Minutes of the Health Commission Meeting
Tuesday, January 8, 2002
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The Health Commission meeting was called to order by Commissioner Roma
P. Guy, M.S.W. at 3:05 p.m.
- 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 DECEMBER 18,
Action Taken: The Commission approved the Health Commission minutes of
December 18, 2001.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Jackson chaired, and Commissioner Monfredini attended, the
Budget Committee meeting.
(3.1) AIDS Office - Request for approval of a retroactive contract
modification with Positive Resource Center, in the amount of $140,000,
for a total contract amount of $365,000, to provide staff support and
consultation services to the HIV Health Services (CARE) Planning
Council, for the period of March 1, 2001 through February 28, 2002.
(3.2) AIDS Office-Prevention - Request for approval to accept and
expend retroactively a one-year grant from the Regents of the University
of California in the amount of $72,500 for an HIV prevention planning
collaborative allocation tool project, for the period of September 30,
2001 to September 29, 2002.
(3.3) CHN-Laguna Honda Hospital - Request for approval of a
retroactive sole source contract renewal with the Regents of the
University of California, on behalf of the UCSF Department of
Physiological Nursing, in the amount of $174,879, to provide specialized
gerontological care services, for the period of October 1, 2001 through
September 30, 2002.
(3.4) CHN-Office of Managed Care - Request for approval of a
retroactive sole source contract renewal with the Regents of the
University of California, on behalf of the UCSF Medical Center, in the
amount of $1,700,000, to provide tertiary care services, for the period
of July 1, 2001 through June 30, 2002.
Action Taken: The Commission approved the Consent Calendar of the
Budget Committee, with Commissioner Sanchez abstaining from voting on
Items 3.2, 3.3 and 3.4.
4) DIRECTOR’S REPORT
(Mitchell H. Katz, M.D., Director of Health)
(Report on activities and operations of the Department)
Chinatown Public Health Center
The Chinatown Public Health Center received an Appreciation Award from
NICOS at their annual meeting in December. NICOS is a coalition of health,
mental health and social service agencies serving the Chinese community.
The Health Center was recognized for outstanding work enhancing the health
and wellness of the San Francisco Chinese community. Two special projects
were highlighted: the Chinese Women Cancer Support group and recent
issuance of their stories, and the publication of "Healthy and
Delicious" low fat Chinese cookbook, which incorporates important
nutrition education. Both publications are "first of their kind"
and are presented in Chinese and English.
Community Mental Health Staff Departures
Louise Rogers, Planner and Risk Manager for CMHS, is leaving after
seven years to become Deputy Director of Operations for San Mateo County
Mental Health. Louise was instrumental in a large number of innovations at
CMHS, including the successful design and implementation of the Single
Point of Responsibility programs.
The Department of Public Health routinely responds to fires and other
incidents that displace residents. Working with the Department of Human
Services, Mayor’s OES, and the American Red Cross, the Health Department
assures that displaced residents have temporary housing, access to their
prescriptions, mental health counseling, and food. DPH staff has been very
busy during the last few weeks, responding to three fires and continuing
to do follow up services. Special thanks to Charlie Morimoto and Mike
Petrie for their response efforts.
227 Turk Street
As reported at the last Commission meeting, a fire occurred December
15th at a 66-unit apartment building on Turk Street. At that time, we
believed that residents of the unaffected units would be able to
reoccupy by December 23rd. The process took longer than we had
anticipated, but residents were back in the building to welcome the New
Year. Inhabitants of the 5 severely burned units have been vouchered
into hotels, and we are working to find alternative housing.
Update for 449 O’Farrell St. Fire
Fire broke out in a 28-unit apartment building at 449 O’Farrell
Street in the early morning hours of December 23rd. Thanks
to the work of the City response team, including Charlie Morimoto, and
DPH outreach staff, residents of the 20 unaffected apartments were able
to reoccupy their units December 29th. DPH is looking to secure long
term housing for the seven families still displaced.
Clay and Locust
On Saturday, January 5, Mike Petrie, from the Department’s EMS
section, responded with the Fire Department, Mayor’s Office of
Emergency Services and the American Red Cross to a 4-alarm fire in three
apartment buildings at the corner of Clay and Locust Streets. There were
not fatalities or injuries, but 19 adults and 5 children living in 15
apartments were displaced. All of the displaced residents were able to
find housing with family and friends.
