Minutes of the Health Commission Meeting

Thursday, February 5, 2004
at 3:00 p.m.
Board of Supervisors Chambers
City Hall, 2nd Floor
1 Dr. Carlton B. Goodlett Place
San Francisco, CA  94102


Commissioner Chow called the meeting to order at 3:08 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 John I. Umekubo, M.D.


  • Commissioner David J. Sanchez, Ph.D.


Action Taken:  The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved the minutes of the January 20, 2004 meeting and January 27, 2004 Special Meeting. 


Commissioner Lee Ann Monfredini chaired the Budget Committee meeting.  Commissioner Penn and Commissioner Umekubo were absent. 

(3.1)  CHN-Laguna Honda Hospital – Request for approval of a retroactive sole source contract with the Regents of the University of California, on behalf of the UCSF Department of Physiological Nursing, in the amount of $198,632, to provide specialized gerontological care services for the period of October 1, 2003 through September 30, 2004.

(3.2)  AIDS Office-HIV Health Services – Request for approval of a retroactive new contract with Instituto Familiar de la Raza, in the amount of $72,103, for the provision of HIV/AIDS case management services targeting Latino behavioral risk populations, for the period of December 1, 2003 through June 30, 2004.

(3.3)  AIDS Office-HIV Prevention – Request for approval of a retroactive new contract with Instituto Familiar de la Raza, in the amount of $100,000, to provide HIV prevention services targeting Latino youth behavioral risk populations, for the period of January 1, 2004 through December 31, 2004.

Commissioners’ Comment

  • Because this is a new program for this agency, the Budget Committee requested a six-month follow-up report to the Population Health and Prevention Joint Conference Committee.

(3.4)  PHP-CHPP – Request for approval of a retroactive new contract with Black Coalition on AIDS, in the amount of $148,630, to provide fiscal agent and support services to the African American Coalition for Health Improvement and Empowerment as the community partner for the DPH African American Health Initiative, serving African Americans citywide, for the period of January 1, 2004 through June 30, 2004.

(3.5)  PHP-Housing and Urban Health – Request for approval of a contract modification with Baker Places, Inc., in the amount of $231,479 for a total contract value of $1,219,675, to provide additional emergency hotel units targeting homeless clients with special needs referred by specific DPH programs, for the period of July 1, 2003 through June 30, 2004.

(3.6)  BHS-Substance Abuse – Request for approval of a retroactive contract renewal with the San Francisco Pretrial Diversion Project, in the amount of $76,833, to provide substance abuse prevention services; referrals, screening and intake services to adult Superior Court defendants through its Substance Abuse Referral Unit, for the period of July 1, 2003 through June 30, 2004.

Secretary’s Note – Staff noted that the contract monitoring report incorrectly stated that this organization does not have a Board of Directors.  The agency does have a Board of Directors, and the list of members was distributed to the Commissioners. 

(3.7)  BHS-Mental Health – Request for approval of a contract modification with YMCA Urban Services, in the amount of $103,030 per year for a total contract value of $1,987,516, to provide mental health outpatient and prevention services, for the period of July 1, 2003 through June 30, 2007.

Commissioners’ Comments

  • Commissioner Monfredini asked that a follow-up report be presented to the Community Health Network Joint Conference Committee in six to eight months, to report on outcomes.

(3.8)  BHS-Mental Health – Request for approval of a retroactive contract renewal with the Regents of the University of California, in the amount of $359,022, to provide mental health services through the Crisis Resolution Team, for the period of July 1, 2003 through June 30, 2004.

(3.9)  BHS-Mental Health – Request for approval of a retroactive new contract with the Regents of the University of California, San Francisco-Child Services Research Group, in the amount of $369,160, to provide a data collection process to encompass all current requirements for evaluations as specified by Community Mental Health Services, for the period of April 1, 2003 through September 30, 2004.

Secretary’s Note – staff noted two errors on the contract monitoring report.  The correct term of the contract is September 30, 2003 through September 29, 2004.  And the number of FTEs is 2.4, not 48.86.

