Minutes of the Health Commission Meeting
Tuesday, September 19, 2006
ALEX PITCHER JR. COMMUNITY ROOM
SOUTHEAST COMMUNITY FACILITY
1800 Oakdale Avenue
San Francisco, CA 94124
1) CALL TO ORDER
Commissioner Monfredini called the meeting to order at 3:15 p.m.
- Lee Ann Monfredini, President
- James M. Illig, Vice President
- Edward A. Chow, M.D.
- Roma P. Guy, M.S.W.
- David J. Sanchez, Jr., Ph.D.
- Donald E. Tarver, II, M.D.
- John I. Umekubo, M.D.
Commissioner Monfredini welcomed everyone to the meeting and said the
Health Commission was honored to be in the Bayview at the Southeast
Community Facility. She acknowledged Dr. Harrison Parker, former Health
Commissioner and current member of the Southeast Community Facility
Commission, who was in the audience. Commissioner Monfredini said the
Health Commission and the Department of Public Health clearly understand
that violence in the community impacts the health of the community, and
that both the response to violence and violence prevention fall within
the purview of the Health Department. The Health Commission welcomes all
2) APPROVAL OF THE MINUTES OF THE HEALTH COMMISSION MEETING OF SEPTEMBER
Action Taken: The Commission approved the minutes of the September 12,
2006 Health Commission meeting with two corrections. Commissioner
Umekubo’s comments on the primary care report should say 20,000
patients, rather than 2,000 patients could be added to the system. The
Credentials Report will be revised to include the accurate year-to-date
count for proctorships completed.
3) APPROVAL OF THE CONSENT CALENDAR OF THE BUDGET COMMITTEE
Commissioner Sanchez chaired and Commissioner Tarver attended the Budget
Committee meeting. The Budget Committee requested that Items 3.1, 3.2
and 3.3 be moved from the Approval section of the agenda to the
Discussion and Approval section.
Items for Discussion and Approval
(3.1) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive
renewal contract with PHFE Management Solutions, in the amount of
$174,211, which includes a 12% contingency, to provide Fiscal
Intermediary Support for the Post Marketing Surveillance, Condom
Availability Program and IDU Risk Assessment & Outreach services, for
the period of July 1, 2006 through
December 31, 2006.
(3.2) AIDS OFFICE-HIV Prevention – Request for approval of a retroactive
renewal contract with PHFE Management Solutions, in the amount of
$96,554, which includes a 12% contingency, to provide Fiscal
Intermediary Support for the SFGH HIV Testing Evaluation, Condom
Availability Program, and Information Systems Administration for CTL
services, for the period of July 1, 2006 through June 30, 2007.
- Commissioner Sanchez asked if the fiscal intermediary contracts were
put out to bid. Tracey Packer, AIDS Office, said they were put out to
bid. Commissioner Sanchez asked this because PHFE Management Solutions
is located in City of Industry, and he likes to see local businesses
have the chance to bid on services. Commissioner Sanchez asked if
demographic data is available. Ms. Packer said they have data for the
Condom Availability program, and could provide a larger presentation,
perhaps at a Joint Conference Committee, with additional data.
Commissioner Sanchez wants to be able to track if the programs are
making a difference over time.
- Commissioner Tarver said he would appreciate more detailed program
information in future monitoring reports.
(3.3) AIDS OFFICE-HIV Health Services – Request for approval of a
retroactive renewal contract with Native American AIDS Project, in the
amount of $168,000, which includes a 12% contingency, to provide case
management and peer advocacy services to native Americans diagnosed with
HIV or AIDS, for the period of July 1, 2006 through December 31, 2007.
- Commissioner Tarver asked if this contract could be a four-year
contract, rather than a one-year contract. Ms. Long replied that the
AIDS Office drafted criteria for multi-year contracts and submitted this
to the Finance office for review. Ms. Okubo, Deputy Finance Director,
said that the Budget Committee would be discussing the multi-year
criteria for all divisions at its next monthly meeting.
