Minutes of the Health Commission Meeting
Tuesday, October 18, 2005
101 GROVE STREET, ROOM 300
San Francisco, CA 94102
1) CALL TO ORDER
Commissioner Monfredini called the meeting to order 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, MD.
- Commissioner David J. Sanchez, Jr., Ph.D.
- Commissioner John I. Umekubo, M.D.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF OCTOBER
Action Taken: The Commission approved the minutes of the October 4, 2005
Heath Commission meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Illig chaired and Commissioner Chow and Commissioner
Sanchez attended the Budget Committee meeting.
(3.1) PHP-Housing and Urban Health – Request for approval of a contract
renewal with Episcopal Community Services, in the amount of $507,863,
which includes a 12% contingency, to provide supportive housing services
at the Folsom-Dore Apartments, targeting homeless adults, for the period
of September 30, 2005 through June 30, 2007.
(3.2) PHP-Housing and Urban Health – Request for approval of a contract
renewal with Catholic Charities CYO, in the amount of $74,779, which
includes a 12% contingency, to provide case management services
targeting homeless or marginally housed families living with HIV/AIDS
with dependent children and a concurrent substance abuse and/or mental
health diagnosis, for the period of July 1, 2005 through June 30, 2006.
(3.3) PHP-Housing and Urban Health – Request for approval of a new sole
source contract with Plaza Apartment Associates, L.P., in the amount of
$379,617, which includes a 12% contingency, to provide studio apartments
at the Plaza Apartments, targeting homeless adults, for the period of
November 1, 2005 through June 30, 2006. Additionally, this contract
includes eight annual renewal options valued at an average annual amount
of $702,337, for a total nine-year contract of $5,998,314, which
includes a12% contingency, and an end date of June 30, 2014.
- Commissioner Sanchez asked why this is a nine-year contract. Erin
Carlson from the Redevelopment Agency said the tax credit guidelines
require the building to be maintained as a non-profit development for 15
years. The building owner wants to be sure that the partnership is for a
long time, so that he is not penalized for violating the terms of the
- Commissioner Illig asked who owns the building after the tax credit
expires. Ms. Antonetty said the tax credit is set up so that after the
15 years, the building ownership reverts to the non-profit partner.
Commissioner Illig confirmed that the DPH subsidy plus rent paid by
tenants covers the operating costs. Ms. Antonetty said yes.
- Commissioner Chow asked if there is an occupancy limit per unit. Ms.
Antonetty said they have developed criteria around this that largely
mimics the Redevelopment Agency’s criteria. For example, a unit can
house up to two adults and one child under a certain age, or one adult
and an older child, or two adults. Given the fact that most of the
tenants will come from the DPH system, many will be single adults.
- Commissioner Illig said many more of these projects are needed. This
is permanent housing. Ms. Antonetty said that this is a unique
opportunity because the building is brand new. There are other exciting
developments in the works as well.
(3.4) CHPP-Health Promotion – Request for approval of a contract
modification with San Francisco Study Center, Inc., to extend the
funding period to June 30, 2007 and increase the contract in the amount
of $1,817,025, to provide additional fiscal sponsor services for the
Tobacco Free Project Community Capacity Building Training Center, for a
total contract value of $2,729,371, for the period of July 1, 2005
through June 30, 2007.
- Commissioner Illig said the Commission is very concerned about
outcomes, particularly the quit rates. He thanked Ms. Hrushow for
providing this data. Some people think that cessation programs do not
work, but the data shows otherwise.
- Commissioner Chow said these projects clearly make sense, and the
fiscal intermediary has assisted in making these initiatives successful.
Commissioner Chow and Commissioner Illig reiterated that when the
Commission considers a fiscal intermediary contract, staff needs to
provide information and outcomes on the program that the intermediary is
(3.5) CHPP-Community Health Education Section – Request for approval of
a retroactive contract renewal with Youth Leadership Institute, in the
amount of $121,318 for two years, to provide technical assistance and
training services for the YouthPower Project to support the youth-driven
Community Action Teams to reduce substance abuse in their community, for
the period of
October 1, 2005 through September 30, 2007.
- Commissioner Illig asked what the community action teams do. Ms. Ana
Validzic said the teams are made up of high school and middle school
students, and they do a variety of things. For example, last year a
group of students went to liquor stores and were successful in getting
owners to remove liquor posters and put up other, youth-created posters.
