Minutes of the Special Health Commission Meeting

Tuesday, June 21, 2005
at 1:00 p.m.
San Francisco, CA 94102


President Monfredini called the meeting to order at 1:20 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 Donald E. Tarver, II, M.D.
  • Commissioner John I. Umekubo, M.D.


Action Taken: The Commission approved the minutes of the June 7, 2005 Heath Commission meeting. Ms. Seaton said a few grammatical and spelling corrections would be made.


Commissioner Illig chaired and Commissioner Sanchez and Commissioner Chow attended the Budget Committee meeting.

(3.1) CHN-SFGH & LHH Facilities - Request for approval of sixteen contracts with the following thirteen firms: A & B Mechanical, Inc., Agbayani Construction, Inc., Anderson Carpet & Linoleum Sale Co., Inc., Angotti & Reilly Inc., Bay City Boiler & Engineering Co., Inc., City Mechanical, Inc., Floortrends Inc., McClure Electric, Inc., Robert Poyas, Inc., Rubecon General Contracting, Inc., Sierra Electric Co., The Shooter Co. and Yerba Buena Engineering & Construction, in the combined amount of $2,678,000, to provide the Community Health Network intermittent, as-needed facility maintenance services above baseline civil service staffing, for the period of July 1, 2005 through June 30, 2007.

(3.2) CHN-SFGH Nursing Operations - Request for approval of four contract renewals with HRN Services, Inc., Medstaff, Inc., Nurse Providers, Inc. and United Nursing International and two new contracts with Agostini Medical Staffing and Arcadia Health Services, Inc., in the amount of $2,700,000, to provide supplemental, temporary Per Diem and Traveling nursing personnel services for San Francisco General Hospital Medical Center, for the period of July 1, 2005 through June 30, 2006.

Commissioners’ Comments

  • Commissioner Sanchez asked how the Moore Grant and other programs are increasing the supply of nurses so that the use of registry could be minimized. Ms. Digdigan said part of their recruitment strategy is to get nurses from wherever they can. They have unit clerks, CNAs and LVNs who are going to nursing school. They continually take high school students on hospital tours. Leslie Holpitt has good liaisons with deans of colleges and schools of nursing.
  • Commissioner Illig asked if the RFP specified the rates. Ms. Digdigan replied that all of the rates were set at the same level. Commissioner Illig asked if the Budget Analyst’s recommendation that this contract be reduced has an impact on this contract. Mr. Sass replied that the Budget Analyst is suggesting that if a certain percentage of vacancies are filled, registry could be reduced. Mr. Sass said it is unlikely this will happen, and the Department will likely use the entire contract. He noted that next year’s budget request for registry is less than the current year’s budget.

(3.3) CHN-SFGH Radiology - Request for approval of two contract renewals with Medical Contracting Services and The Registry Network, Inc. and new contracts with On Assignment Healthcare Staffing, Platinum, Select, LP and RTP Hospital Staffing in the amount of $1,200,000 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, 2005 through June 30, 2006.

Commissioners’ Comments

  • Commissioner Chow asked how likely it is that the radiology positions would be filled. Roland Pickens said they rely on the registries to meet their staffing requirements. They hope to fill the vacant positions, but this is contingent upon SFGH staying competitive in the marketplace.

(3.4) CHN-Health Information Services – Request for approval of two contract renewals with the following firms: Mediscript Medical Transcription and Pacific Medical Transcription and a new contract with California Medical Transcription Corporation, for a combined total amount of $551,177, to provide intermittent, as-needed medical transcription services for San Francisco General Hospital, for the period of July 1, 2005 through June 30, 2006.

