Minutes of the Health Commission Meeting
Wednesday, September 19, 2001
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The Health Commission meeting was called to order by Vice President
Edward A. Chow, M.D. at 3:05 p.m.
- Vice President Edward A. Chow, M.D.
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sánchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
- President Roma P. Guy, M.S.W.
- Commissioner Arthur M. Jackson
- Commissioner Lee Ann Monfredini
2) APPROVAL OF THE MINUTES OF THE REGULAR MEETING OF SEPTEMBER 4,
Action Taken: The Commission (Chow, Parker, Sánchez, Umekubo)
unanimously approved the minutes of September 4, 2001.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
(Commissioner David J. Sánchez, Jr., Ph.D.)
Commissioner Sánchez chaired, and Commissioner Jackson attended, the
Budget Committee meeting.
(3.1) CENTRAL ADMINISTRATION - Request for approval of a resolution
to authorize the Department of Public Health to accept and expend
recurring State grants from the State of California for FY 2001-2002.
(3.2) CENTRAL ADMINISTRATION- Policy and Planning - Request for
approval to accept and expend a new award from the State Department of
Human Services in the amount of up to $180,000, to enroll children in
health insurance programs, for the period of July 1, 2001 through
December 31, 2001.
(3.3) PHP-Maternal and Child Health - Request for approval to accept
and expend a new three-year grant from the California Family Health
Council, in the amount of $525,000 for HIV/AIDS confidential counseling
and testing services, for the period of September 1, 2001 to August 31,
(3.4) PHP-Maternal and Child Health - Request for approval to accept
and expend contract funds from the University of California San
Francisco in the amount of $223,475 to identify barriers to preventive
oral health care, for the period of September 30, 2001 through September
29, 2003, and a sole source contract with Polaris in the amount of
$156,570 for the same time period.
(3.5) PHP-Mental Health/Substance Abuse - Request for approval of a
retroactive contract renewal with Morrisania West, Inc. in the amount of
$439,434, for the provision of day treatment services, for the period of
July 1, 2001 through June 30, 2002.
(3.6) PHP-Women’s Prevention Services - Request for approval of a
retroactive sole source contract renewal with North East Medical
Services in the amount of $218,354 to provide Breast and Cervical Cancer
Control Program services for the period of October 1, 2000 through
October 20, 2001.
(3.7) CHN-Revenue Management - Request for approval of a new contract
with Health Advocates, LLP, to enhance Medi-Cal and other third-party
reimbursements at San Francisco General Hospital, for the period of
certification through December 31, 2005.
This item was continued to the meeting of October 2, 2001.
(3.8) CENTRAL ADMINISTRATION-MIS - Request for approval of a contract
modification to the product and services agreement with Siemens Medical
Solutions Health Services Corp., to extend the term of the contract by
an additional two years and to increase the compensation by $2,822,658,
for a total revised contract amount of $9,990,349, for the term of
January 1, 1999 through June 30, 2004.
Action Taken: The Commission (Chow, Parker, Sánchez, Umekubo) approved
the consent calendar of the Budget Committee, with Item 3.7, approval of a
contract with Health Advocates, LLP, continued.
Prior to Dr. Katz presenting the Director’s Report, Commissioner Chow
asked that everyone take a moment of silence to reflect on the tragedy of
September 11, 2001.
4) DIRECTOR’S REPORT
(Mitchell H. Katz, M.D., Director of Health)
(Report on activities and operations of the Department.)
Update from September 11th East Coast Tragedy
Dr. Katz informed the Health Commission that, as last week’s tragic
events unfolded, the Department quickly went into Incident Command System
(ICS) mode. Appropriate staff reported to the Emergency Operations Center
at the City’s Command Center on Turk Street, the Departmental Operation
Center (DOC) at 101 Grove and the Hospital DOC at SFGH. The Department of
Public Health is a front line first responder in the event of an emergency
situation. Some confusion ensued over conflicting messages that sent
non-essential City employees home and closed all City buildings, but for
the most part, the Department responded appropriately as front line
emergency responders. Our clinics remained opened, including primary care
and mental health services. SFGH activated its Hospital Emergency Incident
Command System and staffed the Emergency Operations Center for 24 hours.