The participants receive a youth stipend.
- Commissioner Sanchez said the School District has a peer mentoring
program. He encouraged Ms. Validzic to contact the district to see that
are efforts are consistent and complementary.
- Commissioner Chow said that client satisfaction applies to this
contract, even though the contract summary indicates that it does not.
It is very important that the Commission and the public know that the
participants think highly of the program.
- Commissioner Illig noted that none of the YLI boardmembers live in San
Francisco, and there are no African Americans on the board. He is
particularly concerned about the latter, given that one of the target
neighborhoods is Bayview Hunters Point. He asked the agency
representative to convey this to the Board of Directors.
(3.6) CHPP-Refugee Health – Request for approval of a retroactive
contract renewal with the International Institute of San Francisco (IISF)
in the amount of $251,783 to provide preventive health services,
including outreach, medical interpretation, health education and
referrals to documented refugees immigrants for the period of October 1,
2005 through September 30, 2006.
(3.7) CBHS – Request for approval of a retroactive modification to the
contract with Resource Development Associates, in the amount of
$172,907, for a total contract amount of $408,422, to provide consulting
services to develop the Mental Health Services Act (Proposition 63)
plan, for the period of February 8, 2005 through September 30, 2005.
- Secretary’s note – the contract term is through January 31, 2006, not
September 30, 2005 as noted in the contract summary documents.
(3.8) CBHS – Request for retroactive approval of a contract renewal with
Positive Resource Center, in the amount of $420,000 per year, for a
total contract value of $1,680,000, to provide advocacy and training
services for disabled, uninsured clients, for the period of July 1, 2005
through June 30, 2009.
(3.9) AIDS Office-HIV Health Services – Request for approval of a
retroactive contract renewal with Mission Neighborhood Health Center, in
the amount of $92,027, to provide case management, treatment advocacy
and nutrition counseling services targeting HIV positive Latinos, for
the period of July 1, 2005 through February 28, 2006.
(3.10) CHN-SFGH & LHH – Request for approval of two contract
modifications with On-Call Therapists, Inc. and Preferred Healthcare
Registry, Inc., to increase the shared contract amount by $164,900, from
$232,075 to $396,975, to provide intermittent, as-needed rehabilitation
therapy personnel services (Physical, Occupational and Speech
Therapists) for San Francisco General Hospital and Laguna Honda
Hospital, for the period of February 1, 2005 through January 31, 2007.
(3.11) CHN-Education & Training – Request for approval of a retroactive
contract renewal with HealthStream, Inc., in the amount of $496,250, for
healthcare training courseware for employees and partners of the
Community Health Network, for the period of September 1, 2005 through
August 31, 2009.
- Commissioner Chow asked if the completion of the mandatory training is
reflected in employee evaluations. Riley Surber from San Francisco
General Hospital replied that completion of training is tied to annual
Action Taken: The Commission approved the Budget Committee Consent
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Director of Health, presented the Director’s
FAST TRACK Emergency Exercise
Last Wednesday, October 12, the Department participated with other City
agencies in a terrorist exercise called “FAST TRACK.” The exercise was
designed and planned by the Homeland Security Units of various
departments to test the City’s response to multiple violent incidents
occurring within a short time period. The City’s EOC (Emergency
Operations Center) the DPH DOC (Department Operations Center) and SFGH
Emergency Center were activated and staff were informed of what was
happening in the City. Anne Kronenberg worked closely with the Mayor’s
office at the EOC in helping to coordinate the Department’s role and
The event allowed DPH to test a number of scenarios including large
group injuries and mortalities and communication models between agencies
and within our own Department. DHP also had to address the matter of
Surge Capacity and the need for Mutual Aid, including how to move large
groups of patients to regional partner counties. We continue to learn
from these exercises and expand our responses accordingly.
Infectious Disease Emergencies
The "Infectious Disease Emergencies: A Preparedness and Response Guide
for San Francisco Clinicians" is a tool designed to help with San
Francisco's communicable disease control efforts. The Sentinel Event
Enhanced Passive Surveillance (SEEPS) project developed and published
the Guide to help clinicians prepare for, recognize and respond to
infectious disease emergencies. The Guide describes the roles and
responsibilities of the SFDPH and clinicians during infectious disease
emergencies, outlines which diseases and conditions clinicians should
recognize and report, provides detailed clinical and infection control
information on priority diseases including bioterrorism related
diseases, and provides guidance for getting prepared for general
disasters and infectious disease emergencies. The guide also contains
forms, regulations, and contact numbers.