(3.5) AIDS OFFICE-HIV Prevention - Request for approval of the FY 2005-2006 Federal Centers for Disease Control and Prevention (CDC), State of California (State), and General Fund (GF) funding for new HIV Prevention Services Targeting HIV Positive and HIV Negative Populations contracts, for a combined total of $11,515,415 for the period of July 1, 2005 through December 31, 2006 for CDC contracts and July 1, 2005 through June 30, 2006 for State and GF contracts.
CDC-Funded Contracts (July 1, 2005 through December 31, 2006)
Agency CDC Fund Amount 12 % Contingency Total Amount
Ark of Refuge, Inc $225,000 $27,000 $252,000
Asian Pacific Islander Wellness Center $183,000 $21,960 $204,960
Asian Pacific Islander Wellness Center $128,925 $15,471 $144,396
Bay Area Young Positives $185,501 $22,260 $207,761
Black Coalition on AIDS $83,160 $9,979 $93,139
Black Coalition on AIDS $208,107 $24,972 $233,079
Black Coalition on AIDS $182,466 $21,896 $204,362
Continuum HIV Day Services $211,683 $25,402 $237,085
Girls After School Academy $75,000 $9,000 $84,000
Iris Center $255,000 $30,600 $285,600
Larkin Street Youth Center $141,076 $16,929 $158,005
Mission Neighborhood HC $281,670 $33,800 $315,470
Mission Neighborhood HC $234,630 $28,156 $262,786
Mobilization Against AIDS Int. $205,500 $24,660 $230,160
Native American AIDS Project $233,649 $28,038 $261,687
New Leaf $364,286 $43,714 $408,000
Shanti Project $984,306 $118,117 $1,102,423
Tenderloin AIDS Resource Center $489,600 $58,752 $548,352
UCSF AIDS Health Project $1,014,332 $121,720 $1,136,052
UCSF AIDS Health Project $375,492 $45,059 $420,551
UCSF Women’s Specialty Clinic $249,795 $29,975 $279,770
Walden House $281,461 $33,775 $315,236
Walden House $284,907 $34,189 $319,096
Subtotal $6,878,546 $825,424 $7,703,970
State-Funded Contracts (July 1, 2005 through June 30, 2006)
Agency State Amount 12 % Contingency Total Amount
San Francisco AIDS Foundation $289,427 $34,731 $324,158
San Francisco AIDS Foundation $237,369 $28,484 $265,853
Stop AIDS Project $389,759 $46,771 $436,530
Subtotal $916,555 $109,986 $1,026,541
Contracts with General Funds (July 1, 2005 through June 30, 2006)font>
Agency General Fund Amount 12 % Contingency Total Amount
Asian Pacific Islander Wellness Center $141,708 $17,050 $158,758
Larkin Street $173,000 $20,760 $193,760
St. James Infirmary $135,616 $16,274 $151,890
SF LGBT Community Center $150,000 $18,000 $168,000
San Francisco AIDS Foundation $631,696 $54,565 $686,261
Stop AIDS Project $702,768 $84,332 $787,100
Tenderloin AIDS Resource Center $253,898 $30,468 $284,366
UCSF Stonewall $316,758 $38,011 $354,769
Subtotal $2,505,444 $279,460 $2,784,904
HIV Prevention Contracts TOTALS $10,300,545 $1,214,870 $11,515,415

Commissioner’s Comments

  • Commissioner Illig noted the importance of having monitoring reports for all of the agencies. He is concerned that some agencies have small boards of directors, and it is important that agencies have adequate boards to provide a level of public oversight. He asked representatives from several agencies to address this concern, including Bay Area Young Positives, Girls After School Academy, Mobilization Against AIDS, Native American AIDS Project, St. James Infirmary and Walden House. Commissioner Illig congratulated the Native American AIDS project on becoming their own 501(c)3.
  • Commissioner Chow reiterated the importance of having organizational support through an active, adequately represented board of directors. Strong boards help make strong agencies that can continue their missions. Commissioner Chow would like additional information on the populations that will be served through these contracts and outcomes. Mr. Tierney said that specific outcomes are determined and outlined in the contract, and as soon as the contracts are finalized, he would present this information to the Joint Conference Committee and the Health Commission, in the next three and six months.
  • Commissioner Illig said he and Barbara Garcia have discussed convening a meeting of board chairs to discuss how to assist and enhance governance of non-profits.
  • Commissioner Sanchez appreciates the overview of the process, and the community dialogues that went on pertaining to the RFP. He also noted that many foundations are funding board development activities. Mr. Tierney added that at the next meeting, he would bring contracts to the Health Commission that address services to Latino community and clinical services with prevention with positives.
  • Commissioner Sanchez abstained from voting on this time as it relates to UCSF.

