Minutes of the Health Commission Meeting

Tuesday, November 21, 2006
at 3:00 p.m.
Room 300
San Francisco, CA 94102


President 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.


Action Taken: The Commission approved the minutes of the November 14, 2006 Health Commission meeting with one addition. On page 12, the following was added to Commissioner Tarver’s comments: Given that African American children have a disproportionate morbidity, perhaps unequal resources were justified. Bayview has among the highest home ownership of any district in the city; hence paying through the property tax side may be another variable considered in how resources are appropriated.


Commissioner Sanchez chaired and Commissioner Chow and Commissioner Tarver attended the Budget Committee meeting. The Budget Committee requested that item 3.7 be moved from the “For Approval” section of the agenda to the “Discussion and Approval Section.”

Items for Approval

(3.1) AIDS Office-HIV Health Services –Request for approval of a retroactive renewal contract with Patricia Sullivan Consulting, in the amount of $141,775, which includes a 12% contingency, to provide professional consultation services to support the Community of Color Community Based Organizations Capacity Building Project, for the period of September 1, 2006 through
August 31, 2007 (1 year).

(3.2) AIDS Office-HIV Health Services – Request for approval of a retroactive renewal contract with Mission Neighborhood Health Center, in the amount of $257,016, which includes a 12% contingency, to provide HIV Integrated Case Management services for individuals diagnosed with HIV or AIDS, for the period of July 1, 2006 through December 31, 2007 (1.5 years).

(3.3) PHP-Communicable Disease Control and Prevention – Request for approval to accept and expend retroactively a new grant from the California Department of Health Services, in the amount of $88,582, for the San Francisco Department of Public Health, Communicable Disease Control and Prevention Section, to undertake pandemic influenza emergency preparedness and response planning, for the period of May 22, 2006 to April 30, 2008.

(3.4) CHN-LHH – Resolution Authorizing the Department of Public Health, Laguna Honda Hospital & Rehabilitation Center (LHH) to accept a gift of a handicapped accessible van valued in the amount of $39,889, from the Laguna Honda Hospital Volunteers Inc., for use in the transportation of LHH residents off campus.

(3.5) CHN-LHH – Resolution Authorizing the Department of Public Health, Laguna Honda Hospital & Rehabilitation Center to accept a gift of funds in the amount of $10,000, to provide supplementary assistance to support the Senior Nutrition Program.

(3.6) CHN-LHH – Request for approval of a contract modification with the University of the Pacific School of Dentistry to increase the contract amount by $105,000, from $174,500 to $279,500, to provide on-site dental clinic services for the residents of Laguna Honda Hospital, for the period of July 1, 2004 through June 30, 2009 (60 months).

Items for Discussion and Approval

(3.7) BHS – Request for approval of a contract renewal with Thunder Road, in the amount of $165,000, which includes a 12% contingency, to provide mental health services for children, for the period of July 1, 2006 through December 31, 2007 (1.5 years).

Secretary’s Note – a corrected contract summary sheet was submitted to the Budget Committee.

Commissioners’ Comment

Commissioner Tarver asked why the hourly rate for medication support is so high. Ms. Weinstein said the rate for medication support is paying for psychiatrists, and they are expensive. This is an allowable rate from the State’s point of view, and the psychiatrists have justified this rate. Commissioner Tarver asked that, for future contracts that include medication support, staff provides information about the range of the State’s Medi-Cal rates, and where the contractor falls within these allowable rates.

