Minutes of the Health Commission Meeting
Tuesday, February 17, 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 3:20 p.m.
- Commissioner Edward A. Chow, M.D., 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.
- Commissioner John I. Umekubo, M.D.
- Commissioner Roma P. Guy, M.S.W., Vice President
2) APPROVAL OF THE MINUTES OF THE MEETING OF FEBRUARY 5, 2004
Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Sanchez,
Umekubo) approved the minutes of the February 5, 2004 meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Monfredini chaired, and Commissioner Penn and
Commissioner Umekubo attended, the Budget Committee meeting.
(3.1) PHP-TB Control - Request for approval of a retroactive sole
source contract renewal with the Regents of the University of
California, in the amount of $1,491,727, to provide Model Tuberculosis
Prevention and Control Center services to local and national TB
healthcare providers, professionals and funders, for the period of
January 1, 2004 through December 31, 2004.
Commissioner Sanchez abstained from voting on this item.
(3.2) PHP-Prevention/Primary Care - Request for approval of a
retroactive contract modification with the San Francisco Study Center,
in the amount of $137,550, for FY 2003-04 only, to provide fiscal agent
services for the Yes We Can Urban Asthma Partnership’s pediatric
asthma community health services, and to add a contingency amount of
$648,285 for a total contract value of $6,050,657 for the period of July
1, 2003 through June 30, 2007.
(3.3) PHP-Housing and Urban Health - Request for approval of a new
sole source contract with Tenderloin Neighborhood Development
Corporation, in the amount of $117,342, to provide housing and support
services targeting homeless, extremely low-income elderly with one or
more disabilities, for the period of February 1, 2004 through June 30,
- John Melone, member of the Homeless Senior Task Force, spoke in
support of this project. We need to get seniors into housing, not
into shelters. The task force is requesting $2 million additional
funds in next year’s budget.
- Mel Beetle, member of the Homeless Senior Task Force, spoke in
support of this project. He told the committee that this site will
have supportive services, as well as housing.
(3.4) CHN-SFGH and Health at Home - Request for approval of a
contract renewal with Toyon Associates, Inc., in the amount of $735,931,
to provide reimbursement and revenue optimization services to San
Francisco General Hospital and Health at Home Agency, for the period of
April 1, 2004 through March 31, 2006.
(3.5) CHN-Laguna Honda Hospital - Request for approval of a contract
renewal with Healthcare Financial Solutions, in the amount of $95,418,
to provide reimbursement and revenue optimization services to Laguna
Honda Hospital, for the period of April 1, 2004 through March 31, 2006.
(3.6) BHS-Substance Abuse - Request for approval of a contract
modification with Mt. St. Joseph-St. Elizabeth’s, in the amount of
$178,175 for FY 2003-04 only, for a total four-year contract value of
$4,457,613, to provide mental health and substance abuse residential and
outpatient services for the period of July 1, 2003 through June 30,
Secretary’s note - the correct amount of the contract is $159,085.
(3.7) BHS-Mental Health - Request for approval of a contract
modification with MedImpact Healthcare Systems, Inc., in the amount of
$3,008,620 for a total contract amount of $9,330,779, for the provision
of pharmacy benefits management services for indigent mental health
consumers, for the period of April 1, 2003 through June 30, 2005.
(3.8) BHS-Mental Health - Request for approval to enter into a
performance agreement with Managed Health Networks, Inc. and its
affiliates to provide comprehensive child crisis services at a capitated
rate, with projected revenues of $75,000 per fiscal year for a total
contract amount of $100,000, for the period of March 1, 2004 through
June 30, 2005.
- Commissioner Monfredini requested an update on this contract to
the CHN JCC in six months.
(3.9) BHS - Request for site approval for relocation of Swords to
Plowshares from 1063 Market Street to 1060 Howard Street, first and
second floors, and relocation of the Department of Public Health’s
Disability Evaluation Assistance Program from 238 Eddy Street to 1060
Howard Street, third floor.