(3.6) AIDS OFFICE-HIV Health Services - Request for approval of a contract modification with Shanti, in the amount of $179,734, for a total 2-year contract amount of $889,457 ($305,563 for year one and $583,894 for year two), to provide HIV Health Services Planning Council Support services, for the period of March 1, 2004 through February 28, 2006.

  • Secretary’s Note – this item was continued to the July 19, 2005 Health Commission meeting.

(3.7) AIDS OFFICE-HIV Health Services - Request for approval of a retroactive contract renewal with Positive Resource Center, in the amount of $254,837 per year ($509,674 for two years), plus a 12% contingency amount of $61,161, for a total amount of $570,835, to provide client advocacy and benefits counseling services targeting people living with AIDS of HIV disease, for the period of March 1, 2005 through February 28, 2007.

Commissioners’ Comments

  • Commissioner Illig commended Ms. Long for the excellent report, which includes everything the Commission has asked for. Commissioner Illig also commended the agency for its commitment of agency funds to this program. This really demonstrates the true partnership between DPH and the agency.

(3.8) CBHS - Request for approval of a contract modification with Resource Development Associates, in the amount of $133,475, for a total contract amount of $235,515, to provide consulting services to develop the Mental Health Services Act (Prop 63) plan, for the period of February 8, 2005 through September 30, 2005.

Commissioners’ Comments

  • Commissioner Chow asked if Proposition 63 funds could be used to reimburse the general fund for these upfront costs. Dr. Cabaj replied that this is his understanding with the State. Commissioner Chow asked the status of the Proposition 63 allocation. Dr. Cabaj said that right now they are scheduled to get less money than anticipated, but they are working with the Mayor’s Office, the state and others.

(3.9) CBHS - Request for approval of a contract modification with Crestwood Behavioral Health, Inc., in the amount of $1,200,000, for a total contract value of $9,947,793, to provide additional mental health bed capacity for 24-hour Skilled Nursing Facility services, for the period of July 1, 2003 through June 30, 2005.

Commissioners’ Comments

  • Commissioner Illig expressed concerned that just a few months ago the Health Commission considered massive cuts to mental health residential services and now we are purchasing additional IMD beds. He asked Barbara Garcia to re-evaluate the residential treatment system, administrative days SFGH is losing, who is being served by the IMDs and other issues. Commissioner Illig asked for a presentation to the Community Programs and Services Joint Conference Committee once this evaluation is complete. Ms. Wang agreed with this approach, and noted that San Francisco has reduced its use of locked beds dramatically from 400-500 beds to what it is today.
  • Commissioner Chow, Commissioner Illig and Commissioner Sanchez thanked Ms. Wang for her 35 years of service to the Department of Public Health.

(3.10) CBHS - Request for approval of a contract modification with Sunny Hills Children's Garden Family and Children's Services, in the amount of $112,000, for a total contract amount of $304,416, to provide mental health services for youth ages 12 through 18, for the period of July 1, 2004 through June 30, 2005.

(3.11) CBHS - Request for approval of ten renewal contracts for the Family Mosaic Project totaling $896,847, to provide various wrap-around services targeting seriously emotionally disturbed children, with the following agencies: Alternative Family Services, Brainstorm Tutoring, Edgewood Center for Children & Families, Families First, Heritage Residential Treatment Center, New College of California, Occupational Therapy Training Program/Special Services for Groups (OTTP/SSG), RISE Institute, Seneca Center and Victor Treatment Centers, for the period of July 1, 2005 through June 30, 2006.

Commissioners’ Comments

  • Commissioner Illig understands that there is ongoing monitoring of these agencies, but asked if there is also an annual monitoring report. Robán San Miguel, Director of Family Mosaic, said that because they do ongoing client-based monitoring, they are not currently doing an annual report by agency. Through the on-going monitoring process they are able to identify problems and in fact have discontinued contracts with agencies.
  • Commissioner Sanchez noted that so many of these children’s residential services are out of county, so it is critical that we are assured of quality care.