The infectious disease chapters include Anthrax, Avian Influenza,
Botulism, Brucellosis, Smallpox, Tularemia, Viral Hemorrhagic Fevers,
and Plague. Each chapter includes detailed information on: epidemiology,
clinical Features, differential diagnosis, laboratory diagnosis,
treatment and prophylaxis, environmental testing, and infection control.
Disease chapters will be updated as needed and additional disease
chapters will be added in the future.
The Guide is being distributed to 3,000 San Francisco clinicians
registered with the health alert notification database. This includes
emergency rooms, infection control practitioners, ambulance companies,
jails, family practice doctors, nurse practitioners, disaster workers,
and others. The guide will also be distributed to police, fire, Office
of Emergency Services, and other city agencies as appropriate. The
entire guide is available for download on our website:
Updates and revisions will be posted there as well.
State Medical Cannabis ID Program
In compliance with recent state legislation, the Health Department is
initiating a State Medical Marijuana ID card program beginning November
7th . This statewide card will replace the local DPH card program, which
has been registering medical cannabis patients since 2000. The new card
program will move from 101 Grove to the lobby at San Francisco General
In preparation for the change over, Dr. Joshua Bamberger will be hosting
a Community Forum to discuss the specifics of the new card program. The
meeting is scheduled for October 24th, 6 p.m. in Room 300 here at 101
Grove St. We anticipate a lot of interest among the medical cannabis
community as this new program evolves.
Update on San Francisco Medical Cannabis
This afternoon the Board of Supervisors is considering Supervisor
Mirkarimi’s proposed ordinance to create permanent guidelines for
Medical Cannabis dispensaries. An interim zoning moratorium on clubs or
dispensaries where marijuana is grown, purchased or distributed with a
medical recommendation has been in effect since April 1st.
The ordinance being considered today would require that medical cannabis
dispensaries obtain a permit to operate from DPH. DPH would then copy
and send applications to the Police Department for criminal background
checks on applicants and security inspections, Fire Department for
relevant code compliance and the Planning Department for Planning Code
compliance. After these departments have completed their review and
returned the applications to DPH, a hearing would be required within 45
days to determine whether the permit application complies with City
policy. Applications that meet City standards would be approved at the
DPH would also be responsible for issuing regulations governing the
permitting and operation of dispensaries, and for inspecting
dispensaries at least twice per year, assuring the accuracy of
dispensaries' scales, and issuing fines and suspensions for violations.
If passed, the ordinance would give existing dispensaries 18 months to
obtain a permit.
The Board will also consider a separate bill today that sets a permit
application fee of $6,110 to cover the costs to all City departments of
investigating and processing applications and an annual license fee of
$3100 to cover the cost of annual inspections, enforcement and other
costs to the City.
2005 Public Managerial Excellence Awards
Congratulations to Diana Guevara, Director of Patient Financial
Services, on being selected as a recipient of the 2005 Public Managerial
Excellence Award. MFAC (the Municipal Fiscal Advisory Committee to the
Mayor), the San Francisco Chamber of Commerce, and SPUR will honor Diana
and six other honorees at the 25th anniversary MFAC Awards Luncheon on
Wednesday, December 7th . The awards provide an opportunity to salute
leadership, innovative spirit, achievements and success to outstanding
Flu Season Kicks Off
The Department kicked off flu on October 5th with a media event at the
Adult Immunization Clinic here at 101 Grove St. DPH encouraged seniors
and those at risk to get flu shots early and reminded the public about
the simple prevention techniques all of us can employ to stay healthy
such as hand washing and covering coughs and sneezes. The CDC is
recommending that those most vulnerable to the flu get immunized by
October 24th when the vaccine will be made available to the general
public. At this point, we are unsure how today’s Chiron announcement
about their flu vaccine shortage will affect local supplies. Dr. Katz
will keep the Commissioners informed as we move into flu season and the
demand for vaccine increases.
Sharps Containers at 101 Grove St.
