Minutes of the Health Commission Meeting
Tuesday, January 4, 2005
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 Roma P. Guy, M.S.W.
- Commissioner James M. Illig
- Commissioner Lee Ann Monfredini, Vice President
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF
DECEMBER 21, 2004
Action Taken: The Commission (Chow, Guy,
Illig, Monfredini, Sanchez) approved the minutes of the December 21,
2004 Health Commission meeting.
3) APPROVAL OF THE CONSENT
CALENDAR OF THE BUDGET COMMITTEE
Commissioner Sanchez chaired and Commissioner Guy and Commissioner
Illig attended the Budget Committee meeting.
(3.1) PHP-Housing & Urban Health – Request for approval of a
retroactive new contract with Episcopal Community Services, in
the amount of $210,666, to provide supportive housing services
at the Folsom-Dore Apartments, targeting homeless adults, for
the period of January 1, 2005 through September 30, 2005.
- Commissioner Illig appreciates the Department’s response
to some of the issues raised by the Commission, including
Board composition and agency contribution
(3.2) AIDS Office-Research – Request for approval of a
renewal contract with PHFE Management Solutions, in the
amount of $90,053, to provide fiscal administrative services
for the “Post Marketing Surveillance for the OraQuick Rapid
HIV-Antibody Test” project, targeting persons who have
received an OraQuick test at a CDC or State
government-funded site, for the period of January 1, 2005
through June 30, 2005.
Secretary’s Note – This contract is
presented by AIDS Office-Prevention, not AIDS
- The Committee requested, at the suggestion of Jimmy
Loyce, a report to the Community Programs and Service
Joint Conference Committee on the outcomes of the study.
This will be scheduled in March 2005.
(3.3) BHS-Mental Health – Request for approval of a
retroactive renewal contract with the San Francisco
Psychoanalytic Institute and Society, in the amount of
$101,957, to provide high quality childcare mental
health services, for the period of July 1, 2004 through
June 30, 2005.
- Commissioner Illig asked what kinds of services
are provided to the children. Sandy Schaaf,
Executive Director of San Francisco Psychoanalytic
Institute and Society replied that they serve three
childcare centers. They help center staff and
parents learn how to manage children before they
develop escalating problems. Commissioner Illig
asked if each individual contractor is monitored.
Ms. Chan-Sew said that agencies are individually
monitored, and the overall program is evaluated.
(3.4) BHS-Mental Health – Request for approval of
a retroactive renewal contract with Children's
Council of San Francisco, in the amount of $238,377,
to provide Quality Child Care Consultation Services
targeting center-based and family child care
providers, for the period of July 1, 2004 through
June 30, 2005.
(3.5) BHS-Mental Health – Request
for approval of retroactive renewal contracts with
six contractors, for a total for all agencies per
year of $403,200, to provide children's mental
health services under the Homeless Mental Health
Initiative for the period of July 1, 2004 through
June 30, 2005, as follows: Asian Women's Shelter,
$60,000; Catholic Charities/CYO, $85,000; Compass
Community Center, $40,000; Hamilton Family Center,
$85,000; La Casa de las Madres, $40,000; and St.
Vincent de Paul/Riley Center, $50,000.
Health – Request for approval of a retroactive
renewal contract with Seneca Center for Children and
Families, in the amount of $3,081,574, to provide
residential, day treatment and therapeutic
behavioral health services, for the period of July
1, 2004 through June 30, 2005.
(3.7) PHP-BEHM –
Request for approval of a renewal contract with
Dillard Environmental Services in the amount of
$200,000 to provide hazardous waste management and
transportation services, for the period of January
1, 2005 through June 30, 2007.
Comments (at the Health Commission meeting)
- Commissioner Chow appreciates the staff’s
edification of the High Quality Child Care
Mental Health Initiative and the Homeless Mental
Health Initiative. He would like the Joint
Conference Committee to explore these two
Action Taken: The Health Commission (Chow, Guy,
Illig, Monfredini, Sanchez) approved the Budget
Committee Consent Calendar.
