Minutes of the Health Commission Meeting
Tuesday, January 20, 2004
at 3:00 p.m.
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
President Chow called the meeting to order at 3:15 p.m.
- Commissioner Edward A. Chow, M.D., President
- Commissioner Roma P. Guy, M.S.W., Vice President
- Commissioner Lee Ann Monfredini
- Commissioner Michael Penn, M.D., Ph.D.
- Commissioner David J. Sanchez, Ph.D.
- Commissioner Harrison Parker, Sr., D.D.S.
- Commissioner John I. Umekubo, M.D.
Commissioner Chow announced that the Commission’s hearing on the
proposed FY 2004-2005 budget will be on Thursday, February 5th at City
Hall at 3:00 p.m.
2) APPROVAL OF THE MINUTES OF THE MEETING OF JANUARY 6,
Action Taken: The Commission (Chow, Guy, Monfredini, Penn,
Sanchez) approved the minutes of the January 6, 2004 meeting with one
correction. Commissioner Penn was absent at that meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET
Commissioner Monfredini chaired, and Commissioner Penn attended, the
Budget Committee meeting. Commissioner Umekubo was absent.
(3.1) CHN/SFGH-Nursing Operations – Request for approval
of contract modification with the following firms: HRN Services, Inc.,
Medical Staffing Network, Inc., Medstaff, Inc., Nurse Providers, Inc.
and United Nursing International, to increase the combined contract
amount by $1,350,000, from $1,350,000 to $2,700,000, to provide
supplemental, temporary per diem and traveling nursing personnel
services to San Francisco General Hospital, for the period of September
1, 2003 through June 30, 2004.
At the request of the Commission, staff provided hourly wage
comparisons between traveling nurses and staff nurses. The traveler’s
base is $64 per hour. DPH RN is $37.25 per hour wage, and $46.56 per
hour when benefits are included.
(3.2) CHN-Primary Care-Tom Waddell Health Center – Request for
approval to retroactively accept and to expend new subcontract funds
from the Tenderloin AIDS Resource Center, in the amount of $597,710, for
early intervention outpatient services to homeless persons at risk of or
infected with HIV disease, for the period of September 30, 2003 to March
(3.3) CHP-Maternal and Child Health – Request for approval to
accept and expend funds from the California Department of Health
Services, in the amount of $99,918, for nutrition education in community
settings to low-income families in San Francisco, for the period of
January 1, 2004 to September 30, 2004.
- Commissioner Monfredini requested an outcome evaluation report to the
Population Health and Prevention Joint Conference Committee.
(3.4) CHPP-Immigrant Services – Request for approval of a new
contract with Bay Area Community Resources, in the amount of $60,374, to
provide outreach and health education services targeting
Russian-speaking refugees, asylees and immigrants, for the period of
January 1, 2004 through December 31, 2004.
(3.5) AIDS Office-HIV Prevention – Request for approval of a
retroactive sole source contract renewal with PHFE Management Solutions,
in the amount of $193,181, to provide staffing for the final phase of
the Zimbabwe HIV Prevention Trials Network protocol 015 (Explore) study,
for the period of July 1, 2003 through June 30, 2004.
(3.6) AIDS Office-HIV Prevention – Request for approval of a
retroactive sole source contract renewal with PHFE Management Solutions,
in the amount of $180,118, to provide staffing for the HIV Vaccine
Trials Network Leadership Group study, for the period of August 1, 2003
through July 30, 2004.
(3.7) AIDS Office-HIV Prevention – Request for approval of a contract
renewal with UCSF/Urban Health Study, in the amount of $272,759, to provide HIV
prevention services targeting defined behavioral risk populations, for
the period of January 1, 2004 through June 30, 2004.
- Commissioners Monfredini and Penn reiterated the importance of
getting the data to DPH.
Commissioner Sanchez abstained from voting on this item.