Action Taken:  The Commission (Chow, Guy, Monfredini, Parker, Penn, Umekubo) approved the Budget Committee Consent Calendar. 

Item 3.3 was referred to the Population Health and Prevention Joint Conference Committee for a follow-up report in six months.

Item 3.7 was referred to the Community Health Network Joint Conference Committee for a follow-up report in six to eight months. 


Mitchell H. Katz, M.D., Director of Health, presented the Director’s Report.

President's FY 2005 Budget

On Monday, President Bush released his $2.4 trillion FY 2005 budget proposal.  On the positive side, the proposal de-emphasizes his previous Medicaid reform proposal, includes $250 million to fund emergency care for undocumented immigrants, and includes approximately $300 million in tax incentives in an effort to expand health insurance coverage to 4.5 million uninsured Americans.

However, the President also includes several proposals that could have a negative impact on DPH.  The budget proposes to restrict the use of intergovernmental transfers (IGT) in the Medicaid program and proposes to place limits on public provider payments under Medicaid.  The estimated savings from these two measures is $1.5 billion in FY 2005 and $23 billion over 10 years.  In addition, the President's budget also contains reductions to public health preparedness that could impact DPH.  The President's budget proposes cutting public health system preparedness funding distributed through the Centers for Disease Control and Prevention by 11.2%, from $934 million this year to $829 million in fiscal 2005.  In addition, preparedness funds for hospitals, distributed through the Department of Health and Human Services' Health Resources and Services Administration, would be reduced to $476 million from $515 million this year, a 7.6% decrease.

The President's budget indicates his priorities for the year and is only the first step in this year's budget process.  It provides a blueprint for Congress to consider as it begins the process of allocating federal monies for spending on programs.  The next step in the budget cycle will be for the House and Senate Budget Committees to approve their own versions of the budgetary parameters that the authorizing and appropriating committees will follow as they take up legislation later this year.

Homeless Youth in the Castro Area

DPH has played a key role in a new housing initiative for homeless youth in the Castro area. Steven Tierney, Director of HIV Prevention, has worked closely with Supervisor Bevan Dufty to convene a work group of DPH staff and community-based partners to secure supportive housing spaces and health and social services for 12 young people.  Marc Trotz, Director of Housing and Urban Health, and Michael Baxter of Adolescent Health, also brought their expertise and resources to this effort.  The youth will be moving into housing this month.  This effort represents an exciting and effective public-private partnership, which includes Larkin Street Youth Services, LYRIC, Most Holy Redeemer Church, the Metropolitan Community Church, the SF Police Department, and the SF Human Service Department.

National Black HIV/AIDS Awareness Day

The HIV Research Section, in partnership with community leaders, will host the fourth annual National Black HIV/AIDS Awareness Day on Saturday, February 7th from 10:30 a.m. to 1:30 p.m. at Glide Memorial Church, 330 Ellis Street.  The event will feature a memorial service for two renowned Black San Francisco activists--Reggie Williams and Brandy Moore--and a strategic planning session for mobilizing the African-American community around HIV research and prevention.

Saturday’s celebration follows the mandate of last spring’s well-attended “Dispelling Myths” forum that articulated the urgent need for African Americans to become more involved as planners and participants in HIV prevention research.  San Francisco is one of more than 60 cities across the U.S. that will sponsor programs on National Black HIV/AIDS Awareness and Information Day.  More information can be found at:  www.blackaidsday.org.

Annual Black History Month Cultural and Educational Event

DPH’s Managers of African Descent are hosting their Annual Black History Month-Cultural and Educational Event from 6 to 8 p.m. this evening at the African American Cultural Arts Center, 762 Fulton Street.  Each year the African American Health Initiative hosts the event which features afro-centric music and food, health information, a pictorial display of African-American Women in medicine and honors African Americans making history in health and science.  This year's honorees include:  Dr. Harrison Parker; the late Dr. Patricia E. Evans, former Medical Director of the Maternal and Child Health Section; Naomi Gray, former Health Commissioner ; Anthony Wagner, former CEO of Hospital Systems; Dr. Raye Richardson; community activist; Mildred Crear, Director of Maternal and Child Health; and Rev. Arelious Walker, faith-based health activist.  For more information contact Gigi Gregory at 581-2451or Janie Buford at 581-2407.