(3.10) AIDS Office-HIV Health Services - Request for approval of a
contract modification with the Regents of the University of California/UCSF/Women’s
Specialty Clinic, to add $50,529 to the original amount of $477,200 for
a two-year total contract amount of $527,729, to provide primary care,
case management and voucher distribution services targeting women with
advanced HIV-related illness or complex medical problems that cannot be
managed at other San Francisco CARE-funded sites that provide services
for women, for the period of March 1, 2002 through February 29, 2004.
Commissioner Sanchez abstained from voting on this item.
(3.11) AIDS Office-HIV Health Services - Request for approval of a
contract modification with the Regents of the University of California/UCSF/Positive
Health Practice to add $78,973 to the original amount of $25,714, for a
total contract amount of $104,687, to provide program enhancement,
outreach worker and psychotherapy services to the Men of Color Program,
for the period of March 1, 2003 through February 29, 2004.
Commissioner Sanchez abstained from voting on this item.
(3.12) AIDS Office-HIV Health Services - Request for approval of a
new retroactive contract with Ramsell Corporation, in the amount of
$163,545, to provide voucher distribution services to CARE-funded
service providers and quality management training and technical
assistance to Office of Minority Health-funded service providers, for
the period of January 1, 2004 through February 29, 2004.
(3.13) AIDS Office-HIV Health Services - Request for approval of a
contract modification with Project Open Hand to add $265,641 to the
original amount of $1,296,809 for a total contract amount of $1,562,450,
to provide delivered meals and Grocery Center services, for the period
of March 1, 2003 through February 29, 2004.
Action Taken: The Commission (Chow, Monfredini, Parker, Penn,
Sanchez, Umekubo) approved the Budget Committee Consent Calendar, with
Commissioner Sanchez abstaining from voting on Item 3.1, Item 3.10 and
Item 3.8 was referred to the CHN JCC for a six-month report back.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
Staff Volunteers to Assist at City Hall
I am pleased to announce that a number of DPH staff responded to a
request from the Mayor over the holiday weekend to assist with the
overwhelming number of couples waiting in line to obtain marriage licenses
at City Hall. As the Commissioners are aware, last week Mayor Newsom
directed the Assessor's Office to begin issuing marriage licenses to same
sex couples. At times, the line for marriage licenses stretched through
two floors of City Hall, out the front door and around three sides of the
building. DPH staff helped with crowd control, distributed information,
helped process applications, collect fees and, in the words of one of the
volunteers, "did whatever needed doing." I am grateful to those
who gave up their holiday weekend to lend a hand to this historical event.
Annual Survey of Laguna Honda Completed.
The State Licensing & Certification team concluded its annual
survey of Laguna Honda on Friday, February 6th and provided preliminary
findings in an exit conference. The Life Safety Code survey team
identified issues related to fire safety and non-conformance to current
building codes in some resident care buildings, which are between 80 and
95 years old. The Licensing Team reported no findings of substandard care.
Upon receipt of the written results, Laguna Honda staff will submit a Plan
of Correction for deficiencies identified in the survey process. I wish to
thank Commissioner Monfredini for representing the Commission at the exit
conference and the staff for successfully managing the survey process.
SFGH Pediatric Asthma Clinic Recognized by the CDC
The SFGH Pediatric Asthma Clinic has been selected by the Centers for
Disease Control and Prevention (CDC) for national recognition for its work
as a leading contributor to the YES WE CAN collaborative, an intervention
that encompasses the delivery of optimal medical care, clinical case
management, social case management by community health workers, home
environmental remediation, and support and education for providers. The
YES WE CAN demonstration project is led by a steering committee co-chaired
by Dr. David Ofman, medical director for Primary Care, and Professor Mary
Beth Love of San Francisco State University with participants from 17 San
Francisco organizations. Dr. Shannon Thyne, medical director for the
Children’s Health Center, heads up research and evaluation efforts. The
CDC’s National Center for Environmental and Respiratory Health conducted
a rigorous review of evidence-based interventions; YES WE CAN was only the
sixth asthma intervention ever to be selected for national publication.
