Minutes of the Health Commission Meeting

Tuesday, April 16, 2002
At 4:00 p.m.
3750 - 18th Street (at Dolores)
San Francisco, CA


The meeting was called to order by President Edward A. Chow, M.D., at 4:20 p.m.


  • President Edward A. Chow, M.D.
  • Vice President Roma P. Guy, M.S.W.
  • Commissioner Arthur M. Jackson
  • Commissioner Lee Ann Monfredini
  • Commissioner Harrison S. Parker, Sr., D.D.S.
  • Commissioner David J. Sanchez, Jr., Ph.D.
  • Commissioner John I. Umekubo, M.D. - Arrived at 4:35 p.m.


Action Taken: The Commission approved the minutes of the April 2, 2002 Health Commission Meeting.


Commissioner Jackson chaired and Commissioner Parker attended the Budget Committee meeting, which was held at 101 Grove Street, Room 300. Commissioner Umekubo and Commissioner Monfredini were absent.

(3.1) DPH-Contracts - Request for approval of a resolution approving the extension of the terms of the FY 2001-02 contracts on a month-to-month basis from July 1, 2002 through December 31, 2002.

(3.2) PHP-Substance Abuse - Request for approval of a contract modification with SAGE Project, Inc., to provide substance abuse services, in the amount of $117,500 for the period of July 1, 2001 through June 30, 2002, for a total contract value of $1,915,940 for the period of July 1, 1998 through June 30, 2002.

(3.3) PHP-Mental Health - Request for approval of a retroactive new contract with the Regents of the University of California in the amount of $213,276, to provide mental health services targeting clients in the male-to-female transgender community, for the period of October 1, 2001 through September 30, 2002.

(3.4) PHP-CHPP - Request for approval of contract modification with San Francisco Study Center in the amount of $63,755, for an increased contract total of $568,484, to provide Health Environmental Resource Center support services regarding cancer and asthma among African Americans in the Bayview Hunters Point area, for the period of July 1, 2001 through June 30, 2002.

(3.5) PHP-AIDS Office - Request for approval of a sole source contract renewal with WESTAT Inc., in the amount of $340,078, to implement the HIS/HITS telephone survey and evaluation services for the HIV Seroincidence Study, for the period of May 1, 2002 through December 31, 2002.

Action Taken: The Commission approved the Consent Calendar of the Budget Committee, with Commissioner Sanchez abstaining on Item 3.1 and Item 3.3.

Mitch Katz, M.D., Health Director, presented the Director’s Report.

Day Laborers Project

Last year, the Department’s Occupational and Environmental Health Section (OEHS) initiated a collaboration between the Labor Occupational Health Program, Cal-OSHA, Occupational Health Branch of the State Department of Health Services, Instituto Laboral de la Raza and the San Francisco Day Laborer Program to build a health and safety program for day laborers. Over the past 10 months, OEHS has conducted 12 training sessions each with over 50 participants, on subjects ranging from back injury prevention to accessing health services and benefits for an occupational injury. DPH also provided laborers with samples of personal protective equipment. The project conducted focus groups to determine how to better communicate health and safety messages to workers. In addition, the project worked to support the placement of more toilets near Cesar Chavez Street, and assisted Disease Control in getting the word out to the day laborers about the recent measles outbreak.

Programs Relocating to the Heart of the Mission

Mission Mental Health Services (outpatient clinic) and the Mission ACT program (one of three single point of responsibility programs) have just moved to their new offices at 2712 Mission Street. These programs serve about 1400 clients annually. Bilingual staff is available to provide treatment and case management services. The clinic uses a harm reduction approach to the dually diagnosed, providing assessment, acupuncture services and harm reduction groups. The newly renovated site is located at Mission and 23rd Streets.

Responding to the Continued Increase in Syphilis Cases

In March 2002 the STD Program sent letters to providers in the Brown and Toland Medical Group, as well as to Infectious Disease providers at Kaiser and all HIV providers in the City notifying them about the continued increase in syphilis and urging them to:

  • perform twice-annual syphilis screening of gay and bisexual men, and
  • test patients who present with rash-like illnesses for syphilis.