(3.8) AIDS Office-HIV Prevention – Request for approval of a
contract renewal with Walden House, Inc., in the amount of $137,629, to
provide HIV prevention education services targeting high-risk
populations, for the period of January 1, 2004 through December 31,
- Commissioner Monfredini congratulated the staff for a commendable
- Commissioner Penn asked if the agency has found an auditor. Don
Frasier of Walden House said that Deloitte decided to continue to
perform the agency’s audit.
(3.9) BHS-Mental Health/Substance Abuse – Request for approval of
a retroactive contract renewal with the Regents of the University of
California-AIDS Health Project, in the amount of $683,962, to provide
mental health and substance abuse services targeting clients with
AIDS/HIV disease or disabling HIV disease who are low income and
uninsured or underinsured, for the period of July 1, 2003 through June
- Commissioner Penn stated that is it difficult when reviewing
contracts to see two-year-old monitoring reports. Linda Wang said that
one of the goals of the integrated Behavioral Health system is to get
the monitoring reports done in a more timely manner, rather than
reviewing two-year old reports when the contracts are considered for
- Commissioner Monfredini thanked Ms. Rinaldi for her attention to
detail over the years.
Commissioner Sanchez abstained from voting on this item.
Action Taken: The Commission (Chow, Guy, Monfredini, Penn,
Sanchez) approved the Budget Committee Consent Calendar, with
Commissioner Sanchez abstaining from voting on Item 3.7 and Item 3.9.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
Governor Schwarzenegger announced his proposed budget on Friday,
January 9th. The State’s $26 billion budget deficit reflects
a $9 billion year-end deficit in FY 2002-2003, a current year (FY
2003-2004) shortfall of $3 billion, and a budget year (FY 2004-2005)
shortfall of $14 billion. The Governor’s proposed solution to close the
budget gap relies mostly on borrowing ($12 billion) and reductions in
program spending ($11 billion). A combination of fund shifts, debt
service savings, transfers, and other revenues are used to close the
remaining $3 billion gap.
As expected, there are a number of proposals that would, if enacted,
have a significant effect on the Department. The majority of the health
reduction proposals, which total $880 million, are the same as those
proposed by Governor Davis as mid-year reductions in the last fiscal
year and would primarily impact Medi-Cal. Our preliminary estimates of
the Governor’s proposed reductions show that they could reduce DPH
revenues by approximately $4.4 million. These proposals include:
- A 10 percent Medi-Cal provider rate reduction (in addition to
the 5 percent reduction made in the Budget Act of 2003);
- Altering the Medi-Cal prospective payment system rate setting
methodology for federally qualified health centers (FQHCs);
- Capping enrollment in the AIDS Drug Assistance Program (ADAP);
- Eliminating the Children’s System of Care mental health program; and
- Capping enrollment in the Healthy Families and California
Children’s Services (CCS) Programs.
The Governor’s proposed budget also included vague language about his
intentions to restructure both the Medi-Cal program and programs serving
immigrants to realize budget savings in future years.
As you know, this is merely the starting point for the State’s
2004-05 budget. The Legislature will soon begin introducing budget bills
and will hold preliminary budget hearings. In May, the Governor will
introduce his revised budget proposal (the May Revise), which will
contain more sound income figures based upon April income tax revenues.
Literacy for Environmental Justice Launches its’ Pilot Good
On December 19th, Youth Envision, a project of Literacy for
Environmental Justice, launched its pilot Good Neighbor partnership with
Super Save in the Bay View. As one of the Tobacco Free Project's
Community Capacity Building Projects, Youth Envision focuses on
improving access to healthy food in existing corner stores, the primary
food resource in the neighborhood. They mounted the “Good Neighbor”
campaign to encourage corner stores to replace tobacco, alcohol and
tobacco subsidiary food products with fresh and healthier food
alternatives in exchange for campaigns to promote community patronage.
Youth Envision held a press conference at Super Save and is working with
Supervisor Sophie Maxwell on a Good Neighbor task force to sustain the
effort. The press event was covered by the Bay Guardian, Independent,
Dr. “Dan” Wlodarczyk Receives Community Service Award
St. Paul of the Shipwreck Catholic Church hosted its 19th Annual Dr.