(3.4) PHP-Housing and Urban Health – Request for approval of a
retroactive multi-year renewal contract with Richmond Area Multi
Services, in the amount of $5,433,389, which includes a 12% contingency,
to provide permanent supportive housing services in a residential care
environment at the Broderick Street Adult Residential Program, targeting
homeless adults, for the period of July 1, 2006 through June 30, 2010.
- Commissioner Tarver applauded the Broderick Street facility. He would
like to highlight this program to see how DPH could replicate these
services. Ms. Antonetty replied that Housing and Urban Health is in
conversation with another agency to help them acquire a 50-60 bed
facility that would be a similar model.
(3.5) AIDS OFFICE-HIV Prevention – Request for approval of a new
contract with Institute for Community Health Outreach, in the amount of
$133,560, which includes a 12% contingency, to provide HIV prevention
services – Health Education and Risk Reduction Services for Youth – to
behavioral risk populations in San Francisco, for the period of August
1, 2006 through
December 31, 2007.
- Commissioner Tarver would like to see, for the next contract
monitoring cycle, more than two contract objectives. This provides the
opportunity to fully capture the impact of the agency’s work.
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
MFAC Awarded to Sue Currin, RN
Dr. Katz announced that Sue Currin, RN, Chief Nursing Officer for San
Francisco General Hospital, has been named as a recipient of this year’s
Municipal Fiscal Advisory Committee, (MFAC) 2006 Public Managerial
Excellence Award. The MFAC Public Managerial Excellence Awards are
dedicated to recognizing outstanding leadership, creativity, and
managerial excellence in San Francisco government. Over the last 25
years, more than 100 City employees have been commended for their
innovation, imagination and dedication to public service.
Sue was nominated for two key issues that she addressed this past year:
the high patient census and the national nursing shortage. Ms. Currin
developed nursing recruitment and retention strategies that helped to
decrease nursing vacancies from 24% to 8 %. She also instituted the CA
State AB394—the Nursing to Patient staffing ratios, which allowed for a
significant decrease in the use of costly overtime and outside agency
nurses, as well as increased consistent quality of care. Also under Ms.
Currin’s leadership, the Bed Utilization Committee and discharge rounds
increased patient flow, resulting in a 20% decrease in diversion and a
decrease in decertified bed days.
Other innovations Ms. Currin introduced included implementation of a
Patient Discharge Lounge; grant funding for professional nurse
management development; a baby-friendly program that has resulted in a
55% increase in breast fed babies; expansion of the Integrated Soft
Tissue Infection Clinic; creation of a Medical-Behavioral Unit;
implementation of the Clinical Institute Withdrawal Assessment for
Alcohol Protocol; development of a business plan in collaboration with
Orthopedic Services; and development of a plan to create a short-stay
unit for cardiac patients to decompress the Emergency Department. I know
the Commissioners join me in extending our sincere congratulations to
Ms. Currin for recognition of her outstanding managerial skills and for
her deep and personal commitment to the patients at San Francisco
General Hospital. She will receive her award on October 24th at the St.
Elizabeth Gray – New Long-Term Care Director
Dr. Katz announced that Liz Gray has accepted the job of Long Term Care
Director. The Commission will remember that the 2005 Health Management
Associates Report recommended the creation of this new position. Ms.
Gray will be responsible for the research, analysis and development of
LTC options to strengthen the continuum of care within DPH. She will
also supervise the Targeted Case Management program that is responsible
for identifying persons at Laguna Honda Hospital or at risk of entering
LHH who wish to receive community-based LTC services as an alternative
to institutional services. Dr. Katz and the Commission joins welcome Liz
to her new role in the Department.
New California Department of Public Health
Governor Arnold Schwarzenegger has signed SB162 establishing a new
California Department of Public Health (CDPH) within the existing Health
and Human Services Agency and statutorily transfers some responsibility
from the California Department of Health Services (CDHS) to the new CDPH
beginning July 1, 2007. At the same time, the Department of Health
Services (DHS) is being renamed as the Department of Health Care
Services (DHCS). The Governor will appoint a State Public Health
Officer, who must be a licensed physician or surgeon, to head the new
CDPH as well as two chief deputy directors.
