Minutes of the Special Health Commission Meeting
Tuesday, March 23, 2004
at 3:00 p.m.
101 Grove Street, Room #300
San Francisco, CA 94102
1) CALL TO ORDER
The meeting was
called to order by Commissioner Chow at 3:10 p.m.
- Commissioner Edward A. Chow, M.D., President
- Commissioner Lee Ann Monfredini, Vice President
- Commissioner James M. Illig
- 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.
Commissioner Chow introduced Commissioner Jim Illig, Mayor
Gavin Newsom’s first appointment to the Health Commission.
Commissioner Illig described his background and shared his
priorities with his fellow Commissioners, staff and members of
the public. His three priorities are:
- Do whatever is necessary to alleviate homelessness
- Focus on the health needs of all San Franciscans. While
the Department has a special responsibility to care for the
poor and uninsured, it must serve all San Franciscans.
- Focus on results and outcomes of patients and clients,
rather than institutions, employees and contracts
Commissioner Illig’s perspective is one of both an
outsider and an insider. He has been observing the Health
Commission since 1985, when it was created. Now that he is
on the Commission, he believes that government is its
citizens, and public office is a public trust. As he begins
his service here, he will pay attention to the public’s
perspective. He looks forward to working with his fellow
Commissioners, Dr. Katz and the public.
2) APPROVAL OF
THE MINUTES OF THE MEETING OF MARCH 16, 2004
Taken: The Commission (Chow, Illig, Monfredini, Penn,
Sanchez, Umekubo) approved the minutes of the March 16, 2004
Health Commission meeting.
3) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the
Public Health Week Activities, April
5 - 11
The San Francisco Department of Public Health
will observe National Public Health Week April 5th to 11th.
The theme this year is “Eliminating Health Disparities,
Communities Moving from Statistics to Solutions”. Planned
activities include two Brown Bag Lunch presentations, one by
Sandra Hernandez, M.D., Executive Director of the San
Francisco Foundation and former Director of Health of the
San Francisco Department of Public Health, and one by Kevin
Grumbach, M.D., Chief of Family and Community Medicine at
SFGH and Research Director for the UCSF Center for the
Health Professions. In addition, the Health Education
Training Center will present a session entitled “A Public
Health Approach to Health Disparities.” For further
information contact Carolyn Lieber at 255-3470 or via email
Barry Zevin Receives
Community Hero Award
Dr. Barry Zevin, Medical Director of Tom Waddell Health
Center, was recognized by Saint Francis Memorial Hospital as
one of its 2004 Community Heroes. A $10,000 award, to be
donated to Tom Waddell Health Center, accompanies the
recognition. The Community Hero award is given to
individuals who go "above and beyond" normal expectations to
create a healthier environment for the community served by
Saint Francis Memorial Hospital, especially the poor and
underserved. As Medical Director of Tom Waddell Health
Center, Dr Zevin has served homeless, indigent and
underserved populations for many years. He is recognized as
a local and national expert on health care for homeless
people, HIV and hepatitis C care. Dr Zevin was instrumental
in founding the first public transgender primary care clinic
in the nation, planning and working with the Homeless Death
Prevention and HOPE health care teams, collaborating to
start the first community based medically supported
residential detox program in San Francisco, and planning and
implementation of the McMillan Stabilization Pilot Project.
McMillan Stabilization Pilot Project Open House
San Francisco Public Health and Fire Departments along with
Community Awareness and Treatment Services (CATS) are
hosting a 3-day Open House from April 5 – 7 for the McMillan
Stabilization Pilot Project. Invitations have been extended
citywide to paramedics and emergency room physicians. The
purpose of the Open House is to promote better understanding
of the McMillan Stabilization Project as well as to
- Commissioner Illig asked for a list of the Strategic
Plan community meetings. Dr. Katz informed the
Commission that there will be one meeting in each of the
supervisorial districts, and all meetings are open to
anyone who wishes to attend.
- Commissioner Chow stated that the Commission would
have formal input into the Strategic Plan update process
through the Joint Conference Committees.
4) CONSIDERATION OF A RESOLUTION REGARDING THE
PROPOSED FISCAL YEAR 2004-05 HEALTH DEPARTMENT BASE
Dr. Katz presented the Commission new information on
issues that were raised at the previous Health
Commission meeting, including information on
pharmaceutical co-pays, status of MediCal funding for
methadone, status of the Mentally Ill Offender Crime
Reduction Grant, the proposal to combine clinics,
additional issues involving Walden House and the
proposal to decrease administrative positions in Primary
Care (see memo, Attachment A).