Martin Luther King Solidarity Mass last Sunday with the theme “Be…The
Dream.” After the mass, Community Service Awards were presented to
Supervisor Sophie Maxwell and Dr. Daniel Wlodarczyk, Acting Medical
Director of Southeast Health Center. Supervisor Maxwell and Dr.
Wlodarczyk received this honor in recognition of their work in the
community that reflects the spirit of Dr. Martin Luther King.
COMMUNITY HEALTH NETWORK: SAN FRANCISCO GENERAL HOSPITAL
|(From 12/08/03 MEC and 12/16/03 JCC)
||7/03 to 12/03
|Changes in Privileges
|Current Statistics - as of 12/1/03
|Affiliate Professionals (non-physicians)
|Applications In Process
|Applications Withdrawn Month of Jan 2003
||8(07/03 to 12/03)
|SFGH Reappointments in Process Def 2003 to Mar
- Commissioner Chow asked if the Governor backfilled the VLF loss
to local governments. Gregg Sass said Governor Schwarzenegger did
use emergency powers to restore the reduced VLF. However, the
Governor’s budget proposal includes a $1.3 billion take back of
local property tax revenues that would otherwise go to cities.
5) PRESENTATION OF THE DEPARTMENT OF PUBLIC HEALTH EMPLOYEE
RECOGNITION AWARDS FOR THE MONTH OF JANUARY
Commissioner Chow presented the January Employee Recognition Awards.
Population Health and Prevention - Environmental Health Section
Ken Sato, Principal Environ. Health Inspector
Emergency: Evacuation Floor Team Leaders
Population Health and Prevention -
Shawn R. Holle, Safety Analyst
Pam Axelson Norma Baldeviso Ishmael Bihl Richard Bitanga Robin
Buckley Jeffrey Burton Tamara Davidson Karen Heckman Robert
Longhitano Carlos Quintanilla Ernest Wong
Disease Control, Microbiology Lab, Immunization, Facilities,
Contracts, CHS Fiscal, OSH and MIS
6) ELECTION OF
PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION FOR 2004
Action Taken: The
Commission (Chow, Guy, Monfredini, Penn, Sanchez) voted to continue the
Election of Officers to the next Health Commission meeting.
7) PRESENTATION OF THE MENTAL HEALTH
REHABILITATION FACILITY BLUE RIBBON COMMITTEE REPORT AND
CONSIDERATION OF A RESOLUTION SUPPORTING THE BLUE RIBBON COMMITTEE
Mitchell H. Katz, M.D.,
Director of Health, presented the Mental Health Rehabilitation Facility
(MHRF) Blue Ribbon Committee Report.
The MHRF Blue Ribbon
Committee was created by Mayor Brown in September 2003 as a result of an
agreement the unions made with the City to pick up employee retirement
contributions and defer pay raises to keep the MHRF open as a skilled
nursing facility for one year. The committee was charged with:
- Determining the future
of the MHRF beyond 03-04 and determining the optimal programmatic design
for the facility given available services and unmet needs;
- Reviewing information
about the mission, history, function, financing, successes and
challenges of the MHRF;
- Surveying existing
models for providing services to persons with chronic mental health
- Holding meetings run by
consensus building process
The Committee was
chaired by the Director of Health and included representatives from
unions, academia, DPH staff, Family and Friends of the MHRF,
administrators from other mental health facilities and that Department
of Aging and Adult services. The committee held nine public hearings,
received presentations, assessed pros and cons of various models of
care, took public comment and met separately with union representatives
and Friends and Family.
recommendation is to create a hybrid model with different levels of care
on each floor. The 3rd floor would be a Mental Health Rehabilitation
Center with a psychosocial rehabilitation focus rather than a
medical/nursing model. The 2nd floor would be a Skilled Nursing
Facility and maintain care for current MHRF geriatric, non-ambulatory
and neurobehavioral patients. Staffing would be similar to existing
staffing at the MHRF. The 1st floor would be a 27-bed Residential Care
Facility and a 14-bed Residential Treatment Facility with day
treatment. There would be less restrictive care for patients who have
difficulty getting admitted to existing DPH contracted facilities.