(3.8) CHN-SFGH & LHH Facilities – Request for approval of twenty-six (26) contract modifications with the following twenty-one (21) firms: A & B Mechanical, Inc., Acker & Guerrero Roof Co., Inc., Agbayani Construction, Inc., Anderson Carpet & Linoleum Sale Co., Inc., Bay City Boiler & Engineering Co., Inc., Birds Away/Pigeons Away, City Mechanical, Inc., William Decker & Co., Elischer Construction, Inc., Galindo Installation & Moving Services, McClure Electric, Inc., Mintie Corporation, Pioneer Contractors, Inc., Pribuss Engineering, Inc., Robert Poyas, Inc., Rubecon General Contracting, Inc., Sierra Electric Co., The Shooter Co., United California Glass Co., Western Roofing Service Co. and Yerba Buena Engineering & Construction, Inc., to increase the total combined amounts by $2,122,500, from $4,515,000 to $6,637,500, to provide the Community Health Network intermittent, as-needed facility maintenance services above baseline civil service staffing, for the period of July 1, 2005 through June 30, 2007 (24 months).

(3.9) BHS – Request for retroactive approval of a new contract with Families First, in the amount of $155,736, which includes a 12% contingency, to provide mental health services, for the period of
July 1, 2006 through December 31, 2007 (1.5 years).

(3.10) BHS – Request for retroactive approval of a new contract with Chinatown North Beach Youth Services and Coordinating Center dba Community Youth Center, in the amount of $201,600, which includes a 12% contingency, to provide mental health services for youth and their families, for the period of September 1, 2006 through February 29, 2007 (1.5 years).

Commissioners’ Comments

Commissioner Chow asked if Washington High School students would be able to access services through this contract. Sara Huang from CYC said that these services would indeed serve students at Washington High School. Ms. Chan Sew added that, in addition to this contract, CBHS is providing funding to the API Wellness Center to do translation of materials for LGBT youth and their parents. Commissioner Chow said this is a nice follow up to the public testimony the Health Commission heard at the meeting that was held in the Richmond.

Action Taken: The Commission approved the Budget Committee Consent Calendar.

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

San Francisco General Opiate Treatment Program
The Opiate Treatment Outpatient Program (OTOP) at San Francisco General Hospital Medical Center recently completed a two-day Commission on Accreditation of Rehabilitation Facilities (CARF) visit. This will be OTOP's third accreditation from CARF. Surveyors reviewed programmatic and administrative domains and met with staff and patients.

At the exit interview, CARF surveyors had only four recommendations for all twenty domains surveyed. In what the surveyors described as an unusual step, they gave OTOP an "exemplary" rating in two areas. The first recognized area was the creation of an enhanced network for integrated care including psychiatric services, medical care, case management and prenatal services. The surveyors noted their approval of the narcotic treatment program with its comprehensive and coordinated care as the first of its kind in any setting. OTOP was also given an exemplary rating for working collaboratively with city, state, and federal agencies to pioneer innovative programs — through the Mobile Methadone Van and the Office Based Opiate Treatment (OBOT) program.
Dr. Katz stated he is proud of the program, and pleased to have others recognize it for its excellence. SFGH shares this success with the program’s patients and with the program’s supporting agencies including Community Behavioral Health Services and UCSF.

Sewer Break at Ocean Beach
As a result of the heavy rains last week, Ocean Beach experienced a sewer and untreated storm water spill, resulting in “no swimming” postings just below the Cliff House. DPH staff reported to the site to offer technical assistance and oversight for clean up efforts. Within 24 hours of the spill, the San Francisco Public Utilities Commission was able to remove the "no swimming" restriction signs and reopen the beach for public access. Tests revealed no elevated bacteria levels, indicating that the overflow did not reach open water.

The SFPUC, in coordination with the Department of Public Works (DPW) and Golden Gate National Recreation Areas, have cleaned most of contaminated sand from a 100-yard section of the beach. DPW brought in three loaders and a 10-wheeler truck to the cleanup efforts, hauling away 18 truckloads of sand. The affected promenade area where the overflow reached was also cleaned and sterilized.
Current investigations indicate that the burst manhole cover was due to rusted bolts unable to withstand the buildup of pressure in the Great Highway sewer main. Since then, all sewer manhole covers in the area have had their bolts inspected and tightened.

