Lee Ann Monfredini HEALTH COMMISSION
President
Roma P. Guy, M.S.W. CITY AND COUNTY OF SAN FRANCISCO
Vice President Gavin C. Newsom, Mayor
Edward A. Chow, M.D. Department of Public Health
Commissioner
James M. Illig Mitchell H. Katz, M.D.
Commissioner Director of Health
David J. Sánchez, Jr., Ph.D. Michele M. Seaton
Commissioner Executive Secretary
Donald E. Tarver, II, M.D. Tel. (415) 554-2666
Commissioner FAX (415) 554-2665
John I. Umekubo, M.D. Web Site: http://www.sfdph.org
Commissioner
MINUTES
JOINT CONFERENCE COMMITTEE
FOR
COMMUNITY PROGRAMS AND SERVICES (CPS) MEETING
Tuesday, March 22, 2005
2:00 p.m. – 5:00 p.m.
at
Community Health Network Building
2789 – 25th Street (at Potrero), Room #2001
San Francisco, CA 94110
1) CALL TO ORDER
Commissioner Guy called the meeting to order at 2:00 p.m.
Present: Commissioner David J. Sanchez, Jr., Ph.D., Chair (arrived at 3:00 p.m.)
Commissioner Roma P. Guy, MSW
Staff: Bob Cabaj, M.D., Wesley Capon, Sai-Ling Chan-Sew, Dave Counter,
Elizabeth Davis, Teri Dowling, Shelley Facente, Barbara Garcia, Joe
Goldenson, M.D., Jeffrey Klausner, M.D., Susan Marshall, Maria Martinez,
Josephine McCreary, Anne Okubo, John Pabustan, Frank Patt, Jo Robinson,
Gregg Sass, Steven Tierney and Wendy Wolf.
Guests: Margaret Gold, Executive Director, Jelani, Inc.
Bennie C. Ferma, President, Board of Director, Filipino Task Force on AIDS
Efren Bose, Executive Director, Filipino Task Force on AIDS
101 Grove Street San Francisco, CA 94102-4505
2) APPROVAL OF MINUTES OF THE FEBRUARY 22, 2005 COMMUNITY
PROGRAMS AND SERVICES JOINT CONFERENCE COMMITTEE MEETING
Action Taken: The Committee approved the minutes of the February 22, 2005 Community
Programs and Services Joint Conference Committee meeting, with
grammatical corrections.
3) CPS JCC SECRETARY’S REPORT
STAFF UPDATES
Dr. Charles Windham Leaving Mobile Crisis
Charles Parker Windham, MD is leaving the Mobile Crisis Treatment Team after seven years. As
Medical Director of Mobile Crisis, he provided countless hours of crisis intervention services. Dr.
Windham started the Medication Linkage Service that kept many clients from falling through the
cracks after acute hospitalization and provided medication and therapy for these clients until their
care could be assumed in outpatient clinics. He also provided supervision to psychiatric residents,
and seminars on various topics to interns and staff of all disciplines throughout CBHS. Dr.
Windham responds to residential fires during his off-hours to provide psychiatric services to
displaced clients.
With his incomparable enthusiasm and commitment, he was the tender heart of Mobile Crisis. In a
time when many people feel disconnected from health services, Dr. Windham instilled hope in
clients and their families. He will be greatly missed. The Department wishes him well and knows
that the community of Miami, Florida is very lucky to have him.
Lynice Pinkard Joins Community Programs Administration
Lynice Pinkard, former Director of the Critical Incident Response Team (CIRT) of Community
Behavioral Health Services, has moved into a new position as Program Development Specialist for
Community Programs Administration. Lynice will be working closely with Charlie Morimoto to
develop a DPH citywide emergency response to gun violence, including training on clinical issues for
community providers.