Dr. Katz recently directed the facilities manger of 101 Grove St. to
install safe sharps containers in all restrooms here at 101 Grove St.
The installation of these containers makes it convenient for anyone
visiting or working here to dispose of needles safely and conveniently.
Dr. Katz reported that these boxes are being used and are very much
appreciated by those who must give themselves injections. In keeping
with this Commission’s policy of harm reduction, he will encourage other
facilities to install sharps boxes for safe needle disposal in restrooms
Acting Program Manager for LHH Rebuild
Dr. Katz reported that the Department of Public Works has appointed Don
Condon as Acting Program Manager during the transition period for the
Laguna Honda Hospital Replacement Program. Don replaces Michael Lane who
left earlier this month to accept a position with Kaiser Permanente in
the East Bay.
Two New HIV Health Services Grants
Last week HIV Health Services received notification of two new grants.
The first is a CARE Title III Capacity Development grant to develop an
In-Depth Needs Assessment and Clinical Best Practices Development for
HIV Positive Transgender Individuals. This grant funds a year-long
development process that will result in the creation and implementation
of the nation's first definitive set of clinical best practice
guidelines specifically developed for the care of HIV-positive
transgender populations. The program also includes a training component
for providers in the best practices model.
The other grant is from the Office of Minority Health, Community of
Color Community-based Organization Capacity Building Project to
implement an innovative project designed to enhance, strengthen and
expand the skills, capacity and self-sustainability of people of
color-based HIV/AIDS care and prevention organizations in the San
Francisco-EMA. This three-year long project focused on basic
infrastructure issues includes a user-friendly training model that
incorporates organizational staff at all levels, broad-based,
individualized technical assistance, and the development of a national
- Commissioner Monfredini welcomed Dr. Katz back from Vietnam.
- Commissioner Umekubo commended staff for creating the Sentinel Event
Enhanced Passive Surveillance (SEEPS) guide.
- Commissioner Tarver asked if there would be other disaster trainings.
Dr. Katz said there would be others, and the current goal is one
citywide exercise per month. Dr. Katz will receive debriefing reports
after each event. Commissioner Tarver would like the Health Commission
to hear some of the findings. Commissioner Tarver asked if DPH
contractors are provided with sharps disposal kits or removal resources.
Dr. Katz said he believes that any individual could go to a Walgreen’s
and ask for a DPH sharps bucket, and return the bucket when they are
done. He will see if this is the case for non-profit agencies as well.
Also, a person could call a disposal hotline for assistance with
removal. With the needle exchange program, DPH funds the removal of the
- Commissioner Sanchez said there have been so many disasters over the
past few years. Disaster preparedness drills are critical. He noted that
Judy and Richard Guggenhime wrote an editorial in the San Francisco
Chronicle regarding the importance of air medical access in San
Francisco. This resource is critical to San Francisco.
- Commissioner Guy would like the Population Health and Prevention Joint
Conference Committee to monitor the State cannabis card program. She
asked if the move to a State card is an improvement. Dr. Katz said the
greatest improvement is that the card is valid throughout California.
The downside is that the State has created a system that requires that
part of the documentation be the physician’s letter. In addition, the
name of the client will be included in the record. DPH currently does
not keep patient’s names.
5) UPDATE ON CONTRACT MONITORING RECOMMENDATIONS FROM THE NON-PROFIT
CONTRACTING TASK FORCE
Anne Okubo, Deputy Director of Finance, gave update on the Health
Department’s implementation of the Non-Profit Contracting Task Force
recommendations. The Board of Supervisors created the task force in
2003. The task force was charged with reviewing city contracting
policies and procedures and making recommendations to improve and
streamline contracting processes. DPH is implementing the
recommendations in two phases. Phase one focused on standardization.
Standardized templates for the scope of work, budget and invoices were
developed. Efforts to streamline contracts resulted in the contingency
contract model, which was approved by the Health Commission and piloted
in CBHS last year. The pilot proved to be successful and now the
contingency contract model is used DPH-wide. The Contracts On-Line
(COOL) system was developed as part of Phase one. COOL serves as a
repository of contract documents that is accessible to both contractors
and DPH. Recently DPH offered COOL to the Office of Contract
Administration to implement the Task Force recommendation to increase
automation and reduce redundancy.
