Minutes of the Health Commission Meeting
Tuesday, May 16, 2006
101 GROVE STREET, ROOM 300
San Francisco, CA 94102
1) CALL TO ORDER
President Monfredini called the meeting to order at 3:15 p.m.
- Commissioner Lee Ann Monfredini, President
- Commissioner James M. Illig, Vice President
- Commissioner Edward A. Chow, M.D.
- Commissioner Roma P. Guy, M.S.W.
- Commissioner Donald E. Tarver, II, M.D.
- Commissioner David J. Sanchez, Jr., Ph.D.
Commissioner John I. Umekubo, M.D.
President Monfredini announced that the Health Commission would hold a
community meeting in September at the Plaza, located at 6th and Howard
Streets. Details of this meeting will be forthcoming.
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF MAY 2,
Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver)
approved the minutes of the May 2, 2006 Health Commission meeting.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Chow chaired and Commissioner Tarver attended the Budget
Committee meeting. Commissioner Sanchez was absent.
Items for Approval
(3.1) CHN/SFGH-Health Information Services – Request for approval of two
contract modifications with the following firms: Mediscript Medical
Transcription and Pacific Medical Transcription, to increase the total
shared contract amount by $115,000, from $551,177 to $666,177, and
extend the term by three months, from June 30, 2006 to September 30,
2006, to provide intermittent, as-needed medical transcription services
for San Francisco General Hospital.
(3.2) DPH-IS – Request for approval of a contract renewal with Dataway,
in the amount of $592,432, which includes a 12% contingency, to provide
information technology support services, for the period of July 1, 2006
through June 30, 2007.
(3.3) CHP-Disease Control – Request for approval of a retroactive
renewal contract with San Francisco Study Center, in the amount of
$592,921, which includes a 12% contingency, to provide fiscal
intermediary services, for the period of August 31, 2005 through August
Items for Discussion and Approval
(3.4) BHS – Request for approval of a contract modification with
ZiaLogic, in the amount of $78,400 for FY 2005/06, with an annual
contract amount of $70,000 for 05/06 and a total contract amount of
$302,400, which includes a 12% contingency, to provide behavioral health
integration consultation services, for the period of June 1, 2004
through June 30, 2007.
- Commissioner Tarver is eager to see the timeline for the 12-step
program of implementation, and asked for an update at a future CHN JCC
meeting. Dr. Gleghorn said last two years have focused on educating
providers about the new paradigm, and the initial project with Zialogic
focused on education around what it means to provide co-occurring
services. Now the effort is moving into an implementation phase.
Commissioner Tarver noted that many front line providers work part-time
and need to be included in trainings and other education efforts.
- Commissioner Chow noted that it is incorrect to assume that because a
contractor does not provide direct services, it does not need to be
culturally competent and comply with the Health Department’s
(3.5) CHN-SFGH – Request for approval of a contract renewal with
Richmond Area Multi-Services, Inc., in the amount of $8,524,624, with an
annual contract amount of $2,131,156, for a total contract amount of
$9,547,579, including a 12% contingency, to provide culturally competent
partial hospitalization and aftercare treatment services, targeting the
community’s mentally impaired population, for the period of July 1, 2006
through June 30, 2010.
(3.6) CHN-SFGH – Request for approval of a contract renewal with
National Medical Health Card, in the amount of $250,000, to provide
third-party administrator services, and $2,300,000 in pass-through
prescription dispensing fees to Rite Aid Corporation and AG Pharmacy,
targeting CHN indigent clients, and a 12% contingency of $306,000, for
the period of July 1, 2006 through June 30, 2007.
- Commissioner Tarver said many patients are part of both CHN and CBHS
and each system has different rules for which pharmacies they can go to.
He asked if there is an opportunity to select a community vendor that
has more overlap with CBHS. Commissioner Tarver also noted that the
formularies for primary care and CBHS are different. Dr. Kotabe said the
two divisions work closely together to try to get the formularies as
similar as possible. Ms. Kotabe said that Rite Aid was the only chain
that was willing to work with the Department for this program. A year
into the program they sent out letters of interest to all pharmacies in
San Francisco. Major chains did not come forward.