Item 3.2 was referred to the Community Programs and
Service Joint Conference Committee for a report in
March 2005 on survey findings. The High Quality
Child Care Mental Health Initiative and Homeless
Mental Health Initiative were also referred to the
Community Programs and Services Joint Conference
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., presented the Director’s
FY 05-06 Budget Preparation
Department of Public Health is working on the budget
for FY 05-06. The Mayor’s Office of Finance
estimates that the City-wide deficit will be $130
million, after taking mid-year reductions into
account. This figure includes negotiated MOU
increases for Civil Service classes, but does not
include increases that that will result from
contracts up for negotiation. DPH’s contract for
nurses and nurse supervisors are among these.
Budget reduction targets have not been set by the
Mayor for large departments, including Public
Health. Smaller departments have been asked to
absorb their own inflationary cost increases within
their existing general fund. Larger departments are
continuing to meet with the Mayor’s Office of
Finance to set individual targets.
In the meantime, DPH staff has completed initial
forecasts of revenue for next year, and have also
identified the structural, inflationary, and
regulatory items that will affect Department
expenses in the coming year. Dr. Katz plans to make
an initial presentation to the Health Commission on
these items at the January 18th meeting.
Project Homeless Connect
On December 8, 2004, over 300 volunteers
participated in the second Project Homeless Connect.
The goal of the event is to reach out to homeless
people living on streets of the Tenderloin/South of
Market and help connect them to medical, behavioral
health, benefits, legal, and housing services. The
event operated out of two main service sites – 201
Turk Street Community Center and 6th/Folsom
Recreation Center. By all accounts the day was a
huge success. The two centers provided services to
over 600 people. Fifty-four chronically homeless
persons were housed in stabilization units that day
and were connected to ongoing intensive case
management. On-site medical services were highly
utilized with the majority of patients having little
or no prior connection to the primary care system.
Nine people who came into the two sites had severe
medical conditions and needed to be transferred to
SFGH. The Department provided a tremendous amount of
support for the day through many sections. Judith
Klain provided planning and logistics support. The
next Project Homeless Connect is scheduled for
February 24, 2005.
Department of Human Services is coordinating this
year’s Homeless Count, which is required by HUD to
be eligible for McKinney funding. The goal of the
Homeless Count is to document the size and locations
of San Francisco’s unsheltered homeless population,
leading to better services and increased funding to
address homelessness. The Homeless Count is a
volunteer effort. Volunteers will be placed teams
and assigned to designated routes. This year’s
Homeless Count will be taking place on January 25,
2005 from 7:00 pm until 12:00 a.m., and will be
staged from 101 Grove Street. Those interested in
volunteering should call 557-5241 or e-mail:
Environmental Health Inspectors
Today, the San Francisco Board of Supervisors
will consider Supervisor Peskin’s commendation
acknowledging the public health efforts of the
Department’s environmental health inspectors. The
resolution recognizes the innovative and
inspirational work of Principal Health Inspector
Lisa O’Malley and her Health District Four team—Mary
Freschet, Dawit Furgassa, Jackie Greenwood, Uzziel
Prado, Mel Seid, Calvin Tom, Melinda Tyler and Nancy
Yee. The Health District Four team is being
acknowledged for its visionary approach to
compliance, enforcement, training and the
educational needs of residents and business owners.
The Rodent Abatement program for Chinatown,
collaboration with the Department of Building
Inspection, and field-based education and training
for food industry workers exemplify this approach.
Dr. Katz congratulated these inspectors for their
exemplary leadership and public health service.
- Commissioner Illig asked the Department to
co nsider the cost of
contractor COLAs as one of the inflationary,
structural costs to the Department. Dr. Katz
replied that he intends to present this
information on January 18, 2005.
5) CONSIDERATION AND POSSIBLE ACTION
REGARDING THE DIRECTOR’S PROPOSED REDUCTIONS TO
HEALTH DEPARTMENT EXPENDITURES FOR FISCAL YEAR
2004-2005 BUDGET (BEILENSON HEARING)
The Beilenson Hearing FY 2004-2005 Mid-Year
Reduction Plan is attached (Attachment A).
