Minutes of the Health Commission Meeting
Tuesday, January 18, 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.
President Chow announced that the election of Health Commission
officers, which normally takes place at the first meeting after January
15th of each year, is being postponed to give Mayor Newsom additional time
to make Commission appointments.
President Chow also announced that Commissioner Roma Guy would be
reappointed to the Health Commission on Friday, January 21, 5:00 p.m.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF
JANUARY 4, 2005
Action Taken: The Commission approved the minutes of the January 4,
2005 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) BHS-Substance Abuse - Request for approval of retroactive
contract renewal with Addiction Research and Treatment, Inc. dba BAART,
in the amount of $5,740,202, to provide substance abuse treatment
services, for the period of July 1, 2004 through June 30, 2005.
(3.2) BHS-Substance Abuse - Request for approval of a retroactive
renewal contract with Curry Senior Center, in the amount of $510,188, to
provide substance abuse treatment and mental health services, for the
period of July 1, 2004 through June 30, 2005.
(3.3) BHS-Substance Abuse - Request for approval of a retroactive
renewal contract with Westside Community Mental Health Center, Inc., in
the amount of $2,850,755, to provide substance abuse treatment services,
for the period of July 1, 2004 through June 30, 2005.
- Commissioner Guy asked why the program received such a low
performance score, and what steps the agency is taking to ensure
that the next evaluation results in higher scores. Abner Boles,
Executive Director of Westside Community Mental Health, replied that
there were two primary reasons for the low score: staff turnover and
a new approach to serving their population. The agency has applied
for additional technical assistance from the AIDS Office, hired a
Director of Clinical Services and carved out a quality assurance
position, all steps that should improve performance. Moreover,
additional management should positively impact staff turnover.
Commissioner Guy urged the staff and the agency to problem solve
throughout the year.
(3.4) BHS-Mental Health - Request for approval of a retroactive
renewal contract with Westside Community Mental Health Center, Inc., in
the amount of $6,420,746, to provide mental health services and fiscal
intermediary services targeting adults and youth/adolescents, for the
period of July 1, 2004 through June 30, 2005.
Action Taken: The Health Commission approved the Budget Committee
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
On January 10th, the Governor released his proposed budget for FY
2005-06. Notable health-related proposals include redesign of the Medi-Cal
program designed to generate administrative savings of $12.3 million,
expansions of health insurance coverage for children, a new Obesity
Initiative, creation of California Rx - Prescription Drugs for the
Uninsured, expansion of the Genetic Disease Testing Fund to test and treat
newborns for genetic disease, a revenue decrease for Proposition 99,
increases in Realignment revenues to cover unfunded 02-03 and 03-04
caseloads, suspension of SSI COLAs, and changes to the outpatient
prescription drug program for dually eligible Medi-Cal/Medicare
Collaboration between UCSF School of Pharmacy and Laguna Honda
This month, Laguna Honda Hospital’s Volunteer Services and Pharmacy
departments are implementing a new collaborative program between the UCSF
School of Pharmacy and Laguna Honda. Under the program, known as
"Patient as a Person," first year UCSF pharmacy students will
observe and experience patient care as hospital volunteers. Each student
will visit with a specific resident for at least a half an hour per week
in order to better understand the patient's perspective. Approximately 120
students representing a diverse set of language skills are participating
in the program. Laguna Honda staff is hopeful that this program will not
only be a great benefit to the residents but also that some of the
students will remain at Laguna Honda as ongoing volunteers and/or members
of the pharmacy team.
Drug Discount Card Enrollment Week
The Department, along with the Bernal Heights Neighborhood Center,
Self-Help for the Elderly, Network for Elders, Senior Action Network,
Department of Human Services and the Mayor’s Office of Disability are
sponsoring a "Drug Card Blitz Week" from Jan 31st to February
4th. The weeklong event is designed to help seniors and individuals with
disabilities learn more about the changes in Medicare and assist them in
signing up for benefits that could save them money on their prescriptions.
Organizers have planned a press conference for Tuesday at noon in front of
City Hall with Supervisor and Board President Aaron Peskin. The enrollment
events are being offered throughout the City in English, Chinese, Spanish,
Tagalog, Samoan, and Russian.