- Commissioner Chow said it is hard to imagine that people in Chinatown,
who must go to the Rite Aid on Market Street, would be highly satisfied
with the service. He encouraged Dr. Kotabe to continue the efforts to
expand the 340B program to allow clients to go to more than one
pharmacy. He asked Dr. Kotabe to pursue conversations with the public
health clinics about possibly generating interest among community
pharmacies to participate in the programs.
(3.7) CHN-SFGH – Request for approval of a contract renewal with the
Regents of the University of California, in the amount of $1,176,000,
which includes a 12% contingency, to provide orthotics and prosthetics
for medically indigent adult clients of the Community Health Network,
for the period of July 1, 2006 through June 30, 2009.
(3.8) CHN-Jail Health Services – Request for approval of a contract
renewal with Haight Ashbury Free Clinics, in the amount of $3,476,478,
which includes a 12% contingency, to provide psychiatric and substance
abuse treatment services targeting inmates in the San Francisco County
Jail system, for the period of July 1, 2006 through June 30, 2007.
Secretary’s Note – This item was continued to the next Health Commission
(3.9) DPH – Request for approval of a resolution authorizing the
Department of Public Health, San Francisco General Hospital Medical
Center to accept a gift of funds in the amount of $146,041, in support
of the Mammography Van Program, which provides mammography services to
indigent and under-served women in San Francisco.
(3.10) DPH – Request for approval of a resolution authorizing the
Department of Public Health to accept a monetary gift of $25,000 from
Cellestis, Inc. to increase TB screening capacity at the Public Health
Commissioners’ Comments (at the Health Commission meeting)
- Commissioner Monfredini said that the gift from Avon is wonderful. DPH
needs to commit additional personnel and funds for the mammography van
and the Avon Comprehensive Breast Center.
Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver)
approved the Budget Committee Consent Calendar.
4) DIRECTOR’S REPORT
Mitchell H. Katz, M.D., Health Director, presented the Director’s
Nurse Week was a great success throughout the Department. Nearly 325
staff and guests gathered at the Ritz Carlton for the Dorothy Washington
Nursing Scholarship fundraiser. Since the creation of the scholarship
fund three years ago, more that $37,000 has been awarded to San
Francisco General Hospital staff enrolled in baccalaureate and graduate
Last week, guest lecturer Susan Hohenhause, from Duke University’s
Office of Patient Safety and Quality, spoke to the staff about "A
Practical Approach to Patient Safety," followed by a reception and
awards program in the SFGH cafeteria attended by 350 staff. Dr. William
Schecter received the Friends of Nursing Award; Karen Boyle, RN received
the Daisy Award; Terry Dentoni and Debbie Tam received the O'Connell
Society Award; and the Mildred Crear Award was given to Margaret Moran,
PHN and Yan Oi Wong, PHN.
At Laguna Honda Hospital, the nursing staff selected the theme, “Making
A Difference in the Lives of Our Residents,” to illustrate their
dedication to those who make the hospital their home. LHH honored its
nursing staff with receptions on all three shifts and a Best Practice
Award was presented at each reception to the Unit O7 interdisciplinary
team and nursing staff. In addition, Lynda Johnson, City College of San
Francisco Nursing Program Instructor, gave a lecture for nursing staff
focused on the Making A Difference theme. The events were well attended
by the LHH nursing staff.
West Nile Virus
The West Nile Virus (WNV) season is fast approaching. On May 9th, the
Communicable Disease Control & Prevention Unit distributed the 2006
"West Nile Virus Health Update” to all San Francisco clinicians. The
Health Update provides information about WNV recognition, testing,
reporting, procedures, surveillance activities and information resources
for San Francisco. The Update and additional West Nile Virus information
can be found at www.sfcdcp.org.
DPH will be working once again this year with the PUC, Recreation &
Parks, Public Works and the Department of Environment in eliminating
areas where mosquitoes breed and alerting the public about how to
prevent West Nile Virus. Last year, WNV infected 935 Californians and
claimed the lives of 19. There were no locally acquired cases of WNV in
San Francisco. DPH hopes to continue this tradition during the upcoming
Balboa Teen Health Center 20th Anniversary
The Balboa Teen Health Center is celebrating 20 years of service to San
Francisco’s adolescents on May 18th, with a reception, silent auction
and program beginning at 5 p.m. at Balboa High School, 1000 Cayuga
Avenue. The theme of the celebration is “Lighting the Way to Healthy
The Center has become increasingly committed to advocating for
school-based health services on both a citywide and a statewide level.