- J.W. Sheffield, Clinical Social Worker
at Maxine Hall Health Center, asked the
Commission to reconsider the elimination of
the Senior Medical Social Worker
classification. He submitted information on
the Senior Medical Social Worker position
(on file in the Health Commission office).
- Ines Ascencio, Senior Medical Social
Worker at Southeast Health Center, said if
her position were eliminated, they would not
be able to meet the needs of the Spanish
speaking community that they serve. These
social workers provide direct services and
bring in revenue.
- Susan Schneider said the ten Senior
Medical Social Workers have dedicated their
careers to the most complex DPH patients,
and provide direct services. She urged to
Health Commission to reconsider these cuts.
- Sharon Pretti, licensed clinical social
worker at Laguna Honda, said the social
worker supervisors provide direct services,
and the loss of these positions will mean a
delay in services.
- Paul Kelley, hospice social worker at
Laguna Honda, said money is always an issue.
He is deeply concerned about the cutbacks.
The loss of the social worker positions will
delay critically needed services.
- Sue Carlisle, M.D., Associate Dean for
UCSF at San Francisco General Hospital,
expressed concern about the reduction to
amount of the affiliation agreement between
UCSF and SFGH. This past year, in meetings
with the Mayor’s Office, they identified
$1.1 million in one-time expenses that could
be used to offset cuts with the expectation
that the situation would improve. There was
also an additional allocation that way taken
away. This means doctors will have to ration
- Valerie Ng, M.D., Chief of Medical
Staff, SFGH, said the cut to the affiliation
agreement is very difficult to manage. This
means the medical staff can no longer
provide the level of services that is
provided today. The medical staff will be
discussing how to ration care. This is very
hard to undertake.
- Karla Thurston, member of San Francisco
Community Clubhouse, spoke against cuts to
mental health services.
- Rickard Soich, Continuum, said services
to low-income people are valuable services.
The cuts will be detrimental to people with
- Denis Beaulne, Member of Continuum, said
every year the clients need to be stressed
out over potential cuts. He submitted a
letter signed by members of Continuum HIV
Day Services (on file in the Health
- Joseph Contreras, member of Continuum,
urged the Health Commission to reconsider
any cuts that may impact these important
- Barbara Rothkrug, Public Health Nurse,
said that the proposed cuts with impact
maternal child health services. The proposed
reductions will impact Spanish-language
services, billing and other services.
- Linda Mullen, Public Health Nurse at
Curry Senior Center, said without public
health nurses, there would be more emergency
services, hospitalization and
institutionalization. She submitted a column
written by Joan Ryan about the work of DPH
public health nurses (on file in the Health
- Paul Wagoner, San Francisco Community
Clubhouse, said this program provides
- Jeanine Bray, Activity Therapist at LHH,
said with more and more disturbed people
coming to Laguna Honda, it is critical that
the Senior Medical Social Worker positions
- Ray Stuart, Medical Social Worker at LHH,
spoke in support of the Senior Medical
Social Worker positions. Social workers are
key in discharge planning, which is one of
the Mayor’s priorities. Mr. Stewart
submitted a petition in support of the
social worker positions (on file in the
Health Commission office).
- Cindy Gyori, Hyde Street Community
Services, said they have made many
modifications to their services based on new
emphases on new City priorities and have
participated in all of the Mayor’s homeless
initiatives. Now they are being asked to cut
services. Also, people who do not need
services do not exist in the Tenderloin. She
submitted letters with information on the
population they serve and the impacts of the
cuts (on file in the Health Commission
- Michael Blecker, Executive Director of
Swords to Plowshares, spoke against the cuts
to services to people who are not
categorized as seriously mentally ill.
Veterans’ issues should be considered
- Bart Casimir, Swords to Plowshare, said
that post traumatic stress disorder is a
serious mental illness.
