on the Voluntary Medical Cannabis ID Card
Program. The program has just completed its first year of operation.
Ms. Johnson provided the Commission with a brief background on the
Voluntary Medical Cannabis ID Card Program. The program was developed as a
result of Proposition 215, the Compassionate Use Act, which was approved
by the voters in November 1996. The Health Commission passed resolutions
in April 1997 and December 1999 strongly supporting implementation of the
Compassionate Use Act and a voluntary medical cannabis identification card
program, respectively. In May 2000, the Board of Supervisors passed an
ordinance authorizing the Department of Public Health to issue the cards.
Ms. Johnson then detailed the process for participating in the program.
Patients with a valid physician referral and designated caregivers are
eligible for the program. Applicants can live in any of the following Bay
Area counties: San Francisco, Sonoma, Marin, Napa, Santa Clara and San
Mateo. Applicants must present a physician’s statement, signed Medical
Release Form, a photo identification card, proof of residence and payment
in the amount of $25, for the costs associated with processing the card.
Applications are submitted to and processed by the Vital Statistics
Office. The authenticity of physician referral is verified, as is the
physician’s standing with the State Medical Board. Ms. Johnson said that
applicants are often issued cards on the same day.
Ms. Johnson stated that the names, addresses and phone numbers of the
applicants are not kept on file, and that all original documents are
returned to the applicant. (Dr. Katz added later in the discussion that
the Department also does not keep records of physicians who sign letters.)
According to Ms. Johnson, utilization of the program for the first year
(July 1, 2000 through June 30, 2001) was as follows:
- 2,018 cards were issued. Of those, 1,749 were for patients, 269 were
- 1,681 unique patients
- 262 unique caregivers
- Median term of each card: 23 months
- Most of the City’s cannabis buyers’ clubs required the DPH card
Ms. Johnson then described Laguna Honda Hospital’s creation of an
interdisciplinary task force to examine the use of medical cannabis at
Laguna Honda, which is home to approximately 1,000 people. A pilot program
was developed to enable patients to access their rights under Proposition
215 and use cannabis for medical purposes. The 90-day pilot program was
just completed and is currently being assessed. Ms. Johnson added that, to
make it easier for Laguna Honda residents to participate in the program,
Vital Statistics’ staff went to the facility on Saturdays to receive and
process applications. Ms. Johnson stated that Laguna Honda Hospital is the
only inpatient facility in the State to have such a program.
Ms. Johnson said that both the District Attorney’s Office and the San
Francisco Police Department are supportive of the program. In addition,
Ms. Johnson said that State Senator John Vasconcellos has sponsored a
bill, SB 187, which would create a statewide voluntary medical cannabis
identification card program, which is modeled on San Francisco’s
Ms. Johnson then described the next steps:
- Supervisor Mark Leno has called for a hearing at the Board of
Supervisors, to take place in October
- Continued participation in Supervisor Leno’s Task Force
- Continued advocacy for SB 187
- Further evaluation of the Voluntary Medical Cannabis ID Card Program
- Commissioner Monfredini is concerned that this card is valid for two
years, and that this gives people a lot of time to duplicate cards.
Ms. Johnson responded that the card is valid for the time period that
the physician deems appropriate, which has an upper limit of two
years. Also, the cards are designed so they cannot be reproduced. Ms.
Johnson spoke with a sergeant at the Narcotics Division of the San
Francisco Police Department who said he has not seen any
- Commissioner Parker asked if there have been any problems getting
physicians to participate, and what has been the physician’s
relationship with the patient beyond just writing the prescription.
Dr. Katz responded that the Department does not require a physician to
sign a letter he or she does not feel it is warranted. Dr. Katz knows
of instances where doctors would not sign the letter.
- Commissioner Umekubo asked if there have there been any problems
with forgery of physician letters. Ed Hernandez, Director of Records
and Statistics, responded that he is aware of only one instance of
- Commissioner Chow asked about the Laguna Honda pilot project,
specifically how the program is controlled at Laguna Honda, and if the
medical orders include a prescription for the use of cannabis for
medical purposes. Dr. Katz responded that staff has to deal with the
fact that while Proposition 215 provides for access for compassionate
use, it does not allow for medical professionals to write specific
doses or having these doses administered by nursing staff. Staff has
developed the program so that patients must have a signed
recommendation from a physician, which is commonly a Laguna Honda
physician, and must comply with house rules, such as no smoking
indoors or outdoors around people who do not want to be near smoke.
- Commissioner Guy asked if staff anticipates any concerns being
raised at the Board of Supervisors hearing that should be discussed by
the Health Commission prior to that hearing taking place. Ms. Johnson
responded that she expects the hearing to demonstrate widespread
support for the program.
- Michael Aldrich, Ph.D., Executive Director of C.H.A.M.P
(Californians Helping Alleviate Medical Problems), stated that
C.H.A.M.P. worked for two years with Dr. Herminia Palacio to develop a
confidential card system. Dr. Aldrich said that the card system in San
Francisco is simple, efficient, and keeps the confidentiality of the
patients. C.H.A.M.P. requires that patients get the DPH card before
they get the C.H.A.M.P. card.