The clinic will be written up in a detailed case study and published as a
toolkit to promote lessons learned and nationwide replication of its
comprehensive multi-pronged intervention.
JCAHO Readiness Kickoff for 2005 Survey
On Tuesday, January 27th, the SFGH’s Quality Management department
held a kickoff at Management Forum with the theme “Bring It On,” to
prepare SFGH for its anticipated Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) survey in 2005. Hiro Tokubo, Director of
Quality Management, and Lawrence Marsco, Manager for JCAHO Regulatory
Affairs and Patient Safety Officer, have been meeting with front-line
managers to discuss the impact of revisions to Joint Commission standards
and the adoption of a new scoring system that defines elements of
performance that determine compliance with each standard. SFGH managers
and associate administrators have been designated into teams responsible
for each chapter of the Joint Commission standards.
Curry Senior Center to Honor Community Partners
On February 28th, Curry Senior Services will honor both St. Francis
Memorial Hospital and Asian Neighborhood Design at its annual fund raising
dinner. This year's "Leap Year Ball" will be held at the Mark
Hopkins Hotel. St. Francis Memorial Hospital will receive the Francis J.
Curry Award for its generosity towards serving the health care needs of
the senior community. Asian Neighborhood Design will be honored with the
Joseph J. Mignola, Jr. award for its expertise and support in planning and
development of Curry's new facility at 315 Turk St., as well as for its
commitment to expanding services to underserved communities throughout the
LHH Executive Administrator Elected to AHA Governing Council.
I am pleased to announce that LHH Executive Administrator, Larry Funk,
has been elected to a three-year term on the American Hospital
Association's Governing Council for Long Term Care and Rehabilitation. The
Governing Council develops national policy and advocacy priorities for
hospitals in the areas of long term care and rehabilitative healthcare
services. We are pleased that Mr. Funk will represent DPH in this venue.
Sue Carlisle, M.D., Ph.D.
Sue Carlisle, M.D., PhD, has been named by the UCSF School of Medicine
Dean as the new Associate Dean at SFGH, succeeding Dr. Phil Hopewell. Dr.
Carlisle has worked closely with Gene O’Connell and managers at SFGH for
the past year as Interim Associate Dean, Chief of Service for Anesthesia
at SFGH, and Vice Chair of the Department of Anesthesia and Perioperative
Care at UCSF. She received her medical degree from University of
Pennsylvania and her PhD in Parasitology and Cell Biology at Tulane
University. She has received numerous accolades, including Outstanding
Resident and Outstanding Clinical Faculty while at UCSF, and a teaching
award from St. Mary’s Residents while practicing at French Hospital.
"Hearts in San Francisco"
The San Francisco General Hospital Foundation kicked off its “Hearts
in San Francisco” campaign on Valentine’s Day. One hundred thirty
five-foot heart-shaped structures will be transformed by renowned artists
such as Michael Osborne, the designer of the popular 2002 LOVE stamp, and
San Francisco Chronicle cartoonist Phil Frank, and displayed throughout
the Bay Area during the spring and summer of 2004. A select few will be
auctioned off in November with proceeds to benefit programs at San
Francisco General Hospital. Designated locations for these structures
include Union Square, Yerba Buena Gardens, Telegraph Hill, Stern Grove,
the Embarcadero, Twin Peaks, and Golden Gate Bridge’s Vista Point.
Volunteers will serve as walking tour guides for visitors.
COMMUNITY HEALTH NETWORK
SAN FRANCISCO GENERAL HOSPITAL CREDENTIALS REPORT
Health Commission - Director of Health Report
(From 02/09/04 MEC and 02/10/04 JCC)
7/03 to 02/04
Changes in Privileges
Current Statistics - as of 02/1/04
Affiliate Professionals (non-physicians)
Applications In Process
Applications Withdrawn Month of Jan 2003
10(07/03 to 02/04
SFGH Reappointments in Process Def 2003 to Mar 2004
- Commissioner Monfredini was honored to be at the Laguna Honda
Hospital exit interview, and is proud of the hospital staff who is
doing great work under difficult situations.