This model meets the
clinical needs of complex medical and psychiatric patients, provides
treatment and housing options for those that need less restrictive care
and provides easier transitions between levels of care.
recommendation is to establish a transition team to evaluate and
implement changes to the MHRF. This would include community and
institutional mental health providers, union representatives and Family
and Friends of the MHRF.
With regard to the
budget, the current MHRF model requires $13.3 million in General Fund
subsidy. The proposed model would require an $11.1 million General Fund
Dr. Katz asked the Blue
Ribbon Committee members who were present at the Commission meeting to
address the Commission.
- Melanie Myers, SEIU 250
– this proposal is a compromise that she voted for. It provides more
services than the original proposal and keep patients in San Francisco.
This proposal will improve the flow of patients at the MHRF and make
transition into the community easier. The model is not perfect and she
is pleased that there will be a transitional work group.
- John Nickens, Progress
Foundation – the hybrid proposal represents the next best effort what
this facility can do for the people of San Francisco. It provides for
fluidity in treatment. It may not be the final step, but it is the next
step. He and Progress Foundation are committed to providing assistance
to the Department during the transition of the new model.
- Linda Chafetz,
Professor at UCSF School of Nursing – The process was sensitive to all
stakeholders. MHRF employees worked with Friends and Family
representatives to bring forward thoughtful proposals. This is a good
- Jenny Hua, IFPTE Local
21 – she supported the model because it fosters hope for the clients.
It will help them safely transition to different levels of care. She
emphasized the need for staff training.
- Piers Mackenzie, Family
and Friends of the MHRF – Family and Friends of the MHRF voted by a
narrow majority to support the hybrid model. They have a number of
concerns about the affect of conversion of the first floor, and change
in the MHRF’s mission. However, they feel the proposed model is a good
compromise. Friends and Family are happy to have a place on the
- Philippa Rutgaizer, RN
at the MHRF and SEIU representative – she is pleased with the process
and hopes that licensure is successful so that the facility can continue
to provide these services to the residents of San Francisco.
- Jennifer Baity Carlin,
dual diagnosis specialist at the MHRF and SEIU member. She opposed
last year’s proposal, and is pleased to be able to support the hybrid
model. While it is not the perfect solution, it is a good compromise.
The need is there for all levels of care, but there are budget
constraints. Staff training is essential.
- Kimberly Tavaglione,
SEUI Local 250, said this was a compromise decision if money were no
object, there would be levels of care for all who need it. But this is
not an option. The members are committed to making this model
successful. If it is not successful, the unions will let the Commission
- Ed Warshauer, SEIU
Local 790, said that the proposed model is a far better model than what
was proposed last year. SEIU 790 is committed to working with the
Department to make this work. One of the key components of the
resolution is the monitoring group. He told the committee that there
would be a mental health initiative on the November 2004 ballot that
would generate additional funds. If this is the case, he would like the
opportunity to reexamine the MHRF to possibly revert it back to a SNF.
- Brian Green,
conservator for his sister who is a resident at the MHRF, said that the
MHRF was a unique facility with a vision and purpose that have been
dropped in this process. The original vision was never implemented.
There has been gross mismanagement. This is a much better model than
last year’s proposals. And there is no programmatic design. He
submitted copies of patient complaints for the public record.
- Criss Romero, IFPTE
Local 21, said that Local 21 had two representatives on the Blue Ribbon
Committee and represents seven or eight staff at the MHRF. The union
would likely request a meet and confer with the Director of Health to
discuss position cuts and impact of Local 21 membership.