Antoinetta III, chair of the Tom Waddell
Advisory Board, said there is no more fat to
trim from organizations that are being cut.
Even small cuts have large impacts on
- Will Dempsey, client of the Tenderloin
Mental Health Clinic, said that a $40,000
savings would cost much more over the long
term. If we really want to save money, keep
- Eve Meyer, ED of San Francisco Suicide
Prevention, spoke in opposition to the cuts
to mental health services to people with
“minor” mental illness. Catastrophic mental
health increases suicide, pushes people up
to more critical needs.
- Mark Molnar, Shanti, said that hundreds
of volunteers provide 2,000 hours of
services to people with HIV and AIDS. The
volunteer is often a client’s only
connection to the outside world. It is not
smart thinking to cut volunteer programs.
- Manuel Vasquez, Mission Mental Health,
said that the proposed cuts are a
contradiction to the Strategic Plan that was
recently approved by the Health Commission.
Do not cut services that are unique to San
- Ellie Dwyer, Clinic Director at Mission
ACT, said that Mission ACT has lost two
staff positions, which has meant a reduction
in services to the patients that cost the
City the most money. These kinds of cuts are
working at cross-purposes with the Mayor’s
goal of reducing homelessness.
- Tara Stacker, Shanti, spoke on behalf of
the more than 200 volunteers who would be
impacted by theses cuts. These volunteers
provide more than 2,000 hours of services.
Volunteers provide practical and emotional
- Stacey Mandel-Sonner, Shanti, spoke in
support of Shanti’s services, and read a
statement from a client that receives aid
from a Shanti volunteer.
- James Rousku, client at Shanti, said he
and many people like them depend on Shanti’s
- Rosalyn Roddy, social worker at
Southeast Child/Family treatment center,
said the population they serve in Visitation
Valley is disenfranchised and extremely
diverse. The leadership provided by the
Senior Medical Social Worker is critical to
providing services. The loss of this
position would mean the loss of the girls’
group and Spanish-language capacity.
- Toho Soma, Shanti volunteer, said the
clients he has worked with have taught him
so much. San Francisco has been a global
leader in the treatment of HIV. Now the
services that put San Francisco a notch
above are being cut. He read a statement
from one of his clients (on file in the
Health Commission office).
- Eric Sutter, Shanti peer advocate, spoke
in support of the numerous clients and
volunteers that would be impacted by the
- Tracy Brown, Executive Director of
Tenderloin AIDS Resource Center, spoke in
support of the HIV/AIDS services that are
proposed to be cut. Alternative therapies
are critical for their patients, and help
them stay engaged in care.
- Sophia Lau, Chinatown Public Health
Center, spoke in support of the nutritionist
at the health center. They have the only
project in the State of California that
targets obesity in the monolingual Chinese
- Jane Russell White opposed cuts to
alternative medicines that help her survive.
Due to services from Shanti, the Black
Coalition on AIDS and the Quan Yin Healing
Arts Center, she is able to lead a normal
life. She read a letter from her Shanti
- Bobby Martin, client at Hyde Street
Community Services, said all the clients
there want to protest the cuts to mental
- Hulda Brown, vice president of Quan Yin
Healing Arts Center, said San Francisco is
known for its services to HIV services, but
these services continue to be cut. Quan Yin
provides people with services they cannot
- Enrique Lopez-Castro, who works at
Instituto Familiar de la Raza as an intern,
said the Latino immigrant community is
concerned about cuts to the Mental Health
System. The immigrant community has many
mental health issues and do not have access
to the system due to legal status. If there
are not enough therapists that speak the
language, services are effectively
- Rebecca King Morrow, Public Health
Nurse, said that there is a nursing
shortage, and DPH nurses have many
opportunities. If these positions are cut,
DPH is not going to get these nurses back.
Nurses can get other jobs, but patients
cannot get other services.
- Martha Hawthorne, Public Health Nurse at
Castro Mission Health Center, said although
she will remain after the budget cuts, her
job will become undoable and she will have
to choose who will and will not get care.