Letters were also sent to the owners and managers of the City's adults bookstores and sex clubs notifying them that new syphilis cases continue to report meeting partners at their establishments. The STD Program put them on notice that the Health Department expects them to take an active role in educating their clients about syphilis and supporting an environment conducive to safer sex. In response to this letter, several of the sex clubs have already developed posters, which are now being prominently displayed encouraging clients to be tested for syphilis.

Dorothy Washington

Dorothy Washington, a nurse at San Francisco General Hospital for 35 years passed away on Easter Sunday. Dorothy had served over the past 20 years on the night shift as hospital supervisor/administrator on duty.

Upon her request, Dorothy spent her last week in the hospital's 5A Unit where she "returned home" to be among her colleagues and friends. She was a highly revered woman of tremendous dignity and a consummate professional who fought passionately for her beliefs. She stood out in her role as mentor to many individuals pursuing nursing careers at SFGH. Dorothy was active in the National Black Nurses Association and volunteered in fund raising for the Lung Association. Dorothy's will be sorely missed but we are deeply thankful she graced our lives.

Bosnian Community Resource Room Open House

The Bosnian Community Wellness Program (BCWP) is a collaborative between the Newcomers Health Program and International Institute of San Francisco, and is funded by the California Endowment. BCWP is holding an open house on May 16th from 4:00 to 6:00 p.m. at 657 Mission Street, 5th floor, Suite 500. A brief presentation will be held at 5:00 p.m. providing the opportunity to learn more about the program, meet staff, Bosnian community members and friends. For more information, please contact Patricia Erwin at 705-8552 or by email at patricia.erwin@sfdph.org.

CHN/SFGH Medical Staff Credentialing Report
April 2002
(From 04/08/02 MEC and 04/09/02 JCC)


2002 YTD

New Appointments












    Reappointment Denials






Disciplinary Actions






Changes in Privileges




    Voluntary Relinquishments



    Proctorship Completed



Current Statistics (as of 04/01/02)

Active Staff


Affiliate Professionals (non-physicians)


Courtesy Staff


Referring Staff


Total Members:


Applications in Process


Applications Withdrawn - Month of March 2002



SFGH Reappointments in process through Sept. 2002


Commissioners’ Comments

  • Commissioner Chow expressed his sympathy to the family of Dorothy Washington. The Commission has a certificate for the family, which will be sent to them.


Jim Soos, DPH Policy and Planning, presented an overview of the demographics of the Mission District as well as the health services in the district. The data was from the 94110 zip code, which encompasses about 70 percent of Supervisorial District 9. In 94110, males outnumber females by 4 percent, which is a slightly larger margin than in the City generally. There is a large percentage of Latinos, as well as families. The leading cause of years of life lost for men is HIV/AIDS and for women is ischemic heart disease.

There are two hospitals in the district-St. Luke’s Hospital and San Francisco General Hospital. There are a number of DPH primary care sites in the Mission, as well as one private site, the Mission Neighborhood Health Center. Mr. Soos described the myriad HIV/AIDS services, mental health services, substance abuse services, homeless and housing services and maternal and child health services in the district. 29% of all 94110 residents use the Community Health Network (CHN). Conversely, 18% of all CHN patients reside in the Mission. Mr. Soos concluded by saying that DPH has a strong presence in the Mission through its own sites and through its contractors.


Commissioner Chow welcomed the members of the Mission community, and conveyed the Commission’s pleasure at being able to meet in their community. Commissioner Chow acknowledged the following individuals for their assistance in preparing for this meeting:

  • Mission High School
  • Gladys Sandlin, Mission Neighborhood Health Center
  • Nora Rios Reddick, Horizons Unlimited
  • Estella Garcia, Instituto Familiar de la Raza
  • Leonard Chavez, Mission Council
  • Carlos Romero, Mission Housing Development Corporation
  • Laura Guzman, Mission Neighborhood Health Center
  • Barbara Garcia, DPH
  • Maria Cora, DPH
  • Jorge Partida, DPH
  • Willie Crawford, Carlos Rendon, Richard Bitanga, DPH
  • Darryl Burton, DPH

Commissioner Chow asked Board of Supervisors’ President Tom Ammiano to address the audience. President Ammiano said he was happy to be at Mission High School, and applauded the Health Commission for holding meetings in the districts. The Mission is an extremely diverse community. There are different cultural values, and the DPH service delivery system has to have a cultural over-lay. Newcomer services are very important in the Mission. They need to feel safe. One thing he would love to work with DPH on is a partnership with the school district for school clinics in every school.