- Commissioner Parker asked if any special or additional preparations
have been taken to provide services to the homeless during the winter
months. Dr. Katz responded that the Mayor’s Office of Homelessness
has opened 550 shelter slots as part of its winter program. Ms.
Kronenberg added that over the last week an additional 40 shelter beds
- Commissioner Umekubo shared that, on Christmas Eve, the house next
door to his caught on fire. He was impressed by the response of the
San Francisco Fire Department and the Red Cross.
- Commissioner Guy commended Dr. Katz for attending at San Francisco
General Hospital during December.
- Commissioner Chow asked what triggers the Health Department’s
response to a fire. Ms. Kronenberg replied that the 911 Dispatch
Center calls the Health Department for three-alarm fires or greater.
However, she has asked that the Department be informed for two-alarm
fires as well, or when more than 12 people will potentially be
5) ADOPTION OF A RESOLUTION COMMENDING THE START OF ENROLLMENT IN
THE NEW HEALTHY KIDS PROGRAM AND PROCLAIMING JANUARY 13, 2002 AS “HEALTHY
Jean Fraser, Executive Director of the San Francisco Health Plan,
presented a proposed resolution that commends the beginning of enrollment
in the new Healthy Kids Program. There will be an official launch
Thursday, January 10, 2002, and the first of many big enrollment events
will occur this weekend.
- Commissioner Monfredini asked what happens to the 1,200 children who
will not be eligible for any public health insurance program. Ms.
Fraser responded that these children are members of families whose
income is above 300 percent of the poverty level. The policy decision
was made to make a cut off at 300 percent because it is believed that
income level is sufficient to purchase private insurance (for a family
of four, this is $53,000). The San Francisco Health Plan has developed
a list of alternative private insurance providers to refer people to.
- Commissioner Parker clarified that, if the 1,200 children are
somehow covered, San Francisco will have 100 percent health insurance
coverage for San Francisco children.
- Commissioner Guy said that this program was one of the Health
Commission’s top priorities, and was pleased to see that it is now
ready to begin enrollment.
- Commissioner Chow said that there will always be some people who
elect not to get health insurance. While it is a complicated issue, he
understands the 300 percent cut off because there should be an
obligation on the part of the family to pay its fare share if it is
able so that dollars can truly be directed toward the very needy
children. Commissioner Chow commended the City and the Health Plan for
achieving such a broad level of coverage.
Action Taken: The Commission unanimously approved Resolution #01-02
titled “Commending the Start of Enrollment in the New Healthy Kids
Program Offered Through the San Francisco Health Plan, Encouraging San
Francisco Families to Obtain Health Coverage for Their Uninsured Children
Regardless of Immigration Status, and Proclaiming January 13, 2002 ‘Health
Kids Day’ in the City and County of San Francisco.”
6) FEDERAL LEGISLATIVE UPDATE
Colleen Johnson, Acting Director, Office of Policy and Planning,
presented the Federal Legislative Update. Ms. Johnson summarized the
Department’s federal legislative and budget priorities, as well as the
major federal policy initiatives and budget actions on which the
Department worked in 2001.
2001 Legislative Priorities
The First Session of the 107th Congress
- Medicaid County Organized Health Systems (COHS)
- HIV/AIDS Funding
- Hospital Facility Replacement
- Public Health Funding
- Substance Abuse -- Treatment on Demand
This session was marked by extraordinary events, including a contested
election, the largest tax cut in more than 20 years, dramatic change in
control of the Senate, the terrorist attacks of
September 11 and economic decline. With new legislative and budget
priorities that emerged as a result of September 11, several pieces of
business were left unfinished.
As a result of Congresswoman Nancy Pelosi’s efforts, the 2001-2002
federal budget included two of the Department’s 2001 budget initiatives:
$1 million for San Francisco’s Treatment on Demand Initiative; and
$650,000 for HIV care and services at San Francisco General Hospital for
women and persons of color.
Upper Payment Limit
In November 2001, the Bush Administration proposed a new rule, which
reduces the Upper Payment Limit (UPL) from 150 percent to 100 percent.