San Francisco Local Homeless Coordinating Board Restructuring
On January 10th, the Board of Supervisors passed a resolution
restructuring the Local Homeless Board (Local Board). The restructuring is
based upon a consensus proposal that came from the Local Board itself. The
existing 35-member Local Board will be disbanded and replaced by a new
nine-member body. The Mayor and the Board of Supervisors will each have
four appointments and the Controller one appointment from the following
constituencies: representatives of homeless, formerly homeless, community
and advocacy organizations, service-provider agencies, business and
corporate sectors and the foundation community. The Local Board will have
two full time staff members, an Executive Director and an Administrative
Assistant who will handle the day-to-day operations of the Board. DPH
staff, in addition to staff from the Department of Human Services, the
Mayor’s Office of Housing, and the Mayor’s Office of Community
Development, will continue to support Local Board efforts and provide
relevant information and act as a resource for the Local Board.
Community Health Network, San Francisco General Hospital,
Credentials Report, January 2005.
07/04 to 01/05
Changes in Privileges
Current Statistics - as of 01/1/05
Affiliate Professionals (non-physicians)
Applications In Process
Applications Withdrawn Month of January 2005
5 (07/04 to 01/05)
SFGH Reappointments in Process Feb. 2005 to May 2005
- Commissioner Illig asked how the Local Homeless Board would dovetail
with the Mayor’s Homeless Task Force. Dr. Katz replied that the
Local Homeless Board should be at the forefront of helping to
implement the 10-year plan. In the past this has not happened. Ms.
Kronenberg added that the implementation group appointed by Mayor
Newsom and chaired by Angela Alioto holds quarterly public hearings,
and is anticipated to be in existence for a short time period. The
restructured local homeless board will be the place where all homeless
policy is discussed, and would deal with the day-to-day specifics of
homeless policy. Commissioner Illig asked if the city still receives
McKinney funds. Ms. Kronenberg replied that while funding has
decreased, the city will receive approximately $10 million.
- Commissioner Chow asked who initiated the pharmacy program at Laguna
Honda Hospital. Ms. Kronenberg said that Sharon Kotabe, CHN Pharmacy
Director, was instrumental in developing this program.
- Commissioner Monfredini asked why SFGH is responsible for the bus
shelter at the hospital. Ms. O’Connell said that the bus shelter is
on SFGH property but clean up is not the hospital’s responsibility.
Ms. O’Connell said they have been working collaboratively with MUNI
to make sure the shelter is clean.
5) PRESENTATION OF THE EMPLOYEE RECOGNITION AWARDS FOR THE MONTH OF
Commissioner Umekubo presented the Employee Recognition Awards for the
month of January.
Contracts On-Line Project Team
Anne Okubo and Fred McGregor
6) STATE AND FEDERAL LEGISLATIVE UPDATE
Colleen Chawla, Deputy Director, Office of Policy and Planning,
presented the State and Federal Legislative Update. Ms Chawla said that
increased local, state and federal advocacy is a key strategy to achieving
partnerships with communities that assess, develop, implement and advocate
for health funding and policies. DPH works in coalition with County Health
Executives Association of California (CHEAC), California Conference of
Local Health Officers (CCLHO), California State Association of Counties
and the California Association of Public Hospitals. By its participation
in coalitions, DPH ensures that the City’s interests are represented.
Ms. Chawla gave highlights of the Federal Legislative Session, which
included the Medicare Prescription Drug Improvement and Modernization Act
of 2003, Medicaid DSH, 340B Inpatient Drug Pricing and Emergency Services
for undocumented immigrants. The federal budget included three earmarks
for DPH: $1.5 million for HIV/AIDS services provided to Medicare and
Medicaid eligible populations; $1.5 million for supportive housing for
persons with mental illness or substance abuse disorders; and $750,000 for
supportive housing and services for recently released ex-offenders. Ms.
Chawla said that looking ahead, federal legislative activity would include
Medicaid reform and Ryan White reauthorization.
Ms. Chawla presented an overview of the 2003-2004 State Legislative
Session. This session was marked by deficits of more than $45 billion over
the two fiscal years of the session. Highlights include Medi-Cal redesign.
The current plan, released with the 2005-2006 budget proposal, lacks
specificity but would include changes to hospital financing, a cap on
adult dental services, monthly premiums for recipients with incomes above
the federal poverty level, and moving aged, blind and disabled into manage
care. Ms. Chawla said the final 2004-2005 State budget had few of the
health services reductions that were originally proposed in January 2004.
Looking ahead, Ms. Chawla said that the State is facing a significant
budget shortfall of $9 billion and discussion about significant changes to
the Medi-Cal program and hospital financing.
