Minutes of the Health Commission Meeting
Tuesday, May 17, 2005
101 GROVE STREET, ROOM 300
San Francisco, CA 94102
1) CALL TO ORDER
The meeting was called to order by Commissioner Monfredini at 3:10 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 Donald E. Tarver, II, M.D.
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MAY 3,
Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver)
approved the minutes of the May 3, 2005 Heath Commission meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Illig chaired and Commissioner Chow attended the Budget
(3.1) DPH-Central Admin. – Request for approval of a renewal contract
with P. B. Strategies, LLC, in the amount of $438,387, to provide
strategic planning and project management services for ongoing primary
care capital improvement projects, for the period of July 1, 2005
through June 30, 2007.
- Commissioner Chow asked the status of the Tom Waddell elevator. Ms.
Kronenberg replied that $64,000 was allocated for the design of the
elevator. Of that, $37,000 has been spent. There allocation does not
include funding for the installation of the elevator. Ms. Kronenberg
added that the elevator has never been part of the scope of work of this
contract. Commissioner Chow suggested that this project be included P.B.
Strategies’ scope of work, and the contractor agreed.
(3.2) PHP-MIS – Request for approval of a renewal contract with Echo
Consulting Services of California, in the amount of $460,237, to provide
ongoing system maintenance and application support services for the
INSYST software application used by Community Behavioral Services, for
the period of July 1, 2005 through June 30, 2006.
- Commissioner Chow asked if the CBHS system is going to utilize the
Soarian system. Fred McGregor of CBHS replied that Siemens does not have
a behavioral health product and would not be able to develop one for
several years. CBHS would like to put out an RFP for a new behavioral
health system that could interface with the Soarian system. They hope to
have this funded through Proposition 63.
(3.3) PHP-MIS – Request for approval of a renewal contract with InfoMC,
in the amount of $288,792, to provide ongoing system maintenance and
application support services for the eCURA software application used by
Community Mental Health Services, for the period of July 1, 2005 through
June 30, 2006.
(3.4) PHP-BEHM – Request for approval of a renewal contract with San
Francisco Foundation Community Initiative Fund, in the amount of
$168,000, to provide fiscal sponsor services for the San Francisco Food
Council, for the period of July 1, 2005 through June 30, 2007.
- Commissioner Chow asked the status of city-owned farmers markets
accepting EBT cards. Dr. Ona replied that the Alemany Farmers Market
would finally accept EBTs. In addition, Environmental Health continues
to support the acceptance of EBTs at other farmers markets in the city.
(3.5) PHP-AIDS Office – Request for approval of a retroactive contract
renewal with Patricia Sullivan, in the amount of $282,240, to provide
consulting services to HIV Health Services, for the period of March 1,
2005 through February 28, 2006.
- Commissioner Illig asked how the Department decides which programs are
contracted out and which are done in-house. Michelle Long Dixon replied
that the quality management program is relatively new to CARE-funded
programs. When it became a HRSA mandate, there was a hiring freeze, and
it is not a full time job. Ms. Long Dixon said that this is a scope of
work that is best managed by a consultant. Commissioner Illig said that
he would like to see performance measures in the contract summaries that
are presented to the Budget Committee.
(3.6) CHN-Jail Health Services – Request for approval of a renewal
contract with Medical Diagnostic, in the amount of $672,000, for the
provision of mobile X-Ray services for inmates of the County Jail, for
the term of July 1, 2005 through June 30, 2009.
(3.7) CHN-SFGH – Request for approval of a renewal contract with the
Regents of the University of California, in the amount of $376,320, to
provide Orthotics and Prosthetics for Medically Indigent Adult clients
of the Community Health Network, for the period of July 1, 2005 through
June 30, 2006.
(3.8) CBHS-Mental Health – Request for approval to accept and expend
retroactively a grant from the California Department of Mental Health,
in the amount of $207,487, for Community Program Planning as part of the
Mental Health Services Act (MHSA) (Prop 63), for the period of
January 1, 2005 through September 30, 2005, and a contract modification
with Bay Area Communication Access for $3,000, for ASL interpretation,
for the same period.
Action Taken: The Commission (Guy, Chow, Illig, Monfredini, Tarver)
approved the Budget Committee Consent Calendar.
4) DIRECTOR’S REPORT
Mitchell H. Katz, Health Director, presented the Director’s Report.