- Tappié Dufresne, staff person at C.H.A.M.P., said it was a pleasure
to work with Laguna Honda Hospital staff to implement the
Compassionate Use Act at the facility. Their clientele has not had
problems obtaining the ID card. They had thought the $25 fee would be
a problem, but it has not been.
- Wayne Justmonn, San Francisco Patients Resource Center, said he was
the first medical cannabis ID card holder in San Francisco, and he
supports the Department’s program. The ID card gives him credible
access to medical cannabis. He knows that his freedom and his rights
will be honored in San Francisco.
7) NURSE WORKFORCE RETAINER AND RECRUITMENT REPORT
(Gene O’Connell, Executive Administrator, SFGH)
Sue Currin, RN, Chief Nursing Officer at San Francisco General Hospital
Medical Center, began the presentation of the Nursing Workforce Report.
Ms. Currin said that the presentation would summarize the findings of a
nursing workforce survey that was conducted in January 2000 by the Nursing
Leadership Council and the Department of Public Health. Ms. Currin then
introduced Leslie Holpit, RN, Interim Director of Recruitment and
Ms. Holpit stated that nationwide the average age of the nursing
workforce is 43, which is a substantial increase from 10 years ago. There
is also a nationwide decrease in the number of women who are choosing
nursing as a career, as well as a shortage of nursing faculty and nursing
Ms. Holpit said that there are 235,566 registered nurses in California,
with an average age of 48 years. Only nine percent of the workforce is
under 30. California has the lowest RN/population ratio in the United
States. Ms. Holpit said that studies indicate that California will need
25,000 more RNs by 2006 and 60,000 more RNs by 2020.
San Francisco Department of Public Health RN Workforce
Ms. Holpit then described the Department of Public Health RN workforce.
At the time of the Nursing Leadership Council’s survey, there were 2395
RNs in the DPH workforce. 1446 of the RNs were permanent, and 949 were per
diem. 29 percent of the RN workforce in DPH is over 50 years of age. Only
four percent are under 30 years of age.
There were 914 respondents to the Nursing Leadership Council survey, 59
percent of whom worked at SFGH and 21 percent of whom worked at Laguna
Honda Hospital. 31 percent stated they planned to leave their job within
five years. Multiple answers were given when asked what would encourage
them to stay, including opportunities for career advancement and improved
Ms. Holpit then described the nursing vacancy situation in the
Department. While the statewide turnover rate at hospitals is 18 percent,
San Francisco General Hospital had about a 10 percent turnover last year,
so they compare very well. The overall vacancy rate is 11%-12%, but the
vacancy rate is higher in some specialty areas, such as Acute Psychiatry
and the operating room.
Ms. Holpit then summarized recommendations that have been made by
various professional organizations to increase the supply of nurses,
including, improving linkages between academic programs and service
organizations, increasing prelicensure entry slots, and making nursing
programs more accessible to prelicensure students and to RNs who choose to
further their education.
Ms. Holpit then described the recruitment and retention activities that
San Francisco General Hospital is undertaking:
- Participating in career fairs and conferences, particularly with the
schools of nursing
- Partnering with the School to Career Partnership Program, which
gives high school students exposure to a career in nursing
- Developed a recruitment brochure. This will be the first brochure
issued by SFGH since 1991.
- Working with the Treasure Island Development Authority to get
temporary housing on Treasure Island
- Exploring the possibility of offering child care nearby, possibly
Mission Child Development Center
- Participating in the Bay Area Health Care Recruiter Organization
- Exploring a training grant with the Department of Labor and the San
Francisco Private Industry Council to develop a training program that
would increase the number of prelicensure candidates who would move
into registered nurse programs, as well as allow nurses who are
already licensed to go back to school for a bachelor’s degree or
- Initiated a Med/Surg new graduate training program
- Formalizing recruitment goals and plan
- Establishing a retention and recruitment committee, which will
consist primarily of bedside caregivers and staff nurses
- Developing an on-going nurse recognition program that would occur
throughout the year, in addition to the activities of Nurse Week,
which is in May
- Developing a “Why Nurses Work at SFGH” campaign
- Developing a formal retention plan.
Ms. Holpit then discussed the features of the desired training program
that staff would like to obtain grant funding for, potentially through the
Department of Labor. They would like to develop a training program that is
built on a career ladder model. They would begin with prelicensure and
then expand the existing program capacity to meet all steps of the ladder.
And they would provide support or incentives for the individuals
participating in the program by reducing their work hours, but providing
them with full pay.
- Commissioner Jackson asked if nurses were leaving nursing, or
leaving the Department of Public Health. Ms. Holpit responded that
they do not know at this time, but that this year they are instituting
the practice of exit interviews so they will be able to get this
information. Commissioner Jackson then asked if exit interviews are
standard. Dr. Katz replied that they are not.
- Commissioner Umekubo asked if enrollment in nursing schools has been
decreasing or remaining constant. Ms. Holpit replied that, on a
national level, nursing school enrollment has been decreasing.
However, in California, this decrease has been less significant.