Many thanks to all our dedicated employees who responded in an outstanding
Last week's series of tragic events presented a new response challenge
for all of us. DPH is taking this opportunity to learn from mistakes and
to tighten response mechanisms for any future incidents. In the
foreseeable future, the number one priority of the Department of Public
Health is emergency/disaster/terrorism preparation. It is essential that
the Department rapidly improve its ability to protect employees and
develop contingencies to deliver high quality health care, should a
disaster occur in San Francisco. Dr. Katz thanked the committed staff at
DPH for their quick and efficient response last week and asked for
cooperation in Departmentwide preparation and response efforts.
Hunters Point Facility Task Force
As one response to the Health Commission’s February 20, 2001 meeting
at Milton Meyers gym in Hunter’s Point, a Department Task Force was
appointed in late April to establish a DPH presence on Hunter’s Point
Hill. The Task Force, chaired by Anthony Wagner, included representatives
of DPH, Recreation and Parks, and the San Francisco Housing Authority.
The Task Force surveyed 45 residents of the Hunters Point Hill. After
several months of community and City agency input, it was decided to
reopen the Ujima Clinic at 195 Kiska Road and also utilize the apartment
at one Harbor Road, on site of the San Francisco Housing Authority.
The following programs/services will be located at the respective
- Ujima - 195 Kiska Road
- Children’s Environmental Health Program - Focus on the Specific
health issues of children related to the impact of the environment (at
home and in the community).
- Health and Environment Assessment Program (HEAP) - General education
about the Bayview Environment.
- Health Education Resource Center - Specifically focusing on asthma,
breast and prostate cancer.
- WIC Project
One Harbor Road
- Directions for Positive Change - An alternative program to
traditional substance abuse rehabilitation.
- A Mentorship Program - An Outreach and education mentorship program
focused on youthful offenders with law enforcement and ex-offenders
partnering as mentors for incarcerated youth and youth-at-risk.
- The MUNI CalWORKS Program
- Renaissance Ex-offenders Program
Until staff is hired, Karen Pierce, Director of the HEAP Program, has
agreed to serve as acting coordinator. She will be relocated to the Ujima
site. The Community Programs Division of DPH is now operationalizing the
recommendations of the Task Force. A November start-up date is projected
for both sites.
American Journal of Public Health Publishes Article on Health
Benefits of Living Wage Ordinance
Dr. Katz reported that the lead article in the American Journal of
Public Health’s Labor Day issue was an analysis performed by Rajiv
Bhatia, M.D. This paper analyzed the estimated health benefits from a
local living wage ordinance. The major conclusion of the paper was that
small increases in the wages of working people are associated with
substantial health improvements. Dr. Katz was pleased with this paper
because it demonstrates to policy makers the close connection between
economic conditions and health.
Tai Chi in the Parks Program
The City has just completed a series of free, weekly Tai Chi classes at
10 neighborhood parks. Medical data supports Tai Chi as a health
maintenance activity with beneficial effects on musculoskeletal
complaints, stress reduction, promotion of safe ambulation and fall
prevention. The neighborhood locations made the classes accessible to
patients who are unable to get to hospital based stress reduction classes
or physical therapy services.
The project has been well received by the community and is looking for
further support from the Community Programs Division when the start-up
grant funding cycle is complete. The Primary Care Medical Directors group
has indicated a strong support for continuation and expansion of the Tai
Bureau of Environmental Health
The California Environmental Protection Agency recently completed a
technical audit of the Hazardous Materials Unified Program Agency. Lead by
the Cal EPA representative, the audit team was composed of representatives
of four State agencies, including the Department of Toxic Substances
Control, Governor’s Office of Emergency Services, State Water Resources
Control Board and Office of the State Fire Marshal. The team spent two
days evaluating all program aspects, including record keeping, policies
and procedures, data management, and enforcement outcomes. Additionally,
the auditors evaluated staff during field inspections at regulated
businesses. At the conclusion of the audit, the State agency
representatives gave high marks to the program and were particularly
impressed with the technical knowledge, skills and abilities of the staff.