Karen Pierce Awarded Scholarship to World Social Forum
Karen Pierce, Coordinator of the Bayview Hunters Point Health and Environmental Assessment
Program, received a scholarship to the 5th World Social Forum (WSF) in Porto Alegre, Brazil
through its Social Equity Caucus. The focus of the Social Equity Caucus was to explore how local
work addressing environmental and social justice tied in with international efforts. An estimated
100,000 people from around the world attended this year's Forum.
PROGRAM UPDATES
Syphilis Awareness Campaign
The STD Program has implemented a new Syphilis Awareness Campaign in the Castro area of the
City as a lead in to STD Awareness Month. The campaign began on March 1st and involves all
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March 22, 2005
Page 2
businesses in the Castro displaying our "Get Tested" poster in their store window. Business owners
have been very supportive of the campaign and no one has refused to display a poster.
CBHS Integration Update
Over 40 Change Agents volunteering from the ranks of CBHS providers, the CBHS Integration
Advisory Committee (composed of provider staff, clients and family members), and CBHS central
administration staff, are about to embark together on a change effort to improve the CBHS system
towards comprehensive, continuous, and integrated services. With the help of assessment-planning
tools such as COMPASS (program-level) and CO-FIT (system-level), opportunities will be
identified to implement quality improvement action initiatives towards dual-diagnosis capability at
CBHS programs, and towards “Any Door, the Right Door” for the system overall.
CBHS Integration Initiative Website
A new CBHS Integration Initiative website is up and running at
http://www.sfdph.org/CBHS/default.shtml This site contains the latest draft version of the CBHS
Integration Consensus Statement. Comments and suggestions about the Statement can be e-mailed
to BHIntegration@sfdph.org and will be incorporated into the final statement to be completed at the
end of March 2005. The new website also contains information about how to participate and
contribute to the integration effort, including leading change initiatives at programs and
participating in any of the Integration Implementation Work Committees.
Peer Support Internship Program
A total of 16 CBHS service provider program sites have partnered with the CBHS Office of Cultural
Competence and Client Relations to host Peer Support Internship Programs that give recovery-oriented
opportunities for peer clients to support other clients. At present, there are 23 consumer peer-support
interns working in a variety of mental health, substance abuse, dual diagnosis, and homeless services
provider work-sites. The interns’ job responsibilities include: administrative, clerical, outreach, dual
recovery support, peer counseling, leadership, facilitator, and receptionist. Each consumer intern
receives onsite supervision at the provider program-site. The goal of the internship program is to
prepare peer-support interns for entry into permanent employment within CBHS by providing them
work experience in an optimum and supportive work environment. A number of graduates from the
program are currently working in permanent jobs within CBHS programs.
EVENTS, TRAININGS AND PRESENTATIONS
Public Health Week Observance
San Francisco Department Public Health will observe National Public Health Week April 4-10th.
The theme this year is “Empowering Americans to Live Stronger, Longer!” Planned activities
include 2 public presentations and a free Tai Chi class at Civic Center Plaza, across from City Hall.
A presentation on “What Is Public Health?” under the auspices of the Health Education Training
Center, will discuss how public health efforts protect people and communities, and how the DPH
Prevention Strategic Plan can be used to improve our efforts to promote healthy aging. A
presentation on healthy exercise programs for frail elders, recovering patients and well seniors will
feature speakers from Laguna Honda Hospital, SFGH Outpatient Services and community agencies.
Information about other classes, walks and exercise programs will be distributed.
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4) JELANI HOUSE CONTRACT UPDATE
Maria X. Martinez, Deputy Director, Community Programs, presented an update on Jelani, Inc.
The Budget Committee requested this update in November 2004 because the monitoring report
that was received at that time revealed that Jelani had not met their contractual program
performance goals. DPH worked with Jelani to redesign programs to reflect the shorter length of
stay, modify performance goals based on more attainable expectations and increase quality
assurance. A review of FY 04/05 (July-December) data showed:
1. Overall Performance: Rites of Passage moved from unfavorable in FY0304 to favorable mid-
way into FY0405. Newhall Manor and From Start to Finish remained favorable. Mission
Recovery scored favorably. Outpatient moved from favorable to unfavorable. Jelani House
remained unfavorable.