This decrease will impact the Department beginning in 2004, with the full
reduction in 2010. The estimated impact on San Francisco General Hospital
is $10 million. The Department is working closely with its California
coalition partners, CAPH and CHA, to attempt a California-specific remedy.
A legislative fix was not achieved before Congress adjourned in December,
although there was language in the conference report to the Labor/HSS/Education
Appropriations bill that supports the higher UPL.
Congress approved a $20 million anti-terrorism package, which includes
$865 million for upgrading state and local public health capacity and $135
million to assist hospitals and emergency departments. Legislation
specifying how the money will be spent did not pass, so the Secretary of
Health and Human Services was charged with developing a distribution plan.
Federal Medical Assistance Percentage (FMAP)
The Federal Medical Assistance Percentage (FMAP) is the portion of
Medicaid and the State Children’s Health Insurance Program that is paid
by the federal government. California’s FMAP decreased from 51.4 percent
in 2002 to 50 percent for 2003, which is estimated to cost California $400
million per year.
Mental Health Parity
The 1996 federal mental health parity law expired September 30, 2001. Congress
considered an expansion of the law that would close loopholes in the 1996
law by requiring insurers that provide mental health coverage to offer
those benefits at the same level as physical health coverage with respect
both to costs (such as deductibles) and to access to services. This effort
was not successful.
However, though the federal initiative was unsuccessful, California law
still provides for mental health parity. State bill AB 88, authored by
Assemblywoman Helen Thomson, was passed in 1999 and, as of July 1, 2000,
requires health plans to provide coverage for severe mental illness.
State Plan Amendments for Laguna Honda
The State Legislature approved three programs that would provide
additional Medicaid funding for Laguna Honda Hospital.
- SB 1128 will provide supplemental Medicaid reimbursement to help pay
for the debt service on the rebuild of Laguna Honda Hospital.
- One-time funding for distinct part nursing facilities was included
in the 2000-01 State budget.
- The Public Distinct Part Nursing Facility Supplemental Reimbursement
Program was included in the 2001-02 State budget.
340B Drug Pricing for Inpatient Pharmacies
Through the Public Hospital Pharmacy Coalition and the City’s federal
lobbyist, the Department advocated to clarify the current CMS
interpretation and of the best price exemption to ensure public inpatient
pharmacies were eligible for the same discounts that are given for
outpatient drugs. Un-fortunately there was no legislative clarification on
this issue, but the Department was able to secure strong support from the
San Francisco Congressional delegation to continue to support efforts next
Community Based Services
The Department submitted comments on the New Freedom Initiative,
President Bush’s initiative to remove barriers to independent living for
people with disabilities. The Department proposed various suggestions
about how federal agencies could work together to ensure that services
were available for persons with disabilities in the least restrictive
Nursing Workforce Shortage Legislation
The House and Senate each passed bills that attempt to address the
nursing workforce shortage, but neither has yet to be finalized. The $136
million Senate bill is broader that the House bill, which has no price
figures. Both will go to conference committee when Congress reconvenes.
2002 Federal Legislative Priorities
- Upper Payment Limit - ensure maintenance of an upper payment
limit of 150% for California
- Disproportionate Share Hospital Program - Eliminate and/or
reduce future Balanced Budget Act-imposed reductions.
- County Organized Health Systems
- Health Care Workforce Shortage - support initiatives that will
increase the health care workforce.
- HIV/AIDS Funding - seek additional funding to minimize cuts in
service as a result of a loss of $545,000 in Ryan White Title I
formula funding in both FY 2002 and FY 2003.
- Substance Abuse, Treatment on Demand - seek to institutionalize
funding of $1.3 million for San Francisco’s Substance Abuse
Treatment on Demand initiative.
- Community-Based Services
- Ensure access to appropriate community-based services as an
alternative to inpatient care.
- Pursue a HUD waiver to prioritize subsidized housing for persons
leaving institutional care to community.