Conference on Survivors of Violence

The Community Health Education Section is co-sponsoring a daylong conference entitled, “SF/Bay Area Survivors Conference for the People,” on Saturday, February 28th, at Fort Mason.  The Conference is being organized in response to the growing number of violent deaths in the community, particularly among youth.  Conference organizers are featuring workshops dealing with loss, supporting survivors of violence, restorative justice, survivor empowerment and advocacy, and art workshops.  The event will conclude with a memorial ceremony, honoring those who have lost loved ones as a result of violence.  There is no charge to attend but registration is requested.  For more information and registration the public is asked to call 581‑2442.

Laguna Honda Hospital Annual Survey Begins

The State Department of Health Services’ (DHS) annual Licensing and Certification survey of Laguna Honda Hospital commenced on Monday, February 2nd.  The survey team comprises 14 representatives from Licensing & Certification, DHS’s Life Safety Code Unit, and the federal Centers for Medicare and Medicaid Services.  The unannounced survey is tentatively scheduled to conclude tomorrow.  I will advise the Commission of the survey results.

Children’s System of Care Youth Task Force

The San Francisco Children’s System of Care (CSOC) Youth Task Force recently won the Gold Medal in this year’s “Community Communications and Outreach” competition in San Antonio, Texas.  The Task Force is a group of San Francisco youth who have received services from one of the City’s major child-serving systems such as mental health, child welfare, juvenile justice or special education.  Members of the Task Force entered into the competition a musical CD entitled, “Free Flow on the Down Low,” containing songs written and performed by City youth.  Song lyrics reflect youth’s experiences with topics that range from community violence to foster care.

Gene O’Connell

Gene O’Connell, CEO of SFGH, has been named Chair of the California Association of Public Hospitals and Health System’s California Health Care Safety Net Institute (SNI).  SNI examines key community health issues, demonstrates and evaluates innovative strategies, shares best practices, and promotes a broader understanding of the role of public hospitals and health systems in promoting community health. 

Commissioners’ Comments

  • Commissioner Chow congratulated Ms. O’Connell for her appointment to the California Association of Public Hospitals and Health System’s California Health Care Safety Net Institute. 


The Commission continued this item to the February 17, 2004 Health Commission meeting.


Prior to the Director of Health’s budget presentation, Commissioner Chow welcomed Mayor Newsom to the Health Commission meeting.  Mayor Newsom provided the Commission with an overview of the City’s General Budget condition and his process for fully engaging the public, commissions and departments in his budget deliberations. 

Commissioners’ Comments

  • Commissioner Monfredini said she would relinquish the pay she gets for serving on the Health Commission, and urged Commissioners across the city to do the same.  Every little bit helps.  She asked the Mayor if his shortfall estimates assume passage of the $15 billion statewide bond.  Mayor Newsom replied that if the bond fails, there would be an additional $100 million impact on the City and County of San Francisco.
  • Commissioner Parker asked if the City has the ability to establish a significant budget reserve so that economic downturns do not have such devastating impacts.  Mayor Newsom said that Supervisor Ammiano authored legislation that establishes a rainy day fund so in future budget years a percentage of the annual growth will be set-aside in a reserve. 
  • Commissioner Guy appreciates the Mayor coming to the Commission at the beginning of the process.  She asked how the Health Commission could best partner with him in his budget preparation.  Mayor Newsom emphasized communicating with him and his budget staff. 
  • Commissioner Chow thanked the Mayor for addressing the Commission, and said the Commission fully supports public engagement in the budget process. 

Dr. Katz presented the 2004-2005 Department of Public Health Budget Proposal, (see Power Point presentation, Attachment A).  The report included an overview of adjustments to the base budget.  Adjustments include added costs due to inflationary increases, structural problems and regulatory requirements; added revenue; and revenue neutral programs.  Because of the serious nature of the program reductions that will be required to balance the budget and the impact of these reductions on public health, Mayor Newsom requested additional time to review the Department’s budget.  Therefore, budget reductions were not included in Dr. Katz’s presentation.  These will be presented at a future Health Commission meeting. 

