Minutes of the Health Commission Meeting
Tuesday, July 15, 2003
at 3:00 p.m.
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The Commission was called to order by Commissioner Chow at 3:10 p.m.
- Commissioner Edward A. Chow, M.D., President
- Commissioner Roma P. Guy, M.S.W., Vice President
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner David J. Sánchez, Ph.D.
- Commissioner Lee Ann Monfredini
- Commissioner Michael L. Penn, Jr., M.D., Ph.D.
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE MEETING OF JULY 1, 2003
Action Taken: The Commission (Chow, Guy, Parker, Sánchez) approved the
Minutes of the June 17, 2003 meeting with one change to Commissioners’
Comments pertaining to Item 4, page 6. Commissioner Chow added “Population
Health and Prevention” before “Joint Conference Committee” in the
“There has been a request that there be additional presentation to
the [Population Health and Prevention] Joint Conference Committee to
describe the impact, especially because the identified Rite Aid is not
always very close to the patient’s clinic.”
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Sánchez chaired, and Commissioner Parker attended, the
Budget Committee meeting. Commissioners Monfredini, Penn and Umekubo were
(3.1) DPH - Laguna Honda Hospital - Request for approval to accept a
gift donated by the Laguna Honda Hospital Volunteers, Inc., consisting
of a 2002 Dodge Ram 3500 customized passenger van for the use of Laguna
Honda Hospital residents. The van is wheelchair accessible and safety
equipment has been installed to the specification of hospital staff and
City regulations. The total value of the van is $37,857.
(3.2) DPH - Laguna Honda Hospital - Request for approval to accept a
gift donated by the McKesson Corporation consisting of two electric
vehicles for the general benefit of all Laguna Honda Hospital residents.
The electric vehicles will be used to provide tours of the Campus to
educate current residents, family members, visitors and the general
public about the LHH Replacement Project. The total value of the two
(3.3) CHN-Nursing Operations - Request for approval of contract
modifications with the following firms for a combined total of
$2,390,000:HRN Services, Inc., Medical Staffing Network, Inc., Medstaff,
Inc., Nurse Providers, Inc. and United Nursing International, to provide
supplemental, temporary per diem and traveling nursing personnel
services for San Francisco General Hospital, Community Health Network,
for the period of September 1, 2002 through August 31, 2003.
(3.4) CHN-Revenue Management - Request for approval of a contract
renewal with Accordis, Inc., previously known as Health Management
Systems, Inc., to provide retroactive electronic claims submissions to
Medi-Cal, Medicare and Commercial/Third Party Insurance payers, when
recipient eligibility was not previously identified by the Community
Health Network, for the contract period of July 1, 2003 through June 30,
2004. [The contractor will only be compensated by a % of recoveries if
their efforts result in revenues to CHN].
(3.5) BHS-MIS - Request for approval of a renewal software
maintenance agreement with The Echo Group, in the amount of $411,597, to
provide ongoing system maintenance and application support services for
the INSYST software application in use by Community Mental Health
Services, for the period of July 1, 2003 through June 30, 2004.
(3.6) BHS-MIS - Request for approval of a renewal software
maintenance agreement with InfoMC, in the amount of $254,160, to provide
ongoing system maintenance and application support services for the
CCURA3 software application for Community Mental Health Services, for
the period of July 1, 2003 through June 30, 2004
(3.7) BHS-Substance Abuse - Request for approval of a contract
renewal with Potrero Hill Neighborhood House, in the amount of $390,766
per year for a total contract amount of $1,563,063, to provide intensive
outpatient substance abuse services targeting youth/young adults and
adult parolees/probationers, for the period of July 1, 2003 through June
- Commissioner Parker recommended that this item be held out
individually for approval of the full Health Commission, enabling
the Commission to publicly honor Enola Maxwell, the former Director
of the Potrero Hill Neighborhood House.
(3.8) BHS-Substance Abuse - Request for approval of a contract
renewal contract with Horizons Unlimited of San Francisco, Inc., in the
amount of $1,229,156 per year for a total contract value of $5,506,619,
to provide day treatment, outpatient and prevention services targeting
Latino youth, for the period of July 1, 2003 through June 30, 2007.