Commissioner Chow introduced Commissioner Sanchez. Commissioner Sanchez said it is an honor to be able to come to the Mission to listen to what people in the community are doing to try to address the many issues in the Mission. The Mission has a multitude of languages and cultures and the Commissioners are very cognizant that there has to be a shared dialogue on the health solutions. He acknowledged Rosario Anaya, who was the first Latina elected to the school board in San Francisco. He said that health is very important, and all of us need to participate in the dialogue.

Community Presentation/Public Comment

Estella Garcia, Instituto Familiar de la Raza, welcomed the Commission to the Mission. Under the leadership of Barbara Garcia, the community took this opportunity to give a broad perspective on health and mental health services, and have asked people to come forward with specific expertise. Ms. Garcia gave the Commission an introduction of all the speakers that would follow.

Beatrice Acosta, Mission Neighborhood Health Center, is 18 years old and has lived in the Mission her entire life. She has seen the neighborhood change in both positive and negative ways. It has become a more diverse community. She works for a program for youth run by youth that offers HIV and pregnancy prevention services. More resources are needed to address issues facing teens. There is more and more relationship violence. Nobody talks about issues around immigration of teens. Girls live with partners and babies in substandard housing and they will not complain because they fear being deported. The schools could do a better job mainstreaming teens into the schools. Many teen immigrants work rather than go to school. There need to be programs to motivate teens to go to school. More and more teens are abusing substances, and need more school programs to keep teens entertained so that they do not turn to drugs out of boredom. Also youth need a better relationship with police. Gangs still exist in the Mission. Everyday she sees younger and younger teens getting involved with gangs, and not just males.

Ana Estrada, was diagnosed with breast cancer in 1997. She was invited to attend a support group for women with breast cancer, but at the time she did not think she needed it. Ultimately she went to the support group where she met a “family” and realized that she was not alone. She was trained so she could offer support to women dying from cancer. The Latino community is particularly vulnerable when they are diagnosed with cancer. When a woman gets cancer, the whole family is affected. Children’s performance at school becomes worse. She asked the Commission to please support the proposal from Carmen Ortiz for a cancer support center in the Mission.

Victoria Herrera said when she was diagnosed with cancer she was lucky to meet Dr. Carmen Ortiz in the breast cancer section at San Francisco General Hospital. Her support and help was great, and she was invited to attend a support group where she got much information, could talk with many women who were going through the same treatment she would soon face. She asked the Commission to do all possible to help Carmen Ortiz to develop her program for Latino women, men and their families of are going through this disease.

Carmen Ortiz said she was diagnosed with breast cancer fourteen years ago, and she still remembers the array of feelings she felt, the affects of chemotherapy. She had many advantages, though, a support group of family and friends, health insurance, and the ability to speak the language of medicine. Breast cancer is the most prevalent cancer among Latinas. Yet Latinas are less likely to get screening, and have the most fatalistic attitude about cancer. Long medical appointments are a low priority when they need to work to maintain the family. There are more uninsured Latinas than any other ethnic group. Uninsured Latinos without breast cancer are more than twice as likely to be diagnosed at a later stage. Her program offers home hospital visits and advocacy services. She has a weekly breast clinic at SFGH for newly diagnosed Latinas. She developed an in-home support service for women in the end stages of their disease. Presently there are no Spanish-speaking support services for Latino men with cancer. She received a grant to open a Cancer Resource Center in the Mission to serve Latino men and women. Funding for her current programs ends next months and she has submitted a request from the SFGH Foundation for 4 months of bridge funding for the SFGH clinic and the in-home support program. She asked the Commission to support the Cancer Resource Center.

Eduardo Palomo, representing the day laborer program at 17th and Hampshire. He gave a summary of the services they provide to day laborers: help them find work, attending to their medical needs, helping them find clothing and shelter. The program helps them enter into the service systems at San Francisco General Hospital and St. Luke’s Hospital. Many of the day laborers have no insurance. Many of the injuries that the workers get never get treated.