She is pleased that 11 nursing positions
have been restored, but the 11 that are
being cut will decimate the system.
- Helen Yuen, Advisory Council Member of
Chinatown Health Center, asked the
Commission to keep the nutritionist at the
Health Center. This is a critical position.
- Laurie C. said that cuts to mental
health services will have long term effects,
and asked the Health Commission not to cut
$40,000 from Hyde Street Community Services.
- April Lax, Senior Social Worker at
Health At Home, read a letter from Health at
Home social workers. Losing these positions
will make a bad situation worse.
- Sandra Aseltine, Senior Medical Social
Worker at Tom Waddell, said senior medical
social workers provide a variety of direct
services. She submitted a petition in
support of reinstating the social worker
positions (on file at the Health Commission
- Carla Wilson, Quan Yin Healing Art
Center, clarified that MediCal and Medicare
does not cover acupuncture. With the
proposed cuts, more than 600 people
currently accessing alternative therapy will
lose services. She submitted a written
statement about the impact of the cuts (on
file in the Health Commission office).
- Barbara Farrell, ED of Ohlhoff Recovery
Services, said the goal should be to have
more mental health services, rather than
cutting services for things that are not
- Jessica Berman, Shanti, thanked the
Health Commission for advocating to restore
funding for Shanti’s breast cancer services.
She asked the Commission to further advocate
to restore services for HIV/AIDS peer
- Michael Lyon, Gray Panthers and
Coalition for Public Health, said this is
not Beilenson Hearing, because that should
be held by the Board of Supervisors. Aleeta
Van Runkle, Deputy City Attorney, responded
to this issue and advised that the Health
Commission is the appropriate place for this
hearing to be held, due to the nature and
timing of the proposed reductions.
- Carl Stokes, spoke on behalf of Quan Yin
and Shanti, and said that volunteers take
care of everything that can fall apart for
the clients. All the cuts are bad.
- Laurie Hampton, co-founder of Justice
for Homeless San Francisco, said she has
already felt the impact of past cuts. The
nurses are the ones that mainly serve people
with chronic mental health problems.
- Robert Haaland, SEIU 790, spoke in
opposition to all the healthcare cuts. The
Health Commission should take an active role
in this process by saying these programs
should not be cut, and instead figure out
how to save the programs. These are
desperate times. Union members have
participated in creative budget problem
solving. Halt the layoffs and look at other
- Dale Milfay, Chair of San Francisco NAMI,
asked the Health Commission to stop these
draconian cuts. These cuts will result in
more homelessness. If mental ill people are
not indigent, they do not get taken care
off. Do not make cuts on the backs of the
- Kent Woo, NICOs, thanked the Commission
for working to save the anti-gambling
initiative, and asked the Commission to
oppose cuts to mental health services. This
will lead to discrimination against mentally
ill people without a payer source.
- Otto Duffy, Tom Waddell Advisory Board,
said the cuts should come from the top, not
the bottom. It is important that people take
advantage of every opportunity to fight for
these services. Another opportunity to
increase revenue is to have MediCal
reimbursements go directly to DPH, rather
than the general fund.
- Doris Hom, Public Health Nurse, said
people with health insurance, family and
friends, and who speak English should be
considered lucky. Public Health Nurses are
the last resort, and the plug in the dyke of
overwhelming health problems. Public health
nurses save lives and money.
- Sam Katheberg, Bayview Clubhouse, said
society is only as good as the way it treats
its minorities, indigent, poor and people
who are different. The cuts will have a huge
impact on services at the Bayview Clubhouse.
- Commissioner Guy asked Dr. Katz to
clarify the cuts over the past year to
the UC affiliation agreement. Dr. Katz
said that the affiliation agreement
states that the City and County of San
Francisco will pay for the cost of UC
providing services at SFGH. UC and the
City have confirmed that with the
current delivery of services, the
agreement is underfunded by
approximately $3 million. Ms. O’Connell
and UC leadership met with the Mayor’s
Office to discuss revenue maximization
opportunities, but identified no new
options. The Mayor allocated $2.3
million in additional funding to the
agreement in FY 04-05, and this has been
withdrawn. The reduction needs to be
implemented over an 18-month period. Ms.