Non-Profit Contact Task Force Update
Commissioner Monfredini, Commissioner Sanchez and Dr. Katz met with contractor representatives of the Human Services Network (HSN) earlier this month. The meeting was very productive and eight action items were agreed upon at the meeting that will encourage better dialogue between DPH and contractors. The two most important outcomes are: 1) the requirement that DPH program managers will meet with contractors annually to discuss all aspects of their contract; and 2) the contract scope of work narratives will be reduced to a single line and the target population narrative will be replaced by a demographic chart.

In addition, other updates include:

  • The Board of Supervisors hearing scheduled for November 13th was cancelled. Dr. Katz will notify the Health Commission when a new hearing date is scheduled.
  • The vendor satisfaction survey has been reviewed by HSN. It is expected that the survey will be mailed to contractors this week (HSN recommended that surveys be mailed).
  • Managers in Community Programs and the AIDS Office were briefed on contractor concerns raised by HSN. Managers were trained on the contingency and 18-month contract models. Further training for program staff will be held soon.

Preliminary recommendations to revise the contract scope of work have been developed. The next step is to get DPH and contractor input on a revised scope of work.

TB Outreach and Prevention Services (TOPS) to Relocate to SFGH
Beginning in mid-December, the TB Outreach and Prevention Services (TOPS), currently located at 1060 Howard St., will begin relocating its operations and staff to the TB Control Clinic on the San Francisco General Hospital (SFGH) campus.

  • The following essential TOPS functions will continue to be provided at the new site:
  • Screening of clients who are homeless, especially those who are HIV+ or who need clearance for shelter or drug treatment programs

Administration of directly observed therapy (DOT)
During the transition period, clients who need to be screened as part of a pre-employment evaluation will be redirected to their private doctor, another clinic or any district health center. Clients who test positive for TB will continue to be referred to the TB control Clinic at SFGH. Screening previously done at TOPS will resume on January 16th at the new location. Inquiries about the new schedule should be addressed to TOPS, 865-5200.

Shape UP SF Walking Challenge: A Prevention Strategy
Launched in early October in conjunction with Walk to School Day, the Shape up SF Walking Challenge encourages teams to walk the length of California over the course of 12 weeks. Teams are encouraged to take weekly walks together — and for individual team members to walk, bike, swim, dance, etc. on their own — with a goal of accumulating the 1016 miles of the California coastline. Though the Challenge was geared toward after-school programs, many City departments also formed teams — as part of the Shape Up @ Work initiative. DPH has several walking teams participating — WIC and the Prevention Section to name a couple.

After only seven weeks, participating teams have cumulatively walked over 50,000 miles, or two times around the globe. Participants will likely “walk” around the globe at least three times before the challenge ends on December 24. Teams will be invited to a closing ceremony at Kezar Pavilion with Mayor Newsom on January 11. For more info check out: http://www.shapeupsf.org.

Vote and Vaccinate Pilot Project
San Francisco was one of three communities in California — 25 across the nation — that participated in Vote and Vaccinate, a pilot program designed and funded by the Robert Wood Johnson Foundation to organize, promote and implement influenza vaccination clinics within easy reach of polling places on Election Day, November 7, 2006.

The goal was to increase the number of adults aged 50 and over in low-income and underserved communities who received the influenza vaccine. Four polling sites were identified to test the premise of the program: two in the Bayview District, one in the Mission District, and one in the Western Addition. Flu shots were offered free of charge to voters, as well as other community members wishing to be protected against the flu.
Dr. Katz was happy to report that DPH vaccinated 215 very grateful and surprised voters on Election Day. DPH will be reviewing the data to see if they reached their target audience.

Commonwealth Club
Last night Dr. Katz was privileged to serve as a panelist at the Commonwealth Club’s program entitled, Upending the Health Care Status Quo: Universal Healthcare Plans. Dr. Katz was joined by John Graham, Director of Health Care Studies at the Pacific Research Institute and Helen Halpin, PhD, Director of the Center for Public Health and Policy Studies at UC Berkeley School of Health. John Wildermuth, political reporter for the San Francisco Chronicle, moderated a lively discussion about health care reform, access to care, system design, funding and a number of other local and national health care related issues.