Phase two of the implementation is focused on joint monitoring of
contracts, training of department staff and in the future, tiered
assessment of contracts. The recommendation to facilitate electronic
processing of contract payments will occur in Phase two. DPH initiatives
have dovetailed with the task force recommendations. For example, the
integration of CBHS has led to consolidated mental health and substance
Gregg Kats, Controller’s Office, updated the Commission on the work that
has been done to implement the Task Force’s recommendations around
streamlining the contract monitoring process, as well as the
Controller’s Office’s broader efforts to support the City’s non-profit
community. The goal is to ensure the fiscal integrity of the City’s
system of health and human services provided by nonprofit contractors,
and there are three key components:
- Streamline and standardize citywide nonprofit contract monitoring
procedures and policies
- Ensure the finance-related preparedness of nonprofits through training
- Increase the efficiency of the contracting process, and strengthen the
City’s ongoing partnerships with the nonprofit community
Mr. Kats described the work that has been done around contract
monitoring and streamlining, including upgrading systems, improving
access to frequently-requested information, developing standardized
fiscal and compliance monitoring procedures and establishing criteria
and creating process for tiered assessment of contractors, among others.
Next steps include training for nonprofit contractors and DPH staff on
new policies and procedures for standard monitoring, reporting to the
Board of Supervisor’s Government Audit & Oversight Committee, monthly
interdepartmental working group meeting to share monitoring results and
coordinate follow-up and ongoing collaboration with the Non-Profit
Contracting Task Force.
Debbi Lerman and Sandy Mori, representatives of the Non Profit
Contracting Task Force, presented the Task Force’s perspective on the
implementation of the recommendations. Ms. Lerman said the process began
four years ago to address contractor frustration with the contracting
process. The Task Force had equal representation from contractors and
city staff. The Task Force meetings helped develop a mutual
understanding of the problems and developed recommendations. The
institution of the Review/Appellate Panel in January 2005 has helped to
move the recommendations forward. Ms. Mori said the non-profit sector
feels strongly about these recommendations and views this effort as a
real partnership with the city. Ms. Mori acknowledged Ms. Okubo’s
involvement in the Task Force as the DPH representative. Her knowledge
and expertise has been extremely helpful. Ms. Mori said that training—of
city staff and non-profit staff—is critical to success. While they
appreciate the COOL system, it has some limitations and should be made
available to all city departments. The non-profit representatives plan
to request that the Board of Supervisors have quarterly reports, rather
than reports every six months.
- Commissioner Illig was a member of the Task Force. The Task Force
spent many hours making sure that departments, supervisors and the Mayor
were educated in the problems non-profits experience in dealing with the
city. The Health Commission needs to pay attention to the implementation
of the recommendations, and should also be receiving regular reports.
One recommendation that the Budget Committee is going to track is the
recommendation that all contracts are certified before the start date.
The DPH initiatives for 12% contingency and 18-month contracts will help
meet this goal. He wants to make sure that all DPH divisions comply with
these recommendations so that services can continue and providers can be
paid. He emphasized that the Health Commission and the Budget Committee
is focused on outcomes. City departments need to improve coordination by
standardizing forms, monitoring and other things.
- Commissioner Tarver asked if any of these recommendations are going to
be applied to the civil service side of the Department. Commissioner
Illig said that the Budget Committee is going to focus on outcomes of
City programs as well. Commissioner Tarver asked if this process would
allow the Department to better monitor the expenditure of grant funds,
to ensure that money is spent the way it is supposed to be. Ms. Okubo
said that State and Federal grants are part of the audit function, and
through this process they know whether money is spent the way it was
supposed to be spent. Commissioner Tarver asked if outcomes are going to
be standardized. Ms. Okubo said the standardizing program monitoring is
by far the most difficult and is still a work in progress. The
Controller has been working very closely with DPH to standardize program
monitoring, and they are close to developing a format that will focus
heavily on qualitative outcomes. Commissioner Tarver looks forward to
updates on this effort.
- Commissioner Sanchez said that this truly is a change in culture. Many
non-profits have contracts with other entities, for example
philanthropic organizations or state and federal governments, each with
different requirements. In addition, non-profits receive different
levels of technical assistance. So this is a challenge.
- Commissioner Chow was impressed with the June 2003 Task Force report.