- Commissioner Illig asked how much unreimbursed emergency care is
provided at SFGH. Ms. Chawla said SFGH does not ask immigration
status, so there is no estimate. Dr. Katz said if SFGH did keep track,
it would be millions of dollars, so the Department needs to see what
mechanism would be used to allocate dollars to determine if there
needs to be a change in how such services are tracked. Ms. Chawla
added that the pot of money is only $250 million nationwide.
Commissioner Illig asked if the Federal earmarks would be included in
DPH’s FY 2005-2006 budget. Dr. Katz said that grant funds exist as a
separate document, and once the funds are certified by the Controller,
and the Health Commission and Board of Supervisors approves the except
and expend resolution, these funds can be spent. Dr. Katz said we
cannot assume that these funds could be used to decrease the general
fund reduction target.
- Commissioner Guy asked if the Health Commission’s position on
Senator Kuehl’s SB 921, which failed this past legislative year,
would still be in effect if Senator Kuehl reintroduces her
legislation. Ms. Chawla replied that the Health Commission would need
to re-examine the new legislation to ensure that it is consistent with
the previous policy statement. Commissioner Guy asked for more detail
on the California Rx program. Ms. Chawla said that California Rx is a
voluntary program and relies exclusively on the participation of
- Commissioner Umekubo asked how the City advocates to CMS for special
waivers, passage of regulation, and other activities. Dr. Katz replied
that the way the regulations are written, counties cannot apply
directly to CMS and must work through the State. This has been a
difficult process. The Department would generally advocate through a
member of San Francisco’s Congressional delegation.
- Commissioner Guy asked if the changes to the 340B inpatient drug
program would result in savings to the Department. Dr. Katz said this
change establishes a mechanism, but it depends on whether the
pharmaceutical companies choose to offer the same discount as they
offer on outpatient pharmaceuticals.
- Commissioner Sanchez said that the issue of undocumented patients
would continue to be football in the national policy arena, and should
be a key component of our health policy debates. And because San
Francisco is a sanctuary city, it is unlikely we would follow a
protocol that required tracking information on illegal immigrants.
- Commissioner Monfredini reminded the Commissioners that nationally,
things are going in a different direction from San Francisco’s
- Commissioner Chow asked if the DSH prgoram is solid. Ms. Chawla said
this funding would go through 2010 at the current level. He asked if
there is general agreement as to whether Ryan White would be
reauthorized. Ms. Chawla said there is general consensus is that the
CARE Act will be reauthorized but there are many proposals about how
it will be structured, and discussion about San Francisco being
overfunded. The current program expires in September 2005.
- Commissioner Illig added that over the last number of years San
Francisco has expanded its representation on the CARE Coalition,
including seats by the Health Services Planning Council, DPH,
Continuum, AIDS Foundation and HIV/AIDS Provider Network. So there are
more voices from San Francisco counteracting the perception that San
Francisco gets too much money.
- Commissioner Chow asked if rate reductions are part of the proposed
State budget. Ms. Chawla said there are not.
7) CONSIDERATION OF A RESOLUTION APPROVING THE CHILDHOOD NUTRITION
AND PHYSICAL ACTIVITY TASK FORCE REPORT RECOMMENDATIONS
Iman Nazeeri-Simmons, Adolescent Health Coordinator and Christina
Carpenter, Health Promotion Consultant, presented the Childhood Nutrition
and Physical Activity Task Force Report Recommendations (Power Point
Presentation, Attachment A). The citywide task force was convened by the
Board of Supervisors in December 2003, and included representatives from DPH, DCYF, SFUSD, Youth Commission, Department of Recreation & Parks,
the medical community, size advocates, youth organizations and others. The
task force was charged with creating citywide policy recommendations for
improving childhood nutrition and physical activity. The recommendations
are prioritized within the categories of nutrition and physical
activities, with the top four strategies in each area as the priority
areas. Additionally, the recommendations are broken out into three topic
areas: environmental - structural improvements in the physical environment
to improve access and utilization; organizational - city agencies and
departments; and awareness/behavior change - individual education and
- Recommendation 1: Ensure that at least one reasonably large
outlet/vendor that sells healthy, nutritious foods is easily
accessible to residents in all sectors of San Francisco.
- Recommendation 2: Increase the enrollment and retention of eligible
clients into the Special Supplemental Nutrition Program for Women,
Infants and Children (WIC) and Food Stamps programs.