Public Comment

  • David Villalobos, District 6/Tenderloin community representative – In his community, it is critical to get people housed and keep them housed, and many of these services are on the chopping block. 
  • Terry Rex Spray, President SEIU Local 790 – Local 790 and other unions sacrificed much last year to help balance the budget, and he has not seen a proportional sacrifice on the part of the downtown or the wealthy.  He wants to maintain services to the San Francisco residents who depend on the safety net.  His members have done their fair share to maintain city services, have suffered and are frustrated and angry.  They cannot support any compromise that would undermine the healthcare safety net.
  • Piers Mackenzie, Representing Friends and Family of the MHRF – He reminded the Commission that as a result of the MHRF Blue Ribbon Committee’s proposed restructuring to the MHRF, there will be a $2 million savings to the General Fund.
  • Sonny Quiniquini – He works at Laguna Honda Hospital (LHH) and is concerned about charging for parking at LHH, for both staff and visitors.  Also, workers should not have to continue to take a 7.5% salary reduction when management bonuses were not reduced and excessive salaries were not examined. 
  • Larry Bevan, shop steward at Local 250 – He appreciates that the most needy in the City do not have to come beg for their services.  Workers are willing to sacrifice, but the City must keep agreements that were put in place at the time these agreements were made.  Also, when cuts are made, focus first on administrative overhead, not on direct services. 
  • Maria Wong, Local 535 steward and SFGH employee – There needs to be more creative solutions to closing the budget gap, because SEIU members have sacrificed a lot with the 7.5% give back and recent increase in parking rates.  Employees are contributing to the solution, but cannot keep cutting services and taking from employees.  The City needs to figure out how to generate more revenue. 
  • Edna James, representing OMI Community Action Organization and the Southeast Health Center – She thanked the Commission for coming to the OMI community.  If health problems are caught in the beginning, people end up at SFGH.  She is concerned about mental health.  There is a lot of violence in OMI and Bayview and need more mental health programs for youth. 
  • Teresita Gatan, SFGH worker – SFGH generates a lot of revenue.  Every time budget cuts are on the table, the most vulnerable people are the first to be targeted.  The 7.5% salary reduction really impacts people, so please do not make employees take this cut again.
  • Linda Martin, Substance Abuse Counselor at SFGH, and shop steward for SEIU 790 – Last year was very difficult.  She would not like to see any cuts to substance abuse, especially not to the methadone clinic.  They are providing a critical service to San Francisco and work with people who have nothing.  She had to give up 7.5% last year, and she would prefer not to do it again this year.  Prices are constantly increased, but pay is going down, so she hopes the Commission can find a way to restore the 7.5%.
  • Tom Barton, Shop Steward at MHRF, expressed concern about the parking increases.  Some of the staff need parking because of the shifts they work.  Concerned about impact on visitors.  Please look at a more reasonable increase that will not be such a burden.
  • Rosie Gleser, Mission Community Council – She urged the Commission to preserve the wellness centers and focus on prevention, integrated services and health promotion. 
  • Otto Duffy, Tom Waddell Health Clinic Community Advisory Board, said the SRO Collaborative is a great and inexpensive program.  DPH should not target health clinics, but can look at cutting fire stations.  Should focus on revenue, and there are a lot of ideas. 