O’Connell is working collaboratively
with the Associate Dean to determine how
to live within this smaller amount. It
is unlikely that major service cuts will
happen in this fiscal year, which could
mean larger cuts beginning July 2005.
Commissioner Guy said there needs to be
transparent discussions with the Health
Commission about these decisions,
particularly if services are going to be
- Commissioner Illig was troubled to
hear the amount of direct services that
are provided by the Senior Medical
Social Worker positions. Will the people
that are currently in these positions be
able to remain in the Health Department?
Dr. Katz DPH might lose some to
retirement, but others will move to a
clinical social worker position or some
- Commissioner Sanchez said there is a
distinct relationship between a
continuum of care and the provision of
quality care. The model over the past
year has been to redefine and
reconfigure in an attempt to deal with
constant cuts. But soon there will be
nothing left. Cutting edge models, such
as the SFGH/UCSF dental clinics, are
gone. But the battle is not lost yet,
and we must work together to come up
with new revenue models.
- Commissioner Illig said DPH cut 130
administrative FTEs last year. This past
November, the Department was faced with
$15.5 million in cuts. These have been
reduced, but there are severe cuts to
vulnerable populations. As a member of
the Budget Committee, he will look more
diligently at every one of the general
fund contracts to make sure money is
spent as effectively as possible and
meets the Strategic Plan.
- Commissioner Mondredini would like
to see all these cuts restored, but she
is particularly concerned about cuts to
programs that are volunteer-based. These
programs cost pennies, yet provide
- Commissioner Chow asked what the
next steps were in terms of the proposed
cuts. Dr. Katz said it was the Health
Commission’s legal responsibility to
notice the proposed reductions and hold
the Beilenson hearing. With that done,
the Health Commission’s responsibility
ends. Dr. Katz noted that over the past
three years, DPH’s general fund
allocation as dropped by $73 million,
and this does not take into
consideration the expanded scope of DPH
services. It is due to the committed and
talented staff that programs are still
running effectively, and this is quite
an achievement. Commissioner Chow
thanked the public for coming to the
meeting, and putting a human face to the
reductions. The Commission cannot do
much to prevent the current round of
cuts, as the Department cannot
overexpend its budget. However, today’s
testimony will stay with each
commissioner as we move into next year’s
6) PUBLIC COMMENT/OTHER BUSINESS
Howard L. Chabner – written summary
The meeting was adjourned at 6:01
Michele M. Olson,
Executive Secretary to the Health
Health Commission meeting minutes are
approved by the Commission at the next
regularly scheduled Health Commission
meeting. Any changes or corrections to
these minutes will be reflected in the
minutes of the next meeting.
Any written summaries of 150 words or
less that are provided by persons who
spoke at public comment are attached.
The written summaries are prepared by
members of the public, the opinions and
representations are those of the author,
and the City does not represent or
warrant the correctness of any factual
representations and is not responsible
for the content.
of 150 Words
Or Less That Have Been Submitted By
Chabner, Item 6 - I am gravely concerned
about what is happening to Laguna Honda,
its residents and its historic mission.
An elderly relative who is severely
disabled due to a serious, progressive,
debilitating medical condition lives
In the past year the medical care has
remained very good but Laguna has
significantly deteriorated. There have
been sexual assaults on defenseless
residents, other incidents of violence,
arson and threats by residents (and
their visitors) with serious, violent
psychiatric disorders and significant
This is due directly to the new
mission and admissions policies, which
have resulted in admissions of dangerous
patients. The latest policy removes
“long term care” from Laguna’s mission.
Please protect Laguna residents,
continue its historic mission of
providing long-term skilled nursing and
medical care to disabled and elderly San
Franciscans with serious medical
conditions, and stop the betrayal of the
voters who approved the rebuild bond.