2. Unduplicated Clients / Length of Stay: Outpatient, Mission Recovery, and From Start to
Finish served more clients than the program was designed to accommodate, reflecting a shorter
length of stay than contracted for.
3. Units of Service: Only Mission Recovery met (and exceeded) their unit of service contractual
goals.
4. Successful Completion: All Jelani Inc. programs have thus far met their contractual goals for
successful completion, an improvement from the year before for Rites of Passage.
DPH staff continues to meet with Jelani Inc. and Rites of Passage leadership to address the above
issues. Susan Marshall reiterated that DPH has been working very closely with the agency and
that the agency is very close to where it needs to be.
Margaret Gold, Executive Director of Jelani Inc. said the agency is beginning to see the positive
effects of the program redesign. The client profile has changed dramatically. Clients have
extreme addictions, are more difficult and are much more traumatized. Court expectations around
family reunification have changed, and this has impacted programs. Ms. Gold assured the
committee that agency staff is committed to the mission to provide quality services to families and
maintain services in Bayview Hunters Point.
Commissioners’ Comments
• Commissioner Guy asked if patients still receive quality care, given that the length of stay has
decreased. Ms. Gold replied that the agency and clients deal with problems through intensive
case management as soon as they walk in the door. Also, staff has increased knowledge and
experience in dealing with these clients. Ms. Garcia said staff should be very cognizant of
outcomes of quality of life for the program participants. Ms. Chan-Sew said Child Protective
Services is undergoing a redesign and has asked DPH to participate in the update.
Commissioner Guy asked for an update on quality issues to come to the Joint Conference
Committee prior to this contract being presented to the Budget Committee for consideration.
5) FILIPINO TASK FORCE ON AIDS CONTRACT UPDATE
Steven Tierney, Director of HIV Prevention, presented an update on the Filipino Task Force on AIDS
(FTFA) contract. The Budget Committee requested this update in October 2004, specifically
information on the status of the three-year audit, the hiring of an executive director and an update on
payroll obligations to staff. Mr. Tierney said that it is staff’s estimation that the agency’s problems are
too great to overcome. Problems include: past payroll taxes have not been paid; staff turnover;
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March 22, 2005
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inconsistent and missing data to corroborate invoices that have been submitted for payment; and no
client satisfaction and program reports. Mr. Tierney said the staff recommendation is to terminate the
contract and begin winding down the program with a logical and reasonable transition that ensures that
clients are taken care of. Mr. Tierney added that the AIDS Office would work with other providers to
see that this population continues to be served.
Efren Bose, Executive Director of FTFA, said there were really shocking revelations in terms of
documentation and payroll taxes. There was a lack of communication between the staff and the Board
of Directors. The agency is looking into the issues and establishing financial transparency. There were
a lot of problems associated with staff turnover and training, and he is trying to clean things up, but this
is difficult. Mr. Bose said FTFA has to figure out how to clean up the mess and hopefully be able to do
business again.
Bennie Ferma, President of the FTFA Board of Directors, said the findings were shocking. A lot of
documentation was lacking. It is an incredibly uphill battle. He feels that the agency can continue.
They have an action plan to get more funding and technical assistance. He added that, in terms of the
programs, the transgender has not had any problems.
Commissioners’ Comments
• Commissioner Guy said the Health Commission cares about these services, and she wants to ensure
that the population continues to be served. She also said the Department needs to find a way in the
monitoring process to identify problems early. Mr. Tierney said that there is a department-wide
task force that provides opportunities to provide capacity building and technical assistance before
problems get this big. He said there are other agencies that have capacity to serve FTFA’s clients
and staff will work with FTFA to transition the clients. In addition, the AIDS Office can continue
to make assistance available to FTFA and perhaps have the agency close the books and start fresh,
to allow the expertise and compassion of FTFA’s staff to continue.
