San Francisco Chronicle; Wednesday, January 28, 1998
Sabin Russell, Chronicle Staff Writer

Katz has been interim director of the Department of Public Health since July, when the highly regarded Dr. Sandra Hernandez left the post to become executive director of the San Francisco Foundation. Brown said he convinced a reluctant Katz to become a candidate for the $170,000 job last month, but did not decide to name him until now; the mayor taking evident delight in surprising his own appointees with a public announcement.

"We interviewed five or six different people," said Brown, who said that the city salary discouraged some qualified applicants. "Then I realized I'm sitting here with a gem next to me."

The 38-year-old Katz earlier had succeeded Hernandez as director of the city's AIDS Office, the key health department post overseeing the epidemic. His appointment, following that of Hernandez, underscores the importance that AIDS holds in the city's health bureaucracy.

CITY'S LARGEST DEPARTMENT

If approved by the Health Commission on Tuesday, Katz will assume full responsibility for the city's largest department, with an annual budget of more than $800 million.

Health Commission President Lee Ann Monfredini, who is director of customer service at California Pacific Medical Center, said she was glad the mayor picked Katz. "Mitch is level-headed, compassionate, and extremely fair. He's an extremely strong leader."

Katz told reporters that he initially did not want the job because he felt it would be difficult to fill his predecessor's shoes. "I never wanted a job I couldn't be good at," said Katz, who graduated from Yale and from Harvard Medical School.

After six months in the temporary role, however, Katz said he felt he was up to the job. "I'm not Sandra," he said. "But I bring my own talents to it."

`TREATMENT ON DEMAND'

He listed as his top priority getting substance abuse "treatment on demand," a program to end waiting lists for drug rehabilitation that he feels will pay back one dollar for every 17 cents invested. Other priorities include equal access for mental health services; supportive housing for people with AIDS, more disease prevention dollars; and achieving citywide universal health coverage -- a pet project of Brown and Hernandez that has yet to get off the drawing board.

The heavy emphasis on social programs was consistent with the theme of yesterday's AIDS conference, which stressed how much the epidemic is now intertwined with problems of poverty, homelessness and drug abuse.

Mayor Brown's task force came up with 175 recommendations -- none of them yet analyzed for cost. Yesterday the mayor came up with another one not on the list: have the city buy and operate residency hotels in the Tenderloin district that are currently housing AIDS patients.

"We flatly ought to pay these awful landlords off and run it as it should be run," said Brown, who disclosed that the city is negotiating the takeover of a 50-room Tenderloin hotel and is considering becoming a landlord of half a dozen others.

HOUSING PROBLEMS

Housing problems of people with AIDS impoverished by the enormous cost of anti-viral drugs emerged as a central problem challenging San Francisco's vaunted model of services for victims of the epidemic.

An estimated 4,000 people are currently on waiting lists for subsidized apartments for people with AIDS. But because federal spending formulas are based on the number of AIDS cases in a city -- and those numbers are falling in San Francisco -- the prospect for housing dollars is dimmer than ever.

Katz told reporters during the session that the most cost-effective use of AIDS housing dollars is to spread small amounts to a large number of people -- so-called "shallow rent subsidies" that help low-income patients hang onto their apartments.

But Katz also said the city cannot abandon the full subsidies that are paid to provide housing for homeless people with AIDS. Among the other initiatives included in the 175-page book of AIDS Summit recommendations are plans to locate two storefront clinics -- one in the Haight-Ashbury, the other in the Civic Center -- to provide a place for homeless AIDS patients to get the life-saving cocktail of anti-viral drugs.

Marcy Fraser, a city AIDS Office staffer, said the proposed medical centers will "welcome any homeless person, regardless of HIV status." They would be designed to help people who do not have a bed, let alone an alarm clock, how to adhere to the strict regime of pill-popping required for the new combinations of AIDS drugs to work.

EXCHANGING NEEDLES

On the city's "wish list," she added, would be that these centers also serve as distribution points for drug addicts to exchange dirty needles for clean ones.

Citing evidence that needle-exchange programs have helped cut new HIV infections in San Francisco to 500 a year, the task force recommended expanding the service to pharmacies and medical clinics. A proposal to provide clean needles to drug-using prisoners was considered by a summit subcommittee, but was not included in the final recommendations, according to summit co-chairman Tom Coates, director of the Unversity of California at San Francisco AIDS Research Institute.

Mayor Brown told the gathering that the 175-page report would be implemented with the help of his new AIDS policy coordinator. From the rostrum, he appointed summit organizer Dick Pabich to the new post.

"I had a funny feeling that might happen," said Pabich, a former political consultant who -- like thousands of other San Franciscans -- is returning to work after the new AIDS drugs restored his own health. "I wrote the job description."

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