Paulette Budrow, Bernal Dwelling Senior/Youth Community Resource Center, 3111 26th Street said that Bernal Dwelling is a very diverse community now. The Resource Center will be a focal point to supply information to residents who are shut in, or have a communication barrier. She asks the Commission to support the Center. The services will be focussed toward youth-job readiness, SAT workshops, etc.

Gladys Sandlin, Mission Neighborhood Health Center, said Mission residents are very busy working to keep their families fed and housed. She thanked the Health Department for putting health programs in the Mission. Families-both the newcomer population and older families-need the same services as everyone else. Mission parents often work three jobs to make sure the children have access to a good education. The Mission Neighborhood Health Center has been in existence for 36 years. Women and children still have a great need. The most prevalent services needed are cancer, asthma, arthritis and diabetes. Access is a key issue, and we need to get people to trust that programs will stay in the Mission. The Latino population has a unique need because of language and immigration issues. Ms. Sandlin asked the Commissioner to monitor the CHDP program. The proposed changes will have tremendous impact on undocumented workers. Her recommendation is to keep access at the forefront. The City needs to start thinking about opening services after hours and on weekends. Also, SFGH has to stay where it is. It has been the only hospital that provides services to the Latino population.

Michelle Moreno and Cynthia Wong, Instituto Familiar de la Raza, run a mentoring program at the Instituto. They said that there is a lot of drug use, and they are advocating for more funding for youth services. The police do not help with the problem of drug use on the streets. The people always return. What is needed are more prevention and intervention programs.

Carlos Romero, Mission Housing Development Corporation, said that San Francisco is the most unaffordable city in the United States. The Mission has 65,000 people, most of whom are people of color. The median income for the Mission is only 41 percent of the rest of San Francisco, so clearly their access to housing is limited. The main issue is that there are no housing units. There is a very clear connection between health and housing. Stable homes equate to stable health.

Amy Fishman, Director of supportive housing program, emphasized that housing is public health. This is not a generally accepted concept, but the Department and the Health Commission are supportive and are partners. When people have housing they see a reduction in stress, improved medical compliance, people getting clean and sober and seniors who can age in place. More needs to be done for families living in SROs, where there are clear effects on health and nutrition.

Laura Guzman, Mission Neighborhood Resource Center, said that the new center will open on May 20th, and shared some of the concepts used to design the center: user-run, 24-hour services, actual services on site (rather than just a referral center) and access to treatment slots. She asked the Commission to have the methadone van visit the resource center and said they want a detox facility in the Mission. There needs to be data on homelessness in the Mission, increased access to bathrooms and a safe needle disposal site. The civil rights of day laborers, homeless people and sex workers need to be protected.

Luis Vasquez Gomez, County Schools Task Force, said that the group has been meeting with the school district, parents, students, and community based organizations. Mental health services are critically needed, and services need to be integrated.

Edgar Callo, Instituto Familiar de la Raza, works with the day laborers. These people go through tremendous stress and trauma. The proposed budget cuts would hurt the most vulnerable members of the community, and he urged the Commission to do everything to prevent this from happening.

Commissioner Monfredini left the meeting at 6:15. Prior to leaving she said she wants to visit the day laborer program and would like more information about Dr. Ortiz’s cancer support programs. She said the commissioners try to learn as much about the health of the city as possible, and coming to the community is the best way to do this.

Estella Garcia, Instituto Familiar de la Raza, said that health is about mind, body and spirit, as a community and as a people. Everything is interrelated-housing, mental health, mentor programs. The Surgeon General recently released a report that says that while mental illness is universal, the burden of the disability is greater on minorities because of disparities in access. It is important for the Health Commission to hold strong to its commitment to services and not let these services be cut. Also, there needs to be a Department policy that funding follows the initiative and creativity of the community organizations. Systems need to support the progressive work of community organizations. Follow their lead, because they know what they are doing.

Leonard Chavez, Mission Council, said that we need to maintain funding for substance abuse services. This is a serious problem. In 1994 there were over 22,000 adult drug and alcohol arrests. In 1999, there were 31,882-a 45% jump. Right now providers are just holding the line. Progressive modalities have been developed that mitigate impact of substance abuse. The first line of defense is drug treatment. Relapse is an important part of the recovery process. These need to be understood and supported. The Department of Public Health is a critical supporter of the non-profits that provide the services.