Commissioner Illig asked how Walden House would be
able to save $300,000 and reduce the length of stay, yet
still keep the same number of clients. Dr. Katz replied
that Walden typically has longer lengths of stay than
other contractors. So there may be a reduction in the
static number of beds, but in terms of the number of
clients the agency serves, there should not be a
- Norma Hotaling, Executive Director of SAGE,
thanked the commission for retaining substance abuse
programs, which is the cheapest services the
department can buy.
- Greg Parks, Team II Clinic, said there are so
many people who still need the services provided by
the Team II Clinic.
- Angel Temple, Client of Team II, opposed to the
relocation and consolidation of the clinic to the
OMI Mental Health Clinic. Patients like her would
fall through the cracks, and instead of saving money
there would be more hospitalization of patients.
- Sharon Parks, patient at Team II Clinic, opposes
the relocation of the clinic. It will be disruptive
and reduce the quality of care.
- Rolando Alfonso, Citywide helped him stay clean
for two years, helps him with his medication, and he
has had no problem with the law for the past two
- Debbie Woods, Citywide client, said this agency
saved her life. All the staff is very supportive.
- Billy Powell, has been incarcerated many times
over the years. Citywide Clinic gives him everything
he needs, and is the best type of rehabilitation he
has ever had.
- Kinneth Bell, client at Citywide, said the
program is helping him deal with depression and
other problems. Please help the agency.
- Michael Williams, client at Citywide, has been
in and out of jails and hospitals for 20 years.
Citywide is helping him with his life. Please keep
- Jay Ordman, objects to the Mayor’s request for a
$50 million cut in healthcare spending, instead of
raising taxes on the very wealthy and big
- Larry Young, client of Citywide, said the
program has provided him with medication and
housing. It is the first program in his life where
he has had anger management, harm reduction and
other programs. Please try to keep the program open.
- David Fariello, program director at Citywide
Case Management. If this program terminates July
1st, in addition to losing 100 treatment slots,
there will be negative impacts to two other partner
programs that share space with Citywide. Second,
although appropriate mental heath treatment is
reducing jail days, the primary result has been
success in getting citizens who suffer from mental
health and substance abuse into treatment often for
the first time in their lives.
- Jane Kiskiras, client of Maxine Hall Health
Clinic, Maxine Hall is the best healthcare she has
ever received. The staff are real caregivers.
- Jenelle, Team II Clinic, said the clinic
provides services to a community that otherwise
would not seek help. The clients will not seek
services in a place they do not feel comfortable in.
Let Team II remain.
- Kathleen Ryan, Chair of the CHN NP Professional
Development Group - the group is sad and dismayed at
the sudden termination of David Ofman. His dismissal
leaves a void in leadership and advocacy. He has
worked diligently to improve care and access for
indigent patients. Dr. Ofman has been a mentor to
many CHN nurse practitioners.
- Bruce Folsom, social worker at Southeast Mission
Geriatrics. The proposed location is inappropriate
for its clients. It is far away for most of the
clients and is in a heavily congested neighborhood.
In addition, the proposed location has had
- Arthur Bosse, National Council on Alcoholism.
Substance abuse problems exist regardless of whether
or not there is funding. Spending money in this area
saves money in so many other areas. The Health
Commission must advocate to at least maintain the
level of substance abuse services.
- Martha Hawthorne, PHN at Castro Mission Health
Center, is very concerned about the administrative
cuts to Primary Care. These cuts will impact patient
care and will result in the health centers serving
- Elizabeth Smith – Maxine Hall Health Center
transformed her life. Do not make cuts to Primary
- David Hall, client of Morrisania West, read from
a letter he submitted to the Commission (on file).
- Yehiel Yisra-el, Morrisania West, said more
funding is needed, and more cuts should be taken
elsewhere. The Health Commission has the bully
pulpit to say to the corporations and leaders, in a
peaceful revolution, that these cuts are draconian.
- Maurice May, Morrisania West, said his job is to
help teens prepare for employment and get jobs.
Please say no to budget cuts to the Health
Department, because the youth need these programs.
- Piers MacKenzie, Friends and Families of the
MHRF, hopes that Commissioner Illig supports the
direction of the MHRF Blue Ribbon Committee, which
has been endorsed by the Health Commission.
- Dale Milfay, said the Commission must take a
stand and demand alternative sources of revenue. We
cannot continue these draconian cuts. People with
mental illness cannot get better with shorter stays.