- Commissioner Sánchez requested a follow-up report to the
Population Health and Prevention Joint Conference Committee,
specifically regarding units of service, demographics and how data
are tracked and quantified among different types of contracts.
(3.9) BHS-Substance Abuse - Request for approval of a contract
renewal with Episcopal Community Services, in the amount of $886,645 per
year for a total contract amount of $3,546,578, to provide mental health
and substance abuse services targeting homeless individuals, for the
period of July 1, 2003 through June 30, 2007.
(3.10) PHP-STD Prevention and Control - Request for approval of a
contract modification with Internet Sexuality Information Services,
Inc., in the amount of $110,000 for a total contract amount of $203,900,
to provide syphilis elimination services targeting men who have sex with
men, for the period of January 1, 2003 through December 31, 2003.
- Patrick Monette-Shaw submitted hand-written testimony regarding
item 3.10. Instructions submitted by Mr. Monette-Shaw with the
comments read: “Do not type, will e-mail to you.” E-mailed
comments were never received but original written comments can be
found in the Department’s Health Commission meeting files.
(3.11) PHP-Community Health Services - Request for approval of a
retroactive contract modification with the Regents of the University of
California, in the amount of $483,801, for an increased total of
$1,975,506, to provide Model Tuberculosis Prevention and Control Center
services to local and national TB health care providers, professionals
and funders, for the period of January 1, 2003 through December 31,
Commissioner Sánchez abstained from voting on this item.
(3.12) PHP-Community Health Services - Request for approval of a
renewal contract with AmeriChoice, in the amount of $228,657, to provide
fiscal intermediary services to the Personal Assisted Employment
Services for dental services, for the period of July 1, 2003 through
June 30, 2004.
(3.13) PHP-AIDS Office HIV Services - Request for approval to
retroactively accept and expend a grant from the Substance Abuse and
Mental Health Services Administration, in the amount of $1,482,354, of
which $1,437,487 is a request to retroactively approve a three-year sole
source contract with UCSF-AIDS Health Project. The period of the grant
and the contract is June 1, 2003 to May 30, 2006.
Commissioner Sánchez abstained from voting on this item.
(3.14) PHP-AIDS Office Research - Request for approval to
retroactively accept and expend a subcontract from Public Health
Foundation Enterprises, Inc., in the amount of $405,101, to fund a
project for “San Francisco HIV Vaccine Clinical Trials”, for the
period of June 1, 2003 to May 31, 2004.
(3.15) PHP-AIDS Office Prevention - Request for approval of a renewal
contract with Lavender Youth Recreation and Information Center, in the
amount of $141,000, to provide HIV prevention services targeting youth,
for the period of July 1, 2003 through June 30, 2004.
(3.16) PHP-AIDS Office Prevention - Request for approval of a renewal
contract with Stop AIDS Project, in the amount of $875,871, to provide
HIV prevention services targeting behavioral risk populations, for the
period of July 1, 2003 through June 30, 2004.
(3.17) PHP-AIDS Office Prevention - Request for approval of a renewal
contract with Larkin Street Youth Services, in the amount of $190,968,
to provide HIV prevention services targeting homeless and runaway
adolescents and young adults ages 13-23, for the period of July 1, 2003
through June 30, 2004.
(3.18) PHP-AIDS Office Prevention - Request for approval of a renewal
contract with Westside Community Mental Health Inc., in the amount of
$135,302, to provide HIV prevention services to female African American
injection drug users, for the period of July 1, 2003 through June 30,
(3.19) PHP-AIDS Office Prevention - Request for approval of a renewal
contract with Harm Reduction Coalition in the amount of $157,337, to
provide harm reduction training services targeting HIV prevention
service providers, for the period of July 1, 2003 through June 30, 2004.
(3.20) PHP-AIDS Office Prevention- Request for approval of a renewal
contract with Haight Ashbury Free Clinic, Inc., in the amount of
$605,727, to provide HIV prevention services targeting behavioral risk
populations, for the period of July 1, 2003 through June 30, 2004.