It is hoped that the creation of the new California Department of Public
Health will result in:
- Focused leadership in public health and health care financing at the
- A more effective public health infrastructure in California, resulting
in decreased illness, injury and death rates;
- Protection for California residents in the event of an act of
bioterrorism or other major public health emergency; and
- Increase accountability and improve program effectiveness for the
public health and health care purchasing functions of state government.
National HRSA Award
Congratulations to Michelle Long who was the recipient of the “Hank”
Carde award at this year’s HRSA conference in Washington, DC. Michelle
was recognized for her dedicated service as the San Francisco EMA
grantee and her outstanding leadership in adapting the service system to
the needs of a changing epidemic. Michelle has worked in HIV/AIDS since
1991. The award is named after Freeland Henry “Hank” Carde III, a
retired US Navy officer and twice awarded bronze star combat veteran of
the Vietnam War, who was considered one of Washington D.C.’s most
effective AIDS activists.
Bronze Key Award
Dr. Katz reported that Jim Stillwell, CBHS Designated County Alcohol and
Drug Administrator, has been awarded the 2006 Bronze Key Award by the
National Council on Alcoholism and other Drug Additions-Bay Area
(NCADA-BA). The Bronze Key Award is presented to a member of the
community who has made significant contributions to the field of
alcoholism. Mr. Stillwell will receive his award on November 30th at the
NCADA-BA annual fundraiser and silent auction. Congratulations to Jim
for this well-deserved recognition.
6th Street Multi-Service Resource Center
Earlier this month, in conjunction with Supervisor Chris Daly’s office,
CBHS conducted two community forums to discuss the development of a 6th
Street Multi-Service Resource Center. Center services will be targeted
to persons frequenting the 6th St. corridor who need resources for
housing, mental health and substance abuse services. Over 85 people
attended the forums and offered input on the types of services they
would like to see at the Center.
- Commissioner Monfredini thanked Ms. Gray for accepting the Long-Term
Care Director position, and congratulated Sue Currin, Michelle Long and
Jim Stillwell for their awards.
- Commissioner Chow said that for the past several months, Liz Gray has
taken exceptional control over the TCM program and has made it much more
successful. This bodes well for her new responsibility. Her work is much
- Commissioner Guy appreciates that the report publicly recognizes so
many of DPH’s great staff. She thanked Ms. Gray for taking on the
challenge of moving the Department forward in long term care. Regarding
the new California Department of Public Health, Commissioner Guy is
interested in having future discussions about what the local impact will
be. Is this a true change or just a bureaucratic change?
- Commissioner Sanchez appreciates the recognition of our wonderful
- Commissioner Umekubo thanked the community for welcoming the
Commission to the Southeast Community Facility. He congratulated all the
DPH employees that were recognized in the Director’s Report.
- Commissioner Tarver recently attended a Google fundraiser for the
Trauma Recovery Center, which is a great example of a public private
partnership. Commissioner Tarver thanked Assemblymember Leno for his
leadership in having the State provide funding for this critical
5) BAYVIEW HEALTH ACTION PLAN
Mitchell H. Katz, M.D., Director of Health, presented a report on
improving the health of Bayview Hunters Point residents. This report
looks at chronic disease and disparities in Bayview Hunters Point and
includes recommendations for further action aimed at improving both
health outcomes and health access in the neighborhood. Currently in
Bayview Hunters Point, DPH funds Southeast Health Center primary care
clinic, 25 substance abuse programs, 22 mental health program and nine
HIV/AIDS services-providers. Through community-based primary care
centers and care provided at San Francisco General Hospital, the
Department serves an average of 12,800 patients from Bayview Hunters
Point annually, with an average of over 31,900 visits each year.