CalEPA considers the San Francisco Program to be a model for others
throughout the State and has requested that their policy manual be made
available as guidance for other agencies struggling to implement this
complicated environmental program. .
Successful CLIA Inspection
Laguna Hospital’s Respiratory Therapy Department passed its biannual
CLIA/DHS inspection September 4th with no deficiencies. Congratulations to
Claudell LeBlanc and his staff on another year of exemplary performance,
and thanks to Dr. Valerie Ng and her SFGH team for their support.
Physician Selected for Health Care Leadership Program
Lisa Pascual, MD, Chief of Rehabilitation Services at LHH, has been
selected as one of 25 professionals for the inaugural class of the CHCF
Health Care Leadership Program, administered by the Center for the health
Professions at UCSF. The intensive, two-year fellowship allows
participants to continue in their current leadership roles while further
developing their knowledge, skills and networks.
MHRF: Appointment of Director of Nursing, Director of Rehabilitation
Services and Director of Quality Management
Dr. Katz announced the names of the newest members of Mental Health
Rehabilitation Facility (MHRF) Executive Staff. Alex Anagnos, MSN, CNS, RN
has joined DPH as the Director of Nursing; Maureen Burns, BSN, RN, is the
new Director of Quality Management; and Linda Fenn is Director of
Psychiatric Rehabilitation Services.
MUNI Annual Family Day and Health Fair
On September 8, 2001 the African American Health Initiative (AAHI)
coordinated and participated in the MUNI Annual Family Day and Health Fair
which had over 3,600 attendees at the WOODs Division-Potrero Hill. MUNI
staff expressed a desire to integrate health as a permanent component of
the Family Day event. The Health Department was well represented.
STD Program's Annual STD Update
The STD Program's Annual STD Update is scheduled at Carr Auditorium
September 20th from 8:00 a.m. to 12:30 p.m., and again on October 3rd from
12:30 p.m. to 5:00 p.m. The Update is for all STD Program Screening Site
providers and other health practitioners who provide care to STD clients.
The STD Program collaborates with the State of California STD Prevention
Training Center to provide CEUs to participants. This year's Update will
include a discussion on: 2000 STD prevalence rates in San Francisco, the
use of amplified testing for gonorrhea and chlamydia for non genital
sites, genital dermatology, an update on the Gonorrhea Iisolate
Surveillance Project and an STD clinical update. If anyone would like to
register, they should contact Sharon Byrd at 487-5524.
Single Point of Responsibility Programs Study Demonstrates Cost
During 1997, Community Mental Health Services initiated the
implementation of three Single Point of Responsibility (SPR) programs to
serve high cost mental health consumers with severe mental illnesses. In
1998, Davis Y. Ja and Associates, Inc. was contracted by CMHS to assess
the effectiveness of the SPR programs. The previous evaluation report,
based on the first two years of follow-up, confirmed what other studies of
such programs had shown--that ACT services break even financially in spite
of higher initial service costs - while allowing clients to have less time
in locked 24-hour care.
The most recent evaluation report has just been completed and these
3-year follow-up findings are beginning to show cost savings, with ACT
clients significantly lower in total overall mental health service cost in
the latter months of the third year after adjusting for baseline
differences between the groups. In addition, days in locked 24-hour care
and use of emergency services both continue to show steady reductions. A
final report on four-year follow-up data will be completed this fall.
- Commissioner Parker said that the events of September 11th were a
wake up call for the entire community, and that the Department should
take this opportunity to mobilize the city and educate its residents
about disaster and emergency preparedness.
- Commissioner Umekubo commented that the tragedy was a wake up call
for the medical community in terms of preparedness. He is concerned
that the medical community is not as prepared as it should be, and
that each institution will have to examine how to be more prepared.
- Commissioner Chow stated that the Department, as well as private
hospitals, needs to take this opportunity to improve emergency
preparedness both on the consumer side and the medical service side.
With regard to the two Bayview Hunters Point Initiatives, Commissioner
Chow asked why, when the trend has been to co-locate services,
services are being established at two different geographical
locations. Dr. Katz responded that there was a specific request from
Bayview Hunters Point residents to provide services at One Harbor
Road, and a separate specific request to reopen the Ujima Clinic. The
Department wanted to be responsive to the community’s requests.