Patients with poverty-level incomes should not be
charged a pharmaceutical co-pay—and remember that
psychotropic drugs are not generic.
- Debbie Lerman, Human Services Network, expressed
concern about standardized indirect rates. The
methodology should not be developed in a
budget-cutting context, with the assumption that
there will be a $1.5 million savings.
- Ed Kinchley, Local 790, said the Department has
a commitment to culturally competent care, yet for
the past three years the Commission has recommended
cutting the interpreters at SFGH. It is a fantasy
that bilingual staff have time to interpret in
addition to their regular jobs. Tell the City that
the Health Department does not have enough resources
to carry out its mission.
- Michael Lyon, Save Public Health, is outraged at
the proposed per-prescription co-pays. The plan to
remove the medical director and clinic
administration only indicate that the big cuts are
coming. The large contingency cuts are being
developed in secret. He submitted a letter written
by Dr. Kevin Grumbach in 1999 on the affects of
- Gene Hartman, Jr., client of Bayview Hunters
Point Foundation, said that the agency’s services
have helped him and please keep the methadone and
- Geoffrey Grier, San Francisco Recovery Theater
and Chair of the Treatment on Demand Council – said
that African Americans are going to be
disproportionately affected by the budget cuts. The
system is obviously broken. Primary Care needs more
- Sasha Cuttler, R.N., provided his testimony in
Spanish on behalf of his patients at SFGH who speak
other languages. If the Commission does not
understand what he is saying, then they understand
how patients without a translator feel. The people
are asking for help. How can someone talk to a nurse
or a doctor if there is no one to provide
translation? There are frequently waits for medical
services. Please save more public health services,
not less. This proposal is dangerous. Mr. Cutler
then provided his testimony in English.
- Matt Crawford, Friends and Family of the MHRF.
He thanked the Commission for saving the MHRF, and
increasing the use of Buprenorphine for heroin use.
His friend was prematurely released from the MHRF,
and is now deteriorating and is no longer conserved.
Please maintain conservatorship. And people who are
severely mentally ill should not be threatened with
losing their housing.
- Commissioner Chow asked for clarification
that the day and evening shifts of interpreters
are being maintained. Dr. Katz said last year’s
budget recommended eliminating the night shift,
which provided Spanish and Chinese translation.
The average usage was two per night. When the
Board of Supervisors restored the funding, the
Department used that allocation to enhance the
number of translators during the day. But,
because the City almost immediately implemented
a hiring freeze, DPH was never able to fill
these positions. So, the positions that are
recommended to be eliminated are funded but not
filled. DPH does pay substantial amounts in
premium for staff that is bilingual. While it is
true that staff is very busy, it raises the
question of whether the bilingual premium is
appropriate. But this is an MOU issue.
- Commissioner Illig asked if the vacant
translator positions are maintained in next
year’s baseline. Dr. Katz said the five vacant
positions are on the table to be cut.
- Commissioner Sanchez said there would likely
be even greater oversight over Title VI, which
requires adequate linguistic services. San
Francisco has been one of the key leaders in
this area. The Department needs to examine
whether it would be vulnerable to Title VI
challenges and to make sure we maintain our
leadership in this area. Dr. Katz said that even
with the reduction in translators, SFGH would
still be far ahead of other hospitals in San
- Commissioner Umekubo asked for an update on
the use of video conferencing for
interpretation. Dr. Katz said there is a pilot
project in progress, such a system would benefit
Primary Care, and would be useful for uncommon
- Commissioner Chow suggested that the San
Francisco General Hospital Joint Conference
Committee continue to monitor proposed
reductions in translation services, including
whether the cuts are part of the final budget,
what the impacts are, how the impacts could be
minimized, and the status of the pilot project
to use video conferencing.
- Commissioner Penn asked for more information
about the impact of shortened stays at Walden
House. Dr. Katz said that ideally a person would
stay in residential treatment long enough to
have a job and a home. This is not the standard
of care DPH is currently providing. With
utilization management, clients are examined
more closely to see if patients are able to
leave the program. This proposal stemmed from
the fact that Walden House has longer average
lengths of stay than other contractors.
Commissioner Penn asked the Department to work
with our contractors to explore whether other
cost savings opportunities exist.
- Commissioner Illig said that capacity will
be lost with the change to Walden House’s
program, because while the same number of people
are being served, there will not be as many beds
in the contract. Dr. Katz reiterated that none
of Walden House’s facilities would be closed.
