Minutes of the Health Commission Meeting
Tuesday, March 1, 2005
at 3:00 p.m.
101 GROVE STREET, ROOM 300
San Francisco, CA 94102
1) CALL TO ORDER
called the meeting to order at 3:30 p.m.
- Commissioner Lee Ann Monfredini, President
- Commissioner Roma P. Guy, M.S.W., Vice President
- Commissioner Edward A. Chow, M.D.
- Commissioner James M. Illig
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF
FEBRUARY 15, 2005
Action Taken: The Commission approved the
minutes of the February 15, 2005 Health Commission meeting.
APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Illig chaired, and Commissioner Chow and Commissioner
Sanchez attended, the Budget Committee meeting.
Radiology – Request for approval of two contract modifications with
Medical Contracting Services and The Registry Network, Inc., to increase
the combined contract amount by $663,000, from $900,000 to $1,563,000,
to provide intermittent, as-needed, professional services of Per Diem
and Traveling Radiology Technologists with on-call availability 7 days a
week, for San Francisco General Hospital, for the period of July 1, 2004
through June 30, 2005.
- Commissioner Chow asked how SFGH plans to hire permanent radiology
technicians, given the competitive recruiting environment. Mr.
Hollingsworth, Director of Radiology at SFGH, replied that the hospital
is competitive in terms of salary. However new employees are often
offered night and weekend shifts, which can serve as a disincentive. One
particular difficulty has been recruiting people into the more
specialized positions, such as CT, interventional radiology and others.
- Commissioner Sanchez asked where most of the applicants come from. Mr.
Hollingsworth replied that most are from City College of San Francisco.
(3.2) PHP-Epidemiology and Disease Control – Request for approval to
enter, retroactively, into a performance agreement between Public Health
Foundation Enterprises, Inc. and the San Francisco Department of Public
Health, Epidemiology and Disease Control, to develop a secure electronic
system by which clinical laboratories can report San Francisco
residents’ hepatitis test results to the San Francisco Department of
Public Health, in the amount of $108,944, for the period of December 30,
2004 to December 29, 2005.
(3.3) PHP-CHSS-TB Control – Request for retroactive approval of a
contract renewal with the Regents of the University of California (UCSF),
in the amount of $1,500,000, to provide tuberculosis training, technical
assistance and medical consultation services to healthcare providers and
other professionals in the field, through the Regional Training and
Medical Consultation Center, for the period of January 1, 2005 through
December 31, 2005.
Commissioner Sanchez abstained from voting on this item.
(3.4) AIDS Office-Health Services - Request for approval of a contract
renewal with Haight Ashbury Free Clinics Incorporated in the amount of
$253,373 to provide HIV Integrated Services targeting persons who are
infected with HIV/AIDS for the period of March 1, 2005 through October
Gregg Sass, DPH CFO, gave an update on the financial condition of the
agency. The agency met its last two payrolls, came current on the
required employee retirement contributions and hopes to finalize
additional financing within the next week. Mr. Sass is getting weekly
updates. HAFC’s problems are complicated and difficult, but primarily
expenditures exceed cash receipts. It is going to take a great deal of
effort on the agency’s part to turn the situation around. Mr. Sass and
Barbara Garcia have been working closely with agency staff and board.
Mr. Sass recommends approving the two contracts that are before the
Commission because the start date is March 1 and clients need to
continue to receive treatment and staff needs to be paid. DPH can make
adjustments to contracts with 30-day notice if need be. Mr. Sass will
bring monthly updates to the Budget Committee.
- Commissioner Chow asked if Mr. Sass is confident HAFC could administer
these funds, and how closely he would be working with the agency. Mr.
Sass anticipates weekly cash forecast updates, and if anything
significant happens, the agency is to notify him immediately. Mr. Sass
has also requested a long-term plan to restructure the balance sheet,
and bring expenses and revenues into line. Commissioner Chow asked the
Chair of the Board if there is a commitment to meeting DPH’s needs.
Darrly Inaba, CEO, replied that he has tried to solidify banking
relationships and adjudicate the embezzlement. He appreciates the
Department’s assistance during this difficult time. Eric Flowers,
president of the Board, said the Board of Directors is fully aware of
the operational and structural issues facing the agency. The form of
governance needs to be made more current. He is taking steps to bring
professionals with the time and skill sets to the board, and have all
the directors understand the business that HAFC is in. They are
evaluating all their contracts to identify services that do not fit
economically or business-wise with the free clinics, and opportunities
to make programs more viable. As Board chair, his priorities include:
refortifying the board; working with bridge financing; restructuring
balance sheet to give more flexibility and adaptability; fundraising.