BVHP experiences a disproportionate number of social determinants with
adverse effects on health: crime and violence; environmental injustice;
limited high-quality employment opportunities; fewer resources for
nutritious foods; fewer opportunities for recreation; lack of culturally
competent providers; and barriers to access to health care. BVHP’s
disproportionate exposure to the negative social determinants results in
negative health outcomes and health disparities, including:
- Lower life expectancy
- Greater rates of violent injuries
- Higher rates of hospitalization for chronic diseases including heart
disease and asthma
- High rates of mortality from cancer
- Higher infant mortality
Dr. Katz presented an overview of the health issues in several key
areas, including Environmental Health, Behavioral Health, Diet and
Physical Activity, HIV/AIDS, Cancer, STDs, Maternal Child Health and
Injury Prevention. For each of these areas, Dr. Katz detailed DPH
activities to improve outcomes. Dr. Katz then presented recommendations
for further work.
Recommendations for Further Work
- General Health Care
- Increase chronic care models to provide better care for diabetics,
asthmatics and other chronic illnesses
- Increase availability of specialty care
- Environmental Health
- Identify key health assets in BVHP to be prioritized in the Bayview
- Ensure sufficient resources for the Green Business Program to conduct
outreach and training
- Use noise and air monitoring to ensure transportation and land use
planning for future development
- Develop more open space and recreational opportunities in BVHP.
- Create asthma information website
- Fund mold remediation workshops
- Cluster asthma care days to utilize mobile spirometry and education
- Tobacco Use and Related Issues
- CCSF should adopt policies that protect residents from second-hand
- Behavioral Health
- Fund additional culturally appropriate behavioral health clinicians
- Fund wraparound services for those not meeting Medi-Cal criteria
- Extend mental health service hours and create a drop-in clinic
- Diet and Physical Activity
- Disincentives to retailers selling unhealthy foods
- Revitalize the Bayview Farmers market and possibly change location
- Design public image and pride campaign
- Develop positive social networks to reduce isolation and depression
- Fund education efforts for medical providers to routinely screen
sexually active youth
- Seek funding to provide increased staffing to conduct STD screening 24
hours a day in jail health programs
Dr. Katz concluded his presentation by saying the disparities in BVHP
need to be addressed in a comprehensive strategic manner and DPH needs
to work with the community to prioritize recommendations for expanded
- Jacob Moody, Bayview Hunters Point Foundation, illustrated the need
for more coordinated leadership and efforts with two examples of city
departments not aware of each others activities. There must be broader
conversations that coordinate efforts. Good intentions expressed by
others towards Bayview Hunters Point need to be harnessed. There are a
number of missed opportunities. There are resources in the community
that when seen as assets can change the quality of life of people living
in the community. Coordination must happen at the highest level, and
solutions must not be imposed on the community.
- Cathy Davis, Bayview Hunters Point Senior Services, said seniors are
missing from the report. There are a lot of aging seniors in the
community, and they need to be considered in planning efforts. There are
not a lot of programs that are geared toward and allow seniors to stay
in the community. Seniors are leaving because facilities and services
are not available. Please add the services that allow seniors to age in
place to DPH’s scope.
- Perry Lang, Black Coalition on AIDS, said that BCA provides HIV
services to men and women, straight and gay alike. The initial report
stated that BCA only provided HIV services to men. We need to engage
directors and board members of agencies involved in this work in this
dialogue. This is not happening. He also urged the establishment of a
Health Support Center. There needs to be a larger conversation with the
people who do the work and do the research to develop the
recommendations for dealing with chronic health conditions.
- Jesse Tello said that Bayview needs a lot of help. There needs to be
more outreach for these kinds of meetings. He is proud to be in this
neighborhood. Many of the problems are caused by people not from this
community. The police have cleaned out a lot of the drug dealers, but
they still gather on Newhall and Kirkwood. He wants more police
surveillance. Sports are needed in the community. The Mayor’s Office and
the Recreation and Park Department need to increase sports
- Daisy Anarchy, Sex Workers Organized for Labor, Human and Civil
Rights, said her organization fights for the rights of all sex industry
workers. They have worked with DPH staff over the years, and have
established a good working relationship. However, they have been
unsuccessful in attempts to meet with Jeffrey Klausner, and would like
assistance in making this happen. The St. James Infirmary and SWOP have
been lobbying against legislation that will protect sex workers. It’s
totally inappropriate for DPH and Dr. Klausner to be working with St.
