Minutes of the Special Health Commission Meeting
Tuesday, October 21, 2003
at 1:30 p.m.
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The meeting was called to order by President Chow at 1:40 p.m.
- Commissioner Edward A. Chow, M.D., President
- Commissioner Roma P. Guy, M.S.W., Vice President
- Commissioner Lee Ann Monfredini
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner Michael Penn, M.D., Ph.D.
- Commissioner David J. Sanchez, Ph.D. - arrived at 2:45 p.m.
- Commissioner John I. Umekubo, M.D.
2) CONSIDERATION OF SUPERVISOR CHRIS DALY’S PROPOSED CHARTER
AMENDMENT REGARDING THE DEPARTMENT OF PUBLIC HEALTH AND CONSIDERATION OF A
RESOLUTION REGARDING THE CHARTER AMENDMENT
Supervisor Daly provided the Health Commission with an overview of his
proposed charter amendment. During last year’s budget, Supervisor Daly’s
priority was health, and he made a commitment to doing fixing the
structural problems in the budget.
The proposed Charter Amendment is an attempt to level the playing field
for the Health Department. The amendment would do many things, including
establish a baseline for funding of approximately $300 million and give
the Health Commission and Department more autonomy.
Supervisor Daly said he concurs with the Health Commission to eliminate
designated seats for the Health Commission.
Supervisor Daly said the Charter Amendment specifically mentions San
Francisco General Hospital, Laguna Honda Hospital and the community
clinics, and states that they would continue to operate. The process for
closing a community clinic would be similar to the process used for
closing a district police station.
With regard to mental health and substance abuse services, Supervisor
Daly said that at one point he was in favor of setting mandates for
waiting lists, but he is now offering language that the Department sets
goals for wait lists for specific modalities.
The Charter makes specific mention of the Mental Health Rehabilitation
Facility (MHRF). The type of services provided at the MHRF could be
changed by going through the Health Commission and the Board of
With regard to community clinics, Supervisor Daly’s intent is to have
DPH continue to provide the type of care through the clinics that it is
Supervisor Daly said he wanted to include homeless funding in the DPH
baseline because he fears that these funds could be cut from other
departments. He is currently working on removing some of the housing money
from the baseline, for example redevelopment money. Other programs, such
as shelter services, should come under the health baseline, and can be
work ordered to departments such as DHS.
Supervisor Guy asked Supervisor Daly what the next steps are in the
approval process, given that there is such a quick turn around time for
the proposed Charter Amendment. Supervisor Daly replied that it is
scheduled for the Rules Committee on October 27. There is the opportunity
for two Rules Committee meetings before it goes to the Board for
consideration on the March ballot. Supervisor Daly said that it is on the
fast track because he is concerned about what will happen during the next
Commissioner Chow asked Deputy City Attorney Aleeta Van Runkle for more
information about the timeline and what changes can occur at the Board of
Supervisors. Ms. Van Runkle’s understanding is that the Board has one
opportunity to amend the legislation, which is at the October 27 Rules
Committee meeting, then the legislation moves forward to a second Rules
Committee meeting on November 3. There is a very tight timeframe, and only
one opportunity to amend the legislation. Both the vote at the November
3rd Rules Committee meeting and the November 18th Board of Supervisors
meeting are up or down votes.
- Ed Kinchley, SEIU 790, takes offense at the term special interest in
the resolution. He thanked Supervisor Daly’s office for helping the
Health Department be what it is today. Local 790 has not had
sufficient opportunity to have a process, and in principle is not in
favor of set asides; however, other departments have them. They will
continue to be in dialogue with Supervisor Daly’s office, on things
such as whether it should state that it is within the authority of DPH
to eliminate health clinics and adequate staffing.
- Debbi Lerman, San Francisco Human Services Network, their steering
committee is still meeting and has not taken a position, but want to
express appreciation to Supervisor Chris Daly in this attempt to
protect health services in this city. They are still discussing
concerns: doesn’t necessarily protect community-based organizations,
which are an essential part of the city’s health services; second,
there are a lot of important safety net services in other departments
that may be squeezed out when the baseline is put in place.
- Brian Green, the conservator of his sister, who is currently at the
MHRF. How will the timing work if the MHRF is included in the Charter
Amendment given the work of the blue ribbon committee?
- John Kozinsky, Local 250 Healthcare Workers Union, doesn’t think
unions should be labeled a special interest group. He thanked
Supervisor Daly for his leadership. He does have reservations at this
point, the Supervisor’s office has been very receptive, and hopes to
have continued dialogue.
- Dick Hodgson, Community Clinic Consortium, is very excited about
stabilizing the health care safety net in San Francisco. This is the
opportunity to strengthen the partnership between community health
centers and DPH. They will be finalizing their position tomorrow and
will forward this to Supervisor Daly. Support it in concept and hope
it will go forward.
- Bill Barnes, staff to Supervisor Daly, said that, with regard to
safety net services in other departments, the State mandates certain
of these programs, so they are protected this way. The measure does
not prohibit future discussions about the MHRF. What it requires is
transparency in these decisions.