- Commissioner Illig asked for assurances that the agency is going to
cut costs immediately, because they are losing hundreds of thousands of
dollars monthly. Mr. Flowers said this analysis is being done now.
Commissioner Illig is particularly concerned with the contract with jail
psychiatric services. The agency needs to carefully evaluate whether it
is able to continue to provide this service to DPH.
- Commissioner Sanchez urged the Board to reach out to the Foundation
resources that are available in San Francisco. Mr. Flowers said they
have been in contact with the San Francisco Foundation, Community Clinic
Consortium and others to identify best practices.
- Commissioner Illig asked how the agency is going to reach the targeted
units of services. Ms. Long Dixon said that there would be discussion
with the agency about how to address this. She reiterated to the
Committee that these services were being put out to bid.
- Commissioner Chow asked for detailed information about what types of
services are provided in a primary care encounter. Ms. Long Dixon will
send this information to the Commissioners.
(3.5) AIDS Office-HIV Health Services - Request for approval of a
contract renewal with Haight Ashbury Free Clinics Incorporated in the
amount of $354,889 to provide Residential Detox and Substance Abuse
Services targeting person who are infected with HIV/AIDS for the period
of March 1, 2005 through August 31, 2005.
- Secretary’s Note – The amount of the contract is $308,222.
- Commissioner Illig asked why there are vacant beds. Ben Eiland,
Director of Substance Abuse Services, said they were having problems
with one of the three residential programs, specifically that they were
unable to find individuals who were appropriate for the service. In
fact, the agency had considered discontinuing this service. But in the
last 90 days, the center has been at capacity. There is a new site
manager who does a lot more community outreach.
Commissioners’ Comments (at the Health Commission meeting)
- Commissioner Monfredini said the agency is in trouble and must get out
of it. She reiterated that Mr. Sass is there to provide assistance to
the agency, and they should take advantage of that. She does not want
the DPH or Health Commission to be the last to know about problems. The
agency provides extremely valuable services, and the Health Commission
wants to continue doing business with them. However the lines of
communication have to be open.
Action Taken: The Health Commission approved the Budget Committee
Consent Calendar, with Commissioner Sanchez abstaining from voting on
There will be monthly updates to the Budget Committee on Haight Ashbury
4) DIRECTOR’S REPORT
Anne Kronenberg, Deputy Director of Health, presented the Director’s
Laguna Honda Hospital Admissions Policy
At the direction of Mayor Newsom, DPH returned Laguna Honda Hospital’s
admissions policy to what it was prior to March 2004. As the Commission
will recall, last March Dr. Katz initiated changes to Laguna’s
admissions policy in order to give priority to patients transferring
from San Francisco General Hospital. This policy change was implemented
as a cost-saving measure to reduce the number of decertified Medi-Cal
days experienced at San Francisco General Hospital. Prior to the policy
change, 54 percent of Laguna’s admissions were from San Francisco
General Hospital. After the new policy was implemented, admissions from
SFGH represented 75 percent of Laguna Honda Hospital's new admissions.
The policy changed saved the Department an estimated $1.7 million.
However, the policy change caused a great deal of distress for Laguna
Honda staff and members of the community. Because Laguna Honda Hospital
has traditionally focused more on meeting the needs of people at the end
of their lives or people with medical disabilities, many felt
uncomfortable with the increase of people coming from General for
shorter stays and with multiple and complex service needs. In order to
bridge the revenue gap created by the policy’s reversal, additional
reductions totaling $1.7 million will need to be included in the base
Ryan White Title I Award Announced
This afternoon, the AIDS Office received verbal notification that the
CARE Title I award for the San Francisco EMA for FY 2005-06 is
$28,297,777. The award represents a $1.55 million – approximately 5.5
percent – reduction from last year’s allocation. An official analysis of
the award will be available from the AIDS Office within the next 48
hours, once they receive additional information from the federal Health
Resources and Services Administration.
Local Disease Prevention Demonstration Project
Today, the Board will consider final passage of an ordinance that will
enable pharmacies in San Francisco to sell syringes without a
prescription. As the Commission is aware, lack of access to sterile
syringes results in higher rates of HIV and hepatitis C infection. The
Local Disease Prevention Demonstration Project will establish an
effective harm reduction strategy to ensure that drug users who continue
to inject have access to new, sterile syringes for each injection to
prevent transmission of these blood-borne pathogens. Under the program,
pharmacists will be able to sell up to 10 syringes to an adult without a
prescription. In addition, pharmacists will provide purchasers with
information on how to access drug treatment, how to access testing and
treatment for HIV and hepatitis C, and how to safely dispose of used
syringes. The Department has been working with a coalition of
stakeholders, including Walgreen’s, Rite-Aid, UCSF, and the San
Francisco AIDS Foundation, to design and implement this program.