James Infirmary and SWOP against this legislation.
- Marilyn Metz, M.D., Arthur H. Coleman Medical Center, informed the
Commission and the community that the Arthur H. Coleman Medical Center
is working towards developing a non profit that would allow them to
expand the types of services they offer. Most of the preventable and
chronic diseases that they deal with are lifestyle related, and as such
they have found a need for support groups, classes, workshops and other
forums where patients can receive health information. One-on-one medical
visits are not the place where people can get this kind of information.
They have been in discussion with Mark Ghaly at Southeast Health Center
about forming a public/private partnership. They have been sponsored by
the San Francisco Foundation.
- Dr. Harrison Parker, Southeast Community Facility Commission and
former Health Commissioner, said that over the past five years, San
Francisco has lost 25 percent of its African American population, 10
percent of the Latino population and 5 percent of its overall
population. What impact has this had on health disparities in Bayview
Hunter’s Point. DPH has been increasing the amount of funding targeted
toward Bayview Hunter’s Point. What impact has this had on health
disparities? The community needs to know what they are getting. When
environmental health determinants are reduced, the population’s health
will improve. He offered a number of suggestions: create a policy to
prorate available community health program funds according to health
disparities; create a policy to incrementally increase primary health
prevention funds from two percent to 10 percent to reduce the onset of
disease and disability; to plan proactively and set goals for health
disparity reductions; and, as the San Francisco safety net, to advocate
to the Board of Supervisors the right to certify all identifiable health
determinants and health disparities in the City and County of San
- Ahimsa Porter Sumchai, M.D., has submitted corrections to the report
via e-mail. For example the incidence of homicide in Bayview has not
declined. One area where DPH needs to be proactive is in the area of
environmental impact reports. There have been a number of large projects
that would have large health impacts, and the Health Department has to
take a larger role. The Department also has to take a larger role in the
area of lead and air quality.
- Abner Boles, Ph.D., Executive Director, Westside Community Services,
said it is imperative that the commission reidentifies violence and
violence response as a public health issue. As part of this there needs
to be identified recommendations and funds carved out for these
programs. It is no longer tolerable and must be made the dynamic public
health issue that must be responded to.
- Javarre Wilson, graduate student in the San Francisco State MPH
Program, is disturbed by the disparities that are identified in the
report. He is equally disturbed about the violence. He lives in Oakland,
where the murder rate has surpassed that of last year. The leaders there
say that the only response is more police officers on the streets. He
disagrees that there is no effective way to deal with the violence in
Bayview Hunters Point. The Health Department should work with other City
departments to provide jobs, education, role models and other efforts.
The Health Department should be more proactive in working with the
residents and leaders in the community.
- Betty McGee, Executive Director, HERC, said HERC is the expert in
pediatric asthma and women’s health. Next year their contract will be
put out to bid. They want to be able to continue providing the services
they do now. With the funds they get from DPH, HERC was able to go into
the homes clean up mold. To date they have done more than 100 homes.
Through another grant they are leaving clean air machines in those
homes. They would like to expand services to address childhood obesity.
They have had requests from childcare facilities to do asthma training.
- Karen Pierce, director of the HEAP Program, offered to take
commissioners on a “toxic tour,” which looks at the condition of the
neighborhood from the perspective of public health and environmental
- Ena Aguirre said there are a number of forums that would be useful in
disseminating information about community meetings. She offered to help
the Health Commission for future meetings.
- Commissioner Monfredini said that each of the commissioners is willing
to meet with anyone from the community to learn more about what we can
do to increase input in Health Department activities and
recommendations. Commissioner Monfredini said she would like the Health
Commission to come back to the community in the next year, perhaps at a
more convenient meeting time.