Dr. Katz clarified that
though there were a number of union representatives on the Blue Ribbon
Committee, DPH will still have to go through the meet and confer process
with all of the affected unions.
- Commissioner Sanchez
thanked everyone for his or her comments, particularly given the
acrimonious debate over losing this quality of care during last year’s
budget discussions. The compromise is the result of good work by DPH
staff, union members, advocates, and others and he is happy to support
- Commissioner Guy
supports the compromise, as well as the need to have a transition work
group. She also understands the reality that the budget position still
has not improved. She asked if there is enough time to get appropriate
licensure. Dr. Katz said he believes we could get licensed by July 1.
What is unusual about this proposal is that there are four types of care
under one roof, which has never been done before. But there is no
reason why it cannot be done. The fact that this is a consensus
proposal will help with both regulatory and financial challenges.
Commissioner Guy appreciates that Friends and Family were and will
continue to be involved.
- Commissioner Penn said
it is difficult to achieve consensus and he is impressed with the
product. He is impressed with the fluidity of the model, and that
patients can tangibly see other patients moving safely through the
system. He asked if there are any comparable models. Dr. Katz said San
Mateo had a similar model—it eliminated a portion of their SNF and added
a residential component. Commissioner Penn said there should be a
formal process for the monitoring committee so there can be continued
accountability as the model moves forward. He asked the top three
concerns about the new model. Dr. Katz said the licensure process,
ensuring that the Mayor and Board of Supervisors does not tinker with
the consensus model and the meet and confer process. His thought is
that the transition team would meet in April or May. Commissioner Penn
asked who is in charge of the MHRF. Dr. Katz said it ultimately reports
to Gene O’Connell, as the SNF is on the hospital’s license.
- Commissioner Chow asked
that the SFGH JCC monitor the transition and implementation of the new
model. While the proposed model may not meet all needs, it does lead to
treatment fluidity—and perhaps a better patient care—as well as cost
- Commissioner Monfredini
said that it is wonderful to have this option available, as the original
proposal was not anything the Commission wanted to accept.
The Commission (Chow, Guy, Monfredini, Penn, Sanchez)
approved Resolution #1-04, “Accepting the Recommendations of the Mental
Health Rehabilitation Facility ((MHRF) Blue Ribbon Committee and
Authorizing that the Changes in MHRF Staffing be Submitted for the
Department of Public Health 2004-05 Budget and that Changes in MHRF
Licensure be Pursued,” (Attachment A).
8) PUBLIC COMMENT
comments on all matters pertaining to the closed session
B) Vote on whether to
hold a closed session (San Francisco Administrative Code Section 67.11)
Action Taken: The
Commission (Chow, Guy, Monfredini, Penn, Sanchez) voted to hold a closed
session. The Commission went into closed session at 4:55 p.m. Present
in closed session were the Commissioners, Dr. Mitch Katz, Larry Funk,
Norm Nickens, Deputy City Attorney Sallie Gibson and Michele Olson.
C) Closed session
pursuant to Government Code Section 54956.9 and San Francisco
Administrative Code Section 67.10(d)
Approval of a
settlement in the amount of $80,000 in the Sofia Rillanos vs. City and
County of San Francisco, Superior Court File #418598, City Attorney File
The Commission (Chow, Guy, Monfredini, Penn, Sanchez), voted
to approve a settlement in the amount of $80,000 in the Sofia Rillanos
vs. City and County of San Francisco.
Reconvene in Open Session
Commission reconvened in open session at 5:15 p.m.
- Possible report on
action taken in closed session (Government Code Section 54957.1(a)2 and
San Francisco Administrative Code Section 67.12(b)(2).)
- Vote to elect whether to disclose any or
all discussions held in closed session
(San Francisco Administrative Code Section 67.12(a).)
Action Taken: The Commission
(Chow, Guy, Monfredini, Penn, Sanchez) voted not to disclose discussions
held in closed session.
The meeting was adjourned at 5:15 p.m.
Michele M. Olson,
Executive Secretary to the Health Commission