Commissioner Umekubo then asked what barriers to nursing school
enrollment exist. Ms. Holpit responded that there are multiple
barriers, which are geographically specific. One factor is that
private nursing programs have closed because of the high cost of
running the programs. Another factor is that the UC system, the Cal
State system and the community college system have different admission
requirements. Still another factor is that high school students do not
have adequate math and science skills, so they often are not
successful nursing programs. Commissioner Umekubo asked how the
Department rewards good nurses. Ms. Holpit responded that she will be
pursing this in her retention committee, and getting input from the
nurses. She stated that the literature indicates that nurses would
like to be respected, and would like to participate in decision
- Commissioner Sanchez asked if the hospital has considered flexible
schedules, such as working less than five days a week. Commissioner
Sanchez emphasized that the hospital should collaborate with other
city agencies and think creatively about helping people pay for people’s
education. In addition, the Department could look at housing
assistance for nurses, much like the San Jose program that is designed
- Commissioner Monfredini said that respect for nurses is a key issue,
and helps the nurses be loyal to the institution. Commissioner
Monfredini asked if the trend was for more nurses to work per diem in
order to have more flexibility and control of their lives. She also
asked about the utilization of mandatory overtime, which sometimes
overburdens nurses. Ms. Holpit replied that, in recruitment
literature, there is a finding of more people who are looking for more
of a balance between work and non-work, and that per diem may be the
only way they can get this flexibility. Ms. Currin stated that the
utilization of mandatory overtime has decreased significantly in the
past six months, and various methods are used to limit the usage, such
as Nurse Managers working nights and weekends. Ms. Currin said that
the nursing staff has responded well. Ms. Currin said that the
impending nursing ratios that are supposed to be issued by the State
Department of Health Services in January 2002 will exacerbate the
- Commissioner Parker said that he appreciates the efforts that are
being made to address this issue on a local level, but emphasized that
this is a nationwide problem that must be addressed at that level as
- Commissioner Jackson stated that, in terms of recruitment, a lot can
be done to reach out nationwide to recruit people from other states to
San Francisco. In addition, the recruiting efforts can begin at the
junior high school level. Commissioner Jackson continued that the
Department should evaluate on-site day care, giving perks to good
nurses, and having good communication between all levels of staff.
- Commissioner Chow stated that the core challenge is to bring new
nurses into the career. He said that the nursing career has to have a
higher visibility as a career path and a career choice. Unless nursing
has a more prestigious reputation, it will continue to be more
difficult to recruit for than other health care professions.
Commissioner Chow said that one way to make this a more attractive
career might be to have additional educational requirements. Prestige
is needed to entice young people into careers. Commissioner Chow said
that giving nurses something to feel satisfied about in their jobs
would improve retention.
- Commissioner Guy said that this is a substantial issue that needs to
be followed at the Joint Conference Committees, where there can be
more discussion about the impact of the various efforts on recruitment
and retention. Commissioner Guy continued that there is a complexity
of nursing care, a changing role of nurses, and a changing nature of
patient needs and focus, and the educational system needs to reform
itself to meet these changing needs. The Department should attempt to
influence educational institutions in San Francisco. Commissioner Guy
stated that the fact that San Francisco General Hospital is a teaching
hospital does impact nursing, and needs to be considered. Commissioner
Guy also said that there needs to be acknowledgment that the
Department’s training costs are going to increase, particularly when
the educational institutions are leaving the training to the
hospitals. The Department needs to consider where funding for training
will come from.
8) OTHER BUSINESS/PUBLIC COMMENTS
9) CLOSED SESSION
A) Public comments on all matters pertaining to the closed session
B) Vote on whether to hold a closed session (San Francisco
Administrative Code Section 67.11)
Action Taken: The Commission (Chow, Jackson, Monfredini, Parker,
Sanchez, Umekubo) voted to hold a closed session.
The Commission went into Closed Session at 5:45 p.m. Commissioner Guy
left the meeting at 5:45 p.m., and was not present for the Closed
C) Closed session pursuant to Government Code Section 54956.9 and San
Francisco Administrative Code Section 67.10(d)
Conference with Legal Counsel - Existing Litigation
Proposed settlement of $15,000 in the David Wellhausen v. CCSF,
Superior Court, Case #303-115
The Commission came out of Closed Session ended at 5:55 p.m.
D) Reconvene in Open Session
1) Possible report on action taken in closed session (Government Code
Section 54957.1(a)2 and San Francisco Administrative Code Section
Action Taken: The Commission (Chow, Jackson, Monfredini, Parker,
Sanchez, Umekubo) approved the settlement of $15,000 in David
Wellhausen v. CCSF, Supervisor Court Case #303-115.
2) Vote to elect whether to disclose any or all discussions held in
closed session (San Francisco Administrative Code Section 67.12(a).)
Action Taken: The Commission (Chow, Jackson, Monfredini, Parker,
Sanchez, Umekubo) voted not to disclose any discussions held in Closed
The meeting was adjourned at 5:55 p.m.
Michele M. Olson, Executive Secretary to the Health Commission