The panel discussion will be broadcast on KQED FM sometime in the future. Dr. Katz will inform the Commission as soon as he knows when the program will be broadcast.

City Desk News Hour
For those Commission members who follow City government on San Francisco Cable Channel 11, Dr. Katz is scheduled to be interviewed by Barbara Taylor on City Desk News Hour next Thursday, November 30th. The interview will air on the following dates and times: Thursday, 7:30 p.m.; Friday, 9 p.m.; Saturday 8 p.m.; and Sunday, 9 p.m.

Public Comment

  • Debbi Lerman, Human Services Network, thanked the Commission, particularly Commissioner Monfredini and Commissioner Sanchez, for the meeting that was held on contracting problems. The meeting created a significant opportunity for progress. A number of agreements were made that are all very important to progress. The Human Services Network is looking forward to working together to move progress forward.

Commissioners’ Comments

  • Commissioner Monfredini is pleased with the outcomes of the meeting that was held between staff and Human Services Network. Everyone came to the table willing to make change and improvements.
  • Commissioner Illig asked that all of the agreements made at the meeting with the Human Services Network be included in the minutes. No other Department is moving in this collective and cooperative way. The agreements are as follows:
  1. DPH program managers will meet with contractor staff annually to discuss and negotiate contract development, including outcome objectives (including those that are imposed externally), scope of work, monitoring, certification and the menu of options to expedite certification (i.e. multi-year contracts, 18-month contract, 12% contingency, interim agreements and/or COLA included in the base budget), cultural competency and exchange of data. This shall be done in a mutually agreed upon timeframe. The meeting will take place annually even if the contractor has a multi-year contract.
  2. In case of data disagreements, contractors can share their data reports with DPH and DPH will match its data with the contractor’s data.
  3. Contracts Office staff will provide training to program staff in contract options. The training will focus on the methods that DPH has available to streamline the contract process (i.e. 18-month contract). The training will also encompass the COOL system. Contractors will have the opportunity to be involved in these trainings, and HSN will take responsibility for ensuring contractor representation. Anne Okubo will schedule training right away in each division.
  4. Any contract changes, including any external state or federal mandates, must be discussed and negotiated with contractors in a timely fashion.
  5. The use of COOL for contract development is voluntary for contractors, and will be combined with conversation and training.
  6. DPH will develop and undertake a vendor satisfaction survey. There will be no field test for the survey. In addition to the one-time survey, the Department will establish a mechanism under which contractors would be able to provide feedback on their contract process at the conclusion of every contract cycle.
  7. When disseminating information and proposing policy changes for contracts, DHP will reach out to organizations and contractor associations for feedback. Barbara Garcia’s December budget meetings are a good model. HSN commits to sending knowledgeable representatives.
  8. The Department will include contractors in the process of streamlining the cultural competency report to better measure effectiveness.
  9. Staff will report to the Budget Committee four times a year and to the Health Commission twice a year.
  10. Contract Narrative Changes
    a. The scope of work will be one sentence
    b. Target population will be in the form of a table or chart
    c. Methodology – Michelle Long has convened a committee to develop a mock up standardized methodology. All three DPH divisions are represented on the committee. A copy of the draft document will be sent to all providers. She will convene a focus group with providers to discuss.
    d. Objectives will be listed.
  • Commissioner Chow hopes that the Department can revisit the idea of DOT in Chinatown. This was dropped last year, and he would like to see if it makes sense to reestablish the service.
  • Commissioner Tarver asked how many people a year went to the TOPS site that would now be seen at San Francisco General Hospital. Dr. Katz will provide the Commission with this information.
  • Commissioner Guy said that the TB program in the shelters has been very successful.
  • Commissioner Monfredini said she met with Daisy Anarchy, Sex Workers Organized for Human and Civil Rights, along with some of her colleagues, and they are going to work together in January to address some of the issues that were raised at the meeting.


Commissioner Sanchez presented the Employee Recognition Awards for November.