- Commissioner Monfredini asked if the federal “homeland security”
money would come directly to public hospitals, and if it will be
earmarked for particular activities. Ms. Johnson replied that it will
most likely go through the State, who will determine how it can be
used. At this time there are no details as to how the money will be
spent, and the federal government is seeking input from local and
state entities. Dr. Katz added that San Francisco is considered a
territory by the CDC, so it might get a separate allocation without
having to go through the State. Also, there seems to be a growing
consensus that good bioterrorism preparedness is not one particular
activity, but rather good general public health-surveillance,
communication, infection control, nursing and other functions.
- Commissioner Chow asked if the Department is participating in the
various nursing workforce initiatives. Ms. Johnson responded that the
Department’s lobbyist and delegation have been involved in the
nursing workforce legislation that will be considered in the 2002
- Commissioner Umekubo asked what impact the FMAP decrease will have
on the Department. Ms. Zmuda said that this will depend on how much
the State will accept this reduction or if they will choose to pass
this reduction on to local governments. They will know better when the
State budget it released on Thursday.
- Commissioner Guy asked if the Department is specifically pursuing
the exemption from the new upper payment limit level. Ms. Johnson said
yes, and all of California is united on this approach. Dr. Katz added
that he has made calls to Senator Feinstein’s office on this issue
because it is so critical to the department’s fiscal ability to
7) EEO ANNUAL REPORT AND CONSIDERATION OF PROPOSED ADOPTION OF
STANDARDS FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (CLAS) IN
Norm Nickens, Director of the Office of Equal Employment Opportunity,
Affirmative Action and Cultural Competency, presented the annual EEO
In FY 2000-01, the EEO Office received 58 formal complaints of
discrimination or harassment. These numbers do not include all requests
for reasonable accommodation under the ADA.
There was a significant increase of complaints filed on the basis of
disability, which in part reflects a change in State law that
substantially expanded the definition of disability. Mr. Nickens stated
that this change has impacted the Department.
Another change that happened in 2001 is that, through court decisions,
Proposition 209 has been firmly applied to public sector employment. Thus
the annual affirmative action plan that was previously submitted to the
Commission on an annual basis will be replaced by a new Equal Employment
Opportunity report, the format of which is still under review by the City
Mr. Nickens stated that one of the major challenges is trying to
improve the communication and coordination between the Department’s EEO
activities, its human resources activities and its workers’ compensation
programs. The EEO office is working with other City departments and the
City Attorney’s office to develop training programs for all City
managers on the interaction between workers’ compensation, ADA and leave
policies. The goal is to find a way to simplify the process such that an
employee does not have to fight her or his way through three complex
Equal Access to Services Ordinance.
Mr. Nickens then gave an update on the Equal Access to Services
ordinance, which was adopted by the Board of Supervisors last year. The
ordinance specifically requires the provision of translation services to
limited English proficient clients, the availability of services and
interpretation at the point of public contact and a uniform,
departmentwide grievance process. Mr. Nickens said that adequate programs
are already in place at San Francisco General Hospital, and the goal is to
use these as models for other areas of the Department. The draft
implementation plan is due on February 1, 2002. Preliminary first year
goals are identification of bilingual clients, bilingual workers and
complaints regarding lack of translation services and development and
posting of bilingual signage related to request for translation. Mr.
Nickens stated that the advocates that brought this to the Board of
Supervisors have made it known that they intend to scrutinize two
departments: the Police Department and the Department of Public Health.
Employee Assistance Program
The Employee Assistance Program (EAP) was placed under the EEO Office
in August 2001. The EAP provides services to employees of all City and
County departments, as well as employees of the San Francisco Unified
School Districts. EAP offers counseling in a number of areas, including
depression, substance abuse, parenting skills, workplace violence and
others. This unit has been increasingly called upon to provide
organizational development services to other departments as well. The work
of this unit was heavily impacted by September 11th and its aftermath.
During the three weeks following September 11th, EAP counselors went out
to 19 City worksites. Mr. Nickens intends to “re-launch” EAP to the
various Departments throughout the City and County so that employees are
aware of its resources.
Mr. Nickens said that the EEO Office formed an interim Task Force on
Cultural Competency to review the Department’s cultural competency
standards and suggest changes. Mr. Nickens summarized the recommendations
that resulted from this review.