Blue Ribbon Committee on SFGH’s Future Location
The Mayor has appointed a 26-member Blue Ribbon Committee to make a
recommendation on where SFGH should be rebuilt—either on the existing
campus in Potrero Hill or at Mission Bay, co-locating with the planned
women’s, children’s and cancer hospitals for UCSF Medical Center. Dr.
Sandra Hernandez will chair the committee and Dr. Katz has been asked to
co-chair with her. Members come from disciplines throughout the City,
including health care, education, advocacy and community, labor,
government, philanthropy and business. Dr. Ed Chow will serve on this
Committee as representative for the Health Commission. As this
Commission is aware, much work has already been done related to this
rebuilding effort and the Blue Ribbon Committee will have this body of
work as a resource to help determine their recommendation. It is
anticipated that the committee will return a recommendation to the Mayor
and Board of Supervisors by the end of the summer. Four meetings over
the next few months are planned. Dr. Katz thanked the Mayor and the San
Francisco Foundation for their leadership in bringing together this
important Committee and look forward to the challenge we have ahead of
Mayor Appoints Citywide Task Force on Crystal Methamphetamine
On April 26th San Francisco became the first city in the nation to
coordinate resources in a citywide effort to deal with Crystal
methamphetamine. This drug, around for many years, is experiencing a
significantly increased impact in the last 18 months. The correlation
between crystal use and HIV and STD infections has highlighted the need
for a comprehensive plan of attack. The Mayor appointed Steven Tierney,
Director of HIV Prevention at DPH to Co-Chair this task for with
Supervisor Bevan Dufty. Other DPH appointees include Jimmy Loyce, Jeff
Klausner and Bob Cabaj. The Task Force will develop a plan of action and
a set of concrete recommendation and deliver them to the Mayor within
six to 10 months.
HIV Vaccine Awareness Day
May 18th is HIV Vaccine Awareness Day. The HIV Research Section has been
working with ISIS, a technology-based health education agency, to launch
a new educational campaign about the need for vaccine research.
SFisReady.org is designed to alleviate fears and myths about
participation in research and inspire San Franciscans to take part in
vaccine trials. San Francisco is one of only 28 cities internationally
to host these trials as part of the HIV Vaccine Trails Network and one
of only 12 US cities. This year, the Research Section needs nearly five
times as many volunteers as last year. When clinical trials are
successful, they advance to another phase of study where the number of
participants needed increases dramatically. Dr. Susan Buchbinder,
Director of the HIV Research Section, will be appearing live tomorrow
night on Gay.com to answer questions about Vaccine Trials and the work
that is being done here in the City.
West Nile Virus Update
As the Commissioners are aware, West Nile Virus continues to be in the
news as a potential health threat again in California. Last year, there
were no cases of WNV within the City, but a number of dead birds tested
positive for the virus. This year, the Department is once again working
with a number of other City agencies to educate the public about
preventing WNV by taking precautions such as wearing long clothing and
using mosquito repellent. We are also focusing on decreasing wet, swampy
areas that host mosquito breeding areas within the City, including on
city-owned property. The Bureau of Environmental Health has received
nearly 100 calls from residents reporting mosquito activity throughout
the City, nearly double the amount of calls received last year at this
time. We have also activated a new WNV hotline, 252-3806 and are
distributing brochures in five languages and designing outreach efforts
to different communities. Each month we are issuing a press release with
a different focus on prevention and awareness. To date, no positive
birds have been identified in San Francisco but we anticipate that with
the wet spring and warm weather ahead, the WVN will reemerge in the bird
population here as it has already in other Bay Area Counties.
AIDS Community Research Consortium of San Mateo Honors Michelle Long
The AIDS Community Research Consortium (ACRC) of San Mateo County
selected Michelle Long Dixon to receive the ACRC 2005 Outstanding
Community Service Award at its spring gala, "Innovation: Embracing and
Empowering a New Community" last month. The award was given for
inventive leadership to HIV/AIDS community based organizations. Also
honored were Steve Westly, California State Controller; Michael Edell,
American Heart Association; and Gilead Sciences, Inc.