Individual Award: Burt Kirson  
Division: DPH
Nominated By: Rajesh Parekh

Team Award
Division : Laguna Honda Hospital Activity Laguna Honda
Nominated By: John Kanaley, Mivic Hirose and William Frazier
Therapy Team:

  • John Chan · · ·
  • Susan Lindsay · · ·
  • Mariel Badiola · · ·
  • Gary Burgess · · ·
  • Henry Cortez · · ·
  • Angela Pownall-Elizalde · · ·
  • Eileen Stafsberg · · ·
  • Michele Lewis · · ·
  • Cheryl Landas · · ·


Heidi Sieck, Acting Director, San Francisco 311 Customer Service Center, presented an update.

What is 311?
The San Francisco 311 Customer Service Call Center will provide comprehensive information regarding non-emergency city services. The mission of 311 is to provide excellent customer service to citizens, businesses and visitors and make it easier for everyone to access government services in San Francisco.

311 Business Objectives

  • Two numbers to reach the City: 3-1-1 and 9-1-1
  • Answer as many questions and requests as possible on the first call to 311.
  • Improve the customer experience for citizens, business and visitors in all instances.
  • Build the foundation for citywide customer service transformation.
  • Be a public safety partner, providing important information during a time of crisis as well as serve as a back up 911 Call Center facility.
  • Implement analytical tools to track performance and identify areas of improvement in both customer service and citywide service delivery.
  • Provide career opportunities and be a great place to work.

Call Center Overview
The 311 Call Center will operate as a division of the General Services Agency out of a new, fully accessible facility at One South Van Ness, Second Floor. The facility is also a back-up 911 Call Center that will house 911 equipment and call takers in the event that the current 911 location is ever compromised. The 311 Call Center will be equipped with state-of-the art telecommunications and computer equipment including the Lagan Frontlink Customer Relationship Management (CRM) application that will be connected to all city departments and agencies. Based on 311 programs in other cities, San Francisco 311 is designed to handle 1.5 million calls annually and will operate 24 hours a day, seven days per week starting on the public launch date.

SCHEDULE (revised October 20, 2006)

  • September 1, 2006 – Call Center Construction Complete
    November 3, 2006 – 25 City Staff Transition Offers Complete
    November 13, 2006 – Supervisors First Day
    December 4, 2006 – Customer Service Agents First Day
    January 22, 2007 – Soft Launch with 28-CLEAN, 673-MUNI, 554-4000 Transition
    March 2007 – Full Public Launch

Commissioners’ Comments

  • Commissioner Monfredini said this is an exciting project. The 911 call center gets too many calls that are not emergency in nature. This is a real selling point for San Francisco, and she will be happy to talk about it.
  • Commissioner Illig asked if the listings for direct telephone numbers would continue. Ms. Sieck said this would be a policy decision made by the appropriate departments. Commissioner Illig said that the Health Department has partnerships with hundreds of non-profit contractors. He asked if these partners would be part of the information provided by 311. Ms. Sieck said that this decision would be made by the Health Department.
  • Commissioner Illig asked how this links with the United Way’s 211. Ms. Sieck said they have been working with 211 for the past two years to see how to best market each product and not overlap services. Ms. Sieck said all parties have agreed to use a quick reference guide for all 11 numbers in San Francisco, including 211, 311, 411, 511, 611, 711 and 911. Her project is also spearheading the N11 counsel, to bring all the parties to the table.
  • Commissioner Chow asked how this would fit in with health issues and health management. It seems burdensome to have someone call the 311 call center to get to San Francisco General Hospital. The intent here is to have one number as a central information center, but we need to make sure that the Health Department does not market 311 as a disease or medical management service. Ms. Sieck said the value of 311 is that if people call looking for a service, 311 can get them to the right place. Ms. Kronenberg said this is a complex process. The Health Department has surveyed staff that provides public information, and 311 and the Health Department are in the process of determining how to best utilize the 311 project. Commissioner Chow asked for a six-month follow-up report after 311 begins in March.
  • Commissioner Guy asked if we have lessons learned from Chicago and New York and other cities that have implemented 311 regarding the health aspect and what is this going to cost the Health Department. Ms. Kronenberg said neither Chicago or New York has an extensive health component—they primarily serve to transfer calls appropriately. With regard to resources, there is a lot of preparation involved. Once the start up period is over, it should not result in more work for Department staff. Ms. Sieck said Chicago used 311 as the number to report West Nile Virus. She added that the experience of other cities is that, once 311 starts, 90% of the misdirected calls stop.
  • Commissioner Tarver urged that the 311 list of resources be inclusive of the Health Department’s vendors. As an example, the only crisis center in San Francisco is Westside Crisis, and this is an important resource to include in 311. Further, if the 311 project is providing information about services, there are a number of caveats that need to be captured and communicated. If this project is informed by consumers, providers and other members of the public, it could be incredibly useful. He asked what the hiring strategy and timetable is, and will they be doing any outreach. He said that there are a variety of vocational programs that could provide applicants. Ms. Sieck said they are about ready to make offers to call takers. They had 1,200 applicants for 15 slots. They hope to have 20 additional slots next year.
  • Commissioner Guy asked if 311 is funded through the general fund. Ms. Sieck said yes. The project received a $4.2 million start up allocation. This year, for first year of operating, the budget was $4.6 million. The annual operating budget will be approximately $7 million. Commissioner Guy asked that the next presentation include lessons learned from other cities, as well as lessons learned from San Francisco’s experience.