- Commissioner Tarver welcomes the invitation to come back to the
community. This is essential because it is the Health Department’s
responsibility to address health disparities, and the Department and
Commission’s responsibility to be accountable to the community. DPH
needs to be reorganized to be more integrated. Many organizations do not
work together and could pool resources to be more flexible and
coordinated. There needs to be a point person who is solely responsible
for tracking health disparities, the Department’s efforts and outcomes.
We need to uncover the primary causes of people’s behavioral health
issues and primary health issues. The Department needs to reexamine how
it connects with people about what their health needs are. Programs need
to be targeted toward and welcoming to African Americans in order for
them to feel like they are being served. He also commented on the loss
of African American administrators within DPH. Recruitment efforts need
to focus on this. Housing is a health issue and as housing is improved,
health outcomes will improve. We need to think about families, as well
as individuals. He views the data outlined in the report as a crisis.
DPH can respond to this, but we must continue to hold ourselves
accountable to making change. With regard to when to have a follow up
Health Commission meeting, he recommends having discussions with
community stakeholders regarding the appropriate time, location and
- Commissioner Illig said this report is a good beginning for getting a
grasp on the services DPH provides in Bayview Hunters Point. Next year,
he would like to see a different report. For example, how much money is
the Department putting into this neighborhood, and what are we getting
for this investment. He noted that the outcomes for the Family Mosaic
Project are excellent, and he would like to see this level of detailed
outcomes for other intervention programs. He would like the Department
to work with community stakeholders to identify, across the health
spectrum, the desired outcomes and the problems we should tackle. Next
year’s report should have numbers attached to the interventions and
identified strategies and outcomes. We also need to identify the impacts
of the changing demographics in the community.
- Commissioner Umekubo said the community is faced with myriad problems.
We need to prioritize the problems and try to break the cycle. This
requires coordination across city departments and with the community.
This is going to take resources. It would be nice if there were the
ability to show small accomplishments as we take on this long task.
- Commissioner Guy heard today that leadership exists to coordinate
programs and services to better serve this community. We have to look at
what we want to do from a population-based perspective. We need to
determine if we are to focus on the geographic neighborhood, which
encompasses the changing demographics, or if we are to focus on changing
the health status of the African American community in the area. From a
policy planning perspective, she wants to see leadership working
together to comprehensively and strategically plan for the future.
- Commissioner Sanchez said the comments conveyed a degree of trust that
DPH is really working with the community as partners. He was encouraged
by the testimony of the SFSU graduate student. This reminded him of the
60s when people came together concerned about violence, concerned about
health, concerned about racism, concerned about housing, concerned about
education. Communities change, but issues that impact the quality of
life of individuals are constant, and it is good to see youth focused on
these issues. Violence as a health issue should be one of our major
focuses. We need to continue and reaffirm the dialogue with the
community. The trust is here. And we are all partners. There are a lot
of resources in the neighborhood, a major one being the Mission Bay
campus. We need to work together to see that our young people have the
benefit of these resources.
- Commissioner Chow said the Health Commission is committed to improving
the health in this community and reducing disparities. We are getting
much more information about the problems, and they are clearly complex.
The Department has given us a snapshot with this report. There are 59
programs that provide services to this community. This clearly requires
coordination, and we do not know the extent to which this happens.
Clearly there is room for improvement. He believes that Dr. Katz’s
conclusions encompass the many things that need to be done. Some
problems need to be addressed geographically, and some ethnically and
culturally. For example, diabetes needs to be addressed in a culturally
competent way throughout the city for those populations that are being
impacted, for example the African American population. There is no
question that the Health Department and Health Commission must work with
the community to refine and prioritize recommendations. There should be
outcomes for each of the initiatives. Violence is a health issue and is
a citywide issue. Given this, what is the Health Department hoping to
achieve? Disparities need to be addressed in a comprehensive strategic
- Commissioner Monfredini committed to the neighborhood that the next
time the Health Commission meets in the neighborhood, the Commission
will work with neighborhood stakeholders to improve outreach and also
will work to bring representatives from other city departments and
6) PUBLIC COMMENT/OTHER BUSINESS
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