The recommendations provide a light at the end of the tunnel. He said
the tiered assessment of contractors should acknowledged size and volume
differences among agencies. The outcomes and client feedback are
critical elements of program review done not only by the Budget
Committee but also by the joint conference committees.
- Commissioner Guy appreciates the leadership around this issue,
including Ms. Okubo, Mr. Sass and Commissioner Illig. Over the next
three months she wants to understand how the Health Commission can
support this transformation. She is interested in what training works
and what does not. Commissioner Guy looks forward to the Budget
Committee’s leadership on this, particularly in helping frame the issues
the joint conference committees should focus on.
- Commissioner Illig asked that every time this issue gets reported to
the Board of Supervisors, there is a report to the Health Commission on
the Health Department’s progress.
6) BLUE RIBBON COMMITTEE ON SAN FRANCISCO GENERAL HOSPITAL’S FUTURE
LOCATION REPORT AND CONSIDERATION OF A RESOLUTION ACCEPTING THE REPORT
Gene O’Connell presented the report from the Blue Ribbon Committee on
San Francisco General Hospital’s Future Location (SFGHBRC). Mayor Newsom
created the SFGHBRC in May 2005 and charged it with making a
recommendation on where SFGH should be rebuilt—on the existing Potrero
Hill campus or at Mission Bay, collocating with UCSF. The committee was
chaired by Dr. Sandra Hernandez and co-chaired by Dr. Mitch Katz. It met
from June to September 2005.
The criteria that was used to assess the locations were:
- Access and Service Issues: this criteria examines the impact of each
location with respect to access to services (ambulatory, inpatient,
specialty and emergency), care coordination and quality of care.
- Cost and Financing Issues: this criteria examines the impact of each
location with respect to the costs (land acquisition, construction and
operating) and financial mechanisms.
- Program Issues: this criteria examines the impact of each location
with respect to faculty retention and recruitment, research facility
needs and future space planning needs of each hospital.
- Neighborhood and Staff Issues: this criteria examines the impact of
each location with respect to potential disruption arising for
construction of a new hospital.
The SFGHBRC’s consensus recommendation is that San Francisco General
Hospital be rebuilt on the existing Potrero Hill campus. This
recommendation is based on better access to services at Potrero, more
coordinated access to service at the Potrero campus, the higher costs of
building at Mission Bay and space limitation at Mission Bay. The SFGHBRC
also made recommendations on future planning, including ascertaining
whether a general obligation bond could be approved, identifying
additional mechanisms for financing the hospital replacement and forming
a planning and/or campaign committee in the immediate future.
Issue for mitigation with a Potrero Location
- Reduce disruption from construction
- Medical helipad
- UCSF/SFGH Relationship, including UC’s acknowledgement that they are
responsible for research and that it is their responsibility to develop
a research facility at San Francisco General Hospital.
Dr. Katz said that this was a very useful planning effort because it
addresses the question about why the two hospitals do not collocate.
This group of experts studied this question and the recommendation is to
rebuild at Potrero, not to collocate. The report fully explains the
rationale for this recommendation. So in terms of the rebuild, decisions
have been made on the size, the scope and now the location. The next
major decision has to do with where on the Potrero Campus. Staff has
looked at a number of possibilities. Building on the north side of the
campus is viable, but it would impact UC’s ability to rebuild the
research facility. The west lawn site is also viable for discussion.
There is a previously approved contract to develop architectural
drawings for a west lawn building. In addition, there will need to be a
broad-based citizen’s committee to help educate San Franciscans about
- Commissioner Chow was a member of the Blue Ribbon Committee. It was an
extraordinary process of bringing together a broad group of people to
discuss this issue. No one on the committee felt stifled. The university
was very frank about its needs, and people greatly appreciated this.
With the frank discussion, the impartial members of the committee—and
those who were wondering why the two institutions could not
collocate—began to understand what was happening. Commissioner Chow is
100 percent behind the recommendation that came out of this process.
Mission Bay is clearly not an option. We need to move forward, and we
need to look at other potential funding sources.
- Commissioner Illig asked if retrofit was considered, rather than a
rebuild. Dr. Katz said SFGH, while built to the seismic safety standards
of the time, does not have any steel in it. The lack of steel makes it
impossible to retrofit. This alternative was reviewed. Commissioner Chow
added that these questions were asked and addressed at the Blue Ribbon
Committee as well. Commissioner Illig asked how we arrived at 267 beds.