Working with the School Health Center’s Association and with funding
from the Kellogg Foundation, nine state associations and community
partners have committed to a five-year project aimed at sustaining and
expanding school-based health care.
Balboa Teen Health Center is the only comprehensive school-based health
center in San Francisco and was the first of its kind to open in
northern California in 1986. The center provides routine medical care,
mental health and substance abuse counseling, and health education
services to all Balboa High School students at no cost to the student or
family. Clients are 95% youth of color, 22% are English language
learners and 61% qualify for free or reduced lunches. Last year, 70% of
Balboa’s student body visited the center for services.
Dr. Katz hopes the Commissioners will be able to join representatives
from the Department of Public Health, the Unified School District,
Bayview Hunter’s Point Foundation, San Francisco Public Health
Foundation and many supporters from the community for this wonderful
Juvenile Justice Pilot Project
The Department used the occasion of Mental Health Awareness day on May
8th to focus attention on a new mental health program for youth and
their families who have become involved the juvenile justice system.
Called the “Multisystemic Therapy (MST) Pilot Project,” the program is
an intensive, home-based mental health treatment program that seeks to
keep juvenile justice youth with their families. The first group of
youth has successfully graduated from this new partnership that the
Department manages with the Juvenile Probation Department. A press
conference highlighted the success of the program and featured a family
who participated in the program.
Network of Care.org Launch
The Mental Health Association of San Francisco co-sponsored a kick off
event today with staff from Community Behavioral Health services for the
new www.networkofcare.org website. This latest addition to the growing
number of web-based resources is an interactive, single information
place where individuals, professionals and anyone concerned about mental
health can go to easily access a wide range of information about mental
health. The website features a special San Francisco resource directory
and is designed to be accessible to everyone, regardless of literacy
level, disability or language.
Community Health Network, San Francisco General Hospital Credentials
Report, May 2006
||07/05 to 05/06
Changes in Privileges
|Current Statistics – as of 05/1/06
Affiliate Professionals (non-physicians)
Applications In Process
Applications Withdrawn Month of May 2006
2 (07/05 to 05/06)
SFGH Reappointments in Process June 2006 to Sept 2006
- Commissioner Illig asked how the Balboa Teen Clinic is funded. Dr.
Katz said it is funded by DPH, though not exclusively. The clinic bills
Medi-Cal to the extent that patients are eligible. This is the only
school-based clinic in San Francisco that provides comprehensive
- Commissioner Chow noted that 70 percent of the school population has
visited the clinic. Commissioner Chow asked where the conversation
should take place about establishing similar clinics at other school
sites. Dr. Katz said the Commission has adopted a policy to establish
more school-based clinics. The challenge is funding, since they would
largely be funded through the general fund.
- Commissioner Guy said that the Health Commission supports wellness
centers at school sites, rather than full-fledged clinics. There was
testimony at the Richmond Health Commission meeting about the lack of
school-based services in the Richmond and as a follow up to that it was
discovered that Washington High School made the decision to close its
center. Other schools are seeking wellness centers. The PHP JCC
continues to discuss this issue.
- Commissioner Illig said that St. Mary’s discontinued its medical van
that went to the Catholic high schools because they found that medical
services could not be provided without parental consent.
- Commissioner Chow wants to continue to pursue how to best serve the
youth of the Richmond.
5) PRESENTATION OF THE ANNUAL EMS AWARDS
presented the Annual EMS Awards.
EMS Field Provider Award:
Mary Roan, EMT-1, AMR
Marla Dukes, ECD
Peter Emblad, M.D., Kaiser, Presidio F.D.
Megan Corry, EMT-P, Community College
Ray Lim Excellence In EMS Award:
James Green, San Francisco Fire Department, EMT-P
6) REPORT ON CHRONIC CONDITIONS OF CALIFORNIANS-SUMMARY OF FINDINGS
RELATED TO SAN FRANCISCO
Frances Culp, Health Planner, Office of Policy and Planning, presented
the findings of a report on the chronic conditions of Californians, as
these findings relate to San Francisco. The report was done by the UCLA
Center for Health Policy Research and was titled Chronic Conditions of
Californians—Findings from the 2003 California Health Interview Survey.