(3.21) PHP-AIDS Office Prevention - Request for approval of a new
sole source contract with Public Health Foundation Enterprises, Inc., in
the amount of $88,995, to provide fiscal administrative services for the
“Post Marketing Surveillance for the OraQuick Rapid HIV-Antibody Test”
project, targeting persons who have received an OraQuick test at a CDC
or State government-funded site, for the period of July 1, 2003 through
December 31, 2003.
(3.22) PHP-EMSA - Request for approval to retroactively accept and
expend funds in the amount of $920,650 from the Emergency Medical
Services Fund to reimburse providers for emergency medical services
rendered during the period July 1, 2002 to June 30, 2004 and for
administrative costs associated with the program.
Action Taken: The Commission (Chow, Guy, Parker, and Sánchez) approved
the Budget Committee consent calendar, approving Item 3.7 separately.
Commissioner Parker introduced a motion approving Item 3.7 and recognizing
Enola Maxwell’s outstanding service to the community, honoring her
memory and acknowledging her work as the Director of the Potrero Hill
Neighborhood House. Sánchez seconded and the Commission approved the
Commissioner Sánchez abstained from voting on Items 3.11 and 3.13.
The Commission requested a follow-up report to the Population Health
and Prevention Joint Conference Committee regarding Item 3.8, specifically
regarding units of service, demographics and how data are tracked and
quantified among different types of contracts.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
Alliance Announces New Best Practice in Ending Chronic Homelessness
Earlier this month, DPH’s Direct Access to Housing (DAH) program was
identified by the National Alliance to End Homelessness as one of only a
handful of model best practice programs in the nation that address and
prevent homelessness. The Alliance highlighted DAH’s significant
achievements in improving the health care service utilization of its
residents, including reduced reliance on emergency room care, acute
inpatient hospitalizations, and psychiatric hospitalizations.
Michael Petrie, EMS Section
Michael Petrie, Administrator of the EMS Section, was recently
selected, as one of 20 civilians nationwide, to enter the prestigious
United States Naval Postgraduate School's Master's Degree Program in
Homeland Defense and Security. This 18-month program is fully funded by
the United States Department of Justice, Office of Domestic Preparedness,
and is designed to provide a graduate-level education and develop research
to help strengthen America's capability to prevent, deter, and respond to
terrorist attacks, and to foster interagency cooperation, which is
critical to terrorism preparedness. This program is regarded world-wide as
the best of its class in this discipline.
Youth Health Advisor appointed to PHP JCC
The Population Health & Prevention Joint Conference Committee is
pleased to announce the appointment of Nicole Williams as its first Youth
Health Advisor. Nicole will be a junior at Mission High School this fall,
she is 16 years old, and is interested in pursuing a career in medicine.
As the Youth Health Advisor to the PHP JCC, Nicole will work to
identify and voice the concerns and needs of youth in San Francisco.
Nicole will also work with the Office of Adolescent Health on DPH’s
annual adolescent health report. Nicole will be supervised and mentored by
Iman Nazeeri-Simmons, Adolescent Health Coordinator and Maria Cora,
Women’s Health Coordinator. The Health Commission and the Office of
Adolescent Health are very excited to have Nicole’s energy and expertise
as a part of the PHP JCC.
Centralized Behavioral Health Court
San Francisco Judge Susan Breall initiated the creation of a
Centralized Behavioral Health Court in collaboration with Community
Behavioral Health Services (CBHS), the Public Defender’s Office, the
District Attorney, Probation, and other behavioral health service
providers. The Centralized Behavioral Health Court is scheduled to begin
on July 14, 2003 and brings together the various drug and mental health
courts such as Drug Court, Proposition 36 court and Mental Health Court.
The Court will focus on addressing the treatment needs of clients. The
Court will use a combination of services, incentives, and sanctions, to
get clients the help they need to not offend again, and to get their lives
on an improved track. Services will include mental health and substance
abuse treatment, case management, housing, education, and vocational
SFGH Regulatory Visit - JCAHO
On June 5, a JCAHO surveyor conducted an unannounced survey stemming
from a report that SFGHMC was placing patients inappropriately as a result
of the hospital’s “no verbal/telephone order” policy. (The “no
verbal/telephone order” policy was implemented in response to JCAHO’s
own Type I recommendation in 2002, citing a lack of documents
authenticating verbal orders within regulated timeframes.) The surveyor
interviewed staff, reviewed closed and open medical records, personnel
files, and hospital policies related to verbal/telephone orders.