5) PROFILE OF INJURY REPORT
(Ginger Smyly, Deputy Director, Community Health Promotion and Prevention)
Ginger Smyly, Deputy Director, Community Health Promotion and
Prevention provided an overview of the Profile of Injury Report. This
report is the fourth edition to be produced by the Department of Public
Health. The goal of the report is get a better understanding of the nature
of injuries in San Francisco and examine methods by which the Department
can support more injury prevention. The report consists of epidemiological
data, cost data, mapping data and demographic data from 1998.
Dr. Elizabeth McLoughlin from the San Francisco Injury Center and
Trauma Foundation continued the presentation by summarizing the findings
and identifying trends. Dr. McLoughlin said that the data for the Profile
of Injury Report was obtained from the following sources: deaths; hospital
discharge data; trauma registry data from San Francisco General Hospital;
emergency care data from San Francisco General Hospital; emergency medical
services data from the San Francisco Fire Department; and traffic crash
data from the Statewide Integrated Injury Traffic Reporting System.
Dr. McLoughlin summarized the major causes of injury deaths in San
Francisco: Drugs and poisonings, 40.3 percent; falls, 10.6 percent;
firearms, 10.2 percent; motor vehicle traffic crashes, 14 percent;
suffocation, 9 percent; fire/burn, 3.2 percent; drowning, 2 percent;
cut/pierce, 1.8 percent; and other, 8.8 percent.
Dr. McLoughlin then summarized major findings:
- Numbers of injury deaths are decreasing, but are far too high. Dr.
McLoughlin used firearm injury deaths as an example. While there has
been a sharp decline in firearm injury deaths in San Francisco, the
rate of firearm injury deaths in San Francisco is more than twice the
target identified in Health People 2010, the health objectives for the
nation that have been developed by the federal government.
- Elders are at a higher risk of dying of injury and of
hospitalization due to injury. This is primarily due to falls.
- Drugs and falls are major problems.
- There is a high rate of pedestrian injuries in San Francisco.
- Prevention is essential. The majority of people who die from injury
death die where the injury occurs, never making it to the hospital or
other medical facility. Dr. McLoughlin stated that this demonstrates
the need to prevent injuries from ever happening.
Michael Radetsky continued the presentation by discussing how the data
in the Profile of Injury report can be used to reduce injuries. Mr.
Radetsky provided a summary of key priorities that were established by the
Department’s Injury Prevention Work Group. He also provided the
Commission with an overview of current interventions, and focus for new
Mr. Radetsky stated that the key priority areas developed by the Injury
Prevention Work Group are:
- Pedestrian Injuries
- Senior Falls
- Firearm Violence
- Intimate Partner Violence
- Poisoning/Drug Overdose
Mr. Radetsky summarized the Department’s current unintentional injury
prevention programs and the violence prevention programs. The
unintentional injury programs are the CHIPPS Senior Injury Prevention
Project, the San Francisco Pedestrian Safety Project, a newly funded
Traffic Safety Project, the Child Passenger Safety Program, and the Stop
Red Light Running Program. The violence prevention programs are Children
and Youth Domestic Violence Free, the tattoo removal program, the violent
injury reporting system, the Violence Prevention Network, and the Youth
Mr. Radetsky then provided the framework for how the Department will
proceed with developing new recommendations. The Department will develop
benchmarks using the objectives identified in Healthy People 2010,
evaluate the strength and effectiveness of the current programs, and
develop very specific outcome measures for injury prevention.
Mr. Radetsky stated that, while specific recommendations will be
developed through the budget process, there is one policy recommendation
for current consideration: that the Health Commission and the Health
Department prioritize the reduction and elimination of injuries by
expanding existing primary prevention strategies and developing new
primary and secondary prevention strategies and programs based on data,
community need, and evidence-based practices.
- Commissioner Umekubo asked how San Francisco’s rate of injury from
pedestrian accidents compares to other metropolitan areas. Dr.