San Francisco Behavioral Health Center
Earlier this year, Dr. Katz updated the Commissioners on the progress
with the San Francisco Behavioral Health Center. Dr. Katz discussed the
State’s recommendation to apply for a single 41-bed Adult Residential
Facility (ARF) license, instead of dual ARF and Residential Treatment
Facility licenses for the first floor. With the Commission’s approval,
DPH submitted the revised application on January 28, 2005. Dr. Katz is
pleased to report that DPH has been awarded the 41-bed ARF license. This
development will allow the Department to complete the reprogramming of
the SFBHC to a multiple levels of care for mentally ill patients in San
Francisco. He thanked the Commissioners, members of the Blue Ribbon
Committee, members of the SFBHC Advisory Committee, and all the SFGH
staff whose efforts have taken the Department so far in this
reprogramming process. Staff will now begin working to implement the ARF
program. He will continue to update the Health Commission on our
Community Forum on “Superinfection” reports from New York City
On Tuesday February 22nd, more than 200 people attended a community
forum designed to answer questions that individuals and community based
HIV service providers had about reports of a new strain of HIV disease
reported in New York. Steven Tierney, Director of HIV Prevention, Sally
Liska, Director of the DPH Microbiology Labs and others made
presentations and answered questions. The DPH message was simple: If you
are sexually active you should get an HIV test every six months; if you
are HIV positive good health care is available and we can help you get
it. All individuals should know their risk and negotiate safety for
themselves and their partners.
San Francisco Drug Court 10th Anniversary Celebration and Fundraiser.
On March 15th, the San Francisco Drug Court will commemorate a decade of
service at the 10th Anniversary Celebration and Fundraiser to be held at
the Delancey Street Foundation. Drug Court has become an important
integrated effort between DPH and the criminal justice system and has
proven effective in diverting substance abusers into community based
treatment. This event is a celebration of the individuals who have
contributed to the program’s success over the past 10 years and an
opportunity to look forward to the next decade. Gordon Park-Li, Chief
Executive Officer of the San Francisco Superior Court, will be honored
for his innovative vision and dedicated support of Drug Court. Proceeds
will benefit the San Francisco Drug Court Scholarship Fund to assist
Drug Court participants and alumni achieve their educational,
vocational, and housing goals.
- Commissioner Illig asked if the Mayor’s Office would add $1.7 million
to the DPH general fund allocation to offset the Mayor’s reversal of the
admissions policy. Mr. Sass said the first step is to remove $1.7
million from base budget revenue projections, and then continue to work
collaboratively with the Mayor’s Budget Office on options to balance the
Department’s budget. Commissioner Illig asked that the AIDS Office
provide the Budget Committee with a report about the specifics of the
CARE allocation, what programs are going to be impacted and the Planning
- Commissioner Monfredini asked if reduction in the CARE allocation is
unexpected. Mr. Loyce replied that it is about what they anticipated.
- Commissioner Chow asked for an update on the “supervirus.” Mr. Loyce
replied that there is not enough scientific evidence to support whether
or not this strain will have the same impact as the other virus. DPH
surveillance staff is monitoring this issue closely.
- Commissioner Guy congratulated staff for the extraordinary amount of
leadership and work that has gone into reprogramming the Behavioral
5) PRESENTATION OF THE DEPARTMENT OF CHILDREN, YOUTH AND THEIR
FAMILIES DRAFT COMMUNITY NEEDS ASSESSMENT
Margaret Brodkin, Executive Director, DCYF, presented the draft
Community Needs Assessment.
She discussed the San Francisco’s innovative programs: children’s fund;
universal health care for children, youth and young adults; wellness
centers; local earned income tax credit; community response network; and
improved well-being indicators. At the same time, families face threats
and challenges, including an exodus of families with children out of the
city, violence and racial disparity in terms of education, health status
and other indicators. The Community Needs Assessment is a report on San
Francisco’s service delivery system for children, youth and their
families, and a roadmap to how the City as a whole can work together to
better address unmet needs and make San Francisco a more family-friendly
- Service delivery systems must expand their scope, their network and
- That the San Francisco Unified School District and community agencies
become better partners in meeting the needs of students.