- Commissioner Chow asked for a budget update. Dr. Katz said he is
continuing to work closely with the Mayor’s Office. The Mayor’s
Office is committed to the Health Commission holding its two public
hearings. He hopes the budget will be ready to be presented in March.
5) ELECTION OF PRESIDENT AND VICE PRESIDENT OF THE HEALTH COMMISSION
Commissioner Umekubo nominated Commissioner Chow to serve as president
of the Health Commission.
Action Taken: The Commission (Monfredini, Parker, Penn, Umekubo,
Sanchez) elected Commissioner Chow to serve as President of the Health
Commission for 2004. Commissioner Chow abstained.
Commissioner Penn nominated Commissioner Monfredini to serve as Vice
President of the Health Commission.
Action Taken: The Commission (Chow, Parker, Penn, Umekubo, Sanchez)
elected Commissioner Monfredini to serve as Vice President of the Health
Commission for 2004. Commissioner Monfredini abstained.
6) RESOLUTION ACKNOWLEDGING CHILDREN’S DENTAL HEALTH MONTH
Action Taken: The Commission (Chow, Monfredini, Parker, Penn, Umekubo,
Sanchez) approved Resolution #02-04, “Acknowledging February 2004 as ‘Children’s
Dental Health Month’ and Honoring the Agencies and Individuals who Have
Made a Difference with Children’s Dental Health in San Francisco”,
Commissioner Chow acknowledged the people recognized by the resolution,
and each person was presented with a certificate. Dr. Katz acknowledged
Dr. Samantha Stephen, Director of DPH Dental Services.
- Commissioner Sanchez said this is an important recognition. The
individuals provided critical services above the safety net. During
the various budget processes, many services will be reviewed,
including the UCSF School of Dentistry. When the school was created,
establishment of community dental clinics was critical. There has been
talk that these will be put on the chopping block. Commissioner
Sanchez encouraged the people in the room, who are very committed and
very active, to fight against any cutbacks to these services. If there
were to be closures to these clinics, the Health Commission could hold
7) SECOND QUARTER FINANCIAL REPORT
Gregg Sass, DPH Chief Financial Officer, presented the FY 2003-2004
Second Quarter Financial Report. This report presents the second quarterly
financial projection of DPH revenues and expenditures for fiscal year
2003-04. Staff is currently projecting a net surplus of $1.842 million.
Projections include a revenue surplus of $8.957 million and over
expenditures of $7.115 million.
Department of Public Health
Preliminary Financial Results
December 31 Projection
Mr. Sass provided the Commission with detail of revenue and expenditure
projections for each DPH division.
- Michael Lyon - concerned that the budget is moving forward and there
has been no information about potential cuts. He informed the
Commission that there is a proposal in Congress that requires
hospitals that want to receive funding for services for undocumented
people to fingerprint and report these people. Dr. Katz informed the
Commission that the Department would not participate in such a
- Shanell Williams, San Francisco Youth Commission, urged the
Commission to continue to support the extension of Healthy Kids. When
looking at cuts, please consider the impacts on youth.
- Commissioner Parker asked if it is typical to backfill positions
with overtime. Mr. Sass said that in some instances, the only option
available for backfilling is overtime, P103 and registry. It is not
fiscally prudent to propose a budget that assumes there will be over
expenditures in these areas, to be offset with additional revenues.
This year, the department is proposing to address these structural
issues. However, to attract permanent personnel, it is likely DPH will
need to offer higher pay, because the department is competing for a
scarce resource. Commissioner Parker asked if Jail Health Services are
entirely general funded. Mr. Sass said yes.
- Commissioner Umekubo asked how far back the cost report settlements
go. Mr. Sass said most go back three years. It is unlikely there will
be many more of these in the future.
- Commissioner Chow asked if the department continues to receive
capitation revenue from entities such as SF Health Plan. Mr. Sass said
DPH does receive capitation revenue from Medi-Cal, Healthy Families,
Healthy Kids and Healthy Workers.