McLoughlin responded that she would provide this information to the
commissioners once she has compiled it. Commissioner Umekubo then
asked how to make pedestrians aware that even though, in many cases,
they have the right of way, they need to be cautious in exercising
their right of way. With regard to falls, Commissioner Umekubo stated
that physicians now have better tools to prevent fractures such as new
osteoporosis drugs and encouraging calcium intake, and he hopes that
this will help prevent injuries due to falls.
- Commissioner Chow asked if the pedestrian injury data has changed
with the red light running campaign. Dr. Katz responded that this can
be looked at during the next report, since the campaign began after
1998, which is the year from which the Profile of Injury data was
collected. Commissioner Chow stated that he looked forward to
discussing areas of concerns at the Population Health and Prevention
Joint Conference Committee, and developing cost-effective and
- Commissioner Parker emphasized the need to offer prevention programs
in the home. He continued that, while private institutions often focus
on specific prevention messages for their particular services, (for
example heart disease and high blood pressure), public institutions
need to be more comprehensive. The Department needs ongoing primary
prevention messages and needs to utilize various channels, such as
newspapers, television, the community clinics and others.
6) BAYVIEW HUNTERS POINT COMMUNITY SURVEY
(Dr. Rajiv Bhatia, Director, Environmental Health)
Dr. Rajiv Bhatia began the presentation by acknowledging the many
people who participated in creating the Bayview Hunters Point Community
Survey. He then introduced Raymond Tompkins, who presented the community
origins and motivations for the Bayview Hunters Point Community Survey.
Mr. Tompkins said the community became engaged in combating
environmental injustice when a new power plant was proposed for Hunters
Point. Concurrently, a number of women in the community had become
concerned about the prevalence of breast cancer in Bayview Hunters Point.
The community discussed their concerns with the Department of Public
Health and created the Bayview Hunters Point Health & Environmental
Assessment Task Force. There was limited neighborhood health and disease
data, and the task force decided to undertake their own community-based
survey. The task force believed that if there were community participation
in the survey, there would be more community buy-in in terms of what
actions are needed to create a healthier community.
Jennifer Mann continued the presentation by discussing the objectives,
survey methods, and notable findings of the Bayview Hunters Point
Ms. Mann said that the first objective was to involve the residents in
the entire survey process, from developing the questions to doing the
interviews to writing the report. The second objective was to obtain
neighborhood-level health data. The third objective was to understand and
prioritize neighborhood concerns. The fourth objective was to evaluate
barriers to health services access. This objective came from the fact that
Bayview Hunters Point has one of the highest rates of hospitalization for
what are considered preventable diseases. Another objective was to
understand the residents’ environmental concerns. The last objective was
to obtain information that would be useful for new city services and other
programs in Bayview Hunters Point.
Ms. Mann then described the methods used to conduct the survey, which
was a random, representative sample. The survey had two parts: a household
questionnaire and an individual questionnaire. 249 randomly selected
households participated in the household questionnaire, representing 71
percent of households contacted. A randomly selected adult was chosen from
each participating household for the individual questionnaire, and 68
percent of those individuals (171 total) participated in the survey. The
household questionnaire was administered by an interviewer and the
individual questionnaire was completed by the individual.
- Local asthma prevalence data - Approximately 10 percent of people in
Bayview Hunters Point have asthma. Approximately 15.5 percent of
children have asthma. While there was difficulty with comparing these
with national asthma rates, it is still clear that asthma is a problem
that needs to be addressed.
- Smoking prevalence - 48 percent of households in Bayview Hunters
Point had at least one smoker. The rates were the same for households
with children and households without children.
- Concern with crime, violence and drugs - More than 40 percent of
people rated crime and violence and drugs and alcohol as their two top
concerns. Only 15 percent of residents thought that environmental
concerns was one of the top two, but almost all residents thought that
it was either somewhat important or very important.
- Views of public services - Almost half of the respondents rated
environmental clean up in Bayview Hunters Point as poor. In addition,
drug and alcohol treatment programs were rated poorly by almost 40
percent of respondents. City Health Clinics were the least likely to
be rated as poor.