Community Health Network -San Francisco General Hospital Credentials
07/04 to 05/05
Changes in Privileges
Current Statistics - as of 05/1/05
Affiliate Professionals (non-physicians)
Applications In Process
Applications Withdrawn Month of May 2005
8 (07/04 to 05/05)
SFGH Reappointments in Process June 2005 to Sept 2005
- Commissioner Illig asked if the Blue Ribbon Committee’s recommendation
would come to the Health Commission. Dr. Katz said it would.
- Commissioner Chow is honored to represent the Commission on the Blue
Ribbon Committee. Commissioner Chow again noted how important it was
that San Francisco General Hospital passed JCAHO and noted that a
hospital in Alameda County is faced with losing its accreditation. He
also noted that the Alameda County grand jury has criticized the Alameda
Medical Center for not managing the system’s finances. San Francisco’s
Department of Public Health should be proud of how it manages its
budget, even in times of budget difficulties.
5) PRESENTATION OF THE EMERGENCY MEDICAL SERVICES (EMS) ANNUAL AWARDS
Commissioner Monfredini presented the annual Emergency Medical Services
- EMS FIELD PROVIDER AWARD TO: Niels Tangerlini, EMT-P, San Francisco Fire
For incredible accomplishments initiating and assisting programs to
serve the homeless, the elderly, and children at risk for asthma, and as
a talented educator.
- EMS HOSPITAL PROVIDER AWARD TO: Joanne Handley, RN, St. Mary’s Medical
For outstanding performance, integrity and problem-solving talents as an
ED nurse, and for tirelessly providing guidance for improving the EMS
- EMS COMMUNITY SERVICES AWARD TO: Connie Berry, Mayor’s Office of
Emergency Services & Homeland Security
For selfless and outstanding performance as the dedicated Chief of the
Auxiliary Communications Service and for restoring confidence in a
valuable asset for the City.
- EMS DISPATCHER AWARD TO: Louise Lopez, Emergency Communications Dept.
For outstanding performance as a trainer and dispatcher and for
exceptional talent in troubleshooting the transition to medical call
taking by police dispatchers.
- RAYMOND LIM EXCELLENCE IN EMS AWARD TO: Chris Wachsmuth, RN, San
Francisco General Hospital Medical Center
For outstanding performance and leadership throughout a distinguished
career as a talented manager, and visionary for hospital emergency
medicine & aeromedical access.
6) BEHAVIORAL HEALTH UPDATE
Bob Cabaj, M.D., Director, Community Behavioral Health Services,
presented an update on Community Behavioral Services. Major initiatives
in the past year have been: integrating Mental Health and Substance
Abuse; Wellness/Recovery model implementation; dialectical behavioral
therapy; community perspective/proper level of care; advanced access;
and MHSA/Proposition 63 planning.
Dr. Cabaj presented data on services and client populations. He also
updated the committee on the status of on-going programs, including:
- OBOAT continues and expands beyond the pilot
- Buprenorphine added as a treatment options
- Methadone Van – successful operation at two sites.
- Police Trainings
- Reverse Staff Experience with the Police
- Collaborative projects with the Police such as studying suicides and
prior police contacts
- AB 2034 continues successes
- Single Point of Responsibility
- Med Impact – pharmacy benefits manager and medications for indigent
Dr. Cabaj described the Children’s System of Care, which includes
initiatives such as gun violence prevention, SafeStart initiative, the
High Quality Child Care Mental Health Consultation Initiative and the
Homeless Children’s Mental Health Initiative.
- Alternatives Grant shows success in reducing re-institutionalization
in African-American men discharged from IMDs
- Methamphetamine Treatment/Intervention
- Fire setting Prevention, Education and Treatment Project
- Horizons Dual Diagnosis Day Treatment Program
- Post Traumatic Stress Disorder Clinic
- Collaboration with Mental Health Association
- Enhanced services for with women with HIV
- Active CBHS involvement in Project Connect
- New Medication Use Improvement Committee replaces old P&T Committee
- Commissioner Tarver asked Dr. Cabaj to elaborate on CBHS’s transgender
services. Dr. Cabaj said a program at the Castro Mission Health Center
provides direct counseling to transgender people and consulting to
primary care staff that work with transgender people. The Center for
Special Problems has a specific transgender track with psychotherapy and
other interventions for transgender clients. Theoretically a transgender
person could get care anywhere in the system because staff are trained,
but they recognize that people prefer to go to people with expertise in
their area. Commissioner Tarver asked if there is a process to recruit
and retain transgender therapists. Dr. Cabaj said they do try to
recruit, and this is definitely a category of interest. Commissioner
Tarver asked what the goals were for the SPR program in terms of clients
graduating from this program. Dr. Cabaj said that they have set a goal
of 17 percent turnover within one year. This is not always easy to do
because clients are so dependent on the care. They are looking at a
step-down process so a person is still tied to the program, but not
receive the same level of care. Commissioner Tarver asked what
approaches are used to streamline placements within the system of care.