The report focuses on chronic diseases that respond well to medical
treatment and management, allowing localities to understand the burden
of specific medical conditions, including heart disease (HD),
hypertension, asthma and diabetes, in their area to inform planning for
proper interventions. In addition, the report reviews a variety of
characteristics of the individuals with chronic conditions, including
race/ethnicity, low-income and Medi-Cal participation.
This summary highlights data presented in the report for San Francisco
and how local findings relate to the state average. In 2003 in
- 1,763,000 adults reported a diagnosis of HD, with 42,000 of these
individuals in San Francisco;
- 6,012,000 adults reported hypertension, with 144,000 in San Francisco;
- 1,678,000 adults reported diabetes, with 42,000 in San Francisco;
- 3,020,446 adults reported asthma, with 69,000 in San Francisco; and
- 1,326,000 children under 18 reported asthma, with 16,000 in San
Ms. Culp presented data on race, ethnicity and socioeconomic status for
In general, San Francisco fares better than the State average for
residents reporting chronic conditions and access difficulties. A
smaller percentage of San Franciscans describe their health as fair or
poor—17.2% in San Francisco compared to 20.5% statewide. Of concern,
however, are data related to the races and ethnicities in San Francisco
reporting chronic conditions more frequently than the State average.
This includes 50% of African American adults diagnosed with
hypertension, 16% of Latino adults diagnosed with asthma and 10% of
Asians reporting a diagnosis of diabetes.
DPH has a number of initiatives that aim to alleviate the burden caused
by chronic conditions on a local level:
- SFGH’s 100,000 Lives Campaign; one of the three interventions is to
deliver reliable evidence-based care to prevent deaths from heart
- Partnering with CBOs to encourage physical activities;
- Statewide collaboration to improve diabetes care;
- Chronic Care Learning Collaborative, which included the Ocean Park
Clinic, improved care for patients with diabetes by adopting a chronic
care model to keep patients healthier and more engaged in managing their
- Mobile Eye Van; and
- Asthma Task Force and Pediatric Asthma Clinic
- Commissioner Monfredini said that the Health Department has invested
in prevention and chronic disease management and hopefully the next
survey results reflect these efforts. Commissioner Monfredini asked if
early diagnosis could prevent a condition from becoming chronic.
Commissioner Chow said that various manifestations of a disease like
diabetes could be prevented. And lifestyle is a key component a managing
chronic diseases. Commissioner Tarver said prevention could offset a
person having a diagnosis or chronic disease progression.
- Commissioner Illig asked if the California State Interview Survey (CHIS)
included HIV in its survey. Ms. Culp said that she is almost certain
that the survey included HIV, but it was not part of UCLA’s report that
highlighted a few of the diseases. DPH and the State consider HIV a
- Commissioner Chow confirmed that the survey is all adults, except for
the asthma data, and self-reported. He noted that the report shows that
in San Francisco, 10.2% of Asian Americans have diabetes. Commissioner
Chow is curious that CHIS data shows that San Francisco has less chronic
disease than the State in general. It is hard to believe that San
Franciscans are healthier, given the city’s aging population. Dr. Katz
said that San Francisco has a much better public and private health care
system than other counties. In addition, although San Francisco has
pockets of extreme poverty, San Franciscan’s median socioeconomic status
is quite high, and socio-economic status is related to health outcomes.
In addition, San Francisco has a different ethnic composition. Any or
all of these factors could contribute to San Francisco’s lower level of
- Commissioner Guy said that if we were to use these highlights to guide
our investments, one key area is asthma. Also, DPH has models in place,
for example the chronic care initiative at Ocean Park. We need to
dissect the impacts of this model and apply to other clinics or to other
diseases. It is also important to look at environmental impacts on
chronic diseases. With regard to hypertension, there are a lot of best
practices for managing this disease. A lot of our primary prevention
could be targeted toward hypertension. The report is a good beginning,
and there is a lot more prevention work that could be done.
- Commissioner Chow said diabetes is becoming a growing problem in the
Chinese community, not just in the United States but also in China. Data
from Hawaii shows that 12% of Japanese have diabetes. The issue of
diabetes in the Asian community is important.
- Commissioner Tarver noted that there are limitations to any survey.