Rosario Anaya, Mission Language and Vocational School, said that the program has been serving the community for 35 years. They have eight programs that range from clerical to the culinary academy to a medical assistant program. She asked that the Commission remember how the lack of English speaking skills impacts access to health care. Also, continue to expand health services through community organizations. Find ways to bring insurance companies and the Insurance Commissioner into the local efforts.

Dan Brajkovich, Mission Language and Vocational School, talked about the relationship between lack of education and English language skills and access to health. When there is lack of access to information there is lack of employment, which means no insurance or ability to pay for care, which means no health care and no access to preventive medicine. People only get treatment when it gets really bad. The system needs to have cultural fluency. Many people in the Mission have a tremendous fear of bureaucracy. The Department, and the services it provides, needs to greet the community with open arms and languages that do not cause fear.

Donna Saffioti-Johnson, Horizons Unlimited, talked about outreach. Outreach requires prople being on the streets on a consistent basis - rain or shine. Outreach is about providing information, being a link to services. It means recognizing some people are not going to quit, so using harm reduction approaches. It means working with families and listening. There are a lot of good services for youth in the Mission, but there needs to be more.

Rob Gidden, At the Crossroads, works with homeless youth and young adults in the Mission and downtown. The program targets youth that are not going into programs, and seeks to establish relationships with these individuals through nighttime street outreach and daytime one-on-one counseling. These youth do not access services for very specific reasons: they are too old for youth services but still identify with youth and do not feel comfortable and safe in an adult environment; they had negative experiences with institutions that were supposed to help them; they fit the profile of a criminal, so they are usually targeted by law enforcement, not for treatment. He said special hours for youth are needed, as is a specific liaison for these people. He cited the ISIS clinic as a good example.

Ray Balberan, Calles Program Director, Mission Resource Centers, submitted documents to be copied and distributed to the commissioners. He said the Health Commission needs to support community organizations. All agencies are advocates. The Calles program is the eyes and ears of the community. All the Mission agencies are interconnected. The people in the Mission want to live free from poverty and free from violence.

Carola Guadamuz, Casa de los Jovenes, said that without youth programs, there would be a lot more negative activities on the streets.

Christina Carrera, Planned Parenthood Golden Gate, said that reproductive health is a major concern for the Latino community. Getting women to their educational sessions has been a challenge because the women need childcare. Another issue is domestic violence.

Nora Rios Reddick, Horizons Unlimited, said that there are no culturally competent residential programs for Latino youth. There are other great youth residential programs in San Francisco, but when Latino youth go there, they do not stay.

Commissioners’ Comments

  • Commissioner Jackson said that he is staunchly behind the community. The greatest challenge is adequate resources. Resources can be stretched though integration, collaboration and out-of-the-box thinking. He encouraged the community to look for opportunities to work with other neighborhoods, to seek funding from foundations and to achieve social justice.
  • Commissioner Parker thanked the community for inviting the Commission to the Mission. He learned a number of things: in spite of our city being considered healthy the level of services is still unacceptable, and the community is asking for change; there need to be changes in funding mechanisms; we need to expand hours of services; and we need culturally competent providers.
  • Commissioner Sanchez said that everyone is working diligently to sustain the safety net and the seawall behind it. He is very aware that we need to find mechanisms to sustain our true partners who are doing the work in the community.
  • Commissioner Guy said that one important thing she learned about this neighborhood is the current transformation that is happening, including people being displaced. The Commission supports community organizations. They are user-friendly in a way bureaucracies never can be. The Department and the Commission need to better understand the complexity of the issues CBOs deal with. She also wants to better understand the changing demographics of the Mission, particularly with regard to the Asian community. She supports the development of the cancer resource center.
  • Commissioner Chow said that the Commission has tried to carry out the goals that were conveyed by today’s speakers, albeit imperfectly. He is fully committed to a culturally competent program, and fully committed to having the community participate in the development of the program. He noted the great emphasis on youth and schools, which the Commission is also very interested in.




The meeting was adjourned at 7:25 p.m.

Michele M. Olson, Executive Secretary to the Health Commission