Dr. Cabaj said there used to be multiple admission screenings for every
level of care, each one different for each program. CBHS now uses a
standardized evaluation tool that looks at the symptoms and presentation
of particular individual to match them with a level of care, and this is
applied uniformly throughout the system. Commissioner Tarver emphasized
the need for the CBHS MIS system to be compatible with Primary Care and
the rest of DPH.
- Commissioner Illig urged CBHS to have a role in the Mayor’s Long Term
Care Coordinating Council so that the behavioral health perspective is
represented. He asked if CBHS is evaluating any of the budget proposals
that related to the restructuring of CBHS, even if these proposals are
not included in the Mayor’s budget. Dr. Cabaj replied that it is clear
that methadone and the rest of the substance abuse system needs to be
put through an RFP process. He would like to tie this effort to the
Mental Health Services Act, but the sequence will depend on the proposed
budget. Commissioner Illig asked what the outcomes are for substance
abuse residential treatment. Dr. Cabaj said that CBHS is developing more
performance-based outcomes, rather than just looking at deliverables.
There are outcomes per contract, but this is not ideal. Commissioner
Illig asked how CBHS interacts with Project Homeless Connect. Dr. Cabaj
replied that the two major avenues for dealing with these clients are
methadone and intensive case management.
- Commissioner Chow said that there is a lot of good data for services
to children and youth, but he is still unclear what the department’s
goals are for these services, and what the unmet needs are in the
community. The report has great data for looking at a picture in time.
Dr. Cabaj said that Proposition 63 asks the same questions, in terms of
unmet needs. They are currently trying to answer this question, and
exploring this with consultants.
- Commissioner Guy said the Department has made inroads with decreasing
waiting times for services. The integration is a strategic goal for the
Health Commission. She is interested in the question of unmet need and
the impact Proposition 63 will have. She asked if the cultures of
substance abuse and mental health have coalesced. Dr. Cabaj said
cultural norms are finally changing, but this will take time. The change
agent group has been the driving force.
7) PRESENTATION OF EMS SYSTEM CAPACITY ASSESSMENT AND REPORT
John Brown, M.D., EMS Medical Director, presented the EMS System Surge
Capacity and Capability Assessment undertaken this year by the EMS and
Emergency Operations Section of the Health Department. This assessment
of health preparedness, focusing on the emergency medical care system,
was done in conjunction with the preparation of the Health Resources and
Services Administration 2005 grant application, and has also been useful
in obtaining Urban Area Security Initiative grant resources to improve
hospital and EMS preparedness. The assessment describes the work that
each hospital facility and the other EMS providers have done in
preparing for a disaster, whether related to a natural or terrorism
event, and the areas where there is a gap in system preparedness.
The assessment used HRSA benchmarks and looked at hospital bed surge
capacity, personnel surge capacity for decontamination procedures,
hospital personnel for 24/7 surge operations, personal protective
equipment, decontamination systems, trauma and burn care and
pharmaceutical cache. Dr. Brown discussed the gaps that exist in each
area. In conclusion, Dr. Brown said the San Francisco EMS System has
surge capacity gaps in the areas of essential personnel, essential
equipment, personal protective equipment, decontamination capabilities,
pharmaceuticals, communications and training.
- Use information to predict system needs during DOC activations and
plan for MCI/Disaster response operations
- Continue system gap analysis by monitoring key categories for gap
- Continue support for SFGH air medical access
- Pursue continuation of grant funding to help with closing readiness
Dr. Brown acknowledged and thanked the hospitals, clinics and ambulance
providers for the hard work they have contributed to this important
assessment and for their continued support of disaster preparedness in
our health care system.
- Commissioner Tarver asked how participating hospitals test the
assumption that they would achieve 100% call back during a disaster. Dr.