6) UPDATE ON ORAQUICK SURVEY RESULTS
Teri Dowling and Shelley Facente presented an update on HIV Rapid Testing in San Francisco. The
OraQuick HIV Rapid Test was approved by the FDA in November 2002 as a waived lab test. The
OraQuick Rapid Test has results in 20 minutes. The test can be run on three types of specimens: oral
fluid, fingerstick whole blood and venipuncture whole blood. If the test is preliminary positive, a
confirmatory test is required.
Rapid testing began in San Francisco in May 2003, with a pilot at one community-based organization,
Glide Health Services. By the end of 2003, five agencies were on board. At this time there are 14
publicly funded agencies offering rapid HIV testing in San Francisco. In 2003, of the 20,376 HIV
tests that were done in San Francisco, 266 were HIV Rapid Tests. In 2004, of the 21,973 HIV tests
that were done in San Francisco, 3,971 were Rapid Tests.
Lessons Learned
HIV Rapid Testing is not rapid to start up. It takes approximately three months to plan and
implement a program that is high quality and conforms to all regulations.
It is important for an agency to start small and build their HIV rapid testing program.
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March 22, 2005
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Quality Assurance (program, counseling and data) is a critical issue that needs to be
addressed before an agency begins to provide HIV rapid testing.
HIV Rapid Testing is preferred to conventional HIV testing by both clients and HIV test
counselors.
HIV Rapid Testing is a more complex form of HIV testing because of the skills required to
actually run a lab test.
In terms of future directions, the Prevention Section’s new RFP process will have an impact on HIV
rapid testing over the next four years. Rapid HIV Testing will be conducted in other venues
(on the street, in clubs, etc). In California, the goal is that by the end of 2006, 80 - 90% of all
government funded HIV tests will be rapid. The oral rapid test makes rapid testing easier to
administer because there is no blood or sharps involved, and the training burden for agencies is
lessened.
Commissioners’ Comments
• Commissioner Sanchez asked if there are data cohorts in terms of age and ethnicity. Ms.
Dowling replied that this data is available.
• Commissioner Guy asked how the program is going to be expanded. Ms. Dowling said that in
the current RFP, 26 agencies have applied to do testing. Staff will also focus on training and
quality assurance for agencies that provide the test, but are funded through other sources. Ms.
Garcia pointed out to the committee that Continuum provided rapid testing services at the last
Project Connect. Commissioner Guy asked if the primary care clinics could offer rapid testing.
Ms. Dowling replied that the program is ready to work with the clinics to do testing, and Castro
Mission and Tom Waddell have expressed interest.
7) JAIL HEALTH REPORT
Joe Goldenson, M.D., Director, Jail Health Services, presented an update on Jail Health Services.
The emphasis of this year’s report is on quality assurance activities. Wesley Capon, Nurse Manager
in charge of quality assurance gave an overview of the quality improvement activities that take
place at the jails.
Quality Improvement Activities
Continuous Quality Improvement
Morbidity and Mortality Review
Interdisciplinary Death Reviews
Case Conferences
Peer Review
Patient Satisfaction Surveys
Utilization Management
Mr. Capon reviewed several different studies that are done over the year, including ETOH Detox.
Audit, Safety Cell Placement Audit and Diabetic Care. He also reviewed the patient satisfaction
surveys. Pending studies include SFGH Emergency Room transfers, OB-Gyn appointments, PPDs
and asthma care.
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March 22, 2005
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Commissioners’ Comments
• Commissioner Guy asked how long this program has been in place. Mr. Capone replied that he
has been doing this for three years. Prior to that time, different studies were done.
Commissioner Guy said that quality assurance during budget cutting is important to present.
She wants the commissioners to understand the gaps that were created by the budget cuts. Dr.