(3.12) SFGH – Request for approval to accept and expend a HRSA grant from the California
Department of Health Services TB Control Unit in the amount of $995,759 for Bioterrorism Preparedness and Dual Use Project for Regional Civil Detention of Persistently Non-Adherent Tuberculosis Patients for the period of June 1, 2005 to January 1, 2013.

Commissioners’ Comment (at the Health Commission Meeting)

  • Commissioner Monfredini asked if Item 3.2 is an as-needed contract, because she knows that SFGH is working diligently to fill vacant positions. Ms. O’Connell replied that it is as-needed, so when we do not need it, we do not spend it.
  • Commissioner Tarver commended the Positive Resource Center on its performance and client satisfaction. Commissioner Tarver noted that in 3.1, there seemed to be some inconsistencies in how the different vendors are monitored. He also reiterated his belief that the discussions around the Laguna Honda Hospital rebuild need to include representatives from across the Department. This is demonstrated by the contract with Crestwood, which cares for many San Francisco residents.

Action Taken: The Commission approved Items 3.1 - 3.5 and 3.7 - 3.12 of the Budget Committee Consent Calendar. Item 3.6 was held over to the next Health Commission meeting. Commissioner Sanchez abstained from Item 3.4 as it pertains to the four University of California contracts.

Mitchell H. Katz, M.D., presented the Director’s Report.

Emergency Medical Services
Over the weekend there was an article in the San Francisco Chronicle concerning two cases of alleged patient abandonment by San Francisco Fire Department EMS crews that occurred in April of 2005. Dr. Katz assured the Health Commission that these incidents were rapidly detected by the EMS Agency through their Exception Reporting system, and by the Fire Department through their Incident Management system, which rapidly assessed the problem and informed both the State EMS Authority and the San Francisco EMS Agency. All EMS personnel involved have been assigned non-patient care duties until the dual investigations (state and local) are completed and a determination is made. The State EMS Authority is handling the paramedic investigation and our EMS Agency is handling the EMT investigation. To give the Health Commission a sense of the proportion that non-transported patients represent to our system, of the approximately 30,000 EMS responses so far this year, about 4,600 involved patients not being transported for various reasons. Of the 77 incidents of all types being tracked by the EMS Agency in their Exception Reporting system since January 1, 2005, 6 have involved patient non-transports and 2 of these 6 have involved potential policy violations and have resulted in the current investigations.

Laguna Honda Hearing
On Saturday, June 18, 2005, the Government Audits and Oversight Committee of the Board of Supervisors along with Assembly member Leland Yee held a joint hearing to look into the California Department of Health Services and CAL/OSHA’s review of Laguna Honda Hospital. There was general agreement that Laguna Honda Hospital needed more resources to care for behaviorally difficult patients and that this would require additional funding at the local and state level. There was a very good turn out for public comment with people expressing a variety of opinions. Some spoke about their desire to make sure that Laguna Honda Hospital did not take behaviorally difficult patients. Others spoke about the importance of finding a solution for funding of and caring for behavioral challenging patients in need of Skilled Nursing services at Laguna Honda or elsewhere. The hearing lasted 4.5 hours after which the Committee continued the item at the call of the chair.

Communicable Disease Report goes On-line
Dr. Katz announced the release of a comprehensive epidemiological review of communicable diseases, managed by the Community Health Epidemiology & Disease Control Section. The San Francisco Communicable Disease Report, 1986-2003 provides the annual incidence for all legally notifiable communicable diseases. Additionally, it describes the epidemiology of 21 selected diseases and compares it with other Bay Area counties, California and the United States. These data are an essential tool for communicable disease control and prevention practice, program planning, and program development. The report can be downloaded from the DPH website. Many thanks to Scott Nabity, Communicable Disease Epidemiologist, who lead the effort to produce and post this comprehensive report.

Green Business Team
The San Francisco Green Business Team, a collaboration between the Department of Health, Department of the Environment and the Public Utilities Commission, hosted its first ever San Francisco Green Business Day Recognition Event. The event was held at Pier 39 in conjunction with World Environment Day 2005. Twenty-one San Francisco Green Businesses were showcased, including the Aquarium of the Bay, Courtyard by Marriot at Fisherman's Wharf, the San Francisco Chronicle, Rainbow Grocery Cooperative, HMR Group and Jardinière Restaurant. Awardees demonstrated exemplary environmental compliance, extensive efforts in toxics reduction and pollution prevention, and energy, water and solid waste conservation. The Team has a growing list of other businesses coming into compliance that will soon join San Francisco’s Green Business community.