- Recommendation 3: Increase the proportion of mothers who exclusively
breastfeed their babies.
- Recommendation 4: Expand information and resources for understanding
healthful nutrition and physical activity
- Physical Activity Recommendations
- Recommendation 5: Ensure that organizations have environments that
provide optimal opportunities for youth to engage in physical
- Recommendation 6: Develop partnerships across public and private
agencies to increase physical activity opportunities.
- Recommendation 7: The San Francisco Board of Supervisors and the
Mayor will issue recommendations of ideal levels of physical activity
for children and youth to City and County departments.
- Recommendation 8: Implement citywide awareness campaign(s)
addressing nutrition and physical activity developed by youth for San
The task force also made the recommendation to create revenue streams
to fund the nutrition and physical activity recommendations, and developed
several strategies including a fee or tax on soft drinks and/or fast food,
advocating for a streamlined application process in all Federal nutrition
programs and establishing a public/private partnership to leverage the
philanthropy community, among others.
Ms. Carpenter said there are a number of DPH activities that fall into
the current recommendations, including the Food Systems Council, Food
Alliance, the Good Neighbor Project, Youth Development Standards of
Practice, the Citywide Chronic Disease Prevention Consortium and resource
development and grant writing.
- Commissioner Monfredini expressed some areas of concern, including
sending negative messages to women who choose not to breastfeed. There
should be some allowance for new mothers who find this too difficult.
She would also like any money that San Francisco receives be used for
free educational seminars for people, rather than a conference. She
also emphasized the fact that many parents are very scared for their
children in terms of playing outside, and may indeed encourage their
children to stay inside. All of these factors demonstrate that obesity
is a multi-faceted problem with no easy answer.
- Commissioner Guy said that this initiative brings a primary
prevention dialogue into our City’s discourse and this is
significant, and we need to bring this to the next level. San
Francisco needs healthy environments and the Department of Public
Health’s involvement in this effort can make it successful.
- Commissioner Sanchez said so many variables come into play in terms
of nutrition and physical activity. Structured, supervised activities
are a priority for all of us, yet there is a continual reduction in
community gymnasium hours, recreation supervisors and other programs.
One recommendation is to ask the San Francisco 49ers and San Francisco
Giants to fund physical activity programs for the next two years at
the high school and middle school levels.
- Commissioner Umekubo said that this initiative increases the
awareness that it is difficult to find safe outdoor venues for
children to play. He is also concerned about the underutilization of
food stamps. Ms. Nazeeri-Simmons said that California is one of four
states that require fingerprinting to become eligible for food stamps,
and this is a major factor in underutilization. USDA does not require
fingerprinting. There is a pilot project in place that waives
fingerprinting and provides a one-day enrollment process.
- Commissioner Illig said there is not a lot of government funding for
healthy food, so the role is to get other parts of government to do
better in this area. One area where DPH could have additional impact
is through the residential treatment programs, where there is no
standard for the type of food that is served.
- Commissioner Chow would like to know how the Department and Health
Commission could help move beyond the pilot project level for the food
stamp initiative. Dr. Katz is not optimistic in this area in that the
State is headed toward more fingerprinting, not less.
Action Taken: The Commission approved the Resolution 01-05, “Endorsing
the Recommendations of the Childhood Nutrition and Physical Activity Task
Force Report,” (Attachment
8) FY 2005-2006 BUDGET PRESENTATION: INFLATIONARY, STRUCTURAL,
REGULATORY, REVENUE-NEUTRAL AND REVENUES
Mitchell H. Katz, M.D., Director of Health, presented an overview of
revenue, inflationary, structural, regulatory and revenue-neutral budget
issues for FY 2005-2006. The citywide budget shortfall is currently
forecast to be $130 million. As of the date of this report, a specific
target has not been set for DPH. Smaller departments have been asked to
absorb their own increased costs of doing business within their existing
general fund and develop a five percent general fund contingency plan. For
DPH, increased costs of MOUs and employee benefits are projected to be $32
million. The Mayor’s Finance Office is carefully considering available
options, and understands the effect a $32 million reduction would have on
Dr. Katz said that before the issue of general fund decreases could be
addressed, he must take into account the unavoidable costs of doing
business resulting from inflationary pressures and structural problems.