Brown said that this should be incorporated into the planning exercises
and would give them a range. Commissioner Tarver asked if there is a
mechanism for immediate privileges to provide services at other
hospitals. Dr. Brown replied that San Francisco’s policy is to have
physicians report to an incident commander or go to a volunteer
reception area and present a current license and photo identification.
This gives them the emergency credentialing to provide basic life
support. What they are working toward is have advanced credentialing of
personnel that would be responding to disasters.
- Commissioner Chow said there are certain gaps that are easy to close
and others that are more problematic and costly. He asked if the gap
analysis assumes that hospitals would have to meet staffing mandates.
Ms. Garay replied that normal staffing ratios would apply even during an
emergency. Commissioner Chow asked how hospitals would deal with a
personnel shortage. Dr. Brown said the first approach is to work with
regional partners with the hope that the disaster would not affect all
regions equally. The other aspect is to bring in Federal medical
disaster teams. Dr. Katz added that one of the take home points is what
to do when there are not enough of the resources that are needed. The
goal is understanding this ahead of time so people can thoughtfully
develop the next best solution ahead of time.
- Commissioner Illig asked if there is a companion assessment for the
region. Dr. Brown replied that the HRSA grand requires this, so as other
counties finish theirs they will be able to marry the data. This will be
key to regional planning. Commissioner Illig suggested that the boards
of each of the hospitals in San Francisco get a copy of the assessment.
- Commissioner Guy asked what the Health Commission should pay closest
attention to in the next year. Dr. Brown said the Commission should
continue to monitor the gaps that have been identified and support
efforts to obtain grant funding to close these gaps. He also asked for
continued Commission support for air medical access. The Health
Commission would be helpful in encouraging other City departments to
participate in planning and hospitals to continue their emergency
- Commissioner Monfredini said there is a greater chance of a natural
disaster than a terrorist attack, and this planning and equipment is
applicable to many types of disasters. The Health Commission can
immediately support requests for critical equipment. However, it is
important to remember that some situations cannot be planned for.
8) PUBLIC COMMENT/OTHER BUSINESS
- Michael Sullivan – 150 word summary submitted; see attached.
- Shirley Bierly, Senior Action Network and California Legislative
Council for Older Americans, asked the Health Commission to find funding
for the CHIPPS (Community and Home Injury Prevention Project for
Seniors) Program. This program assists many people in San Francisco and
allows seniors to maintain their independence. The program needs
- Vittorio D’Angeli, Dimensions Clinic, said without the support of the
Castro Mission Health Center, Dimensions would cease to exist. He urged
the Health Commission to consider this when considering any budget cuts
to Castro Mission.
- George Williams, Senior Action Network, said the CHIPPS program gave
his wife more time living independently. He was able to care for her at
home rather than sending her to an institution. The CHIPPS program
taught him what to do.
- Danzel Cohen, representing Balboa High School Teen Clinic, came to the
meeting because he thought the clinic was going to be closed. He has
learned that it is not going to close, so he thanked the Health
Commission for having these kinds of services.
- Jonathan Morales, student at Balboa High School, said the teen clinic
has helped him a lot.
- Belindah Lee, member of the Youth Advisory Board for the Balboa High
School Teen Clinic, said the clinic has helped her a great deal,
especially with mental health services and primary care. She hopes that
there will be more campus services.
The meeting was adjourned at 6:00 p.m.
Michele M. Seaton,
Executive Secretary to the Health Commission
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
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
Written Summaries of 150 Words of Less that have been Submitted by the
Members of the Public
Michael Sullivan, Item 8, Public Comment – Please request that the Board
of the Laguna Honda Foundation reconsider its decision to suspend the
work of the Foundation. I do not know why Louise Renne is shutting down
the Foundation. I heard it’s about the uncertainty of the hospital
rebuild. The Foundation’s mission goes well beyond the rebuild. The
by-laws clearly state the purpose of the Foundation is to “support
healthcare, including research and education at Laguna Honda Hospital.”
I’m sure there are many projects that need funding as we wait on the
rebuild decision. Closure can’t be about money, staff presented the
Board with a solid, doable budget for FY 05-06. If the Foundation is
suspended it may never get off the ground again. $325,000 in probable
grants will not be given to a suspended foundation. I do not know the
real reason the Foundation is being shut down. You will have to ask
Louise Renne why.