- Percent insured - Approximately 20 percent of non-elderly adults in
Bayview Hunters Point were uninsured, compared to 26 percent
statewide. Ms. Mann stated that this indicates that something other
than lack of insurance is contributing to preventable
- Reliance on diverse health providers - Only 14 percent of
respondents had a regular source of health care in Bayview Hunters
Point. In addition, people in Bayview Hunters Point are receiving
their healthcare from a variety of different sources.
- Mixed sense of personal control - When asked if they agreed with the
statement “If I take care of myself, I can avoid illness,” more
than 80 percent said yes. When asked if they agreed with the statement
“Health and illness are entirely beyond my control,” approximately
50 percent agreed with this statement, which is not necessarily in
line with the first statement.
Ms. Mann stated that the department made an obligation to all
participants to share the report with the community. They presented the
report at the Landscape of Our Dreams Conference, which was held in
Bayview Hunters Point, out of which came the HEAP’s Good Neighborhood
Project. In addition, the report was hand delivered to every single
household that participated. Since the report was published two months
ago, 1,000 copies have been distributed.
Dr. Bhatia concluded the presentation by describing the community
building efforts that will, or in some cases already have, come out of the
survey process. These efforts include the following:
- The Health & Environmental Resource Center.
- The creation of a number of asthma collaborations, including the Yes
We Can Campaign.
- The Food Security Initiative, where youth leaders are identifying
barriers to healthy nutrition in their communities and developing
action plans to remove those barriers, such as bringing new
supermarkets into the community.
- The Youth Power Initiative, which uses participatory approaches to
deal with the issues around violence.
- The African-American Health Initiative, which is a collaboration of
many organizations to deal with issues of chronic disease.
Dr. Bhatia also discussed two new programs in Bayview Hunters Point at
195 Kiska Road and One Harbor Road.
Dr. Bhatia said that that valuable lessons for health promotion came
out of this survey, including respecting the everyday wisdom of citizens,
accessing and demystify information, lending the resources of institutions
and building on community capacities, assets, and skills.
- Commissioner Sánchez asked if most of the individuals who did not
respond to the survey were non-English speaking. Ms. Mann responded
that this was the case, even though the surveys were translated into
Spanish and Chinese and there were bilingual interviewers.
Commissioner Sánchez commended the Department for involving the
community in the research, and added that now we need to generate
funding to support programs to address the problems identified in the
- Commissioner Parker congratulated everyone who worked on the report
for the community survey. He is concerned, however, that we are
continuing to gather information to validate what has been known for
decades: that there are health disparities in Bayview Hunters Point.
He emphasized that what the community needs are results, and for this
we are going to have to do things differently. Dr. Bhatia agreed, and
said that they department is going beyond traditional health services
to make change in the community, including partnerships with the
- Commissioner Umekubo appreciates the community perspective. He noted
the high prevalence of smoking and said that clearly one part of the
solution to asthma is to reduce the number of people who smoke. With
regard to the prostate cancer screening rates, Commissioner Umekubo
said that physicians, understanding the high prevalence of prostate
cancer in African-Americans, try to start screening around the age of
40, and the Department should encourage and support this. With regard
to access to care, Commissioner Umekubo said that he did not
understand why respondents were not receiving health care in the
community when the Department has two clinics in the area. Ms. Mann
responded that one factor is that approximately 30 percent of the
community are Kaiser members, and there are no Kaiser services in the
- Commissioner Chow said the Department should work with Kaiser to
provide services in Bayview Hunters Point. In response to Commissioner
Parker’s concerns, Commissioner Chow said that the goal of the
African American Health Initiative is to address the entire gamut of
needs in the community, not only the health needs. Commissioner Chow
expressed concern about health beliefs, particularly the fact that so
many people feel that illness is entirely beyond their control. Dr.
Katz responded that he not very concerned about people’s perception
of control over their health, which might result from religious
beliefs. He is concerned about how healthy people think they are. The
respondents rated themselves significantly lower than the nationwide
response, which indicates that their health is lower, and that they
are feeling more precarious about their health.
7) OTHER BUSINESS/PUBLIC COMMENTS
The meeting was adjourned at 5:00 p.m.
Michele M. Olson, Executive Secretary to the Health Commission