Dr. Katz said that overall the legislation would be a great help to the
department. The thrust is good for the Department of Health, but there is
a question about whether it is good for the rest of the city. It
strengthens the role of the Commission and gives the department much
greater predictability. Also provides the incentive to achieve savings
because the savings can be retained.
- Commissioner Guy and Commissioner Chow thanked Supervisor Daly for
the work he did during last year’s budget on behalf of health and
the Health Department.
- Commissioner Chow asked for clarification that Supervisor Daly is
looking at removing non-health focused homeless programs. Mr. Barnes
replied that homelessness is an important health issues because people
who are homeless have higher mortality and lower health outcomes, and
Supervisor Daly believes that programs such as hospice care, respite
care, licensed care facilities and Direct Access to Housing stay in
the Health Department. The next draft of the Charter Amendment will
clarify what programs will be part of the baseline.
- Commissioner Guy said the Charter Amendment comes from a genuine
attempt to protect the baseline budget. She is happy to hear that
there is going to be further discussion about which homeless services
will be part of the baseline.
- Commissioner Chow clarified that the language about community
clinics is to support what is currently done, encompassing both the
DPH health centers and the non-profit clinics. Commissioner Chow
clarified the intent of the resolution language about special
interests on the Health Commission. As always, the Commissioners
should consider the good of the whole, rather than representing any
one group. Commissioner Chow is concerned with the language that all
Commissioners must have knowledge of government, finance or labor
relations. Mr. Barnes replied that Supervisor Daly is committed to
more consumer involvement, even though this may not be accomplished
- Commissioner Monfredini does not want designated Commission seats
because there needs to be flexibility to address different priorities
and, again, Commissioners must always keep the good of the whole at
- Commissioner Guy added that history has shown that bodies that have
slots narrow their perspective.
- Commissioner Parker suggested increasing the number of
Commissioners, primarily because the workload of the Commission is
going to dramatically increase and Commissioners are part time. And
having a Commissioner from each district will make the public feel
that they have more of a connection to the Health Commission. Mr.
Barnes stated that in the proposed Charter Amendment, the Mayor
retains the Commission appointments, and he or she represents the
entire city. Supervisor Daly had considered increasing the size, but
decided that the current size would best allow a continuation of the
sense of camaraderie that has existed on the Commission; this could
not happen if there were more members.
- Commissioner Umekubo feels that that the specified slots pigeonhole
the Commission and would not provide flexibility to meet emerging
- Commissioner Penn said increasing the size of the Commission
deserves further consideration. A lot of the work gets done in the
joint conference committees, and Commissioners are only part time.
- Commissioner Monfredini, regarding a larger Commission, is concerned
that it would be difficult to get a quorum with 11 members, and
believes it is easier to make decisions at seven than at 11.
- Commissioner Chow added that there has been past discussion about
the Commission size, and he feels that seven is a workable, effective
- Commissioner Guy is concerned about forensics. Every year, although
the Health Commission tells the Board what level of funding is needed
to adequately fund this service, the Department does not get adequate
funding. She does not want this deficit built into the baseline. Mr.
Barnes replied that the Commission would have more autonomy to create
a budget and prioritize services. Further, the ability for the
Department to retain its revenue will allow the Department to meet its
- Commissioner Penn said the manner in which mental health programs
and goals are laid out in the Charter Amendment in detail, but AIDS
and cancer are mentioned but not specified, is rather arbitrary. He
feels that more specific language should be included in the Charter
- Commissioner Parker said the availability of funds is what drives
new services; if there is no money, there are no services, and if
there is a pot of money available for a dedicated service, then that
is what gets funding. It frustrates the Commission when they say their
hands are tied about what programs they can and cannot fund.
- Commissioner Sanchez said this is a unique approach to supporting
public health. We need resources for comprehensive departments of
public health. His question is what baseline would allow the Health
Commission to meet its mandates? This has never been evaluated or
discussed. Also, the Charter Amendment focuses on diseases that are on
the radar screen now, but he is concerned that it might limit our
ability to address other diseases and public health issues that might
arise. Will this new model move us to the next level? If this is the
first step, then let’s do it and have more discussion and dialogue
as it goes through the approval process. There needs to be much more
dialogue about what the overall impact would be.
- Commissioner Guy commented that it would have been preferable to
have had more time to review this proposal. A Charter Amendment is not
a small thing and, because the devil is in the details, there should
have been more discussion about all the details. Charters are
principles, not operation manuals. In addition to the diseases
identified in the Charter, there are other important health issues as
well-health disparities, cardiovascular disease, etc. Commissioner Guy
applauds Supervisor Daly’s commitment to transparency.
- Commissioner Chow added that the Charter must be realistic, and he
is pleased that Supervisor Daly is willing to change mandates to
Action Taken: The Health Commission unanimously approved Resolution
# 16-03, “Supporting Increased Autonomy and Fiscal Authority for the
Health Commission and Department of Public Health, Supporting the Concept
of Stable, Predictable and Adequate Funding for Health Services, and
Urging Modifications and Enhancements to the Proposed Health Department
Charter Amendment,” (Attachment A).
3) PUBLIC COMMENTS
The Special Meeting was adjourned at 3:15 p.m.
Michele M. Olson, Executive Secretary to the Health Commission