Commissioners’ Comments

  • Commissioner Illig asked if the $3.2 million cut to Outpatient Substance Abuse Services is an annualized amount. Dr. Katz said the savings is based on a September 1, 2005 start date. His guess is that the FY 2005-2006 savings will be less, because the RFP may not be completed by September. Commissioner Illig asked for an update on the Proposition 63 allocation to San Francisco. Dr. Katz said there is an intense effort to get the allocation increased, but at this point there has been no change. Commissioner Illig said Supervisor Daly has introduced two pieces of legislation that impact the Health Department and asked when the Department would weigh in and how will the Commission would be involved. Dr. Katz said he has only recently been given the revised charter amendment. Commissioner Illig hopes that Supervisor Daly would ask for the Health Commission’s input as he moves forward with his proposals.
  • Commissioner Chow Dr. Katz to report the results of the EMS investigation to the Health Commission when it is complete.
  • Commissioner Sanchez feels that the Health Commission has completed its charge in holding public hearings, adopting a budget resolution and forwarding this information to the Mayor and Board of Supervisors, and now is the time for the citizens to be heard at the Board of Supervisors via the Beilenson hearing.
  • Commissioner Chow respects that the Beilenson hearing is the opportunity for the public to express its opinions, and the Health Commission has already provided its input via the budget resolutions. Commissioner Chow expressed sadness on the passing of Dr. Robert Lull. He was a great man. The Health Commission sent a letter of condolence to the family and the medical society, and he was privileged to present the letter at the Medical Society’s memorial service.


Gregg Sass, DPH Chief Financial Officer, updated the Commission on recent developments in the State Medi-Cal 1115 waiver negotiations between the State Department of Health Services (DHS) and the Center for Medicare and Medicaid Services (CMS). Over the past year, DHS and CMS have been negotiating a five-year Medicaid waiver to restructure safety net hospital financing. Central to the negotiation is the desire on the part of the federal government to replace the existing system that utilizes intergovernmental transfers from counties to draw down federal matching funds (FFP) with a system that draws FFP from certified public expenditures (CPE). The existing 1115 waiver expires on June 30, 2005 and the new system is scheduled to take effect on July 1.

Throughout the negotiations, counties have followed developments closely and, until mid-May, had not opposed the new plan despite numerous concerns. That position was based on elements of the plan that had the potential of stabilizing safety net financing and providing for growth in funding to allow hospitals to meet the demand for care by the uninsured, indigent, Medi-Cal and other patients. However, on May 19th, counties were notified that CMS had rejected the proposal under negotiation and proposed a scaled down version of the waiver that contains none of these features and threatens the stability of the safety net.

Mr. Sass described the importance of having a waiver that stabilizes the safety net. There are 6.5 million uninsured people in California in need of health care. Public hospitals make up just 6 percent of all California hospitals, yet provide more than 50 percent of the hospital care to the uninsured. San Francisco General Hospital is one of those providers. 41 percent of the patients at SFGH are indigent and an additional 28 percent are Medi-Cal beneficiaries. In addition, SFGH is the only Level 1 trauma center serving San Francisco and San Mateo counties. With regard to revised proposal, it is very difficult to determine the exact impact of the plan, since it was announced on May 19th and scheduled to take effect just six weeks later. But the major elements of the plan that are problematic are:

  • Reform is limited to public hospitals – The original plan had elements that would have applied to all hospitals, public and private. The new plan bifurcates public and private safety net hospitals, disconnecting their funding and destabilizing the established sharing of workload between the two groups.
  • No provision for growth – While the plan appears to offer some limited growth in the 2005-06 fiscal year, there is a four-year freeze for the remaining life of the waiver. This is equivalent to a cut given the rising number of uninsured and the rising cost of health care. This is the most serious of the problems with the new proposal.
  • Lack of an identified State match – Private safety net hospitals will be reliant on the State General Fund, which would rely on an annual appropriation.
  • Managed Care requirements – $180 million in funding in the first two years is linked to managed care expansion that could supplant payments to public hospitals. This feature could have significant impact on public and University hospitals in many counties.
  • Inadequacy of CPE based payments – the CPE structure is an inadequate source of non-federal share to fully fund safety net hospital. There are also restrictions on the definition of eligible CPEs that could further reduce FFP.