Goldenson said it is too early to ascertain the impacts from last year, but he is monitoring this.
• Commissioner Sanchez asked that, for the Health Commission presentation, one or two slides be
added to the power point regarding overall Jail Health demographics and programs.
8) STD UPDATE
Jeffrey Klausner, M.D., Director, STD Prevention and Control, presented an overview of the
epidemiology of sexually transmitted diseases in San Francisco, 2005. He presented statistics on
early syphilis cases, gonorrhea and chlamydia. He also presented data on monitoring co-morbidity
and risk behavior, including statistics on STDs among persons living with AIDS in San Francisco,
rates of new sexual partner acquisition among gay/bisexual men by HIV status and
methamphetamine use among MSM in San Francisco. In summary:
San Francisco has high rates of STDs relative to other cities in California
There is unique epidemiology of STDs in MSM and young African-American
heterosexuals
Programmatic interventions demonstrate reductions in morbidity in select groups
Increased STDs and sexual risk behavior in HIV positive persons and MSM
Commissioners’ Comments
• Commissioner Guy said chlamydia is an ongoing concern. Dr. Klausner said that San Francisco
does the most widespread testing in the country, so some of the increase is increased testing. He
said they have seen drops in infection rates in some affected groups. In 2005 they have
emphasized efforts in adolescents, particularly in the Southeast sector of the city.
Commissioner Guy said it is important to point out the uniqueness of San Francisco’s screening
and diagnosis. San Francisco does more to understand the prevalence, and Commissioner Guy
supports continuing these efforts. She lauded STD Prevention and Control for keeping abreast
of emerging problems and working with other program areas.
• Commissioner Sanchez said this information should be part of the DCYF needs assessment,
particularly around chlamydia.
9) SOARIAN UPDATE
David Counter, Director, Information Systems, presented an update on the Siemens Soarian Project.
The project involved replacing obsolete systems in several areas of the hospital—San Francisco
General Hospital/Primary Care, Laguna Honda Hospital, Jail Health Services—with a new
generation of web-based technology. Current systems were installed almost 20 years ago. The
Health Department entered into a partnership Siemens as an early adopter site. Mr. Counter said that
the project would be completed within the DPH base budget while maintaining IT operations.
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March 22, 2005
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The initial implementation schedule was very ambitious. There have been delays in the
development of Soarian software. Siemens rolled out the programs to their Beta sites and various
changes and enhancements were required. So the implementation schedule has changed. Clinical
implementation will now be completed by 2007 and financial implementation will be completed by
2008. DPH has been able to negotiate, in recognition of these delays, additional no-cost
enhancements for key DPH areas. These enhancements fall into two categories: Financial/Technical
and Clinical
Financial/Technical Enhancements
Soarian Revenue Management
Laguna Honda Invision Conversion
Claims Denial Management Assistance
Expanded Open Link configuration
Clinical Enhancements
Physician Order Processing (CPOE)
Soarian Critical Care Module
Soarian Medication Oncology Module
Soarian Emergency Department Module
Clinical implementation support at 4,500 hours
10) EMERGING ISSUES
Barbara Garcia announced that the membership for the Behavioral Health Innovations Task Force
(Proposition 63) has been selected. The list of members can be found on the DPH website at the
following link: http://www.dph.sf.ca.us/Prop63/MHSATaskForceMmbrs032005.pdf
11) PUBLIC COMMENT
None.
12) ADJOURNMENT
The meeting was adjourned at 5:25 p.m.
_____________________________________
Michele M. Seaton
Executive Secretary to the Health Commission
*Any written summaries of 150 words or less that are provided by persons who spoke at public
comment are attached. The written summaries are prepared by members of the public, the opinions
and representations are those of the author, and the City does not represent or warrant the
correctness of any factual representations and is not responsible for the content.
**Minutes are approved at the next meeting of the Community Programs and Services Joint
Conference Committee.
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