Inflationary issues include MOU increases to salaries and increase in
costs of benefits, increased pharmaceutical utilization, increases in rent
and savings in natural gas utilization. Inflationary increases total $33.6
million. There are myriad structural issues, totaling $11.7 million, which
must be addressed. These include position corrections and salary savings
deficits, Private Provider Network, contractor indirect and professional
and specialty services structural shortfall at SFGH, among others. (Note:
all budget documents are available on the DPH website at www.dph.sf.ca.us/budget/,
and in the Health Commission Office.)
Dr. Katz also described the 15 revenue-neutral programs that are being
proposed in the budget. These services are funded entirely through
revenues linked to services and include a 23-hour chest pain unit at SFGH,
Folsom-Dore hotel rooms for chronic homeless, improved pharmacy TAR
approval and collection at LHH and the California Children Services
Medical Therapy Program at MCH, among many others.
Dr. Katz said the Department is increasing revenues in the FY 2005-2006
budget by $18.2 million. The bulk of the increase is at SFGH, and reflects
the continuation of trends seen over the past several years. Laguna Honda
and Environmental Health are also budgeting increased revenues. Dr. Katz
said he also recognizes the necessity of addressing the effects of
inflation on contractors and the UC Affiliation Agreement. The Mayor’s
Finance Office wishes to address the issue of COLAs on a citywide basis.
For DPH, the cost for each one percent COLA increase is $2.2 million.
Dr. Katz summarized the issues:
Total Revenue Neutral Programs
- David Semore said it is really sad that the Department is left with
cutting core services. He submitted a letter summarizing his testimony
(on file in the Health Commission Office). There is money coming
forward from Proposition 63. He is against all the health cuts.
- Debbie Lerman, Human Services Network, expressed thanks to Dr. Katz
for how he handled the contractor indirects. Her focus now is on the
non-profit contractor COLAs. This is not a trivial issue. The cost
increases for non-profits is a structural issue, and the City needs to
acknowledge this. Without COLAs, there will be service reductions.
- Commissioner Illig asked if the estimated cost of the contractor
COLA is based on personnel costs only or the total cost of doing
business. Mr. Sass replied that he believes it is personnel cost only,
and he will confirm. Commissioner Illig asked if there are internal
and/or external planning processes by which service priorities are
set, such as is the case with CARE funds. Dr. Katz said this does not
really happen in other DPH areas because so many entities have the
opportunity to reprioritize, such as the Mayor and the Board of
Supervisors. His goal is to have the decision-making process as
transparent as possible, but he is open to better methods.
- Commissioner Guy said that there is discourse at the Health
Commission as to what the priorities are, including through the
strategic planning process. For example supportive housing is a
priority, and this is reflected in the budget.
- Commissioner Chow commended all staff for providing the level of
detail that was in the report.
9) PUBLIC COMMENT/OTHER BUSINESS
10) CLOSED SESSION
A) Public Comments on All Matters Pertaining to the Closed Session
B) Vote on Whether to Hold a Closed Session (San Francisco
Administrative Code Section 67.11)
Action Taken: The Commission voted to hold a closed session.
The Commission went into closed session at 6:20 p.m. Present in
closed session were Commissioner Chow, Commissioner Guy, Commissioner
Illig, Commissioner Monfredini, Commissioner Sanchez, Commissioner
Umekubo, Dr. Mitch Katz, Director of Health, Rick Sheinfield, Deputy
City Attorney and Michele Olson, Health Commission Executive Secretary.
C) Closed Session Pursuant to Government Code Section 54956.9 and San
Francisco Administrative Code Section 67.10(d)
APPROVAL OF A SETTLEMENT IN THE AMOUNT OF $12,500 IN PENTECOST v. SAN
FRANCISCO UNIFIED SCHOOL DISTRICT AND DEPARTMENT OF PUBLIC HEALTH,
COMMUNITY MENTAL HEALTH SERVICES, CASE No. SN 04-02023, FILE No. 021183
Action Taken: The Commission approved the settlement of Pentecost v.
San Francisco Unified School District and Department of Public Health,
Community Mental Health Services, in the amount of $12,500.
D) Reconvene in Open Session
The Commission reconvened in open session at 6:25 p.m.
- Possible Report on Action Taken in Closed Session (Government Code
Section 54957.1(a)2 and San Francisco Administrative Code Section
- Vote to Elect Whether to Disclose Any or All Discussions Held in
Closed Session. (San Francisco Administrative Code Section
Action Taken: The Commission voted not to disclose discussions held
in closed session.
The meeting was adjourned at 6:25 p.m.
Michele M. Olson, Executive Secretary to the Health Commission
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
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