8) PREVENTION STRATEGIC PLAN
Ginger Smyly, Director, Community Health Programs and Prevention,
presented the Prevention Strategic Plan, 2004 through 2008. The Population
Health and Prevention Joint Conference Committee two years ago asked staff
to develop a strategic plan. Participants in developing the strategic plan
were the Prevention Steering Committee, which developed a Prevention
Framework; the Prevention Planning Committee, which guided the Prevention
Strategic Plan development process; and the Prevention Workgroup, which
identified top social determinants and health outcomes.
Guiding Principles for the Strategic Plan were that it be population
based, evidence based, address root causes and inequities, build on
existing efforts, promote public partnership and evaluate results.
Ms. Smyly noted that the strategic plan puts into place a framework and
system for prevention planning and identifies broad issue areas that the
Department should address. It is not meant to supplant and incorporate
section-specific planning. There is a lot of great work already being done
in the sections, for example, HIV Prevention Plan, Tobacco Free Project
plan and others.
DPH Prevention Workgroup recommends the following priority prevention
- Social Determinants, such as socio-economic status, social
connectedness or isolation, institutional racism and transportation
- Health Outcomes, specifically cardiovascular disease, which is the
leading cause of death of every race and cultural group in San
Francisco, and depression.
The Prevention Strategic Plan’s first strategy is to develop a
multi-year prevention plan. The Plan includes the following strategies:
- Develop a future investment strategy. This strategy would include
moving funding to effective, evidence-based prevention efforts and
coordinating fund/grant development for strategic health plan
- Ensure prevention as core component by having some portion of new
programs be prevention oriented, creating ongoing discussion, training
about prevention within and among DPH sections and reviewing new
programs for prevention relevance and best practices.
- Strengthen prevention in health care services - interventions should
be evidence-based, consistent with expert guidelines and linked to
- Evaluate existing prevention programs by establishing an evaluation
workgroup, and having sections evaluate existing programs for
Ms. Smyly reviewed the implementation steps for DPH’s prevention
branch, for the Prevention Planning Committee and for each of the
Ms. Smyly described examples of prevention programs including living
wage, pedestrian and traffic safety, chronic disease management and health
equity and sustainability. These programs are described in detail in the
Challenges and Opportunities
- Poor financial climate for reassigning old dollars
- Will and orientation of management and field staff
- Public health workers lack prevention background
- No revenues in prevention, such as Medi-Cal fee-for-service (despite
this, staff has been creative and successful in getting grants)
- Poor financial climate for new dollars
- Lack of general fund to leverage new grants
Ms. Smyly ended by saying that DPH has a successful track record in
creating successful prevention programs. It is fortunate that the
Department is surrounded by academic resources and private and public
foundations that can assist staff in creating model programs. There is
also an increasing availability of data and best practices.
- Commissioner Parker is impressed that staff was able to take the
prevention framework to the next step. The health professionals are
not focused on prevention, but instead are focused on diagnosing and
treating. By the time a diagnosis has been made, the damage has been
done. It will be incredibly challenging to change this approach. An
underlying component of all the social determinants is disrespect.
This is a barrier. We have to get people to value their health.
- Commissioner Umekubo said prevention is a concept that requires a
different mindset. The medical profession is so focused on rapidly
addressing problems. Insurers also fund treatment, and there is little
incentive to provide prevention services. But if DPH takes that lead
with prevention, for example with cardiovascular disease, this will
have an impact. He encouraged the staff to incorporate private
hospitals, the San Francisco Medical Society and other private
physicians. Ms. Smyly noted one of the efforts is partnership with
Community Clinic Consortium, DPH safety net clinics and Kaiser.
Commissioner Umekubo asked if the Commission and its joint conference
committees could get periodic reports.
- Commissioner Chow reiterated that many private practitioners want to
work on these issues, and look for opportunities. Commissioner Chow
said in the current economic climate, our talent is our biggest
resource, because unfortunately we do not have funding.
9) PUBLIC COMMENT
The meeting was adjourned at 5:00 p.m.
Michele M. Olson, Executive Secretary to the Health Commission