DPH should have statistics about depression and psychosis in its BIS
system. He would like to see the top diagnoses in the CBHS clinics, what
is changing and how we should target our resources. African American
health disparities continue to be despairing in their persistence, and
Commissioner Tarver asked what the Department is doing to target this
declining population. What health resources are in place in the Western
Addition, Bayview Hunters Point, South of Market, and what are the best
practices for serving this population? Ms. Culp will follow up on what
data is available.
Secretary’s Note - Commissioner Illig recognized the participants in the
Mental Health Association’s “Training for Advocacy, Skills, Connections”
program. As part of the training, individuals attended the Health
Commission meeting to observe the Health Commission.
7) CONSIDERATION OF A RESOLUTION REGARDING HRSA/CARE ACT TRANSITIONAL
Margot Antonetty, Director of Programs, Housing and Urban Health,
presented a resolution opposing Health Resources and Services
Administration’s (HRSA) CARE Act transitional housing policy. On March
29th HRSA issued a notices stating that eligibility for short-term and
emergency housing assistance using Ryan White CARE Act funds would be
limited to 24 months beginning in March 2007. Many CARE Act clients
served in transitional housing in San Francisco would be chronically
homeless without these services, and their health status would quickly
deteriorate resulting in increased health care costs as emergency room
visits and hospitalizations increase. This policy would severely impact
DPH’s ability to transition clients into permanent housing, and would
eliminate the City’s flexibility to extend eligibility for transitions
housing in cases or severe need.
Ms. Antonetty said that the Department is asking HRSA to develop a
length of stay policy that gives EMAs flexibility based on the
population being served and system capacity.
- Commissioner Guy asked what the average length of stay is for San
Francisco CARE Act transitional clients. Ms. Antonetty said there are
people in rental subsidies for many years. Ms. Antonetty said that when
the system was created, people in transitional housing left because they
needed a higher level of care or they died. Now people are living longer
but still need supportive housing. Commissioner Guy asked what the
consequences would be if the policy is imposed. Ms. Antonetty said that
400-500 people are on CARE funded subsidy. DPH only places 40 people per
year on all programs, which indicates that more than 400 people have
been on their subsidy for longer than two years. To force people out of
subsidies is bad policy.
- Commissioner Tarver said HRSA’s policy would adversely impact the
people who already have subsidies. SSI provides too little money to
afford living situations. That said, things have changed and San
Francisco should be creative and reform itself before the federal
government reforms for us. In addition, with such a large waiting list,
perhaps there should be more movement into and out of transitional
housing. Employment training, educational opportunities and other
programs should be beefed up to help people move off of subsidies and be
further rehabilitated. Ms. Antonnetty said that Catholic Charities has a
pilot program that incorporates a focus on returning to work.
Action Taken: The Commission (Chow, Guy, Illig, Monfredini, Tarver)
approved Resolution 10-06, “Opposing the Health Resources and Services
Administration Policy that Restricts Transitional Housing Funded Under
the Ryan White CARE Act to 24 Months,” (Attachment A).
8) PUBLIC COMMENT/OTHER BUSINESS
- Laura Lucia Leale, Alliance for Lupus Research, (taken before the
Director’s Report), said the organization, founded by Robert Wood
Johnson IV, has the mission to find a cure for lupus. They are based in
New York but will be having a major grass roots event in San Francisco
in November—The Walk for a Cure for Lupus. They are sponsoring a series
of free events leading up to the walk. They are largest private funder
of lupus research. They have committed $35 million to lupus research and
are committed to advocacy to put this on the national radar screen.
- Michael Wise, Southeast Mission Geriatric Services, said approximately
one third of their clients are Spanish speaking and they do not have
enough Spanish-speaking staff. They also need a working computer to
access client information from the Department’s system.
- C.W. Johnson said he has just been diagnosed with Type II diabetes. He
is finding that only some places take Medi-Cal. There are only three or
four places people with Medi-Cal can go for medications. He would like
to see Medi-Cal reform to increase access.
The meeting was adjourned at 5:35 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 noted in the minutes of the next
Any written summaries of 150 words or less that are provided by persons
who spoke at public comment are attached. The written summaries are
prepared by members of the public, the opinions and representations are
those of the author, and the City does not represent or warrant the
correctness of any factual representations and is not responsible for