On June 25, the follow up report from the JCAHO surveyor showed no Type
I recommendations. There were, however, supplemental recommendations
regarding verbal orders, such as a need to reconcile language differences
between the nursing policy, hospital-wide policy, and the medical bylaws.
The surveyor also recommended that SFGHMC design a data collection system
to determine the impact of the policy on non-emergent cases. The hospital
has already initiated the process of re-reviewing and reconciling all
hospital policies and procedures and has begun monitoring the impact of
On June 9, two nurse-reviewers from DHS-Berkeley/Contra Costa conducted
an unannounced four-day re-certification visit of the UCSF Renal Center.
The purpose of the review was to recertify the Renal Center’s UCSF
provider number, despite our having already submitted an application to
DHS to place the Renal Center on SFGHMC’s license and receive an SFGH
provider number. There were no violations to the Conditions of
Participation and only minor deficiencies noted.
As a result of our application to DHS to acquire a new provider number
for the Renal Center, SFGHMC received an unannounced on-site visit from
DHS-Daly City on July 2. The surveyor mentioned the need to establish an
advisory board with oversight responsibilities. A return site visit is
DHS/Long Term Care Facilities
From June 16-19, SFGHMC successfully completed its annual DHS licensing
and certification visit for long term care facilities. DHS conducted an
unannounced visit of the Mental Health Rehabilitation Facility and 4A-SNF,
and reviewed various support services. There were no major quality of care
or resident issues mentioned. Minor deficiencies were noted in patient
assessment, accident prevention, and fire safety. SFGHMC will provide a
written plan of correction in response to deficiencies.
Institutional Police Transfer to Sheriff
Effective May 10th supervision of the Institutional Police
transferred from DPH to the Sheriff’s Department. The IP’s are now
officially Sheriff Deputies. You will note that the majority of these new
deputies at SFGHMC, 101 Grove and the primary care clinics are now donning
Sheriff Deputy uniforms. This transfer will provide better back up for our
staff and facilities.
COMMUNITY HEALTH NETWORK
SAN FRANCISCO GENERAL HOSPITAL
Health Commission - Director of Health Report (from 07/07/03 MEC)
7/02 to 6/03
Changes in Privileges
Current Statistics - as of 7/1/03
Affiliate Professionals (non-physicians)
Application In Process
Applications Withdrawn Month of July 2003
(07/02 to 6/03)
SFGH Reappointments in Process Aug. 2003 to Nov. 2003
- Commissioner Chow commented on the amazing number of unannounced
surveys, noting that it was good to hear there were such positive
- Commissioner Chow asked how does the centralization of the
Department’s behavioral health programs impact changes like those
seeing in the Court. Dr. Katz said that the Department is a leader in
the creation of a new behavioral health model, and is now asking
everyone else to catch up. The court readily is recognizing that
clients are often dually diagnosed, in need more of treatment
(substance abuse and mental health) than incarceration. Commissioner
Chow asked if this is the centralized court in San Francisco. Dr. Katz
answered that it was, for the dually diagnosed.
- Commissioner Sánchez noted that the next protocol is to link the
Court and Youth Guidance Center with schools. Dr. Katz said that this
particular program would not do this because it is the adult court and
juveniles are handled through a different Court. The juvenile court
has been recognizing the needs of individuals with dual diagnosis, but
Dr. Katz agreed that there is more work to be done in transitioning
and coordinating within the jail, health and school systems.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE
RECOGNITION AWARDS FOR THE MONTH OF JULY
Commissioner Chow presented the July Employee Recognition Awards.