Ms. Garcia added that the Department does not
have utilization review with substance abuse
treatment providers, so this will be a
- Commissioner Penn is bothered by the fact
that there is no plan for indirect costs, so the
Commission cannot know the impact on contractors
and services. Dr. Katz said it is an
across-the-board cut on agencies. In the
best-case scenario, the standardized methodology
would be developed without an assumption of a
$1.5 million savings.
- Commissioner Illig said the recommendations
of City’s Non-Profit Contracting Task Force,
which have been approved by the Board of
Supervisors, would help the Health Department
and other departments develop the methodology
- Commissioner Monfredini reminded the
Commission that Walden House has been forced to
undertake a dramatic self-assessment over the
past year, which allowed them to come to the
table with budget ideas. Ms. Garcia has worked
tirelessly with the organization.
- Commissioner Penn asked for more information
about the ventilation issues at the OMI Mental
Health Clinic. Dr. Katz said that OMI site has
had physical problems, but all have been
corrected to the satisfaction of two industrial
hygienists. Commissioner Penn is concerned about
changes to Primary Care administration. Dr. Katz
said the staff would make Primary Care work.
Although the cuts are stiff, it is unusual by
comparison to see clinics of this size with a
full-time medical director, a full-time
administrator, a full-time nurse manager and a
full-time principal clerk. Commissioner Penn
commended Dr. Katz for reducing his own salary.
He asked his fellow Commissioners if they would
be returning their meeting stipends.
Commissioner Chow said Commissioners would be
doing this. Commissioner Penn noted that many of
the proposed cuts will disproportionately impact
the African American community and he wants this
reflected in the resolution.
- Commissioner Monfredini commended staff for
developing additional alternatives in the week
since the last meeting. She also recognized that
85 DPH employees will be losing their jobs, and
this is difficult. She thanked Dr. Katz for
looking within the Department first.
- Commissioner Sanchez said the proposed
budget is painful. San Francisco has an
unrivaled primary care system, which needs
continued leadership. He asked that the change
to Primary Care by monitored closely by the CHN
Joint Conference Committee, as well as review of
the merger of the three clinics to see that
quality of services does not decline.
- Commissioner Umekubo said a lot of changes
are being proposed, and the impact of these
changes is unknown. It is critical that the
Health Commission receives updates so that it is
able to rectify problems next year. With regard
to Primary Care, anytime changes in leadership
are made, there is a discomfort on the part of
staff and there needs to be constant
- Commissioner Illig said the advocacy now
moves across the street and the Commission and
the public need to be taking the message to the
Mayor’s Office and the Board of Supervisors that
this level of cuts in unacceptable. He asked Dr.
Katz to develop options for the contingency
budget. He is prepared to ask the elected
leaders to be excused from this next phase, at
least for now.
Action Taken: The Commission (Chow, Illig,
Monfredini, Penn, Sanchez, Umekubo) amended the
proposed resolution to add to the end of the
sixteenth Whereas clause “and may reduce direct
Action Taken: The Commission (Chow,
Illig, Monfredini, Penn, Sanchez, Umekubo)
amended the proposed resolution by adding
language to the eighteenth Whereas clause, so
that the clause reads “Whereas, the Health
Commission remains strongly opposed to service
cuts that reduce safety net services, and
recognizes that such cuts disproportionately
affect the African American population and the
mentally ill in San Francisco; ”
Action Taken: The Commission (Chow, Illig,
Monfredini, Penn, Sanchez, Umekubo) amended the
sixth Resolved clause of the resolution so that
it now reads: “Further Resolved, that the Health
Commission requests that the Health Department
work closely with City Administration to develop
a standard policy for indirect costs that
maximally protects direct services and is
appropriate to the various types and sizes of
non-profit contractors that the Department does
Action Taken: The Commission
(Chow, Illig, Monfredini, Penn, Sanchez, Umekubo)
unanimously adopted Resolution #04-04,
“Approving the Submission of the Department of
Health’s Base Budget for FY 04-05, and Urging
the Mayor and the Board of Supervisors to
Develop Strategies for Avoiding Serious Cuts to
the County’s Health Safety Net Services”
(Attachment B), with the amendments.
Debra Brown, Castro-Mission
Health Center, spoke in opposition to the
administrative cuts in primary care. There will
be chaos in the system. She submitted a
statement for the record (on file).
The meeting was adjourned at
Michele M. Olson,
Executive Secretary to the Health
These Minutes will be adopted at the next Health
Commission meeting. Any amendments to these
Minutes made by the Health Commission will be
recorded in the Minutes for the next Health