Commissioners’ Comments

  • Commissioner Parker said that until there are more sources of revenue, adjustments would be necessary.  He said that private hospitals receive a tax benefit without contributing significantly to charity care, and this increases our burden and our costs.  He asked if there is some means that the private hospitals could contribute more charity care, or the City could require them to contribute to the General Fund?  Dr. Katz said there are examples.  In Boston, all hospitals pay into a pool, and draw out of the pool depending on how much charity care they provide.  In Miami-Dade County, a portion of the sales tax is used to pay for the county hospital.  San Francisco does not have the ability to tax hospitals; counties are pre-empted by the State.  DPH has been working informally with some hospitals, for example Catholic Healthcare West, to urge them to take the money they give to other community benefits and put this into direct charity care. 
  • Commissioner Guy said the City needs to address the budget problem in a way that is not incremental, and must seriously consider whether to give up some of the Strategic Plan priorities.  San Francisco has been very supportive of public health, and the General Fund has supplemented State and Federal health funding.  She asked what the next steps are.  Dr. Katz replied that the budget information presented at this meeting will be assumed as DPH moves to the next step, so the Commissioners should express any concerns they have with the baseline adjustments.  The next step is to close the gap.  The Mayor wants to make sure the proposal reflects his goals, and has asked for time to review the budget.  Dr. Katz’s goal is to bring the cuts to the Health Commission’s next meeting of February 17th, but cannot promise that the dialogue with the Mayor will happen in this timeframe.  The tradition of two hearings will not change.  When the cuts are presented, Dr. Katz will provide proposals for closing the gap due to regulatory, inflationary and structural factors, meeting the 5.5% reduction target and meeting the 15% contingency reduction. 
  • Commissioner Monfredini said it is important to be transparent throughout this process.  Many of the cuts that were proposed last year will be back.  Mayor Newsom was correct when he said there are no pots of money left—they have all been drained.  It is frustrating to go through this painful process of cuts, and then see pots of money found for Board of Supervisors addbacks at the last minute.  Dr. Katz said not only are the pots empty, but the City is starting from a very bad fiscal base—deficit is larger, inflation is bigger, and DPH employees have already given part of their salaries.  Everyone should assume that it is going to be worse than last year. 
  • Commissioner Penn asked if the fixed costs have been thoroughly analyzed to ensure they are indeed immovable.  Dr. Katz said that they are currently immovable.  This could change, but only under specific circumstances, such as union negotiations.  Dr. Katz uses a strict standard for keeping these costs as fixed.  Commissioner Penn urged staff to work closely with contractors throughout this process.  He thinks it would be useful to look at other county health systems so that DPH has an idea about how its level of services compare.  Dr. Katz said that San Francisco clearly spends more money per capita than any other city.  He will work with Commissioner Penn to provide information.  Commissioner Penn and other Commissioners emphasized that the first staff priority right now is the budget. 
  • Commissioner Umekubo said that inflation is going to increase costs every year, and the City should develop a strategy to address these anticipated increases without cutting costs.  He would like to take advantage of the opportunity to forward creative ideas to the Mayor.  This is an opportunity to be more proactive.  Finally, he commended Mayor Newsom, Dr. Katz and the other administrators for taking a 15% salary reduction and he supports Commissioner Monfredini’s suggestion to give back the Commissioners’ per meeting pay.
  • Commissioner Chow supports a strategic planning retreat to review the Department’s plans, priorities and funding streams.  Commissioner Chow reiterated that the Commission is committed to holding two public hearings.  The budget presentation today offers an opportunity to provide input on structural and regulatory issues.  Commissioners should take advantage of the time to provide this feedback to Dr. Katz.  
  • Commissioner Guy, regarding structural issues, said it is so important to fully fund jail health services.  Every year DPH tells the Board of Supervisors it is underfunded, every year they deny funding and every year DPH has to rob Peter to pay Paul.  She would like to work with the Mayor.  Dr. Katz surmises that there will again be discussions about closing a jail, which would save money.  The Sheriff has also talked about contracting out jail health.  Commissioner Guy asked the Department and Commission to consider consolidation opportunities.  She supports the change to making the cuts effective in September rather than July because is has a great impact on staff morale.
  • Commissioner Chow asked if the Controller’s Office could perform some of the tasks currently done by DPH to offset the $2 million DPH is paying the Controller pursuant to Proposition C.  Dr. Katz said he is currently negotiating with the Controller to see what existing DPH functions could now be done by the Controller’s office.  It is unlikely the Controller would be able to do DPH’s financial audits.  It is more likely that the Controller’s Office could do things the Department has long wanted to do, but has never had funds for. 




The meeting was adjourned at 5:55 p.m.

Michele M. Olson, Executive Secretary to the Health Commission