Dr. Katz said that this number resulted from three methodologies: an
internal assessment, and external assessment, and average daily census.
It is based on the size we are currently running. Commissioner Illig
said he lives in the neighborhood and would be happy to speak in support
of a helipad at community meetings.
- Commissioner Guy noted that three commissioners live in the
neighborhood. She applauded the committee for its work. She supports the
point around exploring other sources of income in addition to a general
obligation bond. She highlighted the point that UC acknowledged its
partnership with SFGH, not only through the affiliation agreement, but
also in research. The research component needs space, and this must be
incorporated into the design.
- Commissioner Tarver commends the SFGHBRC on this report, and adds his
support for the helipad. It makes him nervous that the city does not
have air medical access. He said he would have been more vociferous if
the decision had been made to separate acute psychiatric beds from the
rest of the acute care hospital. It is critical that these services
remain connected. He asked if there is a possibility that the
psychiatric inpatient unit be incorporated into the new structure. Dr.
Katz gave some background about why the State decided to exclude
psychiatric beds from SB 1953. DPH had decided not to rebuild these
beds. In terms of redesign, adding beds is a question of money. So the
decision was made based on making the rebuild as affordable as possible.
In both design scenarios, there will be some sort of bridge to the
existing hospital. Ms. O’Connell said that they would continue having
acute psych/med unit in the new hospital. PES will be part of the new
building. Commissioner Tarver encouraged rethinking, even at a greater
cost, of integrating hospital psychiatric services. Commissioner Tarver
is concerned about specifying the number of beds in this resolution,
given that there is still planning to be done. He recommended removing
this from the resolution, as well as the statement about psychiatry
wards staying at their current locations.
- Commissioner Monfredini asked Dr. Katz to incorporate Commissioner
Tarver’s concerns into next steps.
- Commissioner Umekubo said the primary concern the medical staff
brought to his attention was that the main reason they wanted to move to
Mission Bay was the availability of and access to research space. Now
that we have UC’s commitment to build research space on the Potrero
site, he would like this to be monitored to see that comes to fruition.
Action Taken: The Health Commission amended the resolution to remove the
fourth whereas clause.
Action Taken: The Health Commission approved Resolution 15-05,
“Accepting the Mayor’s Blue Ribbon Committee on San Francisco General
Hospital’s Future Location’s Recommendation to Rebuild SFGH at its
Current Potrero Avenue Campus,” (Attachment A), as amended.
7) MENTAL HEALTH SERVICES ACT THREE-YEAR PLAN AND CONSIDERATION OF A
RESOLUTION APPROVING THE PLAN
Barbara Garcia, Deputy Director of Health, Director, Community Programs,
presented an overview of the Mental Health Services Act three-year plan.
- To define serious mental illness as a condition deserving priority
- To provide prevention and early intervention services and medical and
- To reduce long term adverse impact of untreated serious mental illness
- To provide consumer-driven, family-focused services
- To expand successful, innovative service programs
The planning process was spearheaded by the Behavioral Health
Innovations Task Force, which was comprised of 42 members appointed by
the Mayor and met seven times in neighborhoods throughout San Francisco.
There were 11 population-based subcommittees, each of which met six
times to address five topics.
Overview of the Draft Plan
- $5.3 million allocated for Community Services and Supports (CCS)
- Approximately $5 million for capital facilities, education and
training, early innovation/prevention and innovative programs.
- 51 percent of CCS funds ($2.3 million) must be used for Full Service
Partnerships. (122-153 individuals and families will be part of the
initial FSP population.)
- 49 percent of CCS funds ($2.2 million) available for use in system
develop and outreach and engagement activities.
- 15 percent of CCS funds ($795,000) allocated to administrative
System Development Activities Prioritized by Task Force
- Children, Youth and Families – funding for community-based violence
and trauma recovery services, integrating psychiatric services within
pediatric settings, increasing capacity to serve LGBT, API, Indigenous,
Latino and African American children, youth and families, and
- Transitional Age Youth – funding to integrate behavioral health
services within primary care settings, for supportive services, for
outreach and engagement services, youth run and youth developed
- Adults – funding for supportive services for housing, vocational
rehabilitation, support for peer-run center and residential treatment.