Dana Horton, MSW, and
San Francisco General Hospital, Medical Social Services
Alicia Boccialiari, Director, Psychosocial Medicine
Joseph Headlee, Clinical Supervisor, Medical Social Services
Leigh Kimberg, MD, Medical Director, Maxine Hall Health Center
Sharon Kwong, Clinical Supervisor,
Medical Social Services
Penney Mitchell, Assistant Hospital Administrator, and Maureen O’Neil,
Clinical Supervisor, Medical Social Services
Greg Merrill, LCSW
San Francisco General Hospital Trauma Recovery Center
6) BIOTERRORISM EXERCISE EVALUATION
Susan Fernyak, M.D., Director, Community Health Epidemiology, presented
this report, prepared by Dr. Fernyak and Amy Pine, Immunization Program
On June 17, 2003, the Department of Public Health held a mass
immunization exercise at Bill Graham Civic Auditorium. The exercise was
the first of its kind in the nation to test a local jurisdiction's ability
to vaccinate a large number of individuals within a short time frame.
Organizers selected a smallpox vaccine scenario because it presents the
most difficult challenge to execute.
Nearly 200 staff and 1400 volunteer patients participated in the
day-long event. Approximately 100 individuals representing the Centers for
Disease Control and Prevention, the State, local and regional cities and
counties and emergency response agencies came to observe and participate.
The following goals were formulated in March 2003:
- Test DPH’s ability to provide mass vaccinations:
- Accommodate 300 - 350 patients an hour
- Operate site in English, Cantonese, and Spanish
- Test DPH’s ability to recruit volunteer “patients” from the
- Activate DPH’s Departmental Operations Center (DOC).
- Evaluate the drill and provide information to other jurisdictions
interested in creating a similar exercise.
There were 66 working days to plan the entire event. Project leaders
were designated, a Steering Committee was formed and tasks were delegated
regarding supplies, equipment, logistics, staff and patient recruitment,
marketing of the event, evaluation of the event and activation of the DOC.
The drill was funded by salary savings from a federal bioterrorism
preparedness grant, and cost approximately $95,000 (excluding personnel).
The exercise was evaluated in three ways:
- A time-motion study was conducted to determine the average amount of
time spent in the clinic per patient. Each DPH staff member had a
code, and each patient volunteer had a data collection sheet. Every
interaction with a staff member was documented with a time stamp. This
study also examined average amount of time per station at the clinic,
and specific amounts of time for different activities. This was set up
via a contract with James Bowman Associates, Inc. Data from the
time-motion study are still being analyzed.
- Patients completed “Patient Evaluation Forms” to learn their
feedback regarding understandability of information and site
organization. Their responses were entered into a database on-site at
the June 17th event and have already been analyzed.
- DPH staff members participated in debriefing sessions at the end of
the event to determine what was successful and what was not successful
in their assigned work areas. This information was all documented. DPH
staff also completed “Staff Feedback Sheets” for qualitative
responses about communication on-site, supplies, and their job
training. Final analysis of this data is expected by July 22.
All evaluation and project information will be available in a
comprehensive “Final Report.” The target date for completion of this
report is July 31. The report will also be available on the SFDPH website.
Approximately 1,400 patients came through the exercise. Self-Reported
information from the patient evaluation forms reveals the following:
- The median age of all patients was 42.
- 63% of patients completed the exercise in 90 minutes or less.
- 12% of patients did not speak English at home.
- Languages spoken at home included Cantonese, Spanish, Tagalog,
American Sign Language, Vietnamese, Russian, Korean, French,
Portuguese, Mandarin and other Chines
Question from Patient Evaluation Form
% of All Patients Who Agreed
% of Monolingual Patients Who Agreed
Medical History and consent Form was easily understandable
Exercise was well organized and orderly
DPH Staff was confident and knowledgeable
Patient was able to understand all written information given
Patient was informed of right to decide against vaccination
A. Significant gaps/barriers identified for a real emergency
There was a need for greater security. DPH staff assigned to specific
areas had multiple job functions for that specific area. Asking them to
act as security guards in addition was overwhelming. More people needed to
be designated specifically to watch patients and ensure that they were not
loitering or in need of assistance.