Lee Ann Monfredini, Health Commission President, presented the Health Commission Attendance Policy.

Commissioners’ Comments

  • Commissioner Chow recommended that the policy by amended to state that the annual attendance report be inclusive of attendance at scheduled Joint Conference Committee meetings and Budget Committees. The Commission agreed.
  • Commissioner Illig asked that the annual report be provided to Commissioners. Ms. Kronenberg said that the report could be posted on the DPH website.
  • Commissioner Tarver said the Commission should consider if it wants to incorporate the Mayor’s suggested guideline that commissioners attend 90 percent of meetings.

Action Taken: The Commission approved the Attendance Policy as modified by commissioner Chow.

Action Taken: The Commission approved Resolution 15-06, “Approving the Health Commission Attendance Policy,” with the amended attachment (Attachment A).


Secretary’s Note – public comment was taken after the approval of the Budget Committee Consent Calendar. Public Comment was also taken in its regular place in the agenda.

  • Dr. Tompkins spoke about the issue of compliance with the agreement that the City entered into for Parcel A of Hunters Point Shipyard. The developer has not complied with the dust control provisions. They are not in compliance with the asbestos requirements. No scientific studies have been done, and he asks that the bad science stop. He asked that a DPH compliance officer monitor the site 24-hours a day.
  • Youth representatives of Chinese Progressive Association and PODER attending the Health Commission meeting to gain exposure to the Health Commission. They are going to present to the Health Commission next year about the Tobacco Free Project.


A) Public comments on all matters pertaining to the closed session

John Kanaley said that Dr. Katz has done an incredible job as the Director of Public Health. He gives him his highest commendation.

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 at 4:55. Present in closed session were Commissioner Monfredini, Commissioner Illig, Commissioner Chow, Commissioner Guy, Commissioner Sanchez, Commissioner Tarver and Commissioner Umekubo and Mitchell H. Katz, MD, Director of Health.

C) Closed session pursuant to Government Code Section 54957 and San Francisco Administrative Code Section 67.10(b)


D) Reconvene in Open Session

The Commission reconvened in open session at 6:15 p.m.

  1. Possible Report on Action Taken in Closed Session (Government Code Section 54957.1(a)2 and San Francisco Administrative Code Section 67.12(b)(2).)
  2. Vote to Elect Whether to Disclose Any or All Discussions Held in Closed Session (San Francisco Administrative Code Section 67.12(a).)


The meeting was adjourned at 6:15 PM

Rebekah R. Varela, 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 meeting.