- Older Adults – funding to support a senior recovery center, supportive
services for housing, and mental health services in primary care
- Belinda Lyon, Executive Director of the Mental Health Association,
said the Mental Health Services Act is about more than additional money.
It is about a true transformation of the system that is client-centered
and recovery-oriented. She thanked DPH, particularly Barbara Garcia, for
bringing such an extensive group of people into the planning process.
The Mental Health Association will submit extensive comments to the
Mental Health Board, but she wants to bring a few issues to the Health
Commission’s attention. First, the language of the executive summary
needs to be restated in the plan. Second, they need to make a plan for
what they would do with additional money.
- Commissioner Monfredini thanked Ms. Garcia for her leadership on this
- Commissioner Illig asked if the $5.3 million allocation is per year,
or over three years. Ms. Garcia said it is per year, for three years.
Commissioner Illig asked why the executive summary was not included in
the plan. Ms. Garcia said the document is a grant application to the
State, so they did not include the statement about underfunding need.
However, San Francisco continues to work with the State on this issue.
Commissioner Illig asked if all the funding would be put out to bid. Ms.
Garcia said that DPH made a commitment to the group that the dollars
would not be allocated automatically to DPH. So 75-80 percent of the
dollars would be put out to bid, and the Health Department would compete
through the bid process. Commissioner Illig was impressed with the
plan’s consumer involvement, focus outcomes and inclusion of vocational
- Commissioner Tarver is very impressed with the report and the
extensive planning process that took place. He is sure that participants
left the meetings feeling enlightened and encouraged. This report
reflects San Francisco’s unique system of care that is culturally
competent. This does not exist in other systems. He appreciates the
focus on the impacts of violence and trauma. Vocational rehabilitation
is an important component of treatment.
- Commissioner Chow commended the public, consumer-oriented process. He
is somewhat concerned that the Asian American population is often silent
in these processes, and he is concerned that they are not highlighted in
this plan. Within a consumer-driven process, this is particularly
exacerbated. He would like the Department to examine how to best serve
the unique mental health needs of this population. DPH has excellent
services, but there is additional need. He supports moving forward with
this plan, but wants to be more proactive in surfacing the needs that
come from the community. Ms. Garcia said that through the RFP process
they would look at underserved communities, including the Asian
community. This was very acknowledged within the task force.
- Commissioner Guy said the process was extensive but also anticipatory
in a preventive way. She acknowledges the disappointment about the State
allocation. $5 million is not going to fund a transformation. She would
like to know how the expenditures, some of which are quite small, are
going to be evaluated. Ms. Garcia said that what is before the
Commission today is an application to the State for the allocation. But
she strongly believes that the Department needs to use the work that was
done to develop a plan for San Francisco that is not constrained by
- Commissioner Sanchez applauded staff and community for the work that
has been accomplished in a limited timeframe.
Action Taken: The Commission amended the fourth whereas clause of the
resolution to read: “Whereas, the community planning process was
informed by more than 75 public meetings, targeted outreach to mental
health consumers, families of consumers, historically unserved
communities, including the Asian Americans, Latinos and Indigenous
Population, and underserved communities, usage analyses and evidence
based practices and policies;”
Action Taken: The Commission approved Resolution 16-05, “Supporting the
City’s Application to the State of California to Fund the Community
Services and Supports Component of the Mental Health Services Act,” as
amended (Attachment B).
8) PUBLIC COMMENT/OTHER BUSINESS
9) CLOSED SESSION
A) Public comments on all matters pertaining to the closed session
B) Vote on whether to hold a closed session
Action Taken: The Commission voted to hold a closed session.
The Commission went into closed session 6:15 p.m. Present in closed
session were Commissioner Monfredini, Commissioner Guy, Commissioner
Chow, Commissioner Illig, Commissioner Sanchez, Commissioner Tarver and
C) Closed session pursuant to Government Code Section 54957 and San
Francisco Administrative Code Section 67.10(b)
PUBLIC EMPLOYEES PERFORMANCE EVALUATION: EXECUTIVE SECRETARY TO THE HEALTH COMMISSION, MICHELE M. SEATON
D) Reconvene in Open Session
The Committee reconvened in open session at 7:15 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 67.12(a).)
Action Taken: The Commission voted not to disclose any or all
discussions held in closed session.
The meeting was adjourned at 7:15 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
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