Clear, large and creative signage is of paramount importance. When
large rooms are full of people, pointing to a sign for the next station is
only minimally effective. Larger signs in more visible display positions
Designate more time for staff training. For this exercise, Job Action
Sheets were used with clear job descriptions, but most staff members
received 45 minutes of training and for some this were not sufficient. In
a real emergency, doors should not open until all staff is adequately
There was need for increased mental health staff presence.
Based on staff estimates for the June 17th drill, in a real emergency,
with 40 different mass vaccination sites happening simultaneously, 16,000
staff members would need to be recruited for two shifts of work per day.
B. How well did we meet our goals?
The primary goal of this exercise was to test our ability to provide
mass vaccinations. While data is still being analyzed, preliminary
information demonstrates that we were able to communicate clearly and
effectively in English, Cantonese and Spanish, and that we were able to
move up to 350 patients an hour through the clinic.
Based on the number and diversity of the patients who came to the June
17th exercise, we were also able to accomplish our goal of patient
recruitment from the community. We had hoped that the clients who came
would reflect the diversity of the San Francisco community and this was,
indeed the case.
Our next steps will be to share our lessons learned and identified
information with other public health departments or interested parties.
The final report for this project will be posted on the SFDPH website, and
future presentations will also be developed to share with others.
- Commissioner Chow asked why it takes each individual an average of
ninety minutes to get immunized. Dr. Fernyak explained that with
smallpox vaccinations there is a large educational component and
informed consent involved. Commissioner Chow also asked about the
Medical History and Consent form that was reported to be not well
understood by participants, how will this form be improved. Dr.
Fernyak explained that this was a Centers for Disease Control (CDC)
form, so the Department will provide the feedback to the CDC.
- Commissioner Chow asked about the number of personnel that would be
needed for a large-scale vaccination and the size of the site
required. Dr. Fernyak said that if 40 mass vaccination sites were
activated, 16,000 staff members would need to be recruited for two
shifts of work per day. Each site would need 200 personnel per shift
for sites to cover the City’s residents and visitors. The Department
is looking to use schools, with a large room (basketball court or
auditorium) as well as smaller rooms to have the educational
- Commissioner Guy pointed out that when you have these types of
exercises you learn something applicable for this type of scenario and
for other emergencies. Commissioner Guy’s question was what is the
Department doing to pursue agreements with the sites that we will need
to use in case of an emergency of this type. Dr. Fernyak explained
that the Department now has a better idea of what types of sites are
required. The Department is getting extra money to use for
bioterrorism activities that it plans to use partially to set up
agreements with appropriate sites.
- Commissioner Chow asked when they did the prophylaxis for Anthrax in
Washington D.C., did they use a similar process? Dr. Fernyak said that
there were mass sites set up in DC during this time, but that most
people that went to sites these were already exposed. The Department
tested a different scenario where people had not been exposed and
would need informed consent before being vaccinated.
- Commissioner Guy expressed her concern about the range of ages that
were not well represented in the exercise. How will the Department
deal with children, frail elderly, etc? Dr. Fernyak said there are
quite a few target groups to consider, and some were represented at
the event. Some other groups will need to be addressed in planning.
- Commissioner Chow asked how the Department would schedule this type
of event over five days, when people may all want to come at once. Dr.
Fernyak said that the Department has not worked this out exactly. The
first groups will be high-risk individuals, including medical, health
and emergency workers, and all contacts for smallpox cases. The
general population will need to be organized, an issue the Department
understands but has not answered.
- Commissioner Chow asked when the Commission would hear about next
steps. Dr. Fernyak said that the next step is to know the results of
the time motion analysis. The Department will then have a staff
working-group to arrange for identified people to set up sites if an
emergency situation occurs. Issues to consider have been identified
through the exercise, and there will be 6-8 months of planning to work
them all out. Dr. Katz said that the Department did this presentation
early because it was so extraordinary, the largest exercise in the
United States with a short planning period. The Department will
forward additional results to the Commission in written form. Dr. Katz
also noted that the issue now is to determine the best way to keep the
Commission and the Department involved in emergency planning.
Generally the Commissioners are updated through the annual Emergency
Medical Services report. However, at this time, there is more
awareness around the idea that a real biological emergency may occur.