- Establish an ongoing Cultural Competency Task Force that includes
departmental and community representatives. Mr. Nickens hopes to add
5-7 community representatives, and will finalize the list of community
individuals on Friday, January 11. He is recruiting individuals with
significant experience in developing standards on culturally competent
services and/or bilingual services as well as individuals from the
disability community and Department contractors. Mr. Nickens will
present this list to the Commission through the Population Health and
Prevention Joint Conference Committee.
- Adopt Culturally and Linguistically Accessible Services (CLAS)
standards as guidelines.
- Require cultural competency objectives, where appropriate, in all
contracts. Mr. Nickens hopes to have training in place by March and
objectives in contracts by July.
- Develop standardized monitoring tool for the evaluation of cultural
competency in the contract monitoring process.
- Develop a series of training programs based on a train the trainer
model for both DPH staff and contractors.
- Develop web-based resources, including training materials, local
resources and model policies and procedures.
Mr. Nickens said that there are advantages and disadvantages to using
the CLAS standards that were developed by the Office of Minority Health.
Among the disadvantages are that they were developed for large health care
institutions as a result of a national process, are weak on disability and
silent on sexual orientation. They are strong in responding to the needs
of racial and ethnic minority populations. They are being recommended as
guidelines because they provide a formal definition of cultural
competency, and a uniform working set of standards on cultural and
linguistic competency for contractors and Department staff. The guidelines
will be adopted as guidance, and adapted to reflect local priorities.
- Commissioner Parker asked if the Department is required to have CLAS
standards. Mr. Nickens replied that some aspects of the CLAS standards
currently exist as part of federal contracting requirements, for
example the provision of bilingual services. Commissioner Parker asked
for clarification that DPH is adding standards beyond what is
required. Mr. Nickens said that many of these standards are going to
ultimately become requirements, so the Department is getting ahead of
the curve. In addition, the CLAS standards have broad applicability
for funding agencies, accreditation agencies, etc. Commissioner Parker
asked if resources are available for smaller contractors to help meet
these new standards. Mr. Nickens said that the first year goal is to
have sample policies on the website, and a possible second year goal
is to offer technical assistance to agencies. Commissioner Parker
asked if the EAP program is available for the contractors. Mr. Nickens
replied that EAP services are available to City and County employees,
their family members and significant others.
- Commissioner Umekubo asked if a standard self-assessment tool has
been developed. Mr. Nickens replied that the Department has not been
overly prescriptive to agencies in terms of what constitutes
self-assessment. The self-assessment tool for the Department has not
yet been developed. Commissioner Umekubo stated that it is an enormous
task to train all DPH staff. Mr. Nickens said that he is hesitant to
recommend mandatory training for all staff, but he is currently
identifying which key divisions and/or key staff do need mandatory
- Commissioner Chow asked if the Department is expecting outcome
measures from agencies prior to the completion of training on the new
standards. Mr. Nickens acknowledged that this is a challenge, but
wants to make the attempt to have some measures in the next contract
cycle. Commissioner Chow said that the resolution gives a framework by
which San Francisco can lead the country in cultural competency.
- Commissioner Guy asked that the membership list of the Cultural
Competency Task Force be forwarded to the Health Commissioners once
the community representatives have been appointed. She also asked that
an update be presented to the Population Health and Prevention Joint
Conference Committee. Mr. Nickens suggested that this be done after
March, as some of the training sessions will have been completed and
the preliminary draft of compliance with Equal Access to Services
Ordinance will have been submitted to the Immigrants Rights
Action Taken: The Commission unanimously approved Resolution #02-02,
“Amending the Department of Public Health’s Policy Directive 24,
Contractors’ Compliance with Antidiscrimination Protections and Cultural
Competency, and Adopting Guidelines for Culturally and Linguistically
Appropriate Services (CLAS) in Health Care.”
Commissioner Sanchez left the meeting at 4:50 p.m.
8) PUBLIC COMMENTS
Michael Lyon, Coalition to Save Public Health, talked about the cost of
the PBM contract. His opinion is that there is no way the Department can
get better pricing in the contract without 340B pricing. Mr. Lyon
submitted an immediate disclosure request for certain information related
to the pharmacy.
The meeting was adjourned at 4:55 p.m.
Michele M. Olson, Executive Secretary to the Health Commission