Commissioners’ Comments

  • Commissioner Chow stated that the last Resolved clause in the proposed resolution would be better placed as a statement in a Whereas clause.
  • Action Taken: The Commission amended the resolution to make the last Resolved clause part of the last Whereas clause.

Action Taken: The Commission approved Resolution 10-05, “Resolution in Opposition to California Medicaid Hospital Financing Waiver Currently Under Negotiations with the Federal Government,” as amended (Attachment B).


Anne Kronenberg, Deputy Director of Health, presented a resolution that would approve a form that would be used to collect information about the number of homeless deaths in San Francisco. Since 1987, homeless advocates have kept count of the individuals who died homeless in San Francisco to honor the life and dignity of each person by name. Counting homeless deaths has never been a precise science because there is no way to track whether individuals who died in the hospital or nursing home had been formerly homeless. Death certificates, which are governed by State law, do not include a classification box that would allow the designation of homeless. Beginning in 1992, DPH worked with the Medical Examiner (ME), the faith community and homeless advocates to review the ME’s records to ascertain how many individuals had died without a fixed address. Subsequently, two laws went into effect that greatly restricted access to health related records. The Health Department is no longer allowed to release copies of the death certificates unless the deceased is known by the requester. In addition, there are severe restrictions on the release of comprehensive death indices to the public.

Supervisor Bevan Dufty convened a committee, with advocates from the faith-based community, the Medical examiner, the City Attorney’s Office and DPH, to explore how the Health Department could most effectively and efficiently resume the Homeless Death Count. The solution was a “Homeless Death Count” form that will be filled out by the institution registering the death, the ME’s office, funeral home or hospital. At the time of registering a death by filing a death certificate with DPH, the registrant will also file the completed Homeless Death Form. Staff will remove the form and file it in a separate file drawer. At the end of the year, all the forms will be in one place, making the count a simple activity. Ms. Kronenberg thanked DPH intern Elise Duryee-Browner, who did research and helped develop the form.

Ms. Kronenberg introduced Amanda Kahn, legislative aide to Supervisor Dufty, who thanked the Health Department for developing the form. It is extremely important to Supervisor Dufty that people who die without a home are recognized, and he is confident that this approach will allow this to happen with minimal impact on Health Department staff and resources.

Commissioners’ Comments

  • Commissioner Guy asked what happens with the information that is collected through the death form. Ms. Kronenberg said that the forms would remain in Health Department files until collected by the advocates at the time of ceremonies honoring and recognizing homeless individuals who have died without a home. Commissioner Guy asked if journalists have access to this information. Ms. Kronenberg said yes, this is public information.
  • Commissioner Illig asked if other cities do this. Ms. Kronenberg replied that other cities do count deaths, but not using this model. States have different requirements in terms of how they count homeless deaths.
  • Commissioner Tarver said that information gleaned from the homeless death forms should be reported annually to the Health Commission. He also urged the use of gender identification categories other than male and female. The commissioners and Dr. Katz agreed with this.
  • Commissioner Chow asked for clarification of the “Circumstances of Death” category. Ms. Kronenberg replied that the faith community, who like to give a profile of the individual who has died, specifically requested this category. This is different from cause of death, which is indicated on the death certificate. The distinction can be explained in the letter that DPH is going to send to the various entities that will fill out the forms. Dr. Katz clarified that the death certificate, including cause of death, is not accessible to the public.

Action Taken: The Commission approved Resolution 09-05, “Resolution Approving The Homeless Death Count Form To Be Filed At The Time Of Registration Of The Death Certificate With Vital Statistics,” (Attachment A).




The meeting was adjourned at 2:55 p.m.
Michele M. Seaton, Executive Secretary to the Health Commission

Attachments: (2)

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.