Rather than health being a part of the planning (as in the case of an
earthquake) it would be the lead agency in dealing with certain
events. Dr. Katz said that he would look at the meeting schedule and
plan for an update every six months regarding the Department’s
emergency preparedness around biological events. The Health Commission
agreed to this approach.
- Commissioner Parker noted that this was an excellent learning
exercise. Commissioner Parker said that one of the most important
things is flexibility. We need to know exactly what to expect when an
event happens and be flexible in our response. He suggested the use of
numbers in helping vaccinees get from station to station, as everyone
can understand numbers.
- Commissioner Guy supported what Dr. Katz said about the Department
getting more involved in emergency planning.
7) FISCAL YEAR 2003-04 BUDGET UPDATE
Gregg Sass, DPH Chief Financial Officer, presented the budget update,
reporting that as of today’s meeting, the Board of Supervisors will
approve the first reading of the budget and the second reading will be in
one week. Hearings by the Budget Committee of the Board of Supervisors
have occurred, and the Department has incorporated the budget cuts
proposed by the Budget Analyst and the restorations proposed by the Budget
Committee. The Department understands that the Mayor endorses the Budget
Committees restorations. Final approval of the Budget Committee’s
recommendations is expected in July.
The Department’s General Fund is declining $35.7M. There are few
service reductions, and the Department has made up for the declining
General Fund and increasing costs of doing business with administrative
reductions, concessions from labor via MOU changes and additional
The Department has also committed to returning a surplus of $16.7M to
the General Fund for 2002-03. The Department was fortunate to be able to
project a surplus for 2002-03 and also budget growth in revenues for
2003-04, the combined effect of which is over $45M and has enabled the
Department to avoid additional service reductions.
Overview of the Budget Process
DPH Baseline Budget and Contingency Cuts
The 2003-04 budget process has been the most was the difficult in the
past decade. The City faced a $357M budget shortfall. Public Health
receives nearly 25% of $1.2B in discretionary General Fund. It was
therefore anticipated that the Department would absorb a similar reduction
to our General Fund. The Department’s initial budget submission,
following three rounds of contingency cuts, included a $39.5M reduction to
the General Fund accompanied by an additional contingency plan that would
have reduced the General Fund an additional $21.6M for a total reduction
of $70.1M or 24% of the $291M General Fund budget. In addition, the
Department committed to returning a $12.7M General Fund Surplus for the
2002-03 fiscal year that would carryover to defray budget shortfalls for
the coming year. That commitment included an $8.7M mid-year surplus plus
an additional $4M commitment made during the budget process.
Throughout the budget process, the Mayor’s Finance Office worked to
identify revenues and consolidate costs of citywide services. Following is
a brief outline of items that affected the Department’s budget.
Offline adjustments by the Mayor’s Office
The Mayor’s Office identified a number of initiatives to reduce the
overall citywide deficit. This process identified over $10M in additional
revenues for DPH, including a $3.7M increase in realignment revenue, $3.2M
in work-order revenues for mental health and substance abuse services, a
$1.45M revenue transfer from the Department of Building Inspection to help
fund the Master Lease and SRO Collaborative program, and $0.9M in
increased recoveries for services to members of Healthy Workers.
The Department was able to increase its commitment to return an
additional $3.8M surplus in 02-03. This was also considered as a source of
funds to allow restoration of service cuts.
Labor negotiations resulted in $16.5M in savings to DPH related to
transfer of responsibility for employee pension contributions. Additional
concessions were made in exchange for a commitment to reverse budget cuts
to the MHRF and the LHH laundry. The Department was able to restore $2.1M
in service cuts and avoid $21.6M in contingency cuts.
Department of Public Health Administrative Cuts
Office of Managed Care (15FTEs)
Health Centers (6FTEs)
DPH Admin (18FTEs)
Behavioral Health, Prevention (6FTEs)
AIDS Office (8FTEs)
Restructuring of Pharmacy Benefit
Other non-salary cuts
Total administrative reductions
Board of Supervisors
The Board of Supervisors held Bielenson Hearings on June 10. The
Department’s hearings with the Budget Committee took place on June 11
and June 26. At the June 26 hearing, the Budget Analyst presented their
listing of proposed cuts to the Department, which had been reduced from an
initial listing of $1.3M to $0.8M. At the meeting, the Budget Analyst
agreed to further reduce proposed cuts to $0.5M.
On Saturday, June 28, the Budget Committee announced the amount of
restorations. The Committee recommended restoration of $13.4M in General
Fund to restore $10.8M in service reductions and $2.6M in funding for new
services, including $500K in funding to backfill federal Ryan White AIDS
funding, $500K to fund planning and startup costs for medical respite care
to patients leaving SFGH, $810K to fund housing for homeless seniors and
$665K to enable UCSF to continue to maintain operations at the blood
Citywide, the Budget Committee restored a total of $24.1M in programs.
Funding to cover restorations were only $18.4M. The Mayor’s office is
working to identify $5.7M of additional funding to re-balance the budget.
The Department recently identified $0.75M in Federal matching funding that
was part of the recent tax bill signed in June and will likely flow to the
Department. It appears that the Department will see a substitution of this
revenue for General Fund to help balance the budget and close the $5.7M
The Capital budget is set at $2.55M, all but $23,000 of which is for
facility maintenance. The Equipment budget is $2.52M. It was necessary to
reduce capital expenditures in order to avoid service cuts. However, this
continues a chronic underfunding of capital investment to support the
Looking forward, there several challenges in managing within budget
over the coming year.
Adequacy of City Reserves for State Cuts
The Mayor set aside $30M in reserves to fund reduced City revenues
resulting from State budget cuts. The reserves were based on a forecast of
cuts included in the Governor’s May revise. Continuing pressure from the
Republican side of the legislature to prevent a sales tax increase creates
the potential for additional spending cuts that could exceed established
reserves. This could lead to mid-year cuts, to re-balance the City’s
Impact of Unbudgeted Inflation in Costs of Materials and Supplies
The budget did not include adequate provision for inflation in the cost
of medical services and supplies. The Department has had increasing
difficulty managing expenditures within existing appropriations.
Unbudgeted Costs of Floating Holidays
In exchange for labor concessions to pick up the employees 7.5% pension
contribution, labor MOUs included 5 additional floating holidays. Where
these holidays have been granted to clinical employees and other classes
at the Hospitals, Clinics and Jail Health that must be backfilled, the
Department will incur additional expense that is not budgeted. Our
analysis indicates that the estimated cost of backfilling these holidays
will cost the Department $2M -$3M that will need to be offset with savings
elsewhere. The cost estimates vary depending upon whether the Department
backfills with regular salary or overtime.
- Commissioner Parker noted that the Department is giving staff five
additional holidays and some will have to be back-filled to keep
services going. He asked if the Department really saves money by doing
this. Mr. Sass noted that there is an overall savings because of the
7.5% that many employees are giving up from their salaries. Not all
employees will need to be filled in for when they miss work, only
- Commissioner Sánchez commended Mr. Sass and the rest of the staff
who pulled together so well on this difficult budget.
- Commissioner Guy noted that Mr. Sass’s leadership was critical and
appreciated in his first year as Chief Financial Officer. She also
said that the Department might see some mid-course corrections that
could be in its favor, but that the Department also has to be vigilant
as there is not yet a State budget. Mr. Sass said that a problem this
huge brought an active involvement from all of the Department’s
leaders. In many ways it was a harder year for the Department, but in
some ways better to have such a high level of cooperation from staff
- Commissioner Chow pointed out that this was one of the most arduous
and difficult budget years in memory. The Department took the
opportunity to improve their operations. Additionally, the
Commissioners have learned about many of the Department’s programs
through this process.
8) PUBLIC COMMENTS
Joseph McInerney spoke out against Conard House, Progress Foundation
and Baker Places. He said that the Department was aiding and abetting
these organizations in a criminal act of involuntary servitude, requiring
residential clients to perform chores. He also requested an audit of the
All-Star Hotel, as it is a slum and nothing has been done to improve it.
In addition, he does not believe that Institutional Police can be used at
The meeting was adjourned at 5:35 p.m.
Frances Culp, Acting Executive Secretary to the Health Commission