- That business, government, financial institutions and community
agencies join together to create more and better career preparation and
job opportunities for youth.
- That the juvenile justice system be restructured to build stronger
relationships with community agencies in operating its facilities, such
as Log Cabin Ranch, and in reducing unnecessary incarceration.
- That recreation centers become true community centers, inviting
neighborhood organizations and individuals in to collaborate as
managers, services providers and decision-makers.
- That facing the #1 threat to child health, lack of physical activity
and good nutrition, become a citywide campaign.
- City and community agencies each have a responsibility to work
together to improve the quality, funding and management of services:
- That DPH, Juvenile Probation, and the Human Services Agency continue
to develop stronger interagency case management systems for families
involved in all three systems.
- That the major city agencies serving children and youth develop
coordinated interagency contract monitoring, performance standards and
- That public and private agencies collaborate to identify technical
assistance needs and share opportunities for training, consolation and
other strategies to improve skills. That peer-learning networks be
developed in a variety of service delivery fields, such as youth
development and family support.
- That a wide variety of funding strategies be undertaken to address the
chronic financial shortfalls in providing needed services.
- Public and private agencies must increase the accessibility of their
services through more effective outreach, addressing barriers to
participation and adapting to new needs of their clients:
- That the city use its broad service delivery network, its internet
capacity, the small business community and the media to disseminate
information to families about services that are available and benefits
to which they are entitled.
- That city agencies commit to work collectively to solve the
long-standing challenge of safety transporting children and youth to the
service and educational locations they desire.
- That more neighborhood agencies develop the capacity to effectively
serve children, youth and families from diverse cultures and
- That the city agencies providing services to families develop
comprehensive service hubs near the seven street corners where most
troubled families reside.
- That public and private sector service agencies modify their hours and
locations to accommodate the real needs of families.
- City government must actively partner with community groups and
individuals who are most affected by the city’s policies and services.
It must develop strategies that empower those groups and individuals to
plan programs and participate in the policymaking process:
- That all arms of government work to give youth a more active voice in
the development of programs and policies that affect them.
- That opportunities for community voices to guide the policymaking
process be expanded, and that city departments continue to explore ways
to facilitate this.
- Commissioner Chow said it would be helpful to identify specific
initiatives that could be focused on and accomplished in the next year
or two. He noted that even though San Francisco has a small number of
children, it has a wealth of model programs. This is a significant
- Commissioner Illig asked how much of DCYF’s budget is contracted out.
Ms. Brodkin replied that the majority is contracted. Commissioner Illig
asked if the Needs Assessment recommends carving out a percentage of
Proposition 63 funds for children’s services. Ms. Brodkin said yes.
- Commissioner Chow suggested that the report include more detailed data
on the various Asian populations.
- Commissioner Monfredini would like the chance to review the entire
needs assessment, rather than just the executive summary.
- Commissioner Guy said that DPH does work collaboratively with DCYF and
other agencies, both programmatically and fiscally. The Health
Commission is fully invested in the wellness centers, and if there is an
effort to expand these into the middle schools, the Health Commission
wants to be involved. Commissioner Guy pointed out that the Adolescent
Health Coordinator is now at DCYF, and she is looking forward to this
collaboration. She pointed out that the Health Commission has a youth
health advisor to the CPS Joint Conference Committee. The major concern
of the report of violence is a citywide issue and a public health issue,
and DPH wants to continue to address this tragic problem
6) PUBLIC COMMENT/OTHER BUSINESS
Alfonso Newton said the Mayor is bringing a lot of homeless addicts
into the Post Hotel, and this has had a negative impact. They need more
security in the building.
Steve Rodriquez, speaking on behalf of the Post Hotel tenants, said
the agreement with DPH is that the management would have 24-hour
security. There is only security from 6:00 p.m. to 3:00 a.m. This is a
problem. A lot of other provisions of the agreement have not been met.
Sarah Norr, Central City SRO Collaborative, said the Post Hotel was an
independent living environment for low-income people. There was no
security, no on-site manager. Now there are a lot of people who are not
capable of independent living, and this has negatively affected other
tenants’ quality of life. Housing the homeless is an important goal, but
must take into account the needs of the long-term tenants. Either put
resources into the hotel to make it supportive housing, or end the
program. Commissioner Monfredini referred the three speakers to Marc
Trotz, Director of DPH Housing and Urban Health.
The meeting was adjourned at 5:00 p.m.
Michele M. Seaton, 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
Any written summaries of 150 words or less that are provided by persons
